Clarence Joe Walker
English 101 Section A
Galen College
Omar Rodriguez, MA
Abstract
Although it remains rare in the United States, planned home birth has drawn increasing attention and criticism in the mainstream media and has come under attack from organized medicine. Yet, recent peer-reviewed studies contribute to the evidence base supporting home birth as a safe option for low-risk women attended by skilled midwifes. I hope to achieve this with a thorough background of medical mistakes that has dehumanized the birthing process for women. It is the purpose of this paper to prove that home births are just as safe as hospital births in low risk women. Home birth …show more content…
with a trained midwife should be an option available to low-risk women. This paper will focus on the history on medicine replacing midwives, the current era of obstetrics and finally the midwives and home birth.
Natural Birth: The Ultimate Sacrifice
The birth of a child is an experience that most men and women in the United States will go through. It is a joyous occasion; however, it can also be a point in one’s life where they are overwhelmed with information and many things to do. Not only are expectant parents having to get their house ready and having to learn numerous things about pregnancy an new baby care, they also must become informed about the endless array of test, medical procedures, and standards of practice commonly used in the field of obstetrics today. Many do not have the time to learn about all the test, procedures and interventions; rather they trust their care provider’s opinion or what friends or family members who have already had children tell them. Most of these expectant parents do not consider delivery outside of a hospital for several reasons, some being perceived safety, hospital birth being standard, or not knowing that there was another option.
It is typical; most expectant parents do not challenge or question anything obstetricians or the hospital staff tells them is best for their baby. Many do not challenge or question the use of test, procedures and other interventions because these practices have become so common and accepted today that their use is expected and their safety is rarely challenged. Many women who choose to have a hospital birth expect to have an IV, electronic fetal monitoring and an epidural because the use of these procedures has become so common and standard that their safety is automatically assumed. But because something is widely used and accepted does not mean that it is safe. To best illustrate this point think back to when prophylactic forceps deliveries were common and therefore assumed safe. It took decades before the obstetric community finally agreed that prophylactic forceps deliveries were not in the best of interest of mothers and babies. But what about the procedures and interventions used today: are they safe?
Exploring the option of home and birthing center births with midwives for low-risk women should be at the core of the national health care reform and research. Instead, several generations of high-tech, low-touch birth and a pervasive cultural belief that birth is imminently dangerous – even in healthy, low-risk women – has led to powerful cultural blinders that limit options for women. The decision to have a natural birth should be embraced and not ostracized because it is not the social norm. Giving birth carries a much bigger impact than a onetime mere medical event. It is the purpose of this paper to pay respect to the hundreds of women that ripple the waters in exchange for the ultimate experience.
For the vast majority of history, childbirth has been a “woman’s thing” and was attended by midwives at home. The word midwife itself means with the woman. Men themselves were not allowed in the birth chamber and thus were excluded from witnessing this uniquely female act. This way of practice remained unchanged for most of history as we know it. Men did began making their way into childbirth; however, and within a short period of time, surgeon and physician guilds were formed. Eventually birth was pushed from home to hospital and out of control of the ones it meant the most to.
The first men to enter the birth chamber were not doctors; they were the barber-surgeons who were, as their name says, hair cutters and beard shavers; however, the also had skills which included using their knives and other tools for bloodletting and extracting dead babies (Blumenfeld-Kosinski 1990). When it became obvious that the mother or child was going to die because she could not deliver the baby, the doctor-surgeons were called in t attempt to save a life. They would use their tools to take the baby out of the woman’s body in pieces: the cranioclast would crush open the baby’s skull, the crochets would dismember it and remove it in pieces. Eventually a guild of surgeons formed in England around 1540 and made statute that specifically stated, “No carpenter, smith, weaver, or woman shall practice surgery” (Mitford 1992).
Midwifery was the first field of medicine taught in medical schools and there was no standard curriculum; therefore, many of the new doctors were inadequately trained Medical school training did not include clinical training and the vast majority of new doctors had not witnessed on solitary delivery when that attended their first paying patient and because of this most of the early doctors did more harm than good (Wertz and Wertz 1989).
New interventions continued into the twentieth century. And along with this time period of great advances in health came breakthrough new medical interventions into childbirth, each with their own unrecognized and potentially dangerous risks and side effects. How can anyone forget the physical, emotional, and psychological results of DES (diethylstilbestrol), x-rays, discouraged breastfeeding, separation of families during labor and the belief that babies didn’t feel pain.
