Safety in Birth

As I was traversing Pinterest I came across a blog here on WordPress called “Outlaw Midwives” and while skimming the articles, I found this one: http://outlawmidwife.wordpress.com/2011/03/30/on-safety-and-consent/; shortly there after I re-read an article also touching on “safe birth” by my mentor, Krista Joy Arias over at MamaMuse: http://www.mamamuse.com/2011/05/trust-love/.

They sparked a thought process in my head that I hadn’t considered before. An idea, a philosophy, that so many mainstream midwives, pro-homebirth (*cough* midwife-attended homebirth) campaigners, etc. would be furious at. Especially when it challenges their biggest ideal: “trusting birth”, that birth is “safe”. My thought process was similar to that of the Outlaw Midwife’s, supported by Ms. Arias’s points.

What is “safety in birth”? Why do we seek “safe birth”? Is it just a ploy by pro-midwifery-licensure campaigners to gain more support? They are trying to not “scare” anyone. “See, look! Birth IS safe if you don’t receive interventions!” But that’s just it. We find comfort in “safety”, even if it is just perceived– which can be dangerous in itself. Our culture, our society, fears death. It fears it, and it is taboo to not fear it, to accept it as an every-day Right of Passage. We fear it, so we fight it with medication and technology. We fight it down to our very cores, though there is a place in our souls, in each of us, that knows Death, and accepts it. But we fear letting that part of ourselves, that part of our humanity, out into the light of day.

To me, Death is a part of Midwifery. It is a part of Motherhood. It is a part of Life. There is no escaping it (though we like to think as much). And the rituals and chants, the songs and whails surrounding the Rite of Passage that is Death (and all other Rites as well, really) are being forgotten. But there are those Rogues who are grasping at the slipping rope, trying desperately to pull it back up to the surface before all is lost to the sea of modernization and technological advancement.

Consider the following taken from the blog over at Outlaw Midwives:

“this idea of safety is so ubiquitous that even the controversial ‘trust birth‘ movement says, birth is safe, interference is risky, as if the question on the table is, how do we have the safest birth possible?  do we follow medical protocol, mainstream midwifery protocol, more ‘hands off’ protocol…which one is safer?

but i want to question, why is safety the goal?  why do we first tout how safe a procedure, before we talk about whether the mama has given informed consent?  and why when we talk about informed consent, we often boil down to whether or not the mama consented to this procedure, despite or because of the risk or safety of the said action?  feel me?

what is safety?  being alive?  fitting into the normative ideas of healthy and average?

and how do we determine safety?  through clinical studies?  medical tradition?  anecdotal evidence?  expert opinion?”

Really consider that for a minute…. “What IS safety?” ….. “WHY is safety the goal?”

In the words of Krista Arias:

“So, when I hear someone say, Birth is safe or Trust Birth –your body knows how to give birth, something in me rebels.

“That’s not true,” it says.

“Birth is anything but safe.”

Birth may not be a medical emergency, but that does not mean it is safe. It is a serious and intense rite of passage that can shake us to our depths. Persephone’s trip to the underworld was not safe. Safe is a cop-out in life, and in birth.”

Let me repeat that: Safe is a cop-out in life, and in birth.

I feel that women, midwives, mothers… that they should not focus on “safety” and “what-if” and “Where did we go wrong” or “What could have been done to make it safer”. Instead, they should focus on allowing what is to be, allowing the birth to unfold in the manner of which it is meant to. Even if you attempt to do what you can with what skills and knowledge you have, and the “best outcome” doesn’t happen, accept that. Accept it as it is. Be present, be responsible, and own the part of the story that is yours. Meet mothers where they’re at. Do not hold judgement. Know the rites, know the rituals, know the words and the way of life and death and you can accept it as it comes, and help mothers and families to do so as well.

Another thought from the Outlaw Midwife:

“i guess it is because i think of safety/security as an illusion.  there  are no guarantees in life.  and playing the statistics game (deciding  ones protocol based on what has proven to be statistically safest or  most effective) is a fools errand.  because you can easily find yourself  in a situation where you do all the right things and the outcome is  horrible.  and you can do all the wrong things and in the end everything  turns out just how you wanted.
and if something is 99 percent  effective, and you turn out to be that 1 percent, do you really care  that 99 other people had difft outcomes?  and what if you are the mama  and you lose your babe, because you are the 1 percent?  is your grief  any less? probably not.
but yr grief probably is harder if you were told to go against your own motherwit, because the stats said xyz.
and  if you did follow your intuition, and the outcome is not what you  expected, then at least you can take responsibility for what happened.   rather than blaming mw’s and obgyns etc, ppl who have little  accountability to you, and will go on doing their jobs barely  remembering you existed a couple of weeks or months later.
i dont  know.  i tell mamas, look, everything will not be perfect.  but if you  follow your own sense of what to do, then you are taking responsibility  for your own life and choices.  everybody has to be who they are.
and  from what i have seen if you follow your own sense of what to do, then  you will have more self-respect, self-love, self-empowerment.  and the  more that we value ourselves, the more we are able to value others  around us, including/especially our children.”

