Wednesday, February 27, 2008

the business of being born

We watched the documentary last night, and I highly recommend it to all of you. It will definitely open your eyes about how birth happens in this country. Here are my thoughts on it.

The purpose of the film is not to push home births. I honestly think the purpose of the film is to show that there are options out there besides a highly medicalized birth. Because the truth is, the majority of births are low-risk and don't need a lot of medical intervention. Ricki Lake, the executive producer of the film, decided to make it after having her first son in the hospital with lots of intervention and her second son at home with a midwife. She felt that the second birth was so much more fulfilling. She called it a gift to her son. Again, she didn't make the film to say that having a home birth is better. She wanted to show that women do have choices. And that having a natural birth is a very different experience than being drugged up. She wants to show that birth can be more.

The film talks about some pretty scary stuff that went on in obstetrics. In the first part of the 20th century the common practice in hospitals was to knock women out during labor and strap them to a bed. It was called twilight sleep. Here is the definition from

Twilight sleep: A term applied to the combination of analgesia (pain relief) and amnesia (loss of memory) produced by a mixture of morphine and scopolamine ("scope") given by a hypodermic injection (an injection under the skin). The mixture of the two drugs created a state in which the woman, while responding somewhat to pain, did not remember it after delivering her baby. Twilight sleep was once in vogue in obstetrics.

The women had to be tied down because they would thrash around while in this state. They would have no memory of giving birth.

Other crazy stuff that used to be routine was x-raying pregnant mothers to check the size of the baby. This went on until they realized it gave the babies cancer. In the 50's mothers were given a drug that caused children to be born without developed arms and legs. And even all through the 90's a drug given to mothers was discovered to be causing major problems. (Sorry I don't remember the specifics. I think it was ruptured uteruses.)

Another point the movie makes is how disturbing the sky-rocketing cesarean rate is in the US. Right now the national average is 1/3 of all births are c-sections. This is much higher than other developed nations. Many believe there are several reasons for this. One is that OBs are mostly trained surgeons and therefore feel more comfortable doing a section than a natural birth. Many OBs very rarely have experienced a natural birth. Another reason is the ridiculous malpractice situation in this country that makes doctors very scared of being sued. They have way more control in a c-section.

Also, there has been an increase in elective c-sections. Women choose to go through major surgery instead of pushing a baby out. Some of the reasons I've heard are the convenience of scheduling the birth, not messing things up "down there", and even doing the c-section a little early in order to lessen the chances of stretch marks. Crazy if you ask me.

There is also evidence that all the interventions common in hospitals today increase the likelihood of a cesarean. The way it is explained in the movie is this: the mother is given an epidural early which slows down labor. So then she is given pitocin to get things going again. Pitocin makes contractions really hard, long, and close together. This puts stress on the baby and usually requires more pain relief. Or it can start with a woman being induced with pitocin and then given the epidural, etc. What happens is this slippery slope occurs where with every intervention, more in often required. And then the baby is under stress and things aren't progressing quickly enough, and so a c-section is given.

Of course, this is not the case with every c-section. There are many emergency c-sections that save the life of the baby and mother and couldn't have been prevented. In fact, the director of the film ends up having an emergency cesarean because her baby is breech and she went into labor 5 weeks early. It turned out that the placenta had stopped working, so her baby had stopped growing. He was only about 3 pounds. Usually, if this condition happens, the baby is stillborn, so they were really lucky.

One thing I thought was interesting is that the director said afterwards that she didn't feel like she gave birth. She felt like she was in a car accident, went into surgery, and was given a baby afterwards. She described the whole thing as being very surreal and that it was hard not to be able to bond with her baby right away. I'm curious if any of you who have had c-sections felt this way.

Another thought provoking point was made by a French doctor they interviewed. He says that the hormones released during natural labor and birth are what help us to bond to our babies right away. He said that if you take that away, especially when a c-section is done, you are taking away the "love hormones" that cause that bonding. He said, for example, that if you give a monkey a c-section, the monkey will want nothing to do with her baby. Obviously, we are human and love our babies however they come to us. I do not think that a mother who births naturally loves her baby more than a mother who has a c-section or a mother who adopts. But the hormone stuff is real and makes one wonder if it is affecting us in some way.

There are few things I wish were a little different in the film. I wish they had shown more hospital births where things go well. I would have liked to seen a natural hospital birth, because that is what I plan on doing. I also wish they had spent a little time on how mothers should prepare for a natural birth because I think it definitely takes some preparation. The film was skewed toward midwives, but I think that is understandable because they were trying to show that midwives are an often forgotten option in the US. Everyone knows you can go to an OB and have a hospital birth. This film is trying to show that women actually have more choices than that. And even if you do have an OB at the hospital, you still have choices. The point is that women should be in control, not doctors.

