Of all the different childbirth methods that exist, there seems to be a common belief that threads them together: Women know how to give birth, and they can do it without medication and without fear. Still, research continues to confirm alarming trends involving medical interventions in the birthing process. The National Center for Health Statistics released a report in January revealing the birth trends for 2006, which found that 22.5 percent of births in this country used induction (medication to enhance labor)—double what it was in 1990—and a cesarean delivery rate that rose to an all-time high of 31.1 percent of all births. Once a woman has had a C-section, research indicates that her next birth will be done by caesarian 92 percent of the time, often without attempting normal delivery.
For Jennifer Houston, a certified nurse-midwife from Catskill, these interventions are all part of a modern misconception that birth is a medical event. “Doctors are practicing a medical model—they’re selling services,” she said. “They’re keeping an eye out for danger and they’re looking through a filter of pathology. Medicine makes birth pathology, and it’s not pathology. It becomes pathology when it’s not supported.” While hospitals and medication certainly have roles to play in risky pregnancies and abnormal labor and delivery scenarios, they are simply not necessary for the average, normal birth.
These days, a common hospital delivery may play out something like this: First, an epidural may be administered to numb pain from the waist down via a spinal injection. But that can hinder natural contractions, so the doctor may give the mother pitocin, a drug that stimulates labor but also causes more pain. That may necessitate another epidural, which may necessitate more pitocin. All of these drugs and injections can cause the baby to go into stress, so a cesarean section may be performed. “A regular, normal hospital routine inhibits the natural physiology of birth happening normally on its own,” Houston said. “Unfortunately, I see a lot of women these days asking for and wanting epidurals and not being well informed. In some ways, they may be more humane-looking births, but in other ways we’re still overusing technology, overmedicating people, and definitely doing too many C-sections. One hospital intervention leads to the next, and there’s this whole cascading effect.”
When you trace these births backward from the moment of delivery, you’ll often see a procession of interventions that fell against one another like dominos—and it often starts with the painkillers.
Explaining Epidurals
According to the American Pregnancy Association (APA), more than 50 percent of women request an epidural during labor in a hospital, making it the most popular anesthesia for pain relief during labor. Epidurals are injected just adjacent to the spinal cord of the lower back, where a catheter is placed that typically administers a combination of local anesthetic and narcotics or opioids. More medications may be dispensed to steady the mother’s blood pressure or to extend the effects of the epidural. The APA notes on its website the benefits of the painkiller (like relieving discomfort and allowing rest in prolonged labor), but the catalog of possible drawbacks is longer and more striking, including rapid drops in blood pressure, severe headaches caused by leakage of spinal fluid, slowed or stopped labor, permanent nerve damage at the insertion site, shivering, nausea, and more. The list also warns that pushing may become more difficult, so that further interventions—pitocin, forceps, vacuum extraction, and cesarean—may become essential to delivery. The use of an epidural can also hold health implications for the baby, with studies suggesting infants may experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability during the delivery process, and may also have difficulty breastfeeding after birth. Though some of these side effects may be rare or need further documentation, an overwhelming complaint against the epidural is that women feel powerless and cheated out of the real childbirth experience.
Houston herself said she was medicated during the birth of her first child, and felt “scared and out of control” during the process. “A lot of women feel less control when they have narcotics,” she said. “Certainly epidurals could be useful if people are having very, very long, difficult labors and just have to have some relief, but midwives generally work on that need for relief through the skills required for an unmedicated birth.”
A Natural Birth
“I always looked at birth like most other women, with fear,” said Kate Murphy of Kingston. “I think we are conditioned as a culture to immediately picture a red-faced woman in excruciating pain screaming and cursing her way through the experience. When I found out I was pregnant, however, my feelings changed. I felt that I could birth my child gently and with confidence.”
Like so many other women, Murphy’s original vision of labor involved one of the foremost deterrents of opting for a natural childbirth: fear.
“Women who have unmedicated births—natural births, empowered births—come away from those births feeling very, very different, much more powerful,” Houston said. “Clearly, it’s transformative, and I think that we’re wired for this. This is our physiology. The culture has given us a sort of propaganda—the danger, the fear, the pain, the complications. The truth of the matter is that most births are completely normal. And it absolutely needs to be supported by well-trained, attentive, skilled birth attendants, preferably midwives.”
Murphy gave birth to her child in December, using HypnoBirthing, the Mongan Method. The primary tenet of the approach is that mothers can birth without severe pain by reducing fear and tension through education and practice of visualization and relaxation techniques. She studied the method during private classes with Jency Elliott, a HypnoBirthing practitioner in Woodstock, and at home, through literature and relaxation CDs.
