Thoughts on Birth

So....

Last Wednesday, David (my husband) and I went to see The Business of Being Born - a documentary about - what else? - the culture of birth-giving and care-taking in the United States.

The film re-stated quite a bit that I already knew from my own research, but that may not be commonly known facts (I just happen to be obsessed with the topic of birth, mothering, bodies, etc.) For example, did you know that:

• The United States has one of the worst infant mortality rates in the developed world? In fact, the rate of 6.37 deaths per 1000 live births puts the United States just below Cuba and South Korea. Thank goodness we've managed to beat Croatia and Belarus.
• The cost of a "routine" vaginal birth in the United States is about $8800. (This number, of course applies to the vaginal births - a Cesarean costs somewhere around $11,000. Hope y'all have insurance to cover that.)
• About 99% of women give birth in hospitals. Most of the 1% non-hospital births take place in a birthing center. Very few births actually happen in the home. After all, most births are attended by an OB, who cannot possibly be expected to make house calls. (By the way, the rate of births that have taken place in the hospital has not changed in over ten years, though the "rise of midwifery" has been predicted since the 1980s.)
• The position in which most women in the US give birth (supine - woman lies flat on her back with legs up in the air. Again, very convenient for the OB) is actually one of the least helpful positions for a woman in labor, and in fact may be harmful both to her and to the baby she is trying to push out...against gravity.
• Despite the current trend of elective Cesarean sections, C-sections are actually major abdominal surgery, and they currently make up about a third of the births in the United States.
  

And now, for things I learned from this film:

• Remember those 99% of American women who give birth in hospitals? It turns out most of them end up with some type of medical intervention, whether they had originally planned it that way or not. (We're talking everything from epidural to emergency C-section.) Abby Epstein (the director of the film) interviewed several MDs in the film who confessed had never (NEVER!) witnessed a completely natural birth (that is, free from all medical intervention, including pitocin or epidural. Also, hardly surprising, most OBs have never been part of a home birth.)
• Hospitals, being businesses, have a keen interest in moving beds (kind of the way restaurants move tables). This puts an artificial time-table on how long labor should last. (About 12 hours for first-time mothers; 7 or so hours for childbirth veterans.)
• With this artificial time-frame, the doc might feel some pressure to induce labor (or progress labor) using pitocin (synthetic form of the hormone oxytocin, which causes contractions). The problem with pitocin is that it is delivered intravenously, meaning that it is delivered into the system at a steady rate. Oxytocin, on the other hand, is delivered by the body in bursts. What does this mean? When oxytocin is causing contractions, there are naturally periods of intense contractions (when the burst of oxytocin is delivered) and then there is a rest. Furthermore, a natural (non-medicated) contraction is "shaped" kind of like a hill - gradually more intense with a peak and then a decline. With pitocin, because it is delivered through an IV pump, the contractions are fairly steady, more intense, closer together, and shaped kind of like a plateau. Therefore, labor induced by pitocin is a good deal more painful than natural labor - making it significantly more likely that mother will need an epidural (which will prevent her from walking around and moving, and will consequently slow down labor).
• Another problem with pitocin is that, due to the nature of the contractions (long and intense), the baby is likely to suffer from such factors as lack of oxygen, since the strong and close-together contractions are likely to cut of blood supply to the uterus.
• Of course, once the baby starts to crave oxygen, it will begin to feel a little uncomfortable (as if labor is all that comfortable for the baby anyway) and will very likely go into 'distress' (the convenient catch-all term for when baby's heart rate is higher or lower than the OB likes it to be.) When this happens, guess what? Emergency Cesarean section.
  
• Phew! It's a good thing we have those doctors to save all those women and babies. What would we do without them?

So that's what I learned. On a side note, the film itself was very well-done, and it featured I think four births, one of which was Ricki Lake's home birth (baby delivered at home in the bathtub.) It was remarkably intense, but also very touching in a "whoa, I just saw four women give birth" kind of way.

There is so much more to say about the film and all the thoughts that have been provoked since seeing it, but I will keep myself to just two, though many themes will return, I'm sure. 1.) There is a trend in our current culture that treats pregnancy like a disease. I think that is a mistake that results in the kind of gross hospitalized care that I've spent the last several minutes discussing. (Another result of pregnancy-as-disease mentality is that it becomes optional to endure it... we have a 'cure' for pregnancy. It's called abortion.) 2.) I don't trust hospitals.