Labor Positions

[Portia]

Overwrought, stressful, or tense could all apply.

[Dragon Lady]

Except that none of those describe what I was trying to say. I was trying to describe mainstream perception of the woman who chooses to birth at home. The person that people think must not be in her right mind. That are so far from mainstream as to be different and regarded with wide eyes, concern and disbelief.

[Dragon Lady]

Ah, wait. I did say "crazy psycho woman" later on. I'd forgotten about that. I was referring to my first reference of "crazy."

[Dragon Lady]

And in the second instance, when discussing the laboring woman portrayed on TV, "overwrought, stressful, or tense" would all be gross understatements. Someone who spends hours screaming, hair flying, yelling at her husband, "YOU DID THIS TO ME, YOU WILL NEVER TOUCH ME AGAIN!" and doing a complete 180º from her normal personality is not simply tense.

[thatonemom]

I was thinking words like caricature, parody, overly dramatized, over the top, etc. Maybe those are more in line with the feeling of that comment?

I think there is an unfortunate stigma associated with planned home birth. That stinks that people have criticized your personal choices. I have a friend who's had all three of her kids via home water birth. It works great for her. She's never been high risk, was under constant supervision from a certified midwife, and lives blocks from a hospital (just in case). It's definitely not for everybody, but that doesn't mean it can't be an option for some.

[Dragon Lady]

I, thankfully, haven't got a lot of outright criticism. I've had people ask genuinely concerned questions, which is fine. If someone is genuinely concerned for me and is willing to have an honest conversation about it, I'm grateful for their love, and I answer their questions. But I know people who haven't been as lucky.

On the other hand, I know many people who have been criticized for their choice to induce for convenience, or to plan for an epidural. The worst is the criticism I've heard for people who had unplanned c-sections. I'm sorry, folks. Maybe it was an unnecessary cesarean, but maybe it wasn't. And if it was unnecessary, it is not the mother's fault. It is the doctor's. Please don't criticize the mother. She's probably feeling plenty of unnecessary guilt as is. Don't add to it.

And yes, thatonemom, I think those words would fit what I was trying to say.

[Whistler]

This idea that there's a "right" way to react to something as salient as birthing a child, in my opinion, produces a repressive culture that can lead to bottled-up emotions are that can manifest themselves in unhealthy ways.

yeah, I shouldn't have used the word "right," but I do have opinions about what birthing practices are in a mother's best interest, which indeed, are informed by my cultural biases. Most of my opinions are that more hospitals should make use of evidence-based birth practices, rather than simply using our own "traditional" practices (things that hospitals do because they've been doing them).

[pillowy]

I'm actually really passionate about this subject as well, though I'm on quite the other side of the spectrum. I don't like how the natural childbirth movement so often attaches a morality to exactly how a woman gives birth, and can be (and very often is) critical, judgmental, and/or condescending to the "naive" women who have different opinions and make different choices than them.

The natural childbirth movement was born out of sexism, racism, and eugenics. In "Holistic obstetrics: the origins of 'natural childbirth' in Britain", Dr. Ornella Moscucci explains the backdrop against which the philosophy of “natural” childbirth developed:

Health policy became the subject of intense public debate in the aftermath of the Boer war, when Britain’s near defeat at the hands of a barely trained army focused the attention on the physical fitness of new recruits...Adherents to the new science of eugenics on the other hand blamed heredity. In their view, health policy should aim to prevent reproduction among “low quality” human stock (“negative” eugenics), and encourage reproduction among “good” stock (“positive” eugenics).

...The development of “natural childbirth” owed much to the activities of physicians and health professionals who were in sympathy with the aims of reform eugenics.

In common with hardline eugenists, these health reformers were concerned about the differential birth rate—the tendency of poorer, less healthy sections of society to have larger families than their “betters”. Thus, as well as endorsing plans for the sterilisation and detention of “degenerates”, they also sought to encourage the middle classes to have more children...Attention was drawn to the...impact of female emancipation on fertility. Female education and employment were seen as a particular evil, insofar as they led women to regard motherhood a burden and to neglect hearth and home...

One obvious way to reverse the falling birth was to entice women of “superior stock” back into the home, where they would fulfil their functions as wives and mothers. Health reformers took up the challenge by developing an ideology of childbirth that emphasised the “naturalness” of pregnancy and birth. This ideology functioned at a number of levels. It was prescriptive, in that it rooted woman’s social role in her biological capacity for reproduction.

In a nutshell? The white, male, upper class men did not like that lower class people and *gasp* non-white people were having more children than them. They viewed education and employment of females as evil, because such things took them away from what the men wanted them to be doing - increasing the "good" population.

