Touching Further on “Safety” in Birth

I shared my previous post on “safety” in birth in the group for my MamaMuse (un)Midwifery program mentored by Krista Joy Arias and she made a comment that spurred a new thought process. My view point on “Unassisted Childbirth” has ebbed and flowed through various thought processes, view points, and opinions since I first discovered the terminology (and the ever-growing movement) but that is for another post. We had talked some on UC in our class and I had made a comment in regards to UC being counterproductive. Krista asked in regards to my last voiced stand on UC how it related to my post on “Safety in Birth”. This was my response:

I feel that if one can go into a UC (here meaning having no one, midwife or otherwise… i.e. someone other than a midwife more experienced in birth than yourself… at your birth to “assist you” in the instance of an “emergency”) with the frame of mind that whatever happens, happens, and feel that they can be present with that and just let birth BE, that UC may be the best thing for that mother…. However, I still feel that it is counterproductive all around, whether for “safety”/”positive” birth outcome or for spiritual growth/enlightenment/what-have-you, to go into a UC planning to “be the midwife” trying to learn as much as you can and practically train yourself to be a midwife, to be able to recognize complications and be able to handle them, WHILE giving birth and being in a completely different state of mind (or, this weight and responsibility you have put on yourself is KEEPING you from going into that essential, primal, state of mind)… this is the route that I see most often in women who seek UC. I feel that it is OK to have people with you. You don’t NEED to be by yourself, to “prove” that you can do it, that your “natural”, or anything like that. I think that women have been giving birth surrounded by women, for millenia. And yes, even though they had women who were more experienced in birth, whether a great-grandmother and their grandmother and their mother (who all had 8+ children), or a midwife, or all of the above… they still knew that even if something happened and no one there knew what to do, or something happened and someone there DID know what to do, and it still didn’t help or salvage the situation and the baby or mother died, that was accepted as the way of things. There was allowance for acknowledgment in this, and allowance of time needed for grieving. But it was known to be a possibility and was accepted as such…. I think that’s the key. Not seeking safety as the goal, or throwing safety out the window. Not seeking to know as much as humanly possible to keep something from going wrong or throwing experience and knowledge out the window, but instead using what we have to the best of our ability (our skills and knowledge) and if what we had to give was not enough (or the mother did not want what we offered and so we met her in that place and acknowledged her right to chose and her choice), and regardless of the outcome let it BE. Acknowledged it, was present in the moment, and took nothing for granted. That, is the key.

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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.”

 

Shifting the Paradigm: Thinking Outside the Box

As I continue along my journey in the birth field, I have evolved time and again. New information is found, new opinions formed, new facets of spirituality discovered. I’ve noticed a shift in my “birth consciousness” that was once all for an off-the-wall seemingly radical idea such as that spouted from the mouths of natural birth advocates, such as “Avoid doctors and Cesareans at all cost!”, “You have to have a midwife at a homebirth”, “Trust Birth”, “Birth is Safer than Not”, or Unassisted Birthers and their stand (I had even considered a UC). Now, I have again shifted my personal paradigm on birth to something seemingly even more radical.

 

I have read articles about UC women losing babies, of people who once advocated UC turning against it, fearing it. I have read over and over again the claims that birth is “inherently safe” and we’ve been doing it “by ourselves” forever. I have compared the “babies lost to UC” to “babies lost under midwifery supervision” to those lost under “OBGYN supervision”. There are varying numbers, but in all cases there are deaths. And in a recent essay I wrote, I talked on the connection between birth and death, and especially that of the role death plays in midwifery.

 

Before I continue, let me make it clear that I am not bashing, advocating, or any of the like any one “side” of the fence (because in my mind, there is no fence, it’s more like the lunch tables in the school cafeteria that are designated to each ‘clique’. Some people are at the hospitals and doctors are the only way table, some are at the pro-midwifery licensure table, some are at the anti-midwifery licensure table, some are at the “trust birth”, pro-UC table). I’ve found that I am at none of those tables, and seek to get people thinking. Let me explain.

 

