First, a normal childbirth is one in which the normalcy of birth is respected and honored. It is a birth in which there are no medically unnecessary interventions. To find out what a medically unnecessary intervention is, you are going to have to do some work. Use this page as a resource.
This was created for anyone interested in learning about their childbirth options. The information provided is given based on the belief that 1)birth is a natural, normal event for the vast majority of women, 2) Birth can have a profound effect on the emotional, spiritual and social aspects of our lives and 3) maternity care should be RESEARCH-BASED and mother-friendly as outlined by the Coalition for Improving Maternity Services (www.motherfriendly.org, www.motherfriendly.org/MFCI/):
The MOTHER-FRIENDLY CHILDBIRTH INITIATIVE
A mother-friendly hospital, birth center, or home birth services offers all birthing mothers:
1)Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
Unrestricted access to continuous emotional and physical support from a skilled woman-for example, a doula or labor-support professional:
Access to professional midwifery care. (References)
2)Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.(References)
3)Provides culturally competent care -- that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's ethnicity and religion.(References)
4)Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.(References)
5)Has clearly defined policies and procedures for:
collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.(References)
6)Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
shaving;
enemas;
IVs (intravenous drip);
withholding nourishment;
early rupture of membranes;
electronic fetal monitoring;
Other interventions are limited as follows:Has an induction rate of 10% or less;
Has an episiotomy rate of 20% or less, with a goal of 5% or less;
Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.(References)
7)Educates staff in non-drug methods of pain relief and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication. (References)
8)Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.(References)
9)Discourages non-religious circumcision of the newborn.(References)
10)Strives to achieve the WHO-UNICEF "Ten Steps of the Baby-Friendly Hospital Initiative" to promote successful breastfeeding:
Have a written breastfeeding policy that is routinely communicated to all health care staff;
Train all health care staff in skills necessary to implement this policy;
Inform all pregnant women about the benefits and management of breastfeeding;
Help mothers initiate breastfeeding within a half-hour of birth;
Show mothers how to breast feed and how to maintain lactation even if they should be separated from their infants;
Give newborn infants no food or drink other than breast milk unless medically indicated;
Practice rooming in: allow mothers and infants to remain together 24 hours a day;
Encourage breastfeeding on demand;
Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics.(References)
What is the Guiding Philosophy Behind Maternity Care in the United States Today?
Birth in America is guided by the false belief that it is a fundamentally flawed process. According to this belief, during childbirth women’s bodies are inefficient, ineffective and a potential danger to the baby. Birth is only seen as normal in retrospect. This philosophy serves as the foundation for the dominant model of maternity care in American today, the technocratic medical model. As Robbie Davis-Floyd describes in her book “Birth As An American Rite of Passage,†birth in this model is doctor and technology centered, only safe inside of a hospital when technology is used, restricted to arbitrary timelines that are not research supported, and the pain of labor is perceived as unproductive and unnecessary. The technocratic medical model ignores an integral part of birth, the importance of the labor and birth environment and how birthing women feel psychologically. [1] The interventions deemed necessary and safe by this model of care are largely not supported by the medical research.
Unfortunately the technocratic model of maternity care has far reaching effects. About four million women give birth each year in the United States. [2] According to data released by the Center for Disease Control in 2003, 99% of births occurred in a hospital and 91.4% of all births were attended by a physician, who tend to employ the technocratic model of maternity care. Only 8% of births were attended by a midwife, who generally practice a more holistic, women centered approach to pregnancy and birth. [3] The vast majority of women are being cared for by providers whose beliefs and practices are founded on the technocratic medical model of maternity care, which does not support birth as a natural, normal, healthy process.
The Birth Experience
The Listening to Mothers Survey conducted in 2002 by the Maternity Center Association surveyed 1,538 women regarding their childbirth experience. According to this survey “a majority of women reported having each of the following interventions while giving birth: electronic fetal monitoring (93%), intravenous drip (86%), epidural analgesia (63%), artificially ruptured membranes (55%), artificial oxytocin to strengthen contractions (53%), bladder catheter (52%), and stitching to repair an episiotomy or a tear (52%).†[4] While these interventions are sometimes necessary and important in birth, their prevalence and the risks associated with each are alarming.
Research demonstrates the following risks:
• Continuous electronic fetal monitoring increases the risk of cesarean and has been shown to have no benefit to the baby’s health. [5] Instead, the American College of Obstetricians and Gynecologists recommend intermittent auscultation be used for healthy, low-risk women.
• “Routine IV use restricts movement (an important tool and comfort measure in natural childbirth), decreases confidence, may over-hydrate mothers, and may contribute to low blood sugar in newborns.†[6]
• Epidurals have a tendency to increase the first stage of labor, as well as the use of pitocin, which carries its own risks. Several studies have shown an increase of vacuum and forcep vaginal deliveries, again each carrying its own set of risks to the mother and baby. Epidurals may also be associated with an increase in cesarean sections.[7]
• “An intact amniotic sac protects the baby’s head and a woman’s vagina during labor. Artificially rupturing the sac increases a woman’s risk of infection and interventions like pitocin, EFM, IV, and cesarean.â€[5]
• “There is no evidence that the prevention of prolonged labor by the liberal use of oxytocin in normal labor is beneficial.â€6 Because pitocin artificially increases the strength of contractions it puts more stress on mothers and their babies. “Pitocin use necessitates the use of an IV and continuous EFM, restricts (a mother’s) mobility, and raises (the mother’s) risk of epidural and cesarean.[5]
Keep in mind that these interventions are being used when most of the time they were never necessary to begin with! As such, caregivers are actually introducing risk to a normal process that would work better and be more beneficial to mother and baby if left alone.
