Monday, July 30, 2012

"Curing" Birth

I'm a huge fan of modern medicine. I'm grateful every day for antibiotics, life-saving surgeries, well-trained emergency room staff, ICU's, NICU's, and PICU's. I find it miraculous that conditions which used to kill us are now easily treated, cured, or managed by medications, surgeries, or simple monitoring and lifestyle changes. Where an illness like strep throat once might have been fatal or cause life-altering disabilities such as deafness and heart disease, now it requires a simple trip to the doctor, a throat culture, and antibiotics to knock it right out and get on with our lives. Appendicitis used to be 100% fatal, and now it can be taken care of with a simple laparoscopic surgery. We can fix or replace teeth so they look better than new. We can repair complicated broken bones with surgically placed pins and help them heal with custom-made splints. We can give people new hearts and lungs and livers and kidneys. We can remove brain tumors with an outpatient procedure using a gamma knife, with no need to even cut through the skull. Modern medicine is a great blessing that has lead to better quality of life, decades-longer life expectancy, and a healthier population.

The problem is that modern medicine is so good at finding and fixing problems that sometimes it seems we're actively looking for things to fix that may not actually need fixing. Or, we go way overboard trying to improve a situation that can be managed with less intervention. For example, often high blood pressure or diabetes can be managed by lifestyle and diet changes, without the need for medications, but we automatically jump to the "quick fix" of medications that may have unknown or unexpected side effects.

Nowhere is this phenomenon more obvious than in pregnancy, labor, and birth. Until about 100 years ago, birth did not take place in hospitals, attended by doctors, hooked up to monitors, using medications. Birth was the territory of women, specially trained midwives, with experienced mothers and grandmothers for support. Indeed, even today, in many other countries, obstetricians only come into the picture if there is a complication or emergency situation where the mother and/or baby need advanced care, made possible by modern medicine.

Statistically, the ability of a woman to safely have a vaginal birth is quite high, possibly over 90%. According to research, the optimal c-section rate (i.e., the total percentage of women who give birth via c-section) should be between 5% and 10% of all births. That is to say that in potentially 90% or more of cases, a woman will not need surgery to help her deliver her baby. Right now, in the United States, the c-section rate is around 32%, meaning that almost one in three women gives birth via c-section. Obviously, there is some disconnect between the optimal and the actual, and the question is, why? It is thought that the high rate of medical interventions during birth, including continuous fetal monitoring, epidurals, and Pitocin, do contribute to the high c-section rate. The bottom line is, in most births, a laboring woman given the proper support will eventually have her baby vaginally using nature's time-tested, age-old methods of contractions to open up the cervix and coax the baby down and pushing to encourage the baby through the birth canal and out into the open. It's primal. It's painful. It's hard work (hey, they don't call it "labor" for nothing!). It involves a lot of bodily fluids and parts of our bodies we don't normally have out in the open. But it's basic. It's biological. And it's a system that has worked to propagate the human race for a very, very long time. I mean, there are, like, seven billion of us. Obviously, we're doing something right.

I'm not saying, by the way, that emergencies don't happen. I'm not saying that interventions, drugs, and surgeries are never necessary. I'm not saying that modern medicine and obstetrical practices haven't saved numerous lives, both mothers' and babies'. I'm not saying that hospitals and doctors don't have a place in the labor and birth process. There's a reason that hospital birth is the norm in the United States and many other Western countries. We feel safe there. We know that if there is, G-d forbid, some kind of emergency, we're right there in a place that can tend to us. I know plenty of stories that end with, "If I hadn't given birth in a hospital, my baby would be dead," or, "If I hadn't been in the hospital already, I would have been infertile after my first birth," or, "Without the c-section, both me and my baby would have died." These stories are true, absolutely. Plenty of mothers and babies died in childbirth in years past from issues that we can now either prevent, treat, or handle because of modern medicine.

The trouble is that because we can make birth "easier" on women, sometimes it seems like we ought to. Obviously, if we have the choice between pain relief and pain in any kind of medical procedure, we typically opt for pain relief. I wouldn't want an appendectomy or tooth extraction without anesthetic! So if we know how to "take away" the pain of childbirth, it makes sense that we would want to. Pain is not typically seen as a good thing, and if we can make it go away, we'd like to do that. I'd rather take an Advil than suffer a headache; I don't know about you.

But birth is different. The pain of childbirth is not a "bad" pain. The pain doesn't mean something is wrong. The process of labor and delivery is part and parcel of bringing a healthy baby into this world. By jumping ahead and providing interventions that may or may not be necessary before finding out if those interventions might be causing problems, we have produced generations of people who were not born "naturally." It's only in the past few years that doctors and researchers are positively identifying real problems that are directly related to interventions during childbirth.

One of the biggest culprits is induction and/or c-section before 39 weeks, which has led to many, many beds in the NICU being taken by "late-term preemies," those born between 37 and 39 weeks, who were not quite ready to be born. Many of these inductions and c-sections were not done for medically indicated reasons but rather for convenience or because the mother was uncomfortable. Hospitals that have started banning non-medically-indicated inductions before 39 weeks are seeing a significant reduction in NICU admits, leaving those beds and resources available for babies who truly did need to come into the world before they were fully developed, in order to save their lives or the lives of their mothers. The use of Pitocin to start and/or "augment" labor is very common, and most women are not told about the risks both to herself and her baby that Pitocin may cause. The use of Pitocin is associated with fetal distress, postpartum hemorrhage, newborn jaundice, and possibly even neonatal brain damage. New studies show that at least half of induced labors lead to delivery by c-section - if the baby is not ready to be born, there is a high chance that induction simply won't work and a c-section will be the only way to get the baby out. Even when labor has started on its own, Pitocin is often used to "speed up" or "augment" the labor, and the risks of the use of Pitocin still apply in these cases.

The fewer interventions and less interference a woman has during labor, the more likely she is to give birth safely and vaginally. And, concurrently, researchers are finding that babies born vaginally tend to suffer fewer neonatal complications and lifelong health problems, such as asthma. Vaginal birth is safer than c-section, and spontaneous labor is more desirable than artificially-induced labor.

The root of the problem is that pregnancy and childbirth are viewed by the modern medical establishment as diseases that need to be treated or injuries that need to be fixed, rather than natural, biological processes that can continue on their own without interference. As more women advocate for their births to be supported rather than treated, the outcome is becoming more positive and healthier for mother and baby.

I'm not advising any woman on how and where she "should" give birth. This post isn't about what choices we as women should be making. Rather, it's about looking at how modern medicine sees birth and to address the changing tides of medical opinion toward better, safer births for all women. We as women need to know our options so that we can have useful, intelligent discussions with our care providers about how, when, and where we want to give birth, and, in return, our care providers need to be sensitive to the changing attitudes toward birth, back to letting nature take its course rather than trying to "improve" upon a system that works better without interference.

Just as we don't try to make our kids grow faster by administering human growth hormone willy nilly, just as we don't try to force our kids to walk before they're ready, or make their teeth start to fall out before the permanent teeth start coming in, just as we only turn to surgery for weight loss as a last resort after trying lifestyle changes, we can look at pregnancy and birth as normal processes that we need to wait out, rather than medical conditions that we need to treat.

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