It Ain't Easy Being Born

Friday night was an interesting experience for me. I attended a professional conference for a screening of a documentary. I'm not good at this kind of estimating, but there were probably more than 150 women in the room, and maybe 20 men. It was the polar opposite of most professional conferences I've been to. It was actually a conference on high risk obstetrics, and I was there to see a screening of a documentary called 'The Business of Being Born'.

This isn't a new idea for me. I've been over our difficulties trying to find the right pre-natal care for The Mrs and the twins, and the whole dilemma was represented very well in the film. There is a growing group of parents that are disillusioned with the whole idea of giving birth at the hospital. The premise is that doctors tend to meddle in a natural process and by doing so screw things up. Unnecessary and seemingly mild induction or 'encouragement' of a woman's labor (using Pitocin, and fetal monitoring to make contractions go faster) lead to more serious interventions and life threatening complications like cesarean sections, the dreaded episiotomy, or using the forceps on a baby.

Aunt B and Rachel have reviewed the film and made some excellent comments so I'm not going to try and recap the information presented. I am going to meta-comment though.

Aunt B says:
On the ride home, Rachel and I were talking about why childbirth isn't more of a feminist issue. It is a feminist issue, of course.
And Rachel agrees:

The second major strength is that the film clearly locates birth issues inside feminism and choice, noting the power disparities of the traditional hospital birth system
That's pretty interesting to me, because when the film started bringing the feminism issue into the equation I thought they were losing focus on the real problem. Their was a lot of discussion about empowering women and how they felt like after giving birth they could do anything. I get that. Birth is hard, and doing anything hard makes you feel a lot more confident about the lesser things in life. However, and you can blame my Y chromosome for this, I think that empowering women and giving them self-confidence is secondary to what is really going on.

The real issue is health. What's best for the health of the mom, and the health and potential of the baby? The doctor focuses on the worst case scenario and ignores the likely side effects, or the unknown side effects. Never mind that the worst case scenario rarely happens, and the bad side effects often do. So then you have a normal pregnancy ending in cesarean because there was a slight chance the baby was too big to fit out the regular way. Never mind that the mom has to have her intestines rearranged and runs a decent risk of infection. Never mind that autism is on the rise and all these pregnancy drugs and cesareans probably contribute to that.

In my opinion that's the point that should be focused on. Expecting the worst isn't always a good thing because you can do a lot of unnecessary damage fighting it off. We're all born and this should be important to all of us.

As a related issue, the demographics of the audience were pretty interesting. Like I said earlier, there weren't too many men in the audience. The woman that introduced the film was the head of the midwife program at Vanderbilt. At one point she asked if there were any doctors in the room. I noticed one hand. One in a room with over 150 people in it. To make it worse, this was part of a high risk obstetrics conference which I'm sure quite a few doctors attended but only one actually stayed over for the film.

Now I want to talk about the end of the film. I'm going to spoil it. You've been warned, but you have a paragraph or two before I get there.

I knew very little about childbirth before my wife got pregnant. Just the stuff I absorbed at 12 years old when my sister was born, and what Hollywood has taught me. Once I found out, a great deal of research began. My wife steered me toward a lot of the issues that I've been talking about here, and Rachel sent me toward several resources to ponder. This particular movie was pretty typical of those. But the thing you rarely hear is that emergencies really do happen. Casareans and all those other medical interventions are sometimes necessary.

I'm glad The Mrs. is thinking about all these things, but my fear all along has been that she will be so wrapped up in the idea of unnecessary interventions that she might ignore a necessary one. The doctor may come in and recommend a cesarean and she thinks it's about him getting to his golf game on time, but it really is an emergency. That's my biggest worry about the whole labor process. (Or at least the most specific one, if you discount vague worries of death, birth defects, and Siamese twins.) It bothers me enough that we discussed it with our doulla.

During the making of the film, the director, Abby Epstein found out she was pregnant with her first child. Obviously that made the whole project a lot closer to her heart. At the end of the movie they show her birthing story. This is where the spoilers start up, so leave now if you don't want to hear it.

