Personal Delivery

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It might seem hard to believe, but as recently as 1900, 95% of all babies were born at home.

In 1938, the rate had dropped to 50%, and by 1955, 99% of all babies were born in the hospital.1

While hospital births seem perfectly normal to us today, the truth is that women have been helping other women have babies at home for hundreds of thousands of years, and the move to medicalize the birthing process is a very recent development in human history.

Birthing Becomes Business

First, let’s take a brief look at how birth has changed in the last 100 years.

Before the second half of the 20th century, most babies were born at home with the assistance of a midwife, a woman specifically trained in the birthing process and the needs of the female body.

In fact, the term midwife comes from the Old English term meaning with woman.

“In order to keep women accustomed to C-sections, they’re often told that vaginal delivery is no longer possible after the procedure.”

As hospitals were formed and later grew into profit-based entities, the push was on to reframe childbirth as a medical procedure that required oversight instead of a natural process of the female body.

When birthing became part of the medical business model, the experience changed drastically for both mother and child. Because childbirth became the most common procedure performed at hospitals, the profit was good, but the process had to be streamlined to accommodate all expectant mothers.

Unfortunately, this uniformity of process stripped away much of the attention previously paid to the spiritual and emotional needs of mother and child in favor of a sole focus on biological issues.

Assuming a woman didn’t have any complex health conditions in addition to her pregnancy, she could expect to receive the same treatment every other woman got with conveyor belt-like precision.

Today, time is money. Birthing rooms can’t be occupied for too long, so extended labors aren’t encouraged.

While most women are administered an epidural for their pain, this often slows down the dilation process. To speed things back up again, a woman is usually prescribed Pitocin, which induces contractions that are longer, stronger, and closer together. Unfortunately, the pain is often too intense, requiring another epidural injection. This slows down the contractions, which means more Pitocin, and so on.

Eventually, this process creates contractions that are so severe that the baby’s heart and respiration rates become extremely distressed. Not long after that, the woman often finds herself being wheeled into the delivery room for an emergency C-section which was artificially induced by mostly unnecessary medical interventions.

Health Risks, Financial Returns

In recent years, however, some health professionals have begun to take note of the increasing number of healthy women with no pregnancy complications who end up having emergency C-sections after induced labor or other unnecessary medical interventions.

Midwives Bring Simplicity and Intimacy Back to Birthing

Research from the American College of Obstetricians and Gynecologists (ACOG) has shown that the risk of needing a C-section rises sharply when labor is induced, especially if it’s the first child.2 Unfortunately, as hospitals rush to be more competitive and serve more patients, the number of C-section births has continued to rise.

Statistics from the Centers for Disease Control and Prevention (CDC) showed that between 1996 and 2007, the rate of C-section births for the U.S. rose 53%—the largest increase ever recorded. In Connecticut, New Hampshire, Rhode Island, Florida, and Colorado, the increases were between 70% and 80%. By 2007, one in every three U.S. babies, 1.4 million, were born via C-section.3

C-section births have become so common now that most of us don’t think twice when we hear someone we know has had one, but the truth is that a C-section is classified as major surgery.

Lots of complications can occur including hemorrhaging and blood clots for the mother, or intensive care for the baby.

Even though these risks increase with subsequent procedures4,5, C-sections are now the most common surgery performed in hospitals.6 In order to keep women accustomed to C-sections, they’re often told that vaginal delivery is no longer possible after the procedure.

This isn’t quite accurate.

Additional research from the ACOG shows that 60% to 80% of women can have a successful vaginal birth after a C-section.7 Perhaps the reason for this misdirection is that C-sections, being surgery, cost twice as much as a vaginal delivery.8

Unseen Sacrifices

This isn’t to say that C-sections are bad. They save lives when they’re absolutely necessary. The real issue is why and how they become “necessary” for so many otherwise healthy women who choose a hospital birth.

Another concern with C-sections is that because the baby does not travel through the birth canal, a final surge of the hormone oxytocin isn’t triggered.

Oxytocin is the “love” hormone that generates intense feelings of euphoria, overwhelm, and bonding between mother and child. Oxytocin is also generated on a much smaller scale during breastfeeding. Because this big hormone rush that normally sets bonding patterns in place doesn’t happen during a C-section, feelings of attachment to the baby can be somewhat lessened.

