What did God design childbirth to be like? A drugged nightmare, with a woman strapped to a table? Or a joyful, magnificent triumph typifying the very destiny of humankind?
DID YOU ever notice that the word most commonly used when speaking of childbirth is miracle? Indeed the "miracle of birth" is a phrase used so often more in the past than now, though that it has become almost a clichι. No doubt there are people, probably quite numerous and vocal these days, who don't see anything at all miraculous about birth. For them, it is all a secular matter of biology and chemistry. But more spiritually inclined people tend to look at birth differently. They see in it the handiwork of God. As King David of ancient Israel wrote: "For thou hast... covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made... " (Psalm 139:13-14). For David, a child in its mother's womb was something "fearfully and wonderfully made" a special part of creation revealing the awesome powers of the Creator. Special consciousness of God available in the process of birth is no accident. Physical birth is a portrayal of spiritual salvation. The destiny of man is to be born into the very Family of God. It was this principle to which Christ alluded when He made His famous statement to Nicodemus, "Except a man be born again, he cannot see the kingdom of God" (John 3:3). These truths, simply stated, have a profound influence on the preferred method of childbirth. If God made childbirth to portray a deeper, spiritual message, then children ought to be born in a way as close as possible to the way God designed it. Furthermore, childbirth not only reveals a spiritual truth, but is itself a part of God's creation! When you have such ideas about childbirth, you gain a new perspective: if at all possible, childbirth should be a natural, family-centered event not the science-fiction technological nightmare it can be in many hospitals. A letter to America's famous advice columnist "Dear Abby" was informative in this regard. The new mother had been involved in a natural childbirth program at Illinois' Masonic Hospital in Chicago. The whole family was allowed to be present. She wrote, "Our children will grow up to respect the miracle of pregnancy and childbirth as a sacred gift from God, instead of something to get rid of."
The Natural Childbirth Movement
One of the few healthy social trends to come out of the 1960s and 1970s was increasing demand for natural childbirth. Natural childbirth is simply keeping interference in the birth process to a minimum. Ideally, no spinal blocks, no leg straps, no drugs or anesthetics are required. Preferably, it does not happen in a hospital, but in the mother's own home or an "alternative" birth clinic (though there are a few hospitals, here and there, which do support natural childbirth). Fathers actually participate in the birth, instead of being shunted to the proverbial hospital room to while away the time in nervous pacing. Of course, natural, or "alternative" birth (as its supporters call it) does carry a degree of risk should complication occur. Probably the worst danger is the mother's post-birth bleeding. Other dangers involve the umbilical cord if it slips out of the mother before it should, or if it gets wrapped around the baby's neck or under an arm. In such cases, having hospital facilities nearby becomes important. Alternative birth advocates, point out, however, that around 90 percent of all pregnancies do not experience such complications. Moreover, some home birth specialists, such as Phoenix, Arizona's, "Baby Buggy" unit, are equipping large vans and motor homes with much of the equipment hospitals provide, allowing a lower risk home birth.
Part of the increased demand for alternative birth stems from the growth of feminism and the desire of many women to reclaim control over their own pregnancies from a mostly male medical "establishment." Another part of the demand came from a growing preference on the part of society as a whole for "natural" things. And part of it, one would hope, also stemmed from people who realized the religious implications of childbirth. However, the most immediate reason for the demand for natural childbirth is its superiority, at least for normal pregnancies, over standard hospital deliveries. For one thing, it is very common to speak of the United States' "scandalously" high infant mortality rates. By contrast other countries, such as Sweden, Britain and Holland, which make greater use of midwives and generally use less drugs in pregnancies, have much better rates. Observes one German obstetrician, "The Dutch, with the highest proportion of home births in Western Europe, have one of the lowest infant mortality rates. That must teach us something." Studies inside the United States also show the desirability of alternative birth. Medical World News (of all places!) in its April 19, 1976, issue, reported a study done for the California State Department of Health by Dr. Lewis E. Mehl. He found, after a study of 1,146 women who delivered, or attempted to deliver, at home, that home birth resulted in lower death rates than the California average. Tonya Brooks, president of the Association for Childbirth at Home, International (ACHI), has recently completed a research project indicating the statistical superiority of home births from studies done as early as 1895. The paper will be available to the public in September 1981 from ACHI headquarters, Box 39498, Los Angeles, CA 90039.