“I always looked toward the upcoming birth very positively,” she said. “I remember people would always ask, ‘Are you scared?’ I could honestly answer no. They always wanted to convince me that I should be scared. People would ask me if I had chosen a method. When I would tell them about HypnoBirthing, more than one person responded, ‘No matter how you do it, it’s going to hurt!’ I had to laugh inside. It always amazed me how hard it was for most people to accept a woman birthing fearlessly. Most people would rather try to convince me to be afraid.”
Elliott probably wouldn’t be surprised to hear this. “Birth acts as a magnet,” she said. “Everyone will tell you their stories and a lot of them are scary because of the fact that the parents were afraid.” But Murphy said that through the HypnoBirthing classes and making informed decisions, her labor couldn’t have gone better. She spent the early stages of labor at home before transferring to a hospital. Once there, “I focused on visualizations to help relax my muscles and allow them to work together,” she said. “I didn’t experience what I would describe as pain. It was more like pressure, very bearable.” Her daughter, almost 10 pounds, was delivered without any dose of pain medication—not even a Motrin afterward, Murphy said.
“What you will not learn is how to ‘deal’ with the pain, as that concept means you are already anticipating and expecting to be miserable,” said Elliott of the HypnoBirthing method. “However, you will learn comfort measures and ways to ease your mind, thereby easing your birthing body.”
Aid from Acupuncture
Studies on the effects of acupuncture during labor are also raising hopes that the practice may be an effective alternative to pain medication. A report prepared by the obstetrics and gynecology department at Saint Vincent de Paul Hospital in Paris cited a number of studies that showed the use of acupuncture during labor significantly reduced the use of epidurals and seemed to lessen pain, with most participants reporting better overall relaxation, too.
Jipala Reicher-Kagan of Transpersonal Acupuncture in Kingston performed acupuncture on herself when she was in labor with her children with positive results. “In my first pregnancy I did a series of prelabor treatments that start in the 36th week to prime the body for labor,” she said. “I also received treatment the morning that my labor started to get the qi moving and open up the pelvic area.” She used acupuncture during her second pregnancy to induce her overdue baby, and delivered within 48 hours.
Therese Sibon of Body Mind Spirit Acupuncture in New Paltz provides acupuncture services for pregnant women, especially for inductions and delivery of breeched babies, which could help avoid the medical interventions designed to deal with these situations. “Acupuncture isn’t going to force the body to do something its not able to do,” said Sibon. “It catalyzes the energy that’s in the body to do what’s beneficial for it.” Through needling, moxa, and demonstrating massage of specific points, Sibon has helped a number of local parents naturally bring their babies into the world.
Plans for natural childbirth may nonetheless go out the window when the labor actually starts. Having an experienced birth attendant can make all the difference, as they can offer a number of methods to help control pain naturally. Houston is not only a midwife but also a certified Kripalu bodyworker and a certified hypnotist with training ranging from the Lamaze and Bradley birth methods to yoga and neurolinguistic programming. Mothers can also benefit from hiring a doula for physical and emotional support throughout the labor. Doulas, as do midwives, often bring a range of ideas for pain management, extending from the use of warm water to soothe and soften tense muscles and make delivery easier, to helping women find positions that help expedite the labor in a safe and comfortable fashion. Cari Naftali, a certified doula based in Canaan, said that she’ll use a combination of techniques for mothers in labor, including birthing balls, warm compresses, and other options.
Be Prepared and Realistic about Pain
As your pregnancy progresses, educate yourself on the options available—the different birthing methods, where you want to have your baby, and who you want to facilitate care. If you decide to choose a nonmedicated birth, get support from your friends, family, and professionals who may be present during labor. Remember that every birth is unique in its process, and have reasonable expectations concerning your pain management choices.
“Most women who haven’t given birth don’t realize it’s not a kind of pain like a broke-your-leg pain or a migraine,” said Naftali. “It’s a productive kind of pain, a unique feeling, and it’s not pain for pain’s sake. It actually can feel good. It’s something that in my personal view is really worth feeling and experiencing.”
RESOURCES:
Susanrachel Condon, CNM, LM
Susan Rannestad, CPM, CM, LM
(845) 256 5430
www.riverandmountain.net
Jency Elliott, HBCE
(845) 679-1180
Jency@hvc.rr.com
Jennifer Houston, CNM
(518) 678-3154
www.midwifejennahouston.com
Cari Naftali, DONA-certified Doula
(518) 781-2202
www.berkshiredoulas.com/doulas-cari.html
Jipala Reicher-Kagan
Transpersonal Acupuncture
(845) 340-8625
www.transpersonalacupuncture.com
Therese Sibon
Body Mind Spirit Acupuncture
(845) 594-3873
www.bodymindspiritacupuncture.com
This article appears in June 2009.