I definitely recommend this film. I was educated and moved. I found it inspiring to watch women give birth naturally and safely. I still plan on having my baby in the hospital. But if this birth goes smoothly, I would certainly consider other options such as a birth center or maybe even home for subsequent births. Midwives are trained professionals who come equipped with many of the tools doctors have in the hospital. I am actually excited for the birth of this baby. I'm excited to see what my body is capable of and to truly experience it all.

I also want to point out that the most important thing is not to have a natural birth, but to have choices. And of course to have a healthy baby. I know many women choose to have epidurals and have no regrets. What concerns me more is all the women I've talked to who are disappointed in their birth experience because of all the interventions. They went into it without knowing much and just went along with hospital protocol. I don't agree with hospitals that pretty much automatically prep everyone for an epidural and pitocin. Laboring on your back in bed is not the best way to get a baby to come out.

What I love about this film is that it shows women that they can have a different birth experience than the one you are likely to get if you walk into a hospital ignorant of your choices.

Any thoughts?


  1. I sometimes wonder about the C-section thing too. I mean I wonder if it kind of feels surreal.

    So in nursing school while doing my labor and delivery rotation I never even saw a vaginal birth...only C-sections. Crazy huh. There just weren't any happening the days I was there. I think another reason for the high rate of C-sections is due to general poor health in our country and obesity specifically. It causes higher rates of Preeclampsia and Gestational diabetes, which both increase C-section rates.

    I can't wait to hear about everyone else's experiences. I am getting close!

  2. Wow--I agree 100% with everything you've said. When I first got pregnant, I really feared the pain of childbirth, but the more I've read and learned in my childbirth class the scarier all the medical interventions seem. I too am planning on a natural hospital birth, though I think it's important to remain flexible. I feel like this is my plan going in, but I'm willing to make adjustments when the time comes. If I end up getting an epidural though, I hope for it to be late in labor and I want to turn it down/off before I start pushing.

    I feel like it is such a blessing that a midwife will be attending my birth! The class I'm taking is of the very standard hospital variety (due more to the cost than anything), but all of the risks associated with medical interventions you bring up have become part of mainstream, standard training for upcoming doctors and are taught in the class. However, there are still a lot of doctors out there--trained in previous decades--who routinely start IVs, do unnecessary episiotomies (as most are), use pitocin to arbitrarily "speed things up," etc. My childbirth teacher will be talking about unnecessary risks that are often taken and then say (to me)--"oh, but you'll be fine. The midwives never do this." Plus they will be there the whole time I'm laboring, rather than showing up 10 or 15 minutes before, so I'll have the support that is so necessary to going natural. I really feel like I'll be getting the best of both worlds.

    Having said that, I think it's sad that highly medicalized birth has become such a part of our culture that some people view home births as an irresponsible choice, when the truth is that for "normal" pregnancies, the statistics just aren't there to prove that home births are any more risky, especially if potential hospital transport is arranged ahead of time. In fact, when you take into account the risks associated with the major surgery that is a cesarean and how high C-section rates are in hospitals, home births come out looking like a less riskier alternative. And even though I'm not choosing a home birth, the fact that having one would guarantee that everyone was on the same page as me philosophically is very appealing.

    I learned recently that Utah--and Utah County in particular--has one of the highest induction rates in the country, for reasons of "convenience," even though ACOG has specifically recommended that inductions be done only out of medical necessity. I wonder what it is about this place or this birth culture that promotes such thinking, but it's scary to me.

    Anyway, I could go on and on . . . so I'll stop. But thanks for the great post!

  3. I think the important thing is to know your options and be prepared to be flexible. I had both of my sons in the hospital, with a nurse midwife. I never saw an OB for either delivery. I loved my nurse midwives.

    Home birth is admirable, but my older son needed open-heart surgery as a newborn. He would have died at home. Surgery is the only thing that saved him. The nurse who realized something was wrong will forever be my hero.

    Not every hospital delivery is miserable. ;)

  4. how interesting!

    i chose to have both of my babies in the hospital, primarily because I knew of potential pre-existing conditions that would necessitate medical intervention on my behalf, since both my mom and I almost died when she was born and I apparently inherited the same problem. And I'm very grateful that I made that choice, since I would have ended up being rushed to the hospital anyway. And I did have elective inductions with both babies for convenience, because that was the only way I could ensure my husband actually being there when the baby was born.

    With that said, I would much prefer to have had a midwife rather than an OB. I would have preferred to have no epidurals. But I am incredibly grateful that the trained OBs were on hand when things got a little shaky, and that an epidural was available after 14 hours of unproductive labor, and that there were drugs and medical staff on hand to stop the hemorrhaging and the other fun things.

    I think the important thing is to know all of your options, and to take the one that is most appropriate for your situation! I'm grateful for ethical, responsible healthcare providers.