A Family Event
One would hope that childbirth would be an event that would bring a family closer together not apart. One of the hallmarks of natural childbirth is the presence of the father, and often, of other relatives as well. In the standard hospital delivery, the father and rest of the family are purposely excluded from the delivery. Yet the wisdom of allowing a woman in labor the presence of a close companion preferably the father has been confirmed by a 1980 report published in the New England Journal of Medicine. Women who had a companion had fewer complications and shorter labors. As one of the researchers said, in a statement carried over the Associated Press wire service: "Certainly a rule is that no mother should ever labor and deliver without a companion. That's awfully clear." The study also showed that women who had companions with them were more affectionate toward their newborn babies. To paraphrase the prophet Malachi, the presence of other family members "turns the heart of parents towards their children." (Compare Malachi 4:6, "And he [Elijah] shall turn the heart of the fathers to the children....") And no doubt, as anyone with any common sense can figure out, the presence of fathers in delivery rooms will also create a greater bond of affection between fathers and their wives and children. A related aspect of natural childbirth is that the mother can immediately hold her newborn baby. As any number of mothers can tell you, there is simply no more rewarding moment in a mother's life than being able to hold and breast-feed her child immediately after what is, understatedly, called "labor." The New Testament, interestingly enough, says much the same thing: "A woman when she is in travail hath sorrow, because her hour is come: but as soon as she is delivered of the child, she remembereth no more the anguish, for joy that a man is born into the world" (John 16:21). The long-established standard hospital practice of taking away a newborn baby from its mother just after birth is, under normal conditions, nothing less than barbaric. Moreover, a famous study made by Drs. Marshall Klaus and John H. Kennel of Case Western Reserve University shows much the same thing. The two doctors compared children who had only brief contact with their mother just after the moment of birth with those who had spent much more time. They discovered that the children who had spent more time with their mothers gained more weight, had fewer infections, and after five years, had higher IQs. Significantly, the study also confirmed Christ's observation: mothers with longer contact felt more rewarded for their labor. But expectant parents have also turned to natural childbirth as much because of a revulsion with standard hospital practices as because of the joys associated with alternative childbirth. There are a number of dangers in the standardized hospital delivery. Besides hospital-involved infections and the risk of crippling the baby for life through the use of forceps, there is the heavy injection of chemicals into the mother's body at a time when her baby still has a direct line to the mother's bloodstream. As one California obstetrician, Hai Abdul of Azusa, remarks, "I believe that natural childbirth is safe because you are not taking the chance of crippling someone with spinal anesthetics." A registered nurse, in a letter to the editor in the Los Angeles Times defending an alternative birth physician against negligence charges, declares: "I am very familiar with standard hospital obstetrical practices and I feel that many are unnecessary, traumatic and even unsafe. For this reason my husband and I made the decision to deliver at home...." Alternative birth advocates can be quite eloquent in their condemnation of certain standard hospital practices. Parents' rights advocate Suzanne Arms recalls her own experience with standardized, hospital birth as a virtual nightmare: she and her baby were subjected to narcotics, anesthetics, labor-inducing drugs, forceps; she says she still feels the "pain and guilt of not having protected my daughter" from the doctors' overeager intervention in what should have been a joyous, natural event. An article in The Wall Street Journal, February 15, 1979, also notes the consumer dissatisfaction with standardized hospital practices: "Parents also are rebelling against regimented and impersonal hospital routines. They dislike the sterile steel instruments, harsh lighting, uncomfortable stirrups and tables, shavings, anesthesia and the usual separation of mother and child after birth." And Dr. Richard H. McDonald, former president of the Orange County (California) Obstetrical and Gynecological Society, makes a startling admission in an article he wrote for the Los Angeles Times in 1977: "Indeed, it is hard to refute critics' charges that hospitals have gradually become a 'doctor's domain,' where nurses seem to cater more to physicians than to parents-to-be." Dr. McDonald also admitted the money cost of hospital is "frightful," and, with "the introduction of new, more sophisticated equipment," likely to increase. As one younger mother told United Press International of her hospital birth: "With my first baby I felt like nobody cared. I was supposed to do as I was told and not make a fuss about anything. I couldn't ask why. Rules were rules. I didn't have any identity... I was in that labor room all alone with someone coming in to check once in a while. My husband was waiting downstairs. I was terrified." In a standardized hospital birth the physician often employs any number of "procedures," which may not be free of damage to either the mother or child: drugs to hasten or slow delivery (often done, consumer groups charge, for doctors' convenience), cesarean section operations, forceps delivery (oh, wonderful!) and routine cutting of the mother's vaginal area.