Abby went into pre-mature labor while her baby was breech. They had to go to the hospital and her son was born by cesarean very early and with very low birth weight. They eventually showed Abby and her son eight months later, and it all worked out, but I'm very glad they included that. It had to be pretty wrenching for her to go through with a cesarean and hospital birth after all the research she had been doing on natural home births. All the pleasant, gentle home births they showed in the rest of the movie weren't anything like her own. I'm very glad she was brave enough to include that.

And finally, I present contrasting comments from the discussion at Tiny Cat Pants. Sistasmiff seems to agree with me:

Chemically aided births are sometimes necessary. There are risks with any birth. Even with a midwife or completely natural birth, with the whole family tree watching, bringing forth in a pool, you can still hemorrage and have other complications.
Kwach has a point as well. But I think she dodged a bullet. Though the fact that they could tell the fetus had a low heart rate during a home delivery says a lot about the competence of home birth midwives.
My son's birth was slightly complicated and his heart rate had slowed because his umbilical cord was wrapped around his chest. In a hospital, that would have meant an emergency c-section. In my bedroom, that meant a whole lot of lube on Janet's forearm, some dextrous manipulation in a tight space, and the arrival of a happy, healthy baby forthwith.


Blogger GingerSnaps said...

I agreed with you, too, W...

5:35 PM, December 03, 2007  
Blogger Rachel said...

A few things... I do think the issue of health is extremely important, and overlooked in the rush to manage, manage, manage is the question of, "is this helping or hurting?" I do not want to diminish that aspect in any way, and I'm appalled by the idea of cutting women open unnecessarily. I also think there are some instances in which an intervention such as a c-section can be necessary. While some reviewers have felt that the bit with Abby's transfer didn't seem to "fit," I disagree. It demonstrated that, at least in her case, when a transfer was indicated, it could be performed quickly and safely.

I bring up the feminist issue because the more I learn about birth practices, the more upset I am that childbirth gets ignored by feminists who talk about "reproductive rights." Okay, so we're standing up for women who choose not to have children ("we" being feminists, although I can't speak for all of them, obviously). Can't we also stand up for women against unnecessary intervention (including the appalling c-section rate) when they *do* decide to have children? Shouldn't that be part of the women's health and reproductive rights and informed consent and access and choice that we're talking about, if we're honest and really think it through? The health thing is important. And I think people who claim to advocate for women's health and treatment should advocate for those women even during birth.

And I understand Sista's point. Much of the conversation among "birth junkies" these days, though, is not about whether a woman should or should not suffer through the pain. What it is about, however, is doctors not adequately discussing potential adverse effects of those interventions. Sista mentioned being induced, and it's generally thought that induction makes labor harder and more painful, making it more difficult to endure without pain relief. A book I'm reading now quotes a nurse saying she thinks it would be torture to let an induced woman labor without an epidural. How many doctors clearly explain that potential for increased pain to their patients? It's not about nothing vs. everything, drugs vs. no drugs, vagina vs. c-section, so much as it is about being honest with women, and asking questions, and finding out whether something is known to help or hurt. Or at least, I think it should be. If interventions are necessary, they're necessary. If they're being pushed because they're convenient or because a baby's "too big" (when it comes out a completely reasonable size/weight), or whatever reason that's not really supported by the evidence/situation, well, that's not how I want women treated in any of their medical care.

Glad you saw the film, and sorry we didn't meet up there.

7:21 PM, December 03, 2007  
Blogger GingerSnaps said...

I bring up the feminist issue because the more I learn about birth practices, the more upset I am that childbirth gets ignored by feminists who talk about "reproductive rights."

*Cheers & Applause! Cheers & Applause!*

7:30 PM, December 03, 2007  
Blogger Anne said...

Thanks so much for your blog. I was actually doing research for my own and came across your post. I am encouraged by your thoughtful wrestling with child birth, rare these days among women, almost non existent among men. Things have changed, I birthed my 5 children between 1980 and 1997. The last two delivered at the hospital you were at. I was able to birth my children without intervention with little resistance. I now await the birth of my granddaughter and realize my daughter doesn't have that same freedom. After much research and prayer she plans on delivering at home with a midwife (who was also my birthing coach for my last 3 births). Keep telling your story, it is powerful. I think we have ended up in this age of intervention because we don't speak up, we don't live in community. Isolation leads to ignorance. The results can be tragic.

9:55 AM, March 31, 2008  

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