CHILDBIRTH ALTERNATIVES - The Choice Should Be Yours
DAVID and Pam chose natural childbirth at home for the delivery of their second child. The rate of children delivered outside of hospitals in America has increased each year by 30 percent between 1975 and 1980 alone, according to the U.S. National Center for Health Statistics. The number of parents wanting more control over how their babies will be born continues to grow in spite of pressure from the medical community. David and Pam, in their mid-20s and college educated, prepared well for the delivery of their child. David learned with his wife the husband — coached method of natural childbirth. Pam was attended by Elaine, a certified nurse-midwife, and her aide, in David and Pam's Southern California residence. A backup physician was available. After Pam went into labor about 8 p.m., February 10, the nurse-midwife was called. Since the couple's bedroom was small, a single bed was set up in the family living room. Pam lay or sat on the bed, with her husband rubbing her back, or arranging pillows as she changed positions for comfort. Here, in her own familiar home surroundings, Pam spent the next six and a half hours of her labor. Elaine, clad in surgical greens, herself the mother of a 6-year-old and a 1-year-old, checked the baby's heartbeat and Pam's progress throughout the night, as contractions intensified. David, whispering encouragements to his wife, cooling her face and arms with a damp cloth, straightening her pale blue nightgown, rested with her in the subdued light during respites between contractions. At 2:26 a.m., February 11, without forceps or drugs, the couple's second son, Ryan David, is born. Immediately, an exhilarated Pam is handed the fruit of her labor to examine and admire. After preliminary preparation of the baby by Elaine, David is handed the surgical scissors to cut the infant's umbilical cord. The baby begins to nurse at his mother's breast. The couple's first son, Aaron, a by-now wide-awake 2-year-old, joins his father and mother to greet his new brother. After Aaron is returned to his bed, David gives his new son his first bath, supporting little Ryan as he floats contentedly in the warm water, his eyes wide and alert. The baby is dried, diapered and wrapped in a receiving blanket before being returned to his mother to be nursed. A joyful conclusion to an unforgettable set of events experienced by this family, and the author. Not every couple would, or should, choose home delivery. Pam had already had an uncomplicated natural delivery with their first child. Her second pregnancy was also low risk. But home delivery is an option expectant parents are taking as obstetric procedures become more complicated and hospital stays more costly.
Childbirth Is Big Business
Obstetrics is big business for physicians and hospitals in the United States. Childbirth is the single most common reason Americans go to hospitals. Of the 38.5 million patients discharged from short hospital stays in 1981, 3.9 million-more than 10 percent of the total — were women who checked into hospitals to deliver children, according to a report by the National Center for Health Statistics. The report, by Edmund Graves and Barbara Haupt of the agency's Division of Health Care Statistics, was based on data involving patients discharged from 550 hospitals nationwide. Adding to the obstetrical activity in hospitals today has been the phenomenal increase in the surgical delivery of newborns. In the past decade the rate of cesarean deliveries has tripled in the United States, and the rate is still rising. Medical researchers are asking, Why? A National Institutes of Health task force several years ago reported that for 80 percent of the cesareans performed, four major reasons are cited. Difficult delivery or dystocia accounts for the largest part of the increase in cesarean birth rates. Of course, various abnormalities in labor could hardly have doubled in the last 10 to 12 years, so a change in the obstetrician's viewpoint of what is abnormal labor is acknowledged. Next highest in the rate of increase is repeat cesarean births. Unlike other parts of the world, in the United States the great majority of women who have had C-sections will have one again if they choose to become pregnant. Twenty years ago, only a small percentage of breech births were by abdominal delivery. Now, most breech births are cesarean. Surgical intervention for reasons of fetal distress is the fourth major reason for the increase in the use of the cesarean birth. The question is whether fetal distress is better recognized by electronic fetal monitoring or whether fetal distress is. being over-diagnosed.
Yet Other Reasons
Studies show that for at least 30 years, cesarean birthrates were high for those infants low in birth weight. Birthing complications occur more frequently in this group. An increase in the number of first-time mothers, along with the increase in the average age, is also given as reason for increased cesarean rates. Genital herpes on the rise in the population is forcing cesarean delivery to avoid serious neurological damage or death that could occur to the fetus infected by vaginal birth. Some obstetricians perform C-sections to avoid possible malpractice suits arising from the delivery of imperfect infants, although suits are also filed against them for performing cesareans. Whether physicians' motivation for this alarming increase in surgical delivery of children in the U.S. is primarily humanitarian or economical is debatable. In some states the cost is almost double for the cesarean delivery. Who performs cesarean deliveries? According to a report in The New England Journal of Medicine, obstetricians more than non-obstetricians such as general practitioners. Where? Larger hospitals, which have had greater increases more quickly in the rate of cesarean births.