“In general, a midwife remains with an expectant mother throughout her entire pregnancy, monitoring her physical and emotional well-being, providing individualized education, counseling and prenatal care.”

Studies of MRI brain scans from Yale University have shown some C-section mothers to be lacking in attachment to their babies or less sensitive to their baby’s upset than mothers who gave birth vaginally.9

Often, monkeys given C-sections will ignore their babies. Oxytocin also works synergistically with serotonin as a mood elevator, which might explain why C-section mothers experience postpartum depression more often. However, additional research needs to be done in this area.

In a vaginal birth, the baby becomes covered in the mucosal lining of the birth canal, with much of it entering its nose, mouth and sometimes the ears. This lining is populated with billions of various strains of probiotics that once ingested, serve as the first inoculation of the baby’s gut, establishing the primary culture of what will become its intestinal flora and immune system.

In a C-section, this vital inoculation doesn’t happen, leaving the baby’s immunity compromised and struggling to catch up later in life.

Priorities & Process

As hospital birthing continues to become more mechanized, increasing numbers of women are looking to midwives and home birth to bring a sense of personalization and peace back to what is essentially a sacred process for themselves and their babies.

In general, a midwife remains with an expectant mother throughout her entire pregnancy, monitoring her physical and emotional well-being, providing individualized education, counseling and prenatal care.

She also provides gynecological exams, hands-on assistance during labor, delivery and postpartum support (while minimizing all technological interventions when possible), lactation consultation, and referrals for additional obstetric care.

At present, a midwife may practice independently or in association with a doctor’s office. A woman can also use a midwife in addition to the care she’s already receiving from her OB-GYN, whether she chooses to have a home birth or not. Midwives are qualified to deliver babies at home, in the hospital, or at birthing centers. Midwifery is currently overseen by the American College of Nurse Midwives (ACNM), Midwives Alliance of North America (MANA), North American Registry of Midwives (NARM), and the Midwifery Education Accreditation Council, along with the support group, Citizens for Midwifery.

Midwives Bring Simplicity and Intimacy Back to Birthing

At present, there are four types of midwife designations.

Certified Nurse Midwives (CNM) hold either a bachelor’s or master’s degree in nursing and have passed a national certification exam administered by the ACNM, earning them a state license to practice.

Certified Midwives (CM) also receive their certification from the ACNM but hold degrees in areas other than nursing.

Certified Professional Midwives (CPM) are trained midwives who have been certified through NARM. The credential requires re-certification every three years.

Direct Entry Midwives (DEM) may or may not hold a college degree, but have trained in apprenticeship and other instructional programs, which include attending home births and those at birthing centers. Whether you are interested in becoming a midwife or using a midwife’s services, it’s very important first to find out which certifications your state recognizes.

You can do this by reaching out to your state midwifery organization through contact information provided by Citizens for Midwifery (cfmidwifery.org). Always be sure your midwife is certified and has ample experience. Ask lots of questions, and always check references with previous mothers they have served. Interview potential midwives in person.

A successful birth experience depends as much on how your personalities and philosophies resonate as it does on the midwife’s credentials and experience.

Additional information can be obtained from contacting ACNM and NARM, as well.

Impressive Outcomes

Even though midwives are thoroughly trained and professionally certified, modern society’s exclusive familiarity with hospital birth might leave some doubting the safety of birthing at home. Hospital birthing has to be safer because well, it’s in the hospital… right? The world was populated long before hospitals, but let’s look at some more recent statistics.

In 2012, the U.S. ranked 174th out of 222 countries with an infant mortality rate of nearly six deaths per 1,000 live births, far behind nearly every other industrialized nation.10

Because 99% of all births today take place in hospitals, it’s clear these mortality rates can’t be coming from babies born at home. On the contrary, a study published by the British Medical Journal following more than 5,000 expectant mothers in North America who chose a home birth with a certified nurse midwife showed they required substantially less of almost every medical intervention including epidurals, episiotomy, forceps, vacuum extraction and C-section, and experienced virtually no neonatal or intrapartum mortality.11

“It stated that mortality rates in the births overseen by midwives showed “excellent outcomes.” In fact, the risk of infant death was 19% lower for births assisted by a CNM than they were for births conducted by physicians.”