Cesarean births are another major intervention with numerous risks to women that is on the rise in the United States. Our current cesarean rate of 31.1% is disturbing given that the World Health Organization (WHO) states that cesarean births should comprise no more than 10-15% of all births. The prevalence of cesarean births is in part due to the fact that over 300 hospitals across the United States are denying women the choice to give birth vaginally after having a previous c-section. This is despite the fact that “Dozens of studies totaling tens of thousands of women have conclusively shown that elective repeat cesarean is more hazardous for the woman, no safer for the baby, and poses serious risks to the woman's future reproductive life. What is more, with appropriate care, 7 or more out of 10 women will give birth vaginally (after a c-section) thus ending their exposure to the hazards of cesarean surgery.†[8]
How Women’s Rights are Being Violated
This model of care undermines women’s reproductive rights because it too often denies women the right to choose how and when they will give birth. If birth is only normal in retrospect as the technocratic model holds, then birth is only safe within the walls of a hospital. Ultimately, this model denies healthy women the choice to birth in a place where they might feel more comfortable, like at home, which has been proven repeatedly to be safe.[9] Women who want to have a natural childbirth are often pressured into undergoing interventions that undermine their ability to give birth naturally such as lying in the supine position or continuous electronic fetal monitoring. Both of these interventions are shown by research to be unhelpful and potentially harmful when used routinely in the absence of medical necessity. Another common example is a caregiver insisting a woman have a c-section, despite the fact that mom and baby are healthy, simply because she isn’t dilating in accordance with the arbitrary time table supported by the technocratic medical model.
Sadly, the Listening to Mothers survey also revealed “about one woman in three either had a limited understanding or none at all about her legal right to clear and full information about any offered procedure, test, or drug, and her right to accept or refuse such careâ€.[3] Women are not only unaware of their legal right to informed consent, but are actively being denied this right by health care providers that use various bullying techniques to push interventions without informed consent and by the hundreds of hospitals that are violating a woman's right to refuse surgery by not offering vaginal births after cesareans. Why are pregnant women systematically being denied their medical rights?
The problem with birth today in America not only lies with maternity care providers, but in women’s acceptance of this deeply flawed model of care. By agreeing to these interventions, often without true informed consent and in the absence of medical necessity, they are implicitly agreeing that their bodies aren’t capable of birthing their baby. They are agreeing to the hierarchy established by this model, placing the caregiver at the top who then dictates to his or her patient what is appropriate and what is not appropriate. Instead of the birth process inspiring confidence and trust in a woman’s inherent ability to give birth, it teaches women to rely on technology and care providers to tell them how to give birth, despite the fact that the care they provide is often unsupported by the medical literature.
What Should Maternity Care Look Like?
Maternity care should be guided by the principles of the midwives model of care, which emphasizes evidenced based and mother-friendly maternity practices. All care providers, not just midwives, should follow this model. The midwives model of care is based on the fact that pregnancy, labor and birth are normal, healthy events. The midwives model of care emphasizes:
the physical, psychological, and social well-being of the mother throughout the childbearing cycle, providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support, minimizing technological interventions, identifying and referring women who require obstetrical attention. The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.[10]
It is revealing to compare the percentage of births attended by midwives in the Netherlands to the United States. The Netherlands has an infant mortality rate of 5.04 deaths per 1,000 births.[11] About 46% of all births in the Netherlands per year are attended by midwives.[12] As stated previously only 8% of births in the United States are attended by midwives and our infant mortality rate stands at an embarrassing 6.50 deaths per 1,000 births.
While interventions are on the rise, maternal mortality has not improved in the United States in twenty-three years and the United States ranks forty-third in the world in terms of infant mortality.[13] Women need to seek out maternity care providers that use evidenced based practices. They should become informed about all of their childbirth options, know the risks and benefits of interventions, and trust that they are capable of giving birth.
[1] The Technocratic and Holistic Models of Birth Compared. http://www.geocities.com/4birthing/midwifevsmd.html.
[2] Center for Disease Control: “Preliminary Births for 2004: Infant and Maternal Health†http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelim_bi
rths/prelim_births04.htm
[3] Center for Disease Control: “Births: Final Data for 2003†http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf
[4] Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences http://www.maternitywise.org/pdfs/LtMreport.pdf
[5] Enkin, M., et al, (2000) A Guide to Effective Care in Pregnancy and Childbirth, New York: Oxford University Press, 248-49.
[7] World Health Organization. Safe Motherhood: A Practical Guide to Care in Normal Birth
[8] Goer, Henci. “Rebuttal to Rationales for Denial of VBAC†http://www.hencigoer.com/articles/vbac/
[9] British Medical Journal. “Outcomes of planned home births with certified professional midwives: large prospective study in North America†http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?eh
om
[10] Citizens for Midwifery, “Midwives Model of Care†http://www.cfmidwifery.org/mmoc/define.aspx
[11]Central Intelligence Agency. “Rank Order: Infant Mortality Rate†http://www.cia.gov/cia/publications/factbook/rankorder/2091r
ank.html
[12] Smulders, Beatrijs. “The Place of Birth The Dutch Midwifery System†http://www.acegraphics.com.au/articles/smulders02.html
[13]Center for Disease Control: Pregnancy-Related Mortality Surveillance :United States, 1991-1999â€
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5202a1.htm