The convenience of physicians often dictates certain impositions on the mother in the standardized hospital birth. Midwives will tell you that there are certain doctors whose babies arrive on certain days of the week (regardless of a baby's schedule!). This problem was recently highlighted in a court case involving the Dortmund Women's Clinic in West Germany. The case brought out that more than half of all the births in the clinic were artificially induced: there were few if any births on Saturdays, Sundays, nights or Wednesday afternoon (which the doctors had off!). (Reuters, May 4, 1981) Labor-inducing drugs, oxytocin primarily, can cause usually strong and frequent contractions, which doctors acknowledge can deprive the baby of oxygen causing brain damage. The best you can say about the inducement of labor, however risky, is that at least it is less barbaric than the practice in standardized hospitals in the 1950s, where babies would be artificially held back from birth because the doctor was not yet on hand!
The Disease Theory of Pregnancy
Another of the reasons why expectant parents turned to natural childbirth in the 1970s was a revulsion towards the "illness-oriented" atmosphere of most hospitals. One writer for the Canadian newsmagazine Maclean's sums up the unappealing nature of hospital birth nicely: "If there's one emotion new mothers may share... it's frustration at a less-than-satisfactory hospital experience. The place is so geared to sickness that childbirth sometimes seems reduced to insignificance." "Doctors," according to Robert Mendelsohn, M.D., "intervene too much in what is a natural process. They act as if pregnancy is a nine-month disease that needs their help to be resolved." The words of a spokesman for the California Medical Association on why his organization opposes home birth are revealing: "Our position is that there are so many things which can go wrong that the procedure should take place in accredited facilities." "The procedure"! A mechanical word for a natural event, reflecting the mentality of orthodox obstetrics! As California State Senator Barry Keene has noted, some doctors believe "that childbirth is a medical event and not a natural event that's been going on for thousands of years."
The movement toward natural childbirth gained growing popular support throughout the 1970s. Yet sometime in the late 1970s (or early 1980s depending with whom you speak), "alternative" childbirth began to come under severe attack from the "establishment" in obstetrical medicine. The challenge to alternative birth is not merely an American trend, though it is centered in the United States. Medical statistician David Stewart declares the medical backlash is "global," noting that physician attendance at a home birth has been labeled "unbecoming conduct" in Canada. The International Association of Parents and Professionals for Safe Alternatives in Childbirth (NAPSAC) cites an estimate that at least 90 percent of physicians who support homebirth or other non standardized childbirth are currently facing some sort of trouble investigation by medical boards, revocation of hospital privileges, cancellation of insurance, or, most drastic, suspension of their licenses. Recently, statistician Stewart, who is head of NAPSAC, noted in early 1981 that "in the last two months, ten doctors in ten states lost their licenses or were threatened with malpractice insurance cancellations or loss of their hospital privileges because they do home births" (quoted in Los Angeles Times, February 27, 1981). In California, where the attack is in full swing, Ginny Cassidy-Brinn of the Los Angeles Feminist Women's Health Center observes that "everybody who attends home births around the state is being harassed." The harassment in some cases seems particularly mean spirited, directed at any doctor, nurse or midwife who has anything to do with home or alternative birth regardless of any instance of supposed negligence or incompetence. Thus NAPSAC News (Spring 81) reports that one Chicago M.D., who doesn't even do out-of-hospital births, has been harassed because he does serve as a back-up for physicians who do engage in home births! In San Diego, California, the local medical society, according to the Association for Childbirth at Home, International (ACHI), has denied membership to doctors attending home births. ACHI also reports that a number of doctors and hospitals deliberately deny prenatal care to women planning home births. One ACHI survey in Houston, Texas, in 1978 found 20 obstetricians who refused prenatal care to such women. ACHI also reports that a local obstetrical society in Franklin County, Ohio, passed a resolution to "advise any physician in Franklin County from participating in prenatal care or delivery of any patient planning home delivery" (emphasis added). At least in some instances, it would appear that "establishment" doctors are less concerned with the health of living mothers and their unborn babies even to the point of denying prenatal care! than they are with upholding the standardized, overly interventionist way of childbirth employed in many hospitals! Midwives have also come under attack. They are increasingly being prosecuted for various "crimes" associated with attending a home birth, mostly practicing medicine without a license. The attacks on those involved in alternative births seem to stem from the deliberate efforts of more orthodox doctors and not from disgruntled patients. NAPSAC reports that in Iowa, one doctor engaged in a home birth had heard, unofficially, that state medical authorities were "out to do away with home births." It also reports that an Alaska home birth physician was told by local doctors that they intended to "get him." And Dr. Hai Abdul, a natural childbirth physician facing similar pressures in California, notes that the California Medical Association in its January, 1981, bulletin, made its "#1 priority an all-out attack on home birth and the practice of Midwifery." (You would think their number one priority should be an attack on disease!)