Under its Professional Development heading, the NARM website provides quite a few research studies published by internationally recognized medical journals that consistently confirm the high rate of safety and positive outcomes for low-risk women birthing at home with the assistance of a midwife.

One study, published in the Journal of Midwifery and Women’s Health, stated that home births rose 41% in the U.S. between 2004 and 2010. It examined outcomes of nearly 17,000 women who planned to give birth at home between 2004 and 2009.

Of that total, 89.1% had a successful home birth. The majority of the women who had to be transferred to the hospital arrived for “failure to progress” with only 4.5% of the total sample requiring Pitocin to induce labor and/or an epidural.

Vaginal birth was accomplished by 93.6%, assisted vaginal birth by 1.2%, while just 5.2% had a C-section, a far cry from the national average of 33%!

Of the 1,054 women in the sample who attempted vaginal birth after a previous C-section, 87% were successful. Postpartum hospital transfers for mother and child were just 1.5% and 0.9% respectively. Most of the babies, 86%, were exclusively breastfeeding by 6 weeks of age.

The intrapartum, early neonatal and late neonatal mortality rates were 1.3, 0.41 and 0.35 per 1,000. Compare that to the U.S. average of 6 per 1,000. The researchers acknowledge that, “Low-risk women in this cohort experienced high rates of physiologic [vaginal] birth and low rates of intervention without an increase in adverse outcomes.” [author’s clarification]12

A study from the National Center for Health Statistics, published in the Journal of Epidemiology and Community Health, followed all single vaginal births in the U.S. in 1991 attended by either a physician or certified nurse midwife (CNM).

It stated that mortality rates in the births overseen by midwives showed “excellent outcomes.” In fact, the risk of infant death was 19% lower for births assisted by a CNM than they were for births conducted by physicians. The risk of neonatal mortality (infant death in the first 28 days after birth) was 33% lower with a CNM than with a doctor, while the risk for low birth weight was 31% lower.13

Midwives Bring Simplicity and Intimacy Back to Birthing

Exceeding Standard Practice

Naturally, these kinds of successful numbers have left some doctors looking down on midwives, feeling competitive and insecure.

At times, this has been known to create a rift between the two groups, especially in rare cases where a woman has a very long labor or an unforeseen complication that requires a midwife to accompany the mother to the hospital. Her reception from the doctor can be professional, but tense.

Of course, none of this helps the expectant mother, who should be the sole focus of the proceedings—not professional egos.

She’s already disappointed that she couldn’t birth at home and doesn’t need a doctor making her feel like she’s inconveniencing him.

It’s because doctors don’t see the vast majority of births that happen smoothly and uneventfully at home, but only the rare case that needs technological intervention, that they have a wild misperception of professional midwives.

The goal should be to work collaboratively with midwives to provide the expectant mother with the highest quality of care based on where, how, and with whom she chooses to have her baby.

If home birth plans change, then a doctor should be fully committed to continuing to provide, as much as possible, the same kind of birthing experience the mother would have had at home with only the technological interventions that are absolutely necessary, while working alongside the midwife.

Unfortunately, the American Medical Association (AMA) wasn’t keen on collaboration when they released an official statement in 2008 saying, “…the safest setting for labor, delivery and the immediate postpartum period is in a hospital or birthing center within a hospital”.14

It’s interesting that the AMA didn’t mention midwives in their statement, especially since midwives can accompany women to the hospital who have chosen them to oversee their hospital birth, many of whom have practice privileges in hospitals.

“Surely women deserve more from the healthcare system than simple relief that nothing went wrong during their delivery.”

Fortunately, most OB-GYNs know and respect their patients, and they’re more than willing to work with a midwife throughout a woman’s pregnancy and be ready to meet them at the hospital when the time comes, if need be.

What all doctors need to understand is that they were educated in a system that’s very reductionistic—one that breaks the human body down into separate, impersonal, mechanical parts with a one-size-fits-all approach to care, especially childbirth.