  5. i love that you are doing all this reasearch, k. my cousin knew NOTHING when she had her first child and the whole experience was terrifying for her. the more you know, the more confident you'll be, and the better choices you can make for yourself and your baby.

    thanks for sharing everything you're learning. it'll come in handy for me one of these days!

  6. I had my twins by c-section (I elected too) and then my son was a v-back and then Alexis was c-section (she was breach). A lot of it goes to what you feel is "safe" for the baby -that had a lot to do with it for me. I don't think my c-secion births were better/worse than my vaginal birth of my son - All WERE MIRACULOUS AND WONDERFUL!

    Take care - Kellan

  7. What a great review - can't wait to see the documentary.

    Like Danielle, Bryan just finished up his OB rotation for nursing school and saw zero vaginal births. He also saw zero married women, and zero women over the age of 20, but that's a different discussion!

    I agree with others who has said that being informed is key. I know you've found my friend Maria's blog, and I love her philosophy. She is a 4th year med student and has seen MANY scary births. She will be laboring in the tub, has a midwife and a doula, and plans on going drug-free, but she is delivering in a hospital just in case something unpredictable happens. I think if I had a baby at home and something horrible happened, I'd never forgive myself.

    I do think that birth is much too medicalized in this country, and our medicine (c-sections, pitocin, epidurals, etc) should be used when it is indicated, not as a baseline protocol.

  8. So you made some really great points. I am really looking forward to seeing this film. I think it is great that you are doing your research. That is what is most important. You need to know your options so you can decide what is best for you.

    I loved my epidural and I plan to have one again (whenever I have my next). My labor and delivery went perfectly...for me, but you need to do it the way you are most comfortable. I really am impressed by you and the research you are doing to make this experience the best it can be for you! Way to go Katrina!!!

  9. Hi Katrina - thanks for coming by today, nice to see you. Hope you are doing well. Have a great day! Kellan

  10. As has been mentioned by several others, I think the main thing is to be informed, and then to make sure you get what you want. You can even write out a birth plan and give it to the nurses and OB. Of course some medical professionals will be easier to work with than others. And you have to find a good fit. I discussed episiotomies (don't mind my spelling) with my first OB, and thought we were on the same page, but then after like 1 push he snipped me. With my new OB I had a long discussion about this, and feel much more confident that we are, in fact, on the same page, and he will only perform one if the baby is in distress or if I'm going to tear upward. (Sorry to be graphic.) Anyway, yeah, you just have to know your stuff. I think lots of women just opt for the epidural withoug having a clue that it does typically slow down labor, which can result in needing forceps or c-section, etc. Or they agree to being induced (which is almost always for the doc's convenience) without knowing why. I will have an epidural this time (unless time is too short, which is very possible) and I'm delivering in a hospital. I'm too neurotic and scared about complications to ever birth at home. But I say party on to birthing in whatever way you feel is best for you.

  11. Thank you for your synopsis of this documentary! I found it very enlightening. I've commented before about how I felt about my one birthing experience and I just wanted to say that I agree with how the hospital are presented and what is "protocol". I hope to do it different next time and being in a different place should give me more options (I really had none before). Thank you for your insight!

  12. wow, i never thought I could take anything that Ricki Lake did/said seriously. Did you ever watch her talk show? Seriously mindless smut, that was. Glad to see she had her hand in something as worthwhile as this.
    As far as my reaction, I'm going to have to agree with Anne, (Mrs. Cropper) especially on one point -- communicating with your OB. And finding an OB whom you trust and feel comfortable with all along. We are consumers in the health care industry -- we don't just have to take what we get, we can shop around and should be choosy about the care we place ourselves (and our unborn babies) under. If you feel like you have an overly-anxious OB who's going to opt for the quick episiotomy and heavy meds...start looking around for a better fit. I ended up having a C-section with my first, but didn't feel quickly pressured into it. My doctor let me labor for 12 hours before a C-section was ever even mentioned. He even let me stay stuck at 9 cm. dilated for 2 hours to see if there was any possibility for progress before they finally took me in for the surgery. Even though childbirth IS a very natural thing, and should be allowed to progress as naturally as possible, it is also natural to have complications that make a peaceful, tub-birth sans anaesthesia an impossibility for some women.
    The face of childbirth has changed dramatically though, and I personally think it has very much to do with insurance companies. I pretty much think they run the health care world -- it's a shame. Bottom line for me is that I want to get my babies here in the safest way possible, and for me, my anatomical situation, and our large baby-tendency, that has proven to be that's what we'll do.

  13. I love natural childbirth. my dream is to open a birthing center. oh by the way, I am jared's cousin. You have to really commit and have a plan if you want to have your baby without an epidural. You can do it. It is amazing. I used a squat bar with my first to help with the pushing it helped so much. Anyway I have a lot of opinions on the matter but I enjoyed your post. nice to meet you.