Born free
Home » Blog » Sarah Heeringa » Born freeThe recent Good article 'Eco mamas and papas' included a segment called 'Born Free' which considered some of the issues around birth in New Zealand. The item prompted the following conversation.
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A letter from a reader ...
I felt the need to write a short response to the article “Born Free” (Good #09). The article briefly talks about choosing the right location to give birth, and encourages women to pursue the ‘process of a natural birth’ by choosing to deliver at home or at a birth centre to avoid the use of “medicalised birth technology”.
The UK study that I think is being quoted (Symon et al, British Medical Journal 2009) shows that choosing an independent midwife and delivering outside of hospital will mean that you’re less likely to use medications for pain, need assistance with the delivery, or have difficulty breast feeding. But the same study also showed that delivering outside of hospital with an independent midwife is associated with double the risk of giving birth to a stillborn baby or having an infant death within the first 7 days of life.
It’s easy to forget that although birth is a natural process, it still is a relatively risky time for the mother and baby. In the UK, even in low-risk pregnancies, the risk of having a stillborn baby or infant death in the first 7 days of life is about 5 in every 1000 births. (I tried to find comparable NZ data for this and haven’t been able to, but it is probably about the same.)
Nobody wants medical intervention in labour. But in the last thirty years, our rates of neonatal death have fallen dramatically (by almost up to 50% in the US), and for this we have to pay tribute to the improvements in obstetric management and premature baby medical care.
"If you are attracted to the idea of giving birth outside of hospital, that’s okay. But you need to ask yourself: how would I get to a doctor fast if something went wrong?"
If you are attracted to the idea of giving birth outside of hospital, that’s okay. But you need to ask yourself: how would I get to a doctor fast if something went wrong? Even normal pregnancies sometimes go wrong and the healthiest of mothers and babies can find themselves in situations where they need medical assistance quickly.
So let’s not get too fixated on the idea of just having a natural birth. The environment in which we give birth is something that we like to control, but we must put safety first. At the end of the day, what we all want to see is a healthy baby and healthy Mum, even if it doesn’t always go according to plan! —Dr Jin Teoh
My response
Thanks for your letter and your feedback about Good magazine. I am glad to hear you enjoy aspects of the magazine. Thanks also for your response to the 'Eco baby' feature. I agree with many of your comments—the ultimate outcome everyone wants is a healthy mother and baby, over and above any hopes for a positive birth experience. I also appreciate that that the topic of birth is huge and fraught with politics and emotion. Quoting fragments of studies and statistics can also be problematic. My feature was not intended as the last word on the subject but was an attempt to get readers thinking about the way we give birth and feed our babies in terms of 'eco' concerns, when perhaps this hasn't been considered before.
In my case, I was attracted to the idea of giving birth outside of hospital, in part due to the excellent (and rapid) birth histories of my mother, grandmothers and two older sisters. My husband and I had a plan for getting to a hospital fast if something went wrong and living in the inner city made this feasible. We chose our midwife carefully, ensuring she had a current practicing certificate, an access agreement with our city hospital and a clear understanding that our primary goal was not necessarily a home birth, but a healthy baby. We weren’t out to make a political statement and we didn’t have an attitude of home or be damned.
I agree that, even with normal pregnancies, births sometimes go wrong and the healthiest of mothers and babies can find themselves in situations where they need medical assistance quickly. But a well trained and experienced midwife is able to pick up any deviations from the normal early and take the appropriate action to proceed to hospital.
"You say that the environment in which we give birth is something that we like to control but that we must put safety first. My experience of birth suggests that it is the subtle cues of our environment that can control us and not the other way around."
You say that the environment in which we give birth is something that we like to control but that we must put safety first. My experience of birth suggests that it is the subtle cues of our environment that can control us and not the other way around. Here’s an example. During my fourth labour, and having regular contractions, I made the planned trip to a birthing unit. The labour immediately stopped. I was advised to go home, where it promptly started up again—resulting in an unplanned home birth 15 minutes later.
You say that no-one wants medical intervention, but injections of pethidine and epidural anaesthetics are now routine modern medical interventions, expected by many labouring women. And our high cesarean rate is due to some degree by 'maternal request'. (Not to mention scans and blood tests, induction, labour augmentation with syntocinon and electronic fetal monitoring during labour.) The reality is, in the case of most births today medical intervention, not natural labour, is the norm.
It seems to that the ‘safety first’ approach is contributing to the ever increasing medicalisation of birth and this is contributing to the increasing cesarean rate. Birth by cesarean is sometimes a necessity, but it’s not without its risks, medically, emotionally and in terms of bonding and the successful establishment of breastfeeding.
It seems to me that safety first is not the only consideration when approaching birth—psychological, cultural, emotional and, to a lesser extent, eco-issues matter as well. My aim in writing the article was to highlight this particular aspect for consideration and to remind people that a natural birth, including home births, and breast-feeding are still viable (and not necessarily unsafe) options as well as being better for the environment. —Sarah Heeringa
And a futher comment
I really appreciated your reply and the fuller picture of your thinking and understanding of this topic. This reply was sensitively written. You are right. In modern-day medicine, eco-concerns seem to receive very little attention and I'm glad you and your team are shedding light on this. I am liking the balance that is achieved in your response. It's a real relief for me, as a medical practitioner, to read "we didn't have an attitude of home or be damned" as a concept being elucidated publicly. Every so often, I have dealt face to face with families who have been very stern, very inflexible, with their wishes for an all natural process and it's led to some tough conversations for both sides! So I'm very glad that your reply is more detailed, as I think it's exhibits a good approach.
I look forward to the reading the next edition! —Dr Jin Teoh
Thu February 11, 2010 @ 06:27 PM