Diethylstilbestrol, more commonly known as DES, was the first synthetic estrogen ever synthesized and prescribed to millions of pregnant women between 1938 and 1971. Believing that low levels of estrogen caused miscarriages, DES was hailed as a wonder drug because it supposedly prevented miscarriages, was cheap to produce and could be taken orally. In 1947, under much pressure from major drug companies, the Food and Drug Administration (FDA) approved DES for use during pregnancy.
In 1952, questions concerning the effectiveness of DES in preventing miscarriages were raised. The appearance of clear cell adenocarcinoma (CCA) began appearing in young women in 1901; and in 1971. The FDA then advised against the use of DES during pregnancy but some physicians continued to prescribe the drug to pregnant women. The DES incident was an embarrassment to the FDA (Northrup 1994). The women who took DES were at an increased risk for breast cancer. And as this paper will show, this was just the tip of the iceberg.
Following DES, x-rays were introduced. They were considered safe and commonly used for almost 50 years-until the negative consequences on embryogenesis, carcinogenesis and genetic mutations were discovered in the late 1950’s. Fetuses and children are ten to twenty times more susceptible to the carcinogenic effects of radiation because their cells are rapidly dividing, and children born to mothers who had x-rays have a higher incidence of leukemia, Down’s syndrome, and among the daughters, more miscarriages and fetal deaths during their childbearing years. The genetic mutations that occurred can be passed down to subsequent generations (Cunningham 1997). X-rays were used for everything from determining gestational age, multiple pregnancy, presentation of baby, and most commonly, pelvic measurements of the mother, all of which could have been determined by less intrusive ways.
Obstetricians, and pediatricians, in this era believed that babies did not feel pain and if there is one thing even the most uneducated person knows, it is that babies do feel pain. The “no pain” belief was so strong that surgical procedures were done without anesthesia or anesthetic. And what is even more appalling about this is that circumcision without pain relief for infant boys continued beyond this era and into the 1990’s and some speculate that anesthesia/anesthetic is not used 100% of the time even today (Ritter 1992). According to current ethical guidelines, surgical procedures cannot be performed on research animals without anesthesia. The following is a statement made by Marilyn Milos after viewing an infant circumcision without any pain relief:
…The silence was broken by a piercing scream-the baby’s reaction to having his foreskin pinched and crushed as the doctor attached the clamps to his penis. The shriek intensified when the doctor inserted an instrument between the foreskin and the glans, tearing the two structures apart…the baby started shaking his head back and forth- the only part of his body free to move-as the doctor used another clamp to crush the foreskin lengthwise, which he then cut…The baby began to gasp and choke, breathless from his screams. How could anyone say circumcision is painless when the suffering is so obvious…? (Milos )
But yet, physicians felt that the response express by the infant during the circumcision were not due to pain. Thankfully, today most circumcisions are performed with some form of pain relief and physicians acknowledge that babies do feel pain.
In the current era of medicine and child birth, there are various methods used but this paper will focus on those with the worst outcomes. Amniotomy, the artificial rupturing of membranes, is performed by obstetricians who wish to speed up the natural process of labor, check for signs of fetal distress or for the insertion of an internal fetal monitor. While amniotomy does in fact cause labor to speed up, the complications include cord prolapsed in which the umbilical cord comes down before the baby and results in a life-threatening situation typically requiring an emergency cesarean, cord compression during contractions, greater head molding and an effect on the fetal heart rate ( Goer 1995).
It is common place in today’s hospital to keep laboring women from eating and drinking during labor.
The belief surrounding the policy of nothing by mouth is fear that a woman under general anesthesia will aspirate the stomach contents. Today general anesthesia has been replaced with epidural anesthesia, thus eliminating the use of general anesthesia and the chance of aspiration. The researchers of one study stated that eating and drinking in labor are not always a factor in maternal aspiration but faulty anesthesia administration almost always is ( Broach and Newton 1988). What is puzzling is that it is not humane to let a woman experience some pain during labor, but it is human to let her starve during a physically demanding process in her …show more content…
life.
