Birth in Bolivia

From an article on the state of childbirth in Bolivia:

Health Ministry estimates attribute the major causes of maternal mortality in Bolivia to haemorrhaging (23 percent), birth-related infections (14 percent), complications from unsafe abortions (16 percent), and eclampsia (12 percent).

All of these are largely preventable from the medical perspective, with the exception of unsafe abortions, which falls outside the scope of health measures, as it is a direct consequence of the country's laws against terminating pregnancies.

The infant mortality rate has also improved, but government projections show that it is unlikely to reach the MDG objective of a two-thirds reduction. From 1989 to 2003, the infant mortality rate was almost halved, falling from 120 deaths to 54 per 1,000 live births. Projections for 2015 are for 34 per 1,000 live births.

Infections? Complications from unsafe abortions? Eclampsia?

I feel the desire to jump on a plane and get over there and try to help make conditions safer. It seems that it would be simple to do.

Education, cleanliness, and good prenatal care.

We have all of these things here in the US, and I fear we seldom appreciate or take good advantage of them. We have education abounding, in various classes, the internet, books from Amazon, so many sources. And we have the ability to choose how well we take care of ourselves. We can eat good foods and get exercise. We can breathe good air (usually). We know there is a small risk of something going wrong in pregnancy and birth, but for us, it is very small. We usually don't fear that we will lose our own lives in the process.

Birth means something completely different to us.

While the birth of a child generally represents joy and life, in Bolivia, new motherhood is all too often plagued with fear, uncertainty and even death of mothers and newborns, report organisations dedicated to maternal and child health.

I feel that having a birth embody joy and life should be a basic right. I am deeply saddened that it is not, and I wish I could do something to change it and make it better for these women and their babies.

This is as extreme as I get

Navelgazing Midwife writes about the problem of rampant c-sections, and the media spin that they're less painful than vaginal birth. What is most startling to me is not that this is being reported as fact, but that women are believing it - they actually believe that major abdominal surgery is less painful than childbirth. Oh, women, sisters, how far we have come, and how backwards we still are. I don't understand your rejection of birth.

Here's another thing I don't understand: Britney Spears as a role model. Especially since she did the one thing that I think is a tragic mistake for someone in her specific situation: she had an elective c-section, because she didn't want to feel a single labor contraction. That's just fantastic. What a way to prepare for motherhood, to demonstrate your womanly strength, and to set yourself up to be a wonderful, self-sacrificing, patient, child-centered parent. The temptation to vilify her is great, but I'll stick to the facts.

The fact is that I disdain the women's movement that brought power to women and left out the education, that brought choice without responsibility, that turned the focus from what is natural and - ok, I'll say it - divinely appointed and, perhaps most importantly, is truly best for the child, and allowed women to become self-centered, self-serving, lazy, and weak. "Laaabor hurrrts" has become women's battle whine. Childbirth is the last area we need to reclaim. No one else can give birth to babies - it's up to us women. I believe that we need to learn more about it and, where we can, embrace the miracle that is ours to give, to ourselves and our babies, to let our bodies do what they are meant to and are completely capable of doing. There is no other place to gain this knowledge and this trust in ourselves and in nature, God, the universe, whatever it is you believe in - this is where you find it, where it's proven.

I'm just extreme enough to believe that it is no accident of evolution that birth is so difficult for humans, that we have to stretch and strain to give birth to our babies. There is no other creature that works so hard at childbirth as we do, that grows a baby so large compared to the size of the birth passage. I believe that is intentional, perhaps because we have so much to learn from the experience and are capable of perceiving and feeling so much. We need to learn to trust. We need to learn to sacrifice. We need to do hard things to prove our strength - we are indelibly strong and tough. That is what we have to gain from childbirth.

Back to feminism. Why feminism has been touted as a cause that encourages women while rejecting what makes them unique and strong is baffling to me. Thanks to the offsprung branches of this well-intentioned movement, many women have learned to disdain their bodies as weak, their vaginas as unfit for their purposes, and have mistaken their own loveliness for mere frailty.

Now, more than ever, women need to reclaim the process that will bring them face to face with the bare truth of their femininity: childbirth. In bringing a child into the world, a woman is tough and tender, is uncertain and perfectly capable, determined, loving, forceful, sexy, and instinctive. This is the core of what it means to be feminine and womanly.

I believe that women who reject birth for being dirty, difficult, or unnecessary, are buying into the notion that male-controlled is still better. There. I said it. Cesareans are the tool of a male culture that does not understand childbirth. I am not saying that sections are brought forth by men and imposed on women, but that women have been convinced that their bodies are flawed, their processes for giving birth are unnecessary, that they are inferior. It looks like misogyny to me.

I will admit my bias:
The very first person I knew who had a c-section, had her nerve leading to her sexual parts accidentally cut, and has since had no sexual sensations. It was her first baby. She was 27. I got interested in natural birth in the first place to avoid a cesarean. 1 in 4 seemed like far too great, and the ratio among my friends was much higher than that. It never seemed right.

So now, when I hear women say that they want to schedule a cesarean to avoid the pain of labor, I want to jump out of my skin. When I read in a book on childbirth that women should "ask your doctor if a VBAC is right for you", I want to yell in protest that it was the cesarean that was wrong in the first place, and that all of you women, you childbearing women, need to be so much better educated than you are.