The Double Standard
Obstetricians are 10 times more likely to be sued than other kinds of doctors, according to the study by Seattle physician Helen Marieskind. Moreover, over the course of time of an obstetrician's practice, whether hospital or alternative, there is a tremendous statistical probability of some small number of tragedies, whether they be still births, cripplings or some other terrible consequence. When such occur to a doctor following standard hospital practice, there is a good chance that medical licensing authorities will choose not to investigate. Yet when tragedies occur to a doctor practicing home deliveries, there is a far greater likelihood that the doctor will be investigated. ACHI argues that "home births are disproportionately investigated. Home births are investigated even when outcomes are good, while hospital mistakes are rarely questioned." NAPSAC makes a similar statement: "What would merely be a cause of mild reprimand with a hospital obstetrician is grounds for suspension of the right to practice for a home birth doctor." Probably the worst example of the double standard is revealed in the murder charge brought against midwife Rosalie Tarpening of Madera County, California. She was put on trial for murder because of the death of a baby. At trial, however, it was revealed that the baby died, not because of anything she did or didn't do, but because the hospital to which the baby was taken blew out the infant's lungs by pumping oxygen in at too high a pressure!
The Biggest Story in Medicine
Dr. Mendelsohn claims the alternative birth controversy "is going to be the biggest story in medicine in the 1980s." As of the moment, the outcome is in doubt, though both sides are mobilizing for what seems to be a particularly hard fought conflict. One natural childbirth physician has already vowed he will "go underground" if state medical authorities try to stop his practice. Of course, in a better world, say the world after Jesus Christ returns, the natural childbirth people will have won hands down. In that world, mothers will be healthy and there will be no need for hospitals. Childbirth will be a peaceful, family-oriented, love-filled event reflecting, as it does, a part of God's own plan for man. It will not be the terror-filled nightmare that it can be in many hospitals today. For the here and now, thousands of parents have already experienced, firsthand, the general superiority of natural childbirth. As it so happens, the world's most beautiful, intelligent and well-disposed baby, Katherine Anne Calkins (my daughter!), was born in an alternative birth center, and she (as well as her mother) profited immensely from the experience. Later, her mother, outraged that state medical authorities would seek, by a pattern of harassment against alternative birth physicians, to deny her next child the same experience, dashed off the following message to her physician who attended her first birth, the eloquence of which speaks for itself: "How can a mother describe to others the beauty of the marvelous, golden moments of childbirth. And then the triumphant feeling of holding, touching and loving the newborn after birth. I was not to be cheated out of this. I truly appreciated you and your staff in allowing me to go my full term and delivery without drugs or being tied down. Also having the father there was a great help to me and a wonderful experience for him. A bond of family love was formed. My delivery was quicker and easier by far than the average. And my baby is very healthy and happy. Dr. Abdul, your methods must be given proper credit."