I feel like saying slogans such as the aforementioned give women a false sense of security that sets them up for failure, or disappointment. But at the same time, I believe that it is possible, and biologically normal, for a woman to give birth on her own. However, I have a growing uneasiness in my gut about how this topic is being handled and gone about. The common scenario that I’ve come across is as follows: a woman is pregnant and decides that she wants to have a “natural” birth. She reviews her options. Attempting as “natural” a birth as possible in a hospital or birth center setting, having a midwife attended homebirth, or an “unassisted birth”. She is more inclined to a homebirth, and considers the options regarding that route. Midwife, or no midwife. Perhaps she can’t afford the midwife, lives in a state/area where there are no midwives/homebirth midwifery is illegal, etc. So she begins to look more at the UC route. Another scenario is that she, from the gate, heads straight for the UC route. Either way, she begins looking into it, trying to find out what she “needs to know”, and essentially begins to self-train herself as a midwife. And of course, there are those out there who do not believe in doing this, after all they “trust birth” as a “biological function” (which it is, I’m not arguing that point) and so they believe that they do not need to be educated in the ways of a midwife and that their bodies will handle everything accordingly. In the first instance, there is the woman who studies and crams as much knowledge as she can, hoping she hasn’t overlooked any vital piece or will forget something in the moment. This, to me, seems counterproductive to the seemingly common thought behind “natural” births as being able to let mom be free of worries and responsibilities and allowing her to be in her own headspace (and in my personal belief, her own spiritual place) while someone else is the one with the knowledge to utilize in the case of a possible emergency. And yes, a birth that is not intervened with, a mother who is allowed to move about as she pleases, eat and drink as she pleases, etc. is the best scenario for the best outcome—that of a smooth, complication-free birth. But it seems to me that a mother who plans a UC, and tries to become “knowledgeable enough” to undergo one, is in a sense a hypocrisy against the theory of “our bodies are capable on their own” and, also, takes the mother out of that worry-free, personal head/spiritual place in my personal opinion. And, it sets her up for potential trauma, disappointment, and failure if she were to happen to have a complication and she does not know how to respond, forgets how to respond, is incapable/incapacitated from being able to respond appropriately and her partner is not “trained” to handle the situation, and the result is a hospital transfer or even death of herself and/or the child. I have read story after story of UC-ers ending up with a hospital transfer, either due to just a “gut feeling” that something was wrong, or there was an actual complication during labor or delivery they couldn’t handle or weren’t prepared for, or even if they were, couldn’t make a difference. Then there are the deaths. And like I said earlier, death is inevitable, in any birthing situation, with any attendant (or none).

 

I think that instead of spouting slogans or teaching women that birth is safe and our bodies are capable at all times of giving birth without the need of assistance from an outside person (which not only gives women the assumption that they shouldn’t have a midwife, but also that they shouldn’t even have a doula, or in some circles even their partner, present at the birth)— that we should be talking about death. We should be teaching midwives and mothers about the death aspects of birth, the potential for death in birth, how to cope with and accept death, the rituals, chants, etc. (the spiritual side) around both birth and death. Not hiding from it, not trying to avoid it at all costs, even at the cost of quality of life, not setting up women for possible trauma, because that’s what’s being done.

 

Here is something to ponder on. I became pregnant with my first child at the age of 16, and subsequently went into preterm labor and delivered a 29 week baby. He was whisked away, unseen, not held to my chest, for almost three days. He was kept in a great NICU facility in a town an hour and a half away, had his ups and downs, and on one of his downs was transferred even farther away to a supposedly “better” hospital, which in my eyes seemed no better than a local hospital, and was a downgrade from the first. Throughout his three weeks of life, he was given intervention after intervention, was denied my breast, was denied my holding of him time and again. I held him, and not even how he should have been held (for hours, skin to skin) maybe a hand full of times in those three short weeks. And regardless of their technology and their efforts, he died. Actually, partially due to their technology, he died. And thinking back on it, with where I’m at right now in my beliefs, I would have done it differently. I would have asked to hold him immediately after birth. I would have made them let me keep him, would have held him naked to my bare chest and stuck my nipple in his mouth, whether he would be able to eat or not. I would have held him for every waking 

moment, and probably the sleeping ones as well. And maybe he would have died anyway, maybe he would have lived. Maybe he would have thrived. (Kangaroo Care saves as much if not more infants, with a better quality of life, than our “technology” which studies have shown over and over). But regardless of the outcome, I would have at least have had those moments, I would have been with him for every second. He wouldn’t have died alone, three hours away from his parents. He may have died, but not alone. And I think that maybe I would have been able to cope with that trauma and be able to better overcome it in that alternative scenario. Maybe not, but I like to think that it would be better. And so many women don’t think about that, or maybe they do but they lock those thoughts and gut-feelings down inside because the “doctors know best”, and I think that needs to change.

I also believe wholeheartedly that we should stop shunning c-section mothers, stop snubbing them—those who chose a Cesarean and those who received emergency surgeries. We should instead be meeting women where they are, accepting them, being present for them, helping them to heal from that trauma (if healing is needed/it was traumatic, because it is possible it was not), and helping to guide them out of that place of ostracized outcast that they most often find themselves in the natural birth community. Help with trauma mending, help with information sharing on VBACs and even being present for them for a repeat c-section and helping them to be able to come to terms with it and make it a more “interactive” experience instead of one where they have no say from start to finish. This is something that I see quite frequently and that the attitude and treatment of needs severe 180 degree turn around on.