Melissa Cheyney, lead researcher on the study of 17,000 home births, said, “The U.S. has a limited idea of what it means to have a positive outcome at the end of a delivery. Basically, it just means that everyone is alive”.15

What many doctors weren’t taught to recognize is how a woman interacts synergistically with her unborn baby, and even her own body, during the pregnancy and birth process.

Surely women deserve more from the healthcare system than simple relief that nothing went wrong during their delivery.

They deserve the kind of experience that connects them with their body and reunites them with the profound sacredness of what it means to bring another human being into this world, surely a woman’s greatest gift.

With a little more focus on personalization instead of profit, we can provide that kind of experience for every woman. Even within an imperfect health system, we can work together to give each mother and child what they deserve: a truly personal delivery.

For more health and inspirational insights from Dr. Sadeghi, please visit Behiveofhealing.com to sign up for the monthly newsletter, check out his annual health and well-being journal, MegaZEN, or for messages of encouragement and humor, follow him on Instagram and Twitter @drhabibsadeghi

Sources

[1] Epstein, Abby, dir. The Business of Being Born. Prod. Ricki Lake. New Line Home Video, 2008. DVD. 2 Sep 2012.

[2] Ehrenthal, MD, Deborah, B., MD, and XiaoZhang Jiang, MD. “Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at Term.” Obstetrics & Gynecology. 116.1 (July 2010): 35–42. Print.

[3] Menacker, Dr. PH, Fay. “Recent Trends of Cesarean Delivery in the United States.” National Center for Health Statistics (CDC) Data Brief. №35. (March 2010): 1–8. Print.

[4] Kuklina EV, Meikle SF, Jamieson DJ, et al. Severe obstetric morbidity in the United States: 1998–2005. Obstet Gynecol. 113(2 Part 1):293–9. 2009.

[5] Liston FA, Allen VM, O’Connel CM, Jangaard KA. Neonatal outcomes with cesarean delivery at term. Arch Dis Child Fetal Neonatal Ed. 93(3): F176–82. 2008.

[6] Russo CA (Thompson Reuters), Wier L (Thompson Reuters), Steiner C. (AHRQ). Hospitalizations related to childbirth, 2006. HCUP, Statistical Brief #71. U.S. Agency for Healthcare Research and Quality, Rockville, MD. April 2009.

[7] “OBGYNs Issue Less Restrictive VBAC Guidelines.” American College of Obstetricians & Gynecologists. ACOG, July 21, 2010. Web. 2 Sep 2012. <acog.org/About_ACOG/News_Room/News_Releases/2010/Ob_Gyns_Issue_Less_Restrictive_VBAC_Guidelines>

[8] U.S. Agency for Healthcare Research and Quality. HCUPnet. Healthcare Cost and Utilization Project: Rockville, MD. AHRQ 2005 [DRGs 370–3].

[9] Swain et al. (2008). Maternal brain response to own baby-cry is affected by cesarean section delivery Journal of Child Psychology and Psychiatry. Volume 49(10), p. 1042–1052.

[10] “CIA World Factbook, Country Comparison: Infant Mortality Rate 2012 Estimates.” Central Intelligence Agency. N.p., 2012. Web. 2 Sep 2012. <https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html>.

[11] Johnson, Kenneth, C, and Betty-Anne Davis. “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” BMJ Group. (June 16, 2005): 330. Web. 2 Sep. 2012. <http://www.bmj.com/content/330/7505/1416.full>.

[12] Cheyney, Melissa et al. (2014). Outcomes of care for 16,924 planned home births in the united states: the Midwives Alliance of North America statistics project, 2004 to 2009. Journal of Midwifery and Women’s Health., 59(1), 17–27. http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/abstract.

[13] Centers for Disease Control and Prevention, National Center for Health Statistics, Press Release: “New Study Shows Lower Mortality Rates for Infants Delivered By Certified Nurse Midwives,” May 19, 1998, https://www.cdc.gov/nchs/pressroom/98news/midwife.htm.

[14] Kluger, Jeffrey, “Doctors Versus Midwives: The Birth Wars Rage On,” TIME, (May 16, 2009), http://content.time.com/time/health/article/0,8599,1898316,00.html.

[15] Ibid.