In addition to telling women that their civic duty was to be in the home and bear children, these health reformers knew they would have to address the pain of childbirth if they were to convince women to endure it. They found their hero in Grantley Dick-Read, often known as the "father of natural childbirth." He said that:

Whether women experienced pain or not depended on cultural attitudes to childbirth rather than on some property inherent to parturition. Dick-Read developed this argument by contrasting the experience of birth in “primitive” and “cultured” societies. Drawing on the anthropological literature of the late 19th century, he claimed that primitives experienced easy, painless labours.

He developed this argument based on anthropological literature from the 1800s, folks. How about we take a look at those "primitives" (I hate that term) with the resources we have today and see how easy and painless their labors are? How about in Nigeria, where the rate of death from pregnancy and childbirth is 1 in 23? Or how about the estimated 2 million women in Asia and sub-Saharan Africa that live with untreated obstetric fistulas from childbirth? Or maybe it's not so great to give birth in Sierra-Leone or Mali, where out of every thousand births, 49 babies die during labor or due to complications from it? And I guess it's not so painless to give birth in Zimbabwe, where a corrupt hospital charges mothers-to-be $5 every time they scream while giving birth?

The "noble savage" with "painless labors" was a myth that should have died with the racist, misogynistic men who perpetuated it for eugenic purposes in the mid-20th century. Labor is not painful because we have been conditioned to believe it will be. Labor is painful because a very large muscle is contracting an extreme amount for a very long time. Any muscle in your body that does that will hurt.

Will every labor hurt every woman equally? Obviously not. Some woman have higher pain thresholds than others, and some labors are more or less painful due to the baby's position or the mother's pelvic shape or the number of nerve endings in the mother's pelvic region (and the list goes on). Even my two labors were very different from each other in the pain department - the first was excruciatingly painful for the first 12 hours (in which I progressed from 1 cm to 5 cm), at which point I was able to receive an epidural and the pain was relieved. Certainly that, more than cultural influences, would condition me to believe that labor was painful. My second labor should have been hell based on my "conditioning." But it wasn't. I didn't even realize I was in labor until an hour before I had the baby. It just didn't hurt. (Until the last twenty minutes. Holy heck. If I was a woman in Zimbabwe I would have had to empty my wallet.) The first baby turned out in a less than ideal position for the birth canal - likely the reason for the increased pain. And the second baby was probably in the ideal position, because she practically shot out.

Again - labor is not painful because we're conditioned by our society to believe that it is. That is a sexist, propagandist argument proliferated by rich white men in the mid-20th century who wanted to increase birth rates among the "good" classes of people.

But, out of this idea the natural childbirth movement was born. It comes with such leaders as Ina May Gaskin (who, aside from being a cult leader's wife, does not understand post dates pregnancy or vaginal anatomy and muscular function during labor, and who writes about practices in her own book that clearly border on sexual abuse).

It also comes with some verifiably false claims about labor and delivery.

Let's take a look at ones about epidurals, shall we?

-The claim that epidurals sedate the mother and/or baby: false. The drug given in an epidural is a local anesthetic which remains in the space of the spine and numbs the nerves from the uterus and birth canal. It cannot impair cognitive function in the mother - it has no way of doing so - and cannot get to the baby in any way.
-The claim that epidurals lengthen labor: the research is divided. Some studies have found it lengthens labor, some studies have found it has no effect upon the length of labor, and some studies have found it shortens labor.
-The claim that epidurals interfere with bonding: false. (Also, really? Pain medication makes it so you won't love your baby, because you don't get "love hormones" when they're pushed out? I guess no fathers love their babies, then. And adoptive parents definitely don't love their children. None of them got to have love hormones from pushing out the baby.)
-The claim that epidurals interfere with breastfeeding: false.

Or how about the claims that electronic fetal monitoring is an unnecessary intervention, and intermittent listening with a doppler works just as well to monitor the baby during labor?

- Researchers have found that EFM cuts the rate of early neonatal death in half. This is exactly what you would find if EFM prevents death from lack of oxygen during labor.
- Here's an example of the information you can get from EFM that you can't get from just intermittently listening to the heartbeat.

Or how about the claim that post dates pregnancies are okay, and you should just wait and wait and wait to naturally go into labor because the baby "knows when to come"? I guess they don't know that as induction rates have gone up, late stillbirths have gone down. (Charts here.)

And this whole long post doesn't even address the difference of CNMs vs CPMs and how US homebirth midwives are shockingly undereducated and unskilled compared to other countries.

Dragon Lady, I absolutely respect your ability to choose to have an out-of-hospital birth with your children, but I won't pretend I won't try to dissuade you from it.