Back in the 1960s and 1970s more and more expectant parents began to rebel against hospital practices of separating the woman in labor from her husband, of routinely sedating her during birth and removing the infant from the parents' presence for more than a week during recovery time in the hospital. Women, supported by their husbands, started to demand a return to a more natural form of childbirth. Experts in child psychology began to promote the importance of the early bonding experience for both parents. The pressure was on. When family doctors wouldn't agree or cooperate, parents-to-be, only a few at first but the numbers began to increase, turned to mid-wives and home births. Physicians, arguing that home delivery was potentially dangerous (some even going so far as to call it child abuse), fought back by attempting to legislate against mid-wifery and by peer pressure on any of their field who would attend home births or agree to back up a midwife. The battle still goes on. More and more birth centers are springing up around the country to give couples yet another option. The birth centers are more likely to be staffed by nurse-midwives who support natural childbirth and bonding. The mother can have family members and her labor coach at her side during labor and delivery, and she can usually go home soon after her child is born. Technical medical services are available if needed at birth centers, and delivery is generally less expensive than a hospital delivery. Insurance firms are including birth centers in their coverage, happy to see the lower rates for deliveries. Hospital administrators have noticed the trend, and. therefore birthing rooms, ABCs — that is, alternate birthing centers, — homelike in decor as opposed to the aseptic coldness of labor rooms, are being made available in hospitals today.
An Educated Choice
Expectant parents should not endanger the life of their unborn child by irresponsibly trying every new fad in child delivery that comes along. Legal restrictions should be observed. But neither should parents neglect their responsibilities and leave all decisions about the delivery of their child to a physician not in tune with their personal preferences or feelings about the matter. Risk may be involved to mother and child whether in the hospital, in a birth center or at home. Couples should learn what those risks are and make an intelligent decision about how and where their children will be delivered. Responsibility is the parents'. They, not the obstetrician, must live with the long-term personal results of whatever decisions are made. If you are an expectant parent or are planning to become one, learn what your responsibilities toward your unborn child are. Are there things you can do even before you become pregnant to better assure an alert, healthy child and a problem — free delivery? Indeed! Learn what they are. You're welcome to send for our free booklet Principles of Healthful Living. What about the duration of pregnancy? Are there things each mother-to-be can do then to make delivery safer and easier? Again, yes. Many good books are on the market to guide couples toward healthy safe deliveries through proper nutrition and exercise. David and Pam made their decision to have their child at home only after thoroughly educating and preparing themselves for a low-risk natural delivery. A certified nurse-midwife, who had been highly recommended, was carefully chosen. Proper health and sanitation procedures were followed. All you expectant couples may not be able to have your newborns safely at home. But whatever decisions must be made, you should be the ones making them. Be well prepared to not only decide where but how your children will be born.
An Informed Choice by Karen Fergen
So you are choosing where your baby will be born. And who your birth attendant will be, whether a doctor or a certified nurse-midwife. There are certain things you must take into account. They include your health at the outset of the pregnancy, your personal desires and the availability in your area of alternative birthing facilities. Select someone whose philosophy about childbirth is compatible with yours. One whom you feel you can trust and with whom you can communicate your feelings and desires. Be sure he or she is qualified and can handle emergencies should they arise. Your attendant should believe that pregnancy and birth are not illnesses and that you should have a reasonable choice in the way your labor is handled. He or she should be able to give you an accurate and detailed explanation of any tests or diagnostic procedures performed If medications or anesthetics are necessary, their purpose and possible side effects should first be thoroughly explained to you Remember, doctors handle any type of birth, however complicated. Certified nurse-midwives, registered nurses with one or two years of additional training, accept only women with healthy, normal pregnancies that could take place outside of the hospital, without medical intervention. Certified nurse-midwives always work with a backup doctor in case of complications. The attendant you choose should be willing to listen to your questions and answer them to your satisfaction, but you should know what it is that you want and how to ask pertinent questions. • Does your prospective attendant feel that the mother and father should be active participants in pregnancy, labor, birth and early parenting? • Does your attendant provide complete prenatal care — a discussion of the use of drugs (including alcohol, cigarettes and over-the-counter medication), nutritional counseling or referral, referral to childbirth classes, discussion of breast — and bottle-feeding? Is he or she willing to answer your questions in terms you understand? • How much experience has the attendant had? How has the attendant had? How assisted at, and how have different complications been handled? Have the mothers been allowed to progress through the birth naturally and unhurried by drugs or equipment as long as no harm is being done to mother or baby? • How does your attendant feel about routine medical intervention (such as induced labor, episiotomies and intravenous procedures)? Does he or she feel they should be used only in emergencies when medically indicated? • Will your attendant or his or her assistant sit through the entire labor with you? This is important, so if complications arise, appropriate action can be taken quickly. • Do you and your attendant understand each other, what you will or will not tolerate, preferences, and a compatible idea of what labor and birth should be? If you are going to have your baby at a birth center or in your home, you should also ask: • Does the attendant adhere to strict guidelines, screening each patient carefully, and accepting only those whose pregnancies are normal, with no foreseeable difficulties? • Is the attendant willing to help with the delivery without interfering, as long as everything is going well? • Will a trained assistant be with the doctor or nurse-midwife throughout the labor and delivery to help out? Remember, there will be two people to take care of. • How close are emergency facilities? Is the attendant willing to transfer you immediately to a backup doctor at a clinic or hospital if difficulties arise? Problems occur most often when attendants or parents are not willing to do this soon enough. Your pregnancy and delivery should be something you look back on with pleasant memories. It's your choice — make sure it's an informed one.