Being Honest about Childbirth Preparation

More on the homebirth debate blog, which is increasingly just an anti-natural-birth blog...

Normally I wouldn't give much weight to the problem of women who want natural births but find that labor is more intense/painful than they expected. I don't instinctively think that natural childbirth education classes bear responsibility for this kind of disappointment, based on the knowledge that all women experience labor differently.

I think that calling natural childbirth educators "liars" based on this discrepancy is inflammatory and nothing more.

But I tried to understand the intentions of writing a blog like this. I gave the author the benefit of the doubt, and I reached an understanding that I think is very important:

If a woman goes into labor, a normal labor (no posterior position, uncomplicated), with the idea that it's going to be a cake walk because she took a class, then she has been duped. The whole idea of childbirth education is to educate. This means making a strong effort to prepare women for what her labor will probably be like.

It does no one any good to attend a class where only ideals are taught. It gives no one any skills for dealing with even small deviations. Women need honesty - that doesn't mean horror stories, things that are going to frighten her into choosing certain options over others. It means telling women that there is an entire range of normal, and that some of it is painful, yes, but here are things you can do to get through it.

Any good childbirth education class - especially, but not exclusively, for women planning on having a natural birth - will tell women that labor is usually painful, but will also educate them on handling the pain. They will be honest about the entire issue. Their goal is to prepare the pregnant woman for labor, not to take shortcuts and present only a very limited view of labor and birth.

This goes both ways. I object to educators who tell women "labor is entirely pain-free if you're relaxed enough" as much as "since most of you will be getting epidurals, I won't go over relaxation techniques". Both approaches are wholly objectionable and are setting women up for failure.

Scrutiny

After spending much of my time looking at studies, researching different statistics, and making lists comparing references and outcomes, I've arrived at a different conclusion regarding homebirth safety.

I feel much more educated now than I was previous to the homebirth debates. I'm not where I would like to be, but I certainly feel more confident in my opinions.

I've reviewed countless studies, and what I've found can be summarized thus: Some studies show a slightly lessened risk of mortality for home birth. Some show a slightly greater mortality rate. Often, when the hospital and home group comparisons are restricted to similar risk profiles, the homebirth group shows a slightly lower risk.

The data is spread out, ranging for both homebirth and hospital mortality to all numbers between 0.5 and 3.5, according to many studies.

In all studies, the mother and baby had fewer interventions (instrument delivery, episiotomy, etc.) in the homebirth group, regardless of risk profile (meaning, the low-risk hospital groups had many more interventions than the low-risk homebirth groups).

This brings me to a good question. What is the definition of safety in childbirth?

Does "safe" just mean that no one died?

I believe it's broader than that. I believe that we must include the whole person, the whole mother and baby. We must examine their physical well-being as well as their psychological and emotional health as a crucial factor for a good outcome. If mother and baby are both alive, but the mother bears an unnecessary cesarean scar and feels violated and deprived of her womanhood, that is not necessarily a good outcome. She may be less likely to bond well with her baby, less likely to continue breastfeeding, and more prone to postpartum depression.

For care of the entire person, addressing all issues of wellness for both mother and baby, which I believe is an essential part of safety, homebirth is far superior. This is well supported in everything I read.

The mortality numbers are basically inconclusive, but honestly, I can't say that they lead me to believe there is anything inherently more dangerous to birthing at home. (I cannot say enough that in my area, laboring women are far safer, in every aspect, at home than at the hospital here...but that is another topic.)

Trying to Understand

This is from Birth as an American Rite of Passage:

After much research and more questioning, I had reached the conclusion that American hospital birth rituals are medically damaging and psychologically
disempowering and degrading to women. Once I had arrived at this conclusion, I had a good deal of trouble understanding why anyone would want a technocratic birth. Although it is true that I did not encounter many women who really wanted a highly technocratic birth, I kept running into woman after woman who felt generally comfortable with such a birth...I must take seriously the notion that American women do not rise up in protest against technocratic birth because it is in fact what most of them want.

Why? To ask why women want technocratic births is, in a broader sense, to ask what technocracy has done for women that they should value it so. The answer to that question seems clear: in the early years of this century technology began to give women the power to expand beyond the "natural order" that made so many of them, in an industrialized society, appear to themselves to be slaves to their biology. Ever since the invention of the bottle - the "war cry" of a generation of women - technology has increasingly offered women a way out of the home and into participation in the wider social world. And this trend has not slowed. Women's continued expansion beyond the "natural order" that kept them in "women's domain" is increasingly facilitated by technology, which women therefore have special reason to value and to seek.

This makes sense to me. I have wondered why so many women reject nature in favor of technology, and now it finally makes sense. People who are not hoping for a natural birth, or people who say "I want a natural birth, but we'll see" - they have an entire belief system that relies on doctors and medicine to alleviate their fears of the dangerous and bewildering natural birth process, to make it mechanical and predictable. I had thought for a long time that it was simply fear of pain, but it is more than that. It is fear of, among other things:

* physical danger
* exile from culture/social expectations
* being enslaved to unpredictable biological rhythms

and has little to do with birth itself. What we believe about birth is part of a larger system of beliefs, and these beliefs affect how we labor and where and how we deliver our babies. "What we believe is what can come true for us...If a woman believes on the deepest emotional level that the hospital is the only safe place to birth, then if she tries to deliver at home she won't be successful" (Lewis Mehl).