 

The Big Three (Actually, Four): Part I

The Big Three (Actually, Four): Part I

The Midwife: Ina May Gaskin

Website: http://www.inamay.com/

Authored Books:

  • Birth Matters: A Midwife’s Manifesta
  • Ina May’s Guide to Childbirth
  • Ina May’s Guide to Breastfeeding
  • Spiritual Midwifery (4 editions)

Biography/History: Ina May is a name that many in the “natural birth” and Midwifery world know quite well. “Ina May Gaskin is sometimes referred to as the “midwife of modern midwifery” because of the role she’s played in the rebirth of that profession in the United States” (1). She has been on the circuit so to speak since the 1970s when she helped found The Farm with her husband, which still to this day is a functioning commune and birth center. She was among a group of 200 who set out to venture forth across the United States with her spiritual leader-husband and along the way, she began to teach herself and train with doctors in regards to midwifery. Throughout the years and over the course of over 3,000 births having occurred at the Farm, 1200 of which were attended by Ina May, the Farm has put out some of the best statistical information regarding safety and homebirth, even and especially so in regards to “high risk” births such as vaginal breeches and multiples. Over the years she has worked with the doctors of the area and women have come from all over, even from other countries, to birth at the Farm under the care of Ina May Gaskin. She has been featured in multiple sources and tours the country performing seminars.

Beliefs:

  • Ability to birth: “Those who are used to the birth ways of other mammals know that it is easy to cause complications during labor by disturbing the mother. If we put horses, goats, and cows through the restrictions and indignities that most laboring women in U.S. hospitals are routinely subjected to, the animals would surely have as many complications as we do. The astonishing thing to me is that we have come to believe that our human bodies are not as well designed for birth as other mammals’ are. Really it’s our brains that can pose problems: we alone among mammals have the ability to scare and confuse ourselves about birth.” (1)
  • Health during Pregnancy: “To accomplish this [a Cesarean rate of 1.7% over the last 40 years], we had to make sure that pregnant women had good nutrition and a healthy amount of exercise, and we needed to do everything we could to reduce the amount of fear surrounding birth by demystifying the process. All of these measures together have made the good outcomes at the Farm Midwifery Center possible.” (1)
  • Hip to Baby Ratio: “But my partners and I have found that c-sections are very rarely necessary because of a mismatch in size between the woman and her baby. Having helped a number of women with what appear outwardly to be small hips give birth vaginally to ten-pound babies, I know that appearances can be deceiving. I have encountered fewer than ten cases out of three thousand in which the baby was actually too large to fit through the maternal pelvis. It happens most often with diabetic women, whose babies can sometimes weigh more than twelve pounds.” (1)
  • Active management of labor and arguments against it (book review): http://www.inamay.com/book-review/active-management-labor
  • “Why should insurance companies continue to get away with limiting the skills that a health profession has always previously required of its members if they were to be considered fully trained?”

― Ina May Gaskin, Birth Matters: A Midwife’s Manifesta

  • “Gardeners know that you must nourish the soil if you want healthy plants. You must water the plants adequately, especially when seeds are germinating and sprouting, and they should be planted in a nutrient-rich soil. Why should nutrition matter less in the creation of young humans than it does in young plants? I’m sure that it doesn’t.”

― Ina May Gaskin, Ina May’s Guide to Childbirth: Updated With New Material

  • “The way a culture treats women in birth is a good indicator of how well women and their contributions to society are valued and honored.”

― Ina May Gaskin, Birth Matters: A Midwife’s Manifesta

  • Unassisted Childbirth: “Ina May Gaskin speculates (“Some Thoughts on Unassisted Childbirth”, Midwifery Today, Issue 66) that the “extremism” of the choice to give birth without a medically-trained attendant has perhaps arisen in response to the extreme medicalizing of childbirth in the past decade.” (2)

 

My Take: Ina May’s Spiritual Midwifery was the first book I ever read about “natural pregnancy and childbirth”. I found it on a library shelf while I was 16 and pregnant. I devoured the stories, but never got to really finish the book until my second pregnancy, at the age of 19, when I bought it not just because I was pregnant, but because I have wanted to be a midwife since I was pregnant the first time, and Ina May was all I knew. I wanted to be how they had been, wanted to live that way and birth that way. I wanted those psychedelic, spiritually-laden births, and to help other women to have them. I was actually reading her Guide to Childbirth book when I went into labor with my second son. I find a lot of her articles (which can be found on her website) eye-opening and she stands for many things that I agree with. I recommend reading her books, and someday would like to travel to the Farm to see it for myself and to meet her in person. I hear things here and there about people disagreeing with her approach (she is a lot more hands-on in birth than I would care for, but there are women out there who want that, or at least think they need it), or claiming that she attacks UC-ers (which I have yet to find a copy of the article she wrote in regards to UC, or any updated opinions voiced by her since 2003, I did however find the aforementioned quote). I think that if it were not for women, and midwives, such as Ina May, Midwifery may not have survived in the United States.

Sources:

(1) http://thesunmagazine.org/issues/433/oh_baby

(2) http://www.mothering.com/community/t/571061/ina-may-on-uc

NOTE: As I come across further information, this may be updated.