Moving Childbirth From Delivery Room to Operating Room
Cesarean sections have become increasingly likely in standardized hospital births. In the last decade there has been a virtual explosion of cesarean operations. Once such operations were rare, considered a last-ditch measure to save the mother's life. Now some hospitals have cesarean rates as high as 40 percent! (New York Post, December 28, 1977.) Overall, since 1970, the cesarean rate has tripled at most hospitals. "Many hospital doctors seem to feel that God made a mistake when He didn't put a zipper in a woman's belly," charges Dr. Robert Mendelsohn, a physician prominent in the alternative birth movement. Besides subjecting mothers to all the hazards of a major operation, cesareans carry other drawbacks. Babies delivered through cesareans run a greater risk of breathing problems. "Labor itself seems to do something for the baby: uterine contractions help expel fluid in the baby's lungs and stomach. In a cesarean, the baby often has difficulty in breathing," states Dr. Ralph Gause, trustee of the American Foundation for Maternal and Child Health (quoted in Ms. magazine, October, 1978). Probably the greatest force pushing cesarean operations is a doctor's fear of malpractice suits. Many doctors fear that if they deliver a "less than perfect" baby, they will be sued, and rather than take that chance, subject the mother to a major, though now common, operation. Yet ironically, Dr. Helen Marieskind, the Seattle physician who found in a 1980 study that a doctor faces a higher risk of a suit over cesarean than vaginal deliveries. Besides malpractice, there are other, little-admitted reasons for the explosion in cesareans: the doctor's convenience and money. In a study of 120 births, sociologist Susan G. Doering of Johns Hopkins University found that 16 out of 20 (80 percent) "emergency" cesareans were at certain hours of the day, even though the births were all spread randomly. She also noted a large Blue Cross study that showed that a woman's chances of having a cesarean rose in direct proportion to what her insurance would pay for the operation! (New York Post, November 28, 1977.)
Who Is the Medical Childbirth "Establishment"?
The primary opposition to home and alternative childbirth stems from several professional organizations: the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP) and, of course, the American Medical Association (AMA). Not surprisingly, such groups seem committed to the standardized approach to childbirth, regardless of how dehumanizing it makes what should be a joyous and triumphant event In some cases, such professional organizations make absolutely ridiculous statements to back up their resistance to home birth. The most famous is Warren H. Pearse's statement made in the ACOG Newsletter of July, 1977, "Home delivery is maternal trauma home delivery is child abuse!" (quoted in Reason, February, 1980). Alternative birth proponents pinpoint ACOG as the prime mover behind the backlash. ACHI notes a 1975 ACOG policy statement on home birth: "The College supports those actions that... provide the mother and her infant with accepted standards of safety available only in hospitals. The key, of course, is that word only It assumes that every pregnancy, no matter how unlikely to suffer complications, requires the whole artillery of medical technology available in hospitals, including "forceps deliveries." Of course, the availability of a hospital in case of unforeseen complications is desirable. As such, the move on the part of some hospitals to deny their facilities to women choosing home births or to doctors attending such births represents nothing less than absolute criminal (in a moral. sense) hypocrisy. Not to mention doctors who say all births should be in hospitals, yet seek to deny hospital facilities in certain cases where they are genuinely needed' The statements of the medical association also have a certain vague, lofty pomposity about them. "We support... accepted standards of safety available only in hospitals"; the "potential hazards" of childbirth "require standards of safety which are provided in the hospital setting and cannot be matched in the home situation"; "The health team necessary to provide optimal maternity care must be directed by a qualified obstetrician-gynecologist', The exasperating aspect of such statements is that they assume the doctors have already won the argument! They assume no reasonable person could believe that their precious (and sometimes brutal) standardized hospital childbirth is anything less than a heaven-sent boon to all mankind. And, of course, "qualified" by definition only includes physicians who subscribe to the "hospital only" philosophy. (It is fascinating that, on the subject of evolution, scientists are forever protesting that science is not a "monolith," meaning it is open to new discoveries. But organized medicine, which deals with the most complex "scientific" system in the universe the human body rather arrogantly assumes that all new knowledge outside of a certain preset pattern must be disregarded!) Even some doctors associated with ACOG admit that there is at least a reasonable case to make in favor of alternative birth. Dr. Saul Lerner, a participant in a 1979 ACOG round table discussion on hospital versus home delivery, was candid about orthodox medicine's prejudice against home birth: "I did a survey for a debate on the home vs. hospital delivery issue and came across a major public health problem. I came up with a book of horrendioma on home birth. But if I'd been assigned the other side I could have called hospitals and. come up with horrendioma that would make us look sick" (Reason, February, 1980, emphasis added). Another doctor, at the same symposium, while still saying that embracing home birth is "unacceptable," admitted that orthodox medicine had an "arrogant opposition to home birth" (id). Perhaps some day organized medicine will realize that those problems that on occasion do happen with home birth are the result of poverty or lack of preparation or proper prenatal care, and not necessarily part of home birth itself.