Here are recent studies down on the safety of home birth:

- A new study by Cornell University just found 4x higher neonatal death rate at home birth, 2x higher death rate at birth centers than at hospitals: Term neonatal deaths resulting from home births: an increasing trend.
- CDC statistics released last January showed a 3.5x higher neonatal death rate at homebirth than at hospitals
- Oregon statistics from 2012 showed a 6-8x higher death rate at homebirth than at hospitals
- An analysis last year from the College of Public Health at University of Arizona found a 3x higher death rate at home birth than at hospitals
- A study last year found that home birth increases the risk of an Apgar score of 0 at five minutes by nearly 1000% - here and here
- Researchers from Weill Cornell Medical Center are presenting research next month in which they found that home birth increased the risk of anoxic (oxygen-derivation) brain injury by 18x

And then there are all the stories here: Hurt by Homebirth
And this one, about going post dates: She Was Still Born
Or this blog, of a woman who was abused by the midwives at Better Birth of Utah: Shame On Better Birth of Utah
Or this woman, who just did an excellent series of posts about what drew her into the natural birth movement and what turned her away: What Ifs & Fears are Welcome

Well, it's getting very, very late, and this is getting very, very long, so I'll wrap up and just say that I just don't want any more babies to die unnecessary deaths. We live in a time and in a place with excellent medical care, and it is tragic that any babies die preventable deaths due to the misinformation and fear spread by the leaders of the natural birth movement.

[Portia]

This was awesome. I always suspected there was something to the propaganda that "it doesn't have to he painful!" The fact that it's related to the Boer War, of all thing, is fascinating.

[thatonemom]

Welcome to the mommy wars, Whistler. It's a lot of good intentioned, research savvy women with very different opinions. And it's not over until someone gets hurt.

I say this with love to everyone involved, but do we really have a responsibility to try to educate other people (especially people we don't know or have a relationship with) about their choices? Or advocate for specific choices? Whether it's breastfeeding or different labor options or working outside the home? Can't we just give each other the space to make our own choices, even when we think certain choices are not the best?

[bobtheenchantedone]

I'm actually following this thread with quite a bit of interest. I can see the good points of both sides, and am I happy to read through any opinions - it's saving me a lot of research and time. Especially because I am far too easily swayed by whoever happens to be talking at the time. To have opposing viewpoints immediately following each other is helping me be more open-minded to all aspects of this issue.

I wouldn't say that they have a responsibility to speak up, thatonemom, but they do have a right to express their opinions (that's what the Reader Response forum is for) and at least one person here is interested in what they both have to say.

[thatonemom]

Thanks for your perspective, bob. I'm sorry if I made anyone feel like they couldn't or shouldn't share their information or opinions. I've seen conversations on these types of topics get dicey before, and end up with people feeling judged or attacked for their choices. That's the kind of thing I'd hoped to avoid.

[Genuine Article]

I'm also curious, in a conversation like this, what word would you use to get across the point I was trying to make?

Hysterical? Also, I am so glad I had a c-section. No labor for me!

[SmurfBlueSnuggie]

Thank you GA. I kept seeing lots and lots of things saying c-sections aren't good. And while I'm nowhere near having a baby, I've managed to minimize my worries by thinking "Well, I can always have them do a c-section if I don't handle labor well." I've had lots of surgeries. That worries me far less. And therefore calms me down about labor too. Because, hey! there's a way out!

This may be a terrible view. But you know, it helps me not freak out for no reason.

[Marduk]

And it seems like freaking out about labor is a contributing factor to making labor difficult.

[bobtheenchantedone]

So true. Which is why, if I got pregnant now, I would be screwed.

[Marduk]

So true. Which is why, if I got pregnant now, I would be screwed.

Bad pun is bad.

[bobtheenchantedone]

It wasn't intentional. I couldn't think of a better word!

[Portia]

So true. Which is why, if I got pregnant now, I would be screwed.

Bad pun is bad.

Order, children, order. Screw first, THEN babies. Sheesh.

[NerdGirl]

They teach us in med school that lying on your back is basically the worst position to labor in. That's why labor and delivery beds fold up and come apart so that you can get into more of a sitting or a squatting position, and they have a grab bar that comes up so that the woman can sit forward and hold onto it, and there are birth balls and stuff available too. Once I got lost on the labor and delivery ward and ended up in the room with all the birth balls and I felt like I had wandered into a giant Chuck-E-Cheese ball pit. It was pretty awesome. I haven't done my final labor and deliver rotation yet (starts in a couple of weeks, actually), but in the births I've seen, there has been a lot of encouraging women to get up and move around and to be in a different position than lying on their backs - ANY position, even just being on one side or the other for a while. Obviously some women prefer to just lie on their backs, and that's totally their choice and is especially understandable if they've had an epidural (I've only seen one vaginal birth with an epidural so far, though) or if they are really tired. But I think if I ever get to give birth (which I probably won't because of the scary drugs I have to take to keep my body from destroying itself), I would be all over the turning the bed into a chair and holding onto the grab bar, which makes it so that you're basically squatting, which is probably the best position to labor in, but you don't actually have to get out of bed to do it. And the births I've seen in that position seem to go quicker once the baby is actually coming out and have less tearing.