 

 

We should be teaching midwives to be able to be as hands-off as mothers want them to be, but to be able to step in in the case of a complication with quiet gentle guidance and quick skill. I wonder how many hospital transports for unassisted births (which include not just the transport and possible fetal/maternal hospitalization, but maternal/fetal separation, delayed nursing, etc.—all of the things that were set out to be avoided in the first place) could have been dealt with at home with someone who has the training, who could have been the quiet presence in the corner, allowing the mother to have her space and her freedom from the weight-bearing of “Will I remember what I learned?” and the like. They could have been dealt with, at home, and there would have been little to no negative side effects such as the aforementioned (of course, unless a dire emergency was indicated and transfer was needed). This is just one of my many personal and evolving views.

 

And, again personally, I believe we did not give birth “alone” in the past. Maybe, when we were Homo erectus in the plains of Africa, we did what mammals do—found a quiet, secluded place safe from predators and were left to our own devices to either come back with a baby, or not. But, looking historically, at least since recorded history, there are records across cultures of women being attended by women. And this was not necessarily just “medical” supervision, but just women-to-women, mother to daughter, grandmother to granddaughter, aunts and cousins and other female tribe members supporting, and being present, for the birthing mother. They were her chair, they were her arms, they were her spiritual support also, and probably most importantly. There may, or may not have been a midwife, but there were women who had birthed before there who knew some ways of birth, and if there wasn’t, or something was wrong, the midwife was called. But regardless, the mother was allowed to “be”, and whatever the outcome was, it was also allowed to “be”. This is my evidence for my argument against UC-ers who preach “birthing alone”, etc. in order to be a “true” UC-er. Yes, women are mammals and the actions behind mammalian birth is the same (quiet, safe, dark places, etc.) but this can be accomplished with a woman still being supported, cared for, adored and pampered, and spiritually supported.

 

We should also be looking more at the biology around labor, on a cultural level as well as a personal, woman by woman basis. If you want to claim birth is “biological” then act like it matters. Look at how we have changed biologically, physiologically, over the last few hundred years. How does that affect how we birth? Yes, women have “known” how to give birth since we evolved. But, how have we changed, physically (and mentally) that could hinder this natural, biological process? A major one: pelvic shapes. The major contributor? Diet. Diet has been probably the most drastic change humans have undergone in the shortest time, and even though birth is natural and we were capable of birthing, supposedly without midwives or other more-knowledgeable attendees, we are different now than when we were then. Even just compared to a few hundred years ago, or even less than a century ago. We should be looking at, and again training midwives and teaching mothers, and potential mothers, about how things in our lives could affect our capacity to birth, naturally. Diet I, and many others, believe is the main contributor, but also environmental factors such as chemical exposure, mental health, past traumas (whether birth related or not), etc. We should be trying to change these kinds of things, to help bring women back to the way it was before, when we could “birth naturally” instead of just saying “Oh, you can do it by yourself, no problem!” not even considering that even if that mother did everything “right” and still had a complication or her baby still died, no one thought to help her with a past trauma that re-surfaced during birth, or to talk to her about nutrition, before pregnancy or during. (Of course, even in antiquity, before the drastic lifestyle and diet changes of the mostly-Western world and those places that they have influenced, babies and mothers died. It was a part of life. And even if we can get back to a similar way of life or way of eating, death is inevitable at any time, for anyone, and takes me back to what I said earlier about the other key point that we are missing in regards to birth—death.)

 

And again, yes I believe that birth is a natural, biological function. I’ve even seen it mentioned a few times that if it didn’t “work” there wouldn’t be so many people. My radical thought on that? Doctors and technology is the reason for the outrageously high human population of this earth. Yes, birth “works” and more babies survive birth than they die during it, but with the increase in “life-saving” and “life-extending” technology, which is the field of doctors, more and more live (regardless of their potential quality of life). It has always been that babies die. Mothers die. And though populations steadily increased over time regardless, it was nothing compared to the last few hundred years with the advent of such “advanced” technology. And now, we have the ever-present looming fact, the elephant in the corner that everyone seems oblivious to, that our ecosystem (the Earth) has long-since reached its peak in population sustaining capabilities. In simple terms, the Earth cannot sustain us anymore at our current nor projected population growth rate.

 

And I understand, and am prepared for, how the aforementioned comments, personal beliefs, and theories will cause people to react. But, like those before me who went out on a limb and became “radicals” in their thinking, and their doing, so shall I take my turn, and perhaps, someone will read this and be able to think for themselves and possibly they will take their turn, and on it will go.

[And again, please take heed that I am NOT bashing or belittling anyone’s personal beliefs, or any one particular institute or organization’s beliefs or teachings. I am only stating my personal take, and hoping to get people thinking in a new light.]