
Natural Birth

Ideally childbirth should be one of life's most precious moments; a time
when instincts can take their course, when intense bonding with the
newborn occurs, or so we think. The reality for most women is rather
different: birth has become a medical event in need of effective
management by the professionals of obstetrics. Women are made to lie
passively on a table - the physiologically most difficult position in
which to give
 birth - whilst the experts decide which medical inter-ventions are
needed. These can include every-thing from sed-atives, intra-venous drips
delivering syn-thetic hormones, epidurals and other anaes-thetics, right
up to caesareans. According to childbirth expert Sheila Kitzinger the
'active manage-ment' of hi-tech births means taking drugs which will
tranquillise, stupefy, disorient, cause hallucinations, produce amnesia,
change the woman's body chemistry, and also deprive the the foetus of
oxygen, turning the newborn baby into a limp, sleepy little bundle with a
headache, instead of a wide-eyed, searching, learning creature. This
leads to a 'snowball effect': interfering in one way makes it necessary=
 to
interfere in others too; an epidural anaesthetic, for instance, makes it
likely that forceps will have to be used in the delivery. In U.S.
hospitals this has meant that up to
 65% of mothers face the trauma of forceps delivery and risk the injury to
the baby which it occasionally results in. The typical delivery room in a
modern hospital is full of bright lights as well as the noise and bustle
of the obstetrician and a team of assistants. Electronic monitoring
machines and hospital antiseptic add to the oppressive atmosphere - little
wonder t hat many women find hospital birth depressing. Obstetricians have
by and large excluded mothers from their central role in childbirth, and
at the same time drained the experience of its sexuality. All this is done
in the misplaced hope that it will achiev e a painless effortless managed
birth, at a convenient time; fitted in with the obstetrician's game of
golf according to many critics!=20

The Birth of Obstetrics Historical studies tell a different story:
vertical positions for giving birth have been prevalent across the globe
for thousands of years. Aristotle was the first known advocate of a
recumbent - and passive - position. It was much later in 17th century
France where male doctors first assumed the midwives' role and required
their aristocratic women clients to lie on their backs so that the
recently-invented forceps could be used more easily. The fate of women was
sealed when Louis XIV had his mistress en dure this position so that he
could see the birth better from his hiding place behind a curtain on the
other side of the room. Later Queen Victoria was the first woman in
England to use a chloroform anaesthetic - which further en-trenched the
lying down p osition in defiance of the force of gravity. The practices of
confining a woman to bed for much of her labour and then the rise of the
obstetric table for deliveries soon followed and spread throughout the
Western world.  Looking at the current situation in her latest book, "The
American Way of Birth", Jessica Mitford found that a powerful alliance of
medical societies, including the American Medical Association (A.M.A.),
and insurers had succeeded in making midwives into outlaws in many U.S.
states. She has even come across recent examples of midwives being
arrested at gunpoint and taken away handcuffed! The hospital births
favoured by the A.M.A. cost a minimum of ten times as much as home birth
with a midwife and can ea sily add up to far more.=20

Alternatives

The trend has not all been one way: since 1962 the in-hospital maternity
unit at Pithiviers in France has been a notable centre of experimentation.
As he gradually gained the courage to return control over childbirth to
women, its chief obstetrician Miche l Odent found that women themselves
would instinctively choose the upright position for birth, and would also
choose to move around during labour. The delivery room there was small and
quiet with subdued lights. Machines and drugs were kept only for the few
real emergencies and forceps banished. The midwife, and the husband too,
were able to play a greater role - such as in helping to support the mo
ther in the squatting position which is commonly chosen for birth.  Odent
began to realise, against the common wisdom, that women during childbirth
act most 'rationally' when they 'forget' themselves and follow their
instincts - deliveries became faster and easier. Both he and Sheila
Kitzinger agree that The right enviro nment for birth is exactly the sam=
e
as the environment in which to make love. Most labours should be
uncomplicated and do not need special equipment. They need not be seen as
a kind of illness needing treatment in an intensive care setting. As the
Pithiviers staff became more sure in trusting women's own instincts they
broke more and more of the accepted conventions of obstetrics: they
stopped wearing rubber gloves, they stopped speeding up delivery by
breaking waters which surround the unbo rn, they stopped prescribing
bedrest for the mother during pregnancy and after, and they allowed the
newborn to be with the mother from the moment of birth. Odent brought in a
warm pool where women could relax during the painful contractions of
labour and, to everyone's surprise, found that many seemed to develop an
affinity with the water and some would remain immersed to give birth,
which is perfectly safe.=20
 Some women who had previously claimed to dislike water even moved over
into the pool to give birth. As far as the clinical results are concerned
(mortality rates etc.), those at Pithiviers compare favourably with the
best in the world. The caesarean rate of 6-7% is far better than the 25%
in the U.S. ( a 400% increase in 20 years); postpartum depression
 is also rare at Pithiviers. Those who come to Pithiviers to give birth
live mostly in the surrounding area and are not pre-screened in order to
avoid difficulties. Others who come from further afield - even from other
countries - have often had difficul t births or caesareans beforehand and
come in order to secure the best chance of having a rewarding vaginal
birth.  Hammersmith hospital recently claimed credit for discovering that
close contact with both parents may be the best thing for a premature
baby, rather than an incubator. Instead of crossing the Channel to reach
Pithiviers, where this had long been common kn owledge, a research project
was carried out in Colombia to make these findings!  Wishing for a similar
return of control over birth to the mothers, the 'Active Birth Movement=
'
was founded in Britain in April 1982 after one London hospital which had
initially encouraged upright positions changed its mind and banned them. A
small Birth rights Rally, planned as a 'squat-in' of the hospital=
 foyer,
ended up as a rally of 6000 on Hampstead Heath; speakers including
Kitzinger and Odent helped reverse the decision. Odent has long questioned
his own role as a male obstetrician: The revolution so many of us are
seeking, he writes, will not be triggered by the professionals of
obstetrics, or even by the medical profession overall. He has since left
Pithiviers and n ow works in London with mothers giving birth at home
which he currently believes is the only place... where a woman has the
degree of privacy needed to allow maximal efficiency of the physiological
and hormonal responses. The strikingly good results at Pithiviers have
led to other maternity units being established along similar lines around
the world and other hospitals too have gradually been adjusting to women'=
s
demands to choose whatever position they find most comfortable throughout
labour and deliv ery: to change from passive patients to active
birth-givers.=20


Adapted from: Birth Reborn - What Birth Can and Should Be, Michel Odent
(London: Souvenir Press, 1984); New Active Birth: A Concise Guide to
Natural Childbirth by Janet Balaskas (Thorsons, 1991) who is co-founder of
The International Active Birth Centre, 55 Dartmouth Park Road, London, NW
5 1SL Tel.  071 267 5368; also relevant: The Continuum Concept, Jean
Liedlof (Arkana, 2nd. ed, 1987); The American Way of Birth, Jessica
Mitford, (Gollancz, 1992)


