The United States as a nation had long moved away from the home as the place where childbirth took place by the 1970s. From the time of the 1930s through the 1960s, US women were told little about how their babies were brought into the world, nor were they prepared for the experience. No longer was there a rich tradition of experienced women supporting women through birth, and in many cases the experience of birth itself was not discussed amongst family and friends. During this period women were put under various kinds of general anesthesia and often gave birth unconscious, making it necessary for doctors to use instruments like forceps to pull a baby through the birth canal. Birth injuries to both the mother and baby were more common because of this practice. Also, being unconscious, women were not able to assume the traditional upright birthing positions that allowed gravity to help bring the baby down the birth canal and into the world.
The following video is a depiction of this period in the history of US birthing practices. There are images of the full view of women birthing.
During this period in southeastern Kentucky, Mary Breckinridge was bringing the nurse midwifery model to the mountains through the Frontier Nursing Service. This was the type of care that Breckinridge had seen working well in European countries, as discussed at the end of the preceding video. It brought the best of both worlds – an understanding of the medical side of birthing, while leaving the work of birth to the mother in the place where she was most comfortable. The role of the health practitioner was to remain vigilant, and to keep things safe. Eastern Kentuckians were fortunate during this time in birth history to have caring women such as Breckinridge advocating for mothers worldwide while basing herself in the area.
When eastern Kentucky did catch up to the rest of the nation in the latter part of the sixties and the whole of the seventies, birthing in hospitals with male attendants (for the most part), as described previously, had drawn some resistance from women who began requesting that they be allowed to be conscious during their birth and to have their husbands or family with them in the room. Childbirth education became available to women, and more began having natural childbirth in the hospitals.
However, having doctors trained in obstetric practices attending the majority of births in the country brought with it an increase in medical interventions for normal birth. Obstetricians are instructed in methods to handle emergency and/or difficult situations, which for many women and babies is lifesaving. Their expertise is a blessing and a needed thing for women the world over. Yet, when the obstetric model of care is applied to a normal birthing situation we often see it leading to complications that otherwise would not have been present in that mother’s/baby’s case.
For example, induction of labor is a practice that has risen dramatically and is commonplace currently. In the past, mother’s were given a birth month instead of a due date. Today, women are closely monitored and will often be induced for convenience of the doctor and/or mother, for common pregnancy discomforts, being a few days past the due date, or fear that baby is growing large. These are not reasons for induction according to the American Congress of Obstetricians and Gynecologists, the board who sets the standards for safe and effective obstetric care in the United States. For what ever reason, many practitioners across the country are choosing to ignore such guidelines despite the consequences of using techniques meant for a medical situation when there is none present. The Mayo Clinic states, “By definition, induction promotes delivery before your body is ready for labor — which may lead to poor labor progress and the need for a C-section.” For more information on this topic, read this article by Henci Goer.
Induction is not the only medical procedure that has become common and elective in the United States. C-section rates are on the rise, and well above the recommended average by the World Health Organization. (The United States c-section rate is 31.8%. The WHO recommends a safe range as being 10-15%.) Kentucky has the 7th highest c-section rate in the United States with 34.6%. This means that there are c-sections being performed in our state and across the nation that are not necessary, needlessly posing a higher risk to the mothers and babies who give birth through this major abdominal surgery. Again, you can look to the ACOG guidelines to see the standards/reasoning your obstetrician should use when determining whether a c-section is necessary for you. Also, vaginal birth after a cesarean should be offered as an option to women who fit within the safety criteria as studies show vaginal birth poses less risks to mother and baby than repeat cesarean surgery.
With the breakdown in support from woman to woman, moving normal birth into the medical arena, and the influence of media perpetuated myths surrounding birth, many women relinquish their input into their birthing experience, and opt to choose a practitioner and follow all of their recommendations, no questions asked. Why? Birth has become somewhat mysterious, instead of a normal part of the womanly existence. We have lost trust in our bodies to be able to do the work it was designed to do. We fear childbirth. Are their instances when modern medicine is needed in childbirth? Of course, and we should be thankful for it. Is natural childbirth practical for everyone? No, there are cases where it is known beforehand that medical intervention is needed to maintain safety for mother and baby. Sometimes, difficult births need medical intervention and pain relief for mothers. However, natural childbirth is an option for every low risk healthy mother who prepares herself and her body, and is supported by those around her. It doesn’t take tremendous pain tolerance, just faith in the process and support of your practitioner and those you choose to support you. More important though than simply choosing natural birth, is understanding the risks and benefits of common medical procedures before you choose them, or they become necessary for your birth. This is why childbirth education is a great thing for all women no matter how they choose/need to give birth. Childbirth education isn’t just for those preparing for natural childbirth.
To ensure that you have chosen a practitioner that is aware of ACOG guidelines, and will respect your preferences, it is crucial to ask questions, and to inform yourself of the risks and benefits of medical interventions before accepting one for your birth. Having a dialogue with the practitioner you have chosen is important. Making sure you fully understand why they are recommending certain procedures is a must. Your practitioner should be more than happy to discuss your options with you and to help you understand their approach to your situation. If they are not, it isn’t unreasonable to change practitioners.
In the next entry, I will write about where childbirth is going for the future. What is happening now that could change for better or worse the way we give birth.
To see how our Kentucky hospitals stack up statistically for c-section and VBAC rates visit the Inpatient Quality Indicator page for the state of Kentucky. You can search the hospitals in your county and compare them to the national and state statistics. When choosing a practitioner delivering in that hospital, keep in mind whether the stats for that facility were lower, higher, or comparable to the national/state averages. Ask yourself why, and don’t be afraid to ask your practitioner. You should also ask for any other stats your practitioner may keep on their performance of any other procedures which concern you.
If you would like more information, or help looking at the stats, feel free to email firstname.lastname@example.org.
Many happy days to you and yours,