Childbirth Nazis?

So, the Oregonian recently had an article about how Oregon has rates of natural childbirth that are double the national average (about 20% attended by midwives, vs. about 10% nationally, and about 2% in birthing centers vs. about 1% nationally), and that many women here feel judged for their childbirth choices if they are not able to live up to the ideal of a completely natural birth. It probably won't surprise you that I had a pretty strong reaction to this article.

First, I don't think it's very good journalism. Like the "opt out" series of articles from a couple of years ago (about Ivy-League-educated mothers who chose to stay at home with their children), it seems overly colored by the author's own experience. Just as the "opt out" group of women were overwhelmingly white and wealthy, and a tiny minority of all mothers, the women who have angst over their birthing choices are also overwhelmingly white and educated, and urban. The article mentions the national rates of delivery by Caesarian section (up to almost 30% of all deliveries, with almost a 50% increase in the last 10 years), but doesn't reveal the rates in Oregon. Even if it is significantly lower than the national rate, I feel fairly certain that it is still greater than the rate of natural childbirth. The vast majority of birthing women are perfectly happy to go along with whatever their doctor suggests, and generally don't have misgivings about those choices unless something goes wrong.

The author also doesn't look at the underlying statistics. She mentions the increasing national rate of Caesarian sections, but doesn't compare it to the rate in Oregon or in other developed countries (Canada's rates of Caesarian sections and infant mortality are both lower than in the US), nor does she look into the possible reasons for the increase (higher malpractice insurance rates, larger numbers of multiples, women seeking to avoid pain and exercise greater control over the process, I think all play a role), or whether it is a good or bad thing. There are also statistics (somewhere . . . ) about the effects of various childbirth interventions (epidural or other anesthesia, episiotomy, hormonal induction or augmentation of labor, etc.) on fetal and maternal outcomes, but she doesn't mention these at all. It seems she's so concerned about women passing judgment on each other that she's unwilling to entertain the possibility that they might be right.

So, here is where I tell you about my own experience on the matter. Both my boys were born in a hospital, attended by a midwife, and both arrived vaginally, full-term, and healthy. That's about the extent of the similarities. Number One was conceived in the course of regular marital relations, but when it came time to be born, he stubbornly had his face turned to the side (the baby's head has to be turned the right way in the mother's pelvis to be able to come out). So, progress was slow, and, desperate, exhausted and nauseated, I opted for epidural anesthesia. It offered relief from the pain, but lessened the strength and effectiveness of my contractions. So right away, one intervention led to another, as I was put on a Pitocin drip. Progress continued, albeit slowly, and my midwife eventually decided she should break my bag of waters to help things move along (yet another intervention). Of course, his head was still turned sideways, so he couldn't come out in any case. I pushed and pushed and pushed, to very little effect (other than to wear me out), until after 2.5 hours I threw up, he turned, and emerged with his arm wrapped around his neck (as if to give himself a pat on the back).



Good final outcome, but I felt like I had been not so much in control of the process. I resolved right away that for my next child, I would a) get a doula (I thought that with the right kind of support, I could have gone without the epidural, and the resultant other interventions), b) let myself throw up instead of fighting it so hard (since so much progress happened when I did). I later learned about Hypnobirthing®, and resolved to use its techniques in my next labor experience.

So, Number Two was a lot harder to come by. After trying lots of different, lesser interventions, we ended up conceiving him through in vitro fertilization. As his due date approached, I practiced with the Hypnobirthing materials I had borrowed from my sister-in-law. One evening a week before my due date, my water broke as we were moving Number One towards bed. I called my midwife, and she told me to call her back if I decided to go to the hospital. Water broke at 8, contractions started at 10, went to the hospital at 11:30. Called my sister-in-law (veteran of 4 natural childbirths, at the last two of which I served as labor support) to come to the hospital to support me in labor. Walked the halls for a while, sat on a birthing ball with my upper body resting on the bed, listening to the Hypnobirthing relaxation CD for a while (actually falling asleep between contractions once or twice), sat in the Jacuzzi tub for a while, as my contractions grew more intense. At about 4:30, my body started doing a weird pushing thing, completely out of my control. At my sil's suggestion, my midwife came into the bathroom, saw what was happening, and said, "Time to get out!" I got out, made my way to the bed, and Number Two was born at 4:47 after just a few minutes of pushing.



The birth experience with Number Two was better than with Number One, and not just because it was shorter. I felt calmer and more in control of the whole process, and fewer interventions meant a shorter recovery (as well as a more alert baby, who latched on right away, yada yada yada).

So, my own personal experience tells me that natural childbirth is better than childbirth with even relatively few medical interventions. I believe the statistics for maternal and fetal outcomes are also better. Given this, what can I do to encourage women to make this choice without coming across as being judgmental? What can I do to help them have confidence in their ability to do it on their own? How can I convince them that they shouldn't be afraid of the pain (which, after all, can't kill them) or of not being in (conscious) control of what is happening with their bodies? Am I limited to saying, "Try it, you'll like it"?