[from Monty Python’s The Meaning of Life. Transcript here.]
A couple of articles have been sitting in my Journalwatch pile for a goodly while now, so here they are.
“Effects of Pushing Techniques in Birth on Mother and Fetus: A Randomized Study”
Gulay Yildirim, PhD, Nezihe Kizilkaya Beji, MD
Birth, 35(1), pp 25-30, March 2008.
This Turkish study randomised a group of term low-risk first-time mothers into two pushing groups.
The first was coaching on conventional Valsalva-type pushing, which is routine in labour management in many countries. It was accepted as standard in Turkey before this study. If you’re unfamiliar with birth, this is the technique you see in the vast majority of American movies and sitcoms: “PUUSH! PUUUUUUUUSH! PUUUUUUUUUSH!!!!!!”. The woman is instructed to close her glottis and hold her breath while pushing. Typically this occurs when the woman’s cervix is determined to be “ten cm” dilated, sometimes without waiting for the spontaneous urge to push to become overwhelming.
The second group of women was supported in spontaneous open-glottis pushing.
The results:
* In this study, there was no significant difference in episiotomy, tearing, or haemorrhage (other studies have shown increases in perineal damage and pain with Valsalva pushing: 1, 2).
* The duration of second stage was longer with Valsalva pushing.
* The babies did worse with Valsalva pushing, with lower 1- and 5-minute Apgar scores, lower umbilical cord pH, and lower oxygen levels.
* Women were less satisfied with coached Valsalva pushing.
So women don’t like coached Valsalva pushing, it lengthens labour, and it may put babies at risk. Why are we still doing it?
~~~
Women’s Autonomy and Scheduled Cesarean Sections in Brazil: A Cautionary Tale
Joseph E. Potter, Kristine Hopkins, Anibal Faúndes, Ignez Perpétuo
Birth 35(1), pp 33-40, March 2008
This study looked at birth in Brazil, which has a private-sector Caesarian section rate of 70%. The authors interviewed over a thousand women, one-third private sector and two-thirds public sector, twice during their pregnancy and once a month after the birth, about their birthing wishes and about what eventuated.
Results:
* Over 70% of women in each group expressed a preference for vaginal birth, with the rate slightly higher in the public-sector group. However, the cesarean section rate was 72% in the private group and 31% in the public group.
* 64% of the private C sections were scheduled, compared to 24% of the public C sections.
* The incidence of medical reasons for a scheduled C section among private sector patients who had no previous cesarean birth and who wanted a vaginal delivery was 13 percent (31/243).
We already have a massive difference in Caesarean section rate between our private and public hospitals here in Australia. In WA in 2005, the C section rate was 46% in the private sector, and 28% in the public sector. Is this where we’re headed?
~~~
And lastly, this joyful birth video. I could watch it over and over. The woman is on her back, but it is said in comments that she chose the position freely (a few women do.) The smile on her face as she meets her baby is just gorgeous.
Posssibly NSFW, if birth is NSFW where you are, but there’s nothing unexpected or unpleasant about it.
Categories: ethics & philosophy, gender & feminism, health, medicine, violence
Hoyden About Town 
That was just beautiful.
That was utterly fantastic. That’s the best video I’ve seen in ages.
Wow. Was that drug assisted? All the other birth films I’ve seen have been terrifying, with women screaming their heads off and sucking down gas and air.
What a wonderful video! Deux Ex Machina, doesn’t look drug-assisted to me. She obviously didn’t have an epidural, she wasn’t sucking on gas. And narcotics tend to make women feel more out of control than otherwise (more screaming, not less) (and generally aren’t given to women in advanced labour anyway because of the effect on the baby). I think you’ve just been watching videos of typical medicalised births – try watching Ricki Lake’s documentary on home birth, there are heaps of really cool births in it.
“So women don’t like coached Valsalva pushing, it lengthens labour, and it may put babies at risk. Why are we still doing it?”
