Saturday, October 07, 2006

Last year, when I was pregnant, one question I was frequently asked by friends, colleagues, and even strangers was, "Are you going to have a natural birth?".

I could tell that some of them were just asking in a roundabout way, "are you going to have an epidural?". Depending on my mood, I would give one of two answers: "I will try to hold out from an epidural as long as possible" and "I will give up pain-free pregnancy right after I give up pain-free dentistry." The others were really asking, "Are you going to have a midwife and give birth at home?" To which I would answer, "I feel more comfortable giving birth at the hospital."

The real question behind the question was this "How committed are you to having birth with as little medical intervention as possible?"

There are many people feel that the act of "naturally" giving birth is under seige from the medical profession who unduly pressure women to induce their pregnancies, have epidurals, and have C-sections.

Most of my friends with kids had C-sections.

I had a C-section. Here's the abbreviated birth story:

- my water broke before the contractions were noticeable
- I knew that would only be given a short window of time for a 'natural' birth to kick in because my 'broken water' carried a significant risk of infection. So I took up the offer to be induced
- I was offerred an epidural before the contractions really kicked so I could get some sleep. I chose the epidural. I went to sleep.
- The contractions did pick up but the baby's heart beat was showing distress with each contraction. Rather than have the baby's heart rate rise and fall for possibly several hours, I was offered a C-section and I accepted it
- My new boy emerged healthy. I had a pain free pregnany and I recovered quickly.

I was not coerced or pressued into any of these decisions (although some nurses did praise me for making 'the right choice' after I had done so). Was I duped? Why was my birth just another number added to the growing amount of C-section births in Canada, the US, and beyond?

I never had a good answer to these questions, that is, until now. I have finally found an article in the latest New Yorker that gives the best response I've found to this brave new world of childbirth: The Score: How childbirth went industrial by Atul Gawande. Its brilliant.


Lisa said...

i couldn't help myself... had to read this. i thought it was interesting also (and not too scary) and relates to something i heard recently about midwifery. when the midwives were licensed in ontario, they had to agree to conform to some of this standardization of care. for instance, the rule in ontario hospitals is that pregnancy will not go longer than 42 weeks, and so the mother gets induced around 41/42 weeks if nothing is happening. (40 being the norm) This rule is obviously because the baby is getting bigger and bigger, making birth harder and more dangerous with each day. however, the midwives didn't have such a rule, (nor of course the ability to prescribe the medication for the induction). they favoured natural remedies and lots of walking, sex, etc to induce labour -- and would be more likely to wait til baby's ready to make an appearance. they thought that forcing things to happen is not necessarily the best thing for either mom or baby in all cases. they would have (in the olden days) paid more attention to the unique aspects of the particular case, before resorting to more extreme measures to induce birth. and they might have sometimes waited 43 weeks or longer. with the licensing though, they had to agree to the 42 week standard rule, thus sacrificing particularity for the reliability of standardization. something lost and something gained -- just like the article suggests. i think after reading it that i'm going to start visualizing my hopefully all natural birth process (at 40 weeks) as the production of a fine artisanal cheese.

Anonymous said...

Hey Mita,
Thanks for pointing me to this. It was excellent. When I was pregnant and reading about the APGAR score I always thought, "well, duh, isn't that obvious." I guess it wasn't and I had no idea just how revolutionary a clinical practice it turned out to be. The explanation for the prevalence of C-sections was equally intriguing.

BTW, did you see the "Life of Birth" obstetrical chronology in the October Walrus. It's not as expansive as this article but it was interesting nonetheless.

Oh and one more thing: do you remember meeting me a couple of years ago? And a couple of years before that? I remember you. Lisa mentioned to me that she passed on my blog url to you. Just thought I would complete that link of personal connection. Congratulations on your son. How old is he now?

Mita said...

Hey Mad Hatter!

'course I remember you! (and your kind hospitality when I tagged along with Lisa when I was last out your way).

Didn't see the Walrus article. Is it worth tracking down?

Yeah, that Lisa girl hooked me up with your blog some time ago - and its a beautiful thing. And speaking of beautiful things, my little guy is just over 13 months now. Wow.

Glad you dropped a line. Will try to break out of my lurker mode more often.

Anonymous said...

I found the Walrus article informative if perhaps not earth-shattering. It's still pretty new so it should be in your current periodical room.