The national cesarean section in 1965 was at 4.5% and has quickly risen to 32% as of 2011 (Hamilton et al. 2012). It is believed by many in the medical community that cesareans sections reduce the perinatal mortality rate and many also believe that cesarean delivery is safer for the baby, but neither of these are true. Cesarean sections do have adverse effects on both mother and baby when compared with a vaginal delivery. The risks to the mother, other than that of increased maternal mortality, include damage to uterine blood vessel, damage to the urinary bladder, respiratory complication and lower subsequent fertility. Why has this number ballooned out of proportion? ChildBirth Connection offers the following bulleted points:
The following interconnected factors appear to contribute to the high cesarean rate: Low priority of enhancing women 's own abilities to give birth, Side effects of common labor interventions, Refusal to offer the informed choice of vaginal birth, and limited awareness of harms that are more likely with cesarean section. (ChildBirth Connection)
It is the job of every medical professional to provide and offer these answers to new and existing parents, not just for stats but for the well being of those they care for and the life they are going to bring into the world. Medical professionals tend to neglect the emotional and psychological aspects of procedures, but they are just as important as more and more women suffer from postpartum depression, these issues need to be addressed.
So how are midwives and home birth so different from hospital births? The explanations are virtually endless, but revolve around a few central issues; following evidence-based practice, prevention instead of intervention, giving control of the birth process back to women, and trusting women’s ability to give birth. Childbirth is a natural and normal process in a womans’s life and a woman’s body is well designed to birth a baby. Midwives have a general philosophy that as long as everything is progressing smoothly, whether fast or slow, and there are no signs of tension or stress in the mother or baby, there is no need for interventions. Each womans labor is different and her experience is unique so there really is not a concept of a “normal labor and delivery”. Some labors are 30 minutes and others may last 3 days. Some women feel little or no pain during birth and other find the contractions excruciating. Some women prefer to eat in labor and some cant. Midwives respect and appreciate this uniqueness, where obstetricians find it pathological and must do something to make it more normal and thus controllable.
Midwives follow a care model which revolves around pregnancy and birth as normal events. They focus on prevention rather than intervention or treatment. Every intervention discussed previously is rarely, if ever used in a typical midwife-attended home birth. support during labor is used instead of anesthetics or anesthesia. Midwives aim to build the mothers confidence in herself and in her body’s ability to give birth without the use of medical interventions by educating her about the various opinions available to her and encouraging her during the rough parts of the pregnancy, labor or delivery. Midwives encourage the partners to emotionally an physically support their pregnant partner, exercise and ear properly with their partner, as well as educate them about the entire process of bringing a child into the world.
Medicine has led to a decrease in women’s confidence in their ability to give birth. Women have become used to hearing about or having medical interventions used during pregnancy and childbirth that they have begun to feel that they simply couldn’t have a baby without it. The decrease in women’s ability to give birth afflicts our society as a whole and has led to the increased dependence on the medical system. Women depend on their doctors to confirm their pregnancy with a blood test and then they rely on the doctor to tell them their exact due date. Ultrasounds to judge the growth rate of the developing baby has replaced relying on obtaining and adequate nutrition and having an appropriate weight gain. These views have caused so many women to think of pregnancy and childbirth as something that they have to go through in order to have a baby instead of a moving and power experience-after all how can it be a powerful experience when you are powerless. Low risk mothers should have the right to decide if she wants to delivery her baby at home. Who are we to rob them of the ultimate sacrifice?
References
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Brackbill Y, Rice J, and Young D. 1984. Birth Trap. New York: Warner Books
Broach.J, Newton, N.
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ChildBirth Connection. (2013) Cesarean Section: Why is the National U.S cesarean section so high? http://www.childbirthconnection.org/article.asp?ck=10456
Coburn, J. 2000. “Formula for Profit: How marketing breast milk substitutes undermines the health of babies.” Mothering July/August: 58-68
Cunningham, F, et al. 1997. Williams Obstetrics. Stamford, CT: Appleton and Lange.
Goer H. 1995. Obstetric Myths versus Research Realities. Westport, CT: Bergin and Garvey.
Hamilton B, Martin. J, Ventura S. Nov 2011. National Vital Statics Report. Birhts: Preliminary Data for 2010. http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_02.pdf
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At the start of the 20th century 85% of all babies were born at home. By the end of the century that figure had fallen to around 2%.