Because the womenz, their bodies are defective and can only getz the babies out by following the instructions of the menz. Clearly.
Sarcasm aside, the first time I saw a birth without any medical interference, I was so surprised to see how little pushing it actually takes to get a baby out if everything’s working as it should – there were a couple of grunts, a bit of bearing down, baby came out in two contractions – the head in one and the body in the next – after maybe three contractions of bearing down a little. Before that I thought there was full on pushing (holding breath, really, you know PUSHING) for ages – turns out, is just another lie told by the medical profession.
What Rebekka said, DEM – she’s not hooked up to drips and monitors and is moving actively (so no epidural), she’s engaged (so narcotics extremely unlikely), and there’s obviously no gas. Note also that the midwife is hands-off and the ?partner catches the baby, which makes me think it isn’t being obstetrically “managed” at all. Just a normal, healthy, happy, amazing birth.
If you don’t have access to The Business of Being Born, Youtube has heaps of undrugged birth videos.
Here’s a twin birth – bit hands-on with the breech twin for my liking (that’s the obstetric way of dealing with breech birth), but the first babe is completely hands-off.
[If you’re ever attending a breech birth, just repeat Rule One to yourself over and over and over again: Hands Off The Breech (except to stop it falling to the ground). Really. Sit on them if you have to. Just completely off, unless you happen to be trained in exactly what to do and you’re performing a specific emergency manoeuvre, in which case you’re obviously not going to be taking my advice. Any pulling or “help” will deflex the head and make it more difficult for the mother to birth the baby, not less.]
I’m planning a Friday Hoyden feature on Ina May Gaskin at some point…
Oh, that made me cry! I remember that amazing joyful feeling.
Although, Rebekka, that was the second one ; )
Is that guaranteed with the second Zoe?
My labour didn’t look or feel that joyful, but it was mine, the midwife kept her hands to herself and was supportive and encouraging, so it was pretty quick and we were both well when it finished. The boy did have suction though, because he was born in the caul. It’s his claim to fame.
Mine is that I was facing the wrong way and was too tired and ‘stuck’ to turn around and see him. The Bloke didn’t take any photos because I’d told him not to during the birth, and I was too tired to tell him this was a special circumstance and I’d changed my mind. So I still have no idea what a baby born in the caul looks like. Must go and google that…
You know, when I watch a birth scene, even if it’s only a cheesy pretend one in a movie, I can’t help bearing down! 🙂
(Good job I did all my pelvic floor exercises)
What an amazing birth video. That was truly what I wanted when I gave birth. I’m a little wistful (okay, and disappointed) that it didn’t happen that way.
I have a question. Okay, more than one. I did some looking through the blog archives to discover that lithotomy=bad (totally new concept to me; apparently, I have swallowed what Hollywood/crappy sex ed taught me) because the mother is helpless and not in control in that position. Are there any other reasons it’s not optimal? I mean, does it make the actual labor more difficult?
Also, what are the alternatives? I came up with squatting and hands/knees, but I have no idea if those are any better or why.
And that is an amazing video. I had no idea birth could look so…calm; she wasn’t screaming or yelling or having trouble breathing, and I don’t think I’ve ever seen birth portrayed without those things. Doesn’t the baby need to be cleaned off at all? Isn’t there still afterbirth?
“[If you’re ever attending a breech birth, just repeat Rule One to yourself over and over and over again: Hands Off The Breech (except to stop it falling to the ground). Really. Sit on them if you have to. Just completely off, unless you happen to be trained in exactly what to do and you’re performing a specific emergency manoeuvre, in which case you’re obviously not going to be taking my advice. Any pulling or “help” will deflex the head and make it more difficult for the mother to birth the baby, not less.]”
One thing you can do, should you find yourself unable to keep your hands to yourself, is wrap the baby’s body in something warm once it’s emerged – the cold air on the baby’s body can stimulate it to breathe before the head is born. But totally not pulling!
