Conscious Birthing and Bonding

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From as far back as history records, a woman birthing a child was supported in the process by a coterie of other women, including a midwife, supportive doulas, and close family. Birth was a natural process that generally occurred at home or in a women-run birthing center.

The conventional medical perception is that birth is a “dangerous” process, in which both the mother’s and child’s lives are at risk. The fact is that only ~3% of births are associated with pregnancy complications, most common of which are breech babies. In normal deliveries the baby’s head comes out first, in a breech situation, the baby is turned around and is delivered with the baby’s buttocks, feet, or both are positioned to come out first. About 2/3 of breech births can be safely handled by a midwife. However, a small number of such births absolutely require medical attention. The question now, is why are so many uncomplicated, normal births in a hospital?

The main shift to birthing in hospitals occurred between 1910 and 1920, when the US medical school curriculum began to define birth as a “pathology-oriented medical model” … this set the stage for doctors to take over the traditional role of the midwives.

The 1910 Flexner Report unified the field of healthcare by creating a standardized medical curriculum that was to be adopted by all medical schools. The report concluded that America’s first obstetricians were poorly trained and recommended hospitalization for all deliveries. This move specifically led to the gradual abolition of midwifery in the States.

In 1914, “twilight sleep” was introduced in the birthing practice with a combination of pain-relieving morphine and scopolamine, an amnesiac that caused women to have no memories of giving birth. At the time, upper-class women initially welcomed twilight sleep as an expression of medical progress.

Perhaps the most important shift to hospital births occurred in 1915 with the work of Dr. Joseph DeLee, author of the most important obstetric textbook of that time. DeLee defined childbirth as a “pathologic process that damages both mothers and babies, often and much.” He emphasized that birth was properly viewed as a destructive pathology rather than as a normal function. His article in the first issue of the American Journal of Obstetrics and Gynecology, proposed a sequence of interventions designed to save women from the “evils natural to labor.” These interventions included routine use of sedatives, ether, episiotomies, and forceps, all of which are now found to be harmful when routinely used.

DeLee changed the medical focus of birthing from responding to problems to preventing potential problems through routine use of interventions during labor. Consequently, medical interventions were no longer just for the relatively small number of women with diagnosed problems, but instead, these interventions are used for every woman in labor. How’s this working out?

Both the Journal of the American Medical Association (JAMA) and the British Medical Journal (BMJ) recognize that medical practice in the United States is the 3rd leading cause of death via iatrogenic illness (illness caused by medical examination or treatment). With all our vastly expensive medical expertise, the U.S. is the only industrialized nation in the world where maternal mortality is rising, and currently has nearly the highest maternal mortality rate among high-income countries. A significant contributor to these statistics is the rising number of Cesarean sections, a major surgery that is over prescribed, and quite frequently not even necessary.

An even more dismal statistic is that the U.S. has nearly the highest infant mortality rate among high-income countries. The United States ranks No. 33 out of 37 in the Organization for Economic Cooperation and Development (OECD), a unique forum comprised of the governments of 37 democracies.

Not wanting to “throw the baby out with the bath water,” I should emphasize that doctors do play a significant and vital role in in many pregnancy complications and should be available in the rare cases where such complications arise. But for most births, medical interventions are not needed, and when employed may be more of a problem than a benefit.

Lastly, birthing in hospitals was also promoted for a generally unmentioned reason: Before births were in hospitals, they were “dark” places filled with the sick and dying. However, when births became part of the hospital’s practice, the energy and vitality of birth changed the perception of the hospital as a welcoming place representing “life.”

As a biologist, I must conclude that when it comes to birth, this is a life function wherein women should be primarily engaged to support and empower women. Most importantly, the supportive role of the father or partner in the process is now recognized to be profoundly important in assuring a healthy, happy experience for all involved!

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