Quixotess you should watch homebirth and freebirth videos 😉 Women who move instinctively, undrugged, roaring, sighing or crying or laughing as they push their babies out. Hospital “birth” ain’t birth, it’s factory conveyor belt “delivery”.
Women left alone to birth will do whatever their body and baby need to push them out. It’s no big deal, it’s just another normal physiological function of the female body.
Babies aren’t dirty after birth so no, they don’t need ‘cleaning”. They’ve come out of a vagina, it’s normal, desirable and optimal.
Vernix serves many purposes of which we’re not yet able to chart all but we certainly do know that it provides a lot of help to babies in learning how to breastfeed. Undrugged, unhindered babies will crawl to the breast after birth (my baby did it 30 mins after she was born and I was still sitting upright in the pool she was born in, in my study) and the vernix helps them.
“Afterbirth” is the placenta. It comes out at some point after the baby is born (sometimes minutes, sometimes hours in a physiological experience) and while it’s still attached to the mother, it pulses and the baby receives oxygen and blood. Babies are meant to switch from foetal circulation to earthside circulation slowly, with the help of their previous life support system and the practice of ripping them off it immediately not only increases risks to the mother like postpartum haemmorage but means the baby can struggle to breathe and lose up to 50% of it’s blood supply. Hospitals are baaaaaaaad place to try birthing a baby.
Birth is just normal use of the body, it’s not a medical emergency. 🙂
http://www.joyousbirth.info/
Quixoitess:
“Are there any other reasons it’s not optimal? I mean, does it make the actual labor more difficult?”
Yes – a woman’s pelvis is around 30% bigger in an upright position, and lying down the pelvis is on an angle that means you’re actually pushing upwards, against gravity, rather than downwards with gravity if you’re upright, so it definitely makes the labour more difficult.
“Also, what are the alternatives? I came up with squatting and hands/knees, but I have no idea if those are any better or why.”
Left alone, women will instictively get into the optimal position for birth, which varies depending on the baby’s position among other things, but squatting or hands/knees are two positions women definitely choose.
And yes, there’s still afterbirth (placenta) – in hospital women are usually given an injection of oxytocin to speed up the delivery of the placenta, but in a physiological birth, the baby being put on the breast will generally stimulate more contractions and the placenta will put in an appearance within an hour after the baby.
This is a whole thread called the happy smiley birth photo thread 🙂 So lovely and normal!
http://joyousbirth.info/forums/showthread.php?t=13277
Enjoy!
With a couple of cites: routine lithotomy positioning increases perineal lacerations[1]; and slows second stage, increases instrumental deliveries, increases episiotomies, increases blood loss, increases pain, and increases the chance of abnormal fetal heart rate patterns [2].
The World Health Organisation started recommending against routine lithotomy position over twenty years ago, with the Forteleza Declaration (the rest of the Declaration is well worth a read.)
Note that the woman in this video is on her back, but is not in the true lithotomy position. And she is active, tilting her pelvis as she feels she needs to to improve positioning.
[1] ”Getting through birth in one piece: protecting the perineum.”
[2] ”Position for women during second stage of labour.”
Wow. Thank you all. I don’t plan on having children, ever, but it’s so shocking how little I know about this stuff. I almost feel as though *someone* must have been lying to me for me to be this misinformed, but maybe it was just Hollywood/Friends.
Birth is just normal use of the body, it’s not a medical emergency.
I *did* know that. I was just sort of figuring…women and babies used to die a lot from that normal use of the body. But a lot more has changed from then than just hospitals, hasn’t it? General hygiene, safety, and nutrition has all gotten way better.
And, y’know, the whole Patriarchy. Or most of it.
Absolutely. Don’t forget sexual violence, female genital mutilation, untreated infectious disease (comes partly under hygiene), and impregnation before the body has finished growing.
And there are no (or very, very, very few) birthing advocates who claim that medical intervention is never needed. Birth centre plans, homebirth plans, freebirth plans; all these typically include backup and emergency plans, criteria for intervention, criteria for transfer, and so on.
Quixotess, don’t feel alone. My hubby and I both went into hospital (with baby no. 1) with the mindset 1. Pregnant 2. ?? 3. Baby. We knew about labour and stuff of course but didn’t know about pushy private hospital staff and obs who get paid more for caesars etc. That said I did have a complicated pregnancy so it could have ended in a caesar anyway. But I just wish now that I had been better informed at the time.
“I was just sort of figuring…women and babies used to die a lot from that normal use of the body. But a lot more has changed from then than just hospitals, hasn’t it? General hygiene, safety, and nutrition has all gotten way better.
Absolutely. Don’t forget sexual violence, female genital mutilation, untreated infectious disease (comes partly under hygiene), and impregnation before the body has finished growing.”
Let’s not forget either that women used to wear corsets from when they were children, including while they were pregnant… nothing like having your body completely deformed and then wondering why a baby couldn’t come out. Or that death rates went UP, not down, with the move to using doctors as care providers, and again went UP as birth moved from the home to hospitals (and only came back down with the advent of antibiotics in the 1940s).
For the drop in childbirth mortality we can pretty much thank Ignaz Semmelweis. He discovered that specific germ that caused the most common fatal infection of the uterus after childbirth (Puerperal sepsis), and pioneered the use of sterile hospital environments.
Before this, the cause of Puerperal fever was theorised to be excess breastfeeding, miasma, or pent-up discharge, and the only treatments were blood-letting and rest. Semmelweis noticed that midwives had a much lower mortality rate than the doctors. At the time, the theory was that women’s modesty was compromised when babies were delivered by men, and this lead to putrefaction.
So he opened up a whole ward where sterility was mandatory, and the mortality dropped from 12% to about 1%. But the establishment still didn’t believe him, and strongly denounced his practices, right up up to his own death from the same infection – Puerperal fever – gained through a papercut. He cared so much about his patients, and was the only man around willing to learn from midwives. One of the few good ones.
And now, onto my birthy squeemishness. Dear God No, not for me, not for me. *crosses legs, takes a packet of Yasmin, becomes a celibate lesbian*
I’ll just add that his hospital mortality rate (12%) was actually uncommonly low already, due to aforementioned midwives. Some hospitals had rates running upwards of 80%.
Doctors not washing hands between patients! And they are still encouraging handwashing in hospitals because some carers still don’t wash their hands between patients.
Not just between patients. The difference between doctors and midwives in Semmelweiss’ hospital was not that the midwives scrubbed up and the doctors didn’t. It was that the doctors and medical students came straight from autopsies of women who had died from puerperal fever, to attending the next birth. The midwives didn’t do autopsies.
“The Cry and the Covenant” is an amazing book, a fictionalisation of his life. It’s well worth reading.
Pet peeve: when people these days advocating against the scientific method use Semmelweiss as their touchstone. “But nobody believed him then, and therefore I’m right too, because nobody believes me!”, goes the argument. Semmelweiss should be the touchstone for people who do use the scientific method; his work is the archetypal example of the scientific method in action. Nobody knew a thing about germ theory, but he worked out his methods anyway through pure empiricism and meticulous record-keeping.
I’ve always been scared of birth videos, but that was so different. It was so beautiful I cried! Thanks so much for sharing it!
I’ve attended several births, sadly all hospital, as a doula friend (trained as a doula, but never did my volunteer hours to be certified – long story). I fully intend to have my own (including the one I think I’m carrying now) at home, with my wife and mom and a midwife. I’ve cried at every birth, and laughed, it’s amazing, but the videos don’t usually have the same effect; this one is truly amazing! Personally I CANNOT wait for my own birthing experiences; I look forward to them with great anticipation and joy! Thanks for this post; I hope that soon Western women will be a lot less frightened of birth.