22 July 2011

Less is Not Best

Yesterday I suggested that the medicalization of childbirth and the overwillingness of the medical profession to allow, or even promote, surgical deliveries might be a less than fabulous thing, not only in the States but worldwide. And then I happened to have a chance to listen to Radio Boston's account of the legislation now on Beacon Hill proposing state regulation of home births and nurse midwives.

Clearly these two stories cover opposite ends of the intervention spectrum and, as with all things, the right answer for most expectant moms probably lies somewhere in between - some medical supervision of their birth process but a hands off approach when things seem to be going well all on their own. But for those who want, sometimes desperately want, their birth to go a certain way, should it really be for the state to say what is allowed?

Yes. Sorry. And feel free to unleash your fury in my general direction.

The fact of the matter is that delivering a child is probably one of the most dangerous things women in the United States will ever do. Natural or not, the act of child bearing has been killing women for as long as women were women. Before that, childbirth probably killed females from the species Homo erectus, but you'd have to ask an anthropologist about that and despite the letters after my name I don't really fit that bill.

We live under the misguided impression in this country that pregnancies result in healthy, happy babies. We are lucky enough that this is for the most part true. But it is not luck and it certainly is not evolution that has brought us to this place. Just the opposite. Our enormous heads don't really help the situation much. So why are fewer women dying in childbirth than they did before? Medicine.

Has medicine overstepped the bounds on many different occasions? Yes. From the soaring rates of infection on maternity wards due to puerperal or Childbed fever in the absence of hand washing before Semmelweis instituted good hygeine practices in 1847 to the overabundance today of Cesarean births in the U.S. and abroad, there have been and continue to be missteps along the way.

But before you consider foregoing all that medicine has to offer, consider this. Group B Strep (GBS) is a bacteria that many women carry. Before the initiation of antibiotic prophylaxis for carriers, 7500 infants in the U.S. contracted GBS from exposure every year. Once an infant is sick, it has about a 50/50 chance of dying. Not in Africa. Not if you fail to bring your new son or daughter to the hospital. Even with treatment, these babies die, they hemorrhage into their brains and ooze blood from around their IVs. So fine. Hire a doula. Have a midwife attend your delivery, but get tested for GBS and if you're positive (as I was) get your freaking antibiotics.

And while we're on the subject, just a word about vitamin K. Yes, it gets injected into your baby's thigh and no, maybe that's not the kindest welcome into this world, but seriously, you think getting pushed out of a vagina didn't already ruin your baby's day? Without vitamin K supplementation, the incidence of stroke (again with the BLEEDING INTO THE BRAIN) is not 1 in a million. It's not 1 in 100,000. It is, in Vietnam anyway, 116 per 100,000 live births. Why are these numbers difficult to calculate in the U.S.? Because babies get vitamin K! So for these 116 infants (and keep in mind that more than 300,000 infants are born daily so that's 348 babies having strokes EVERY DAY), some die and about half suffer serious neurologic impairment.

If your baby didn't get vitamin K because you refused the injection and then he had a stroke and needed to be fed through a G-tube and never recognized you, would you still love him? I hope so. But I think you would find it hard to love yourself.

So pick out music and scented candles for your birth plan. Buy an enormous bouncy ball. Take control of your delivery. But then take a moment to think about what happens if your baby is in trouble and realize that it's not actually about you, is it? It's about getting your baby out safe. So have a back up plan that involves a hospital and an obstetrician. Do your research about these things, even if you want to try to avoid them, so that if your baby needs out now, at least you are not standing the in the way.

The difference for Emmaline was about a minute. She was fine and then she was not. And even though the one thing I wanted from my delivery was to NOT be cut open by a surgeon, when her heart rate was plummeting I was one hundred percent grateful to be going to the OR.


  1. Thank you for writing about this. Both of my son's dropped their heart rates - one during labor and the other during and NST. While the 2nd was scheduled for c-section (my choice but they were only 17 mos apart, which raises the risk, as you know of uterine tearing) he dropped his heart rate in the 80s during a contraction during NST. I was never so thankful I had to give up an hour of my life 2-3 times a week as I was when they found that. The first one dropped his heart rate (and so did I) during labor. All I wanted out of my surprise pregnancies was happy children - who don't really care how they are born and how much pain you put yourself through to get them here...they're just glad you love them enough to get them here safely and take care of them. I sometimes think people think things about me that are none of their business because both of my children were born in a hospital AND via C-section. I find myself biting my tongue and reminding myself that they don't know what it was like and it's none of their business... Thanks again.

  2. Hey Meghan - I've been enjoy these posts about delivery. When I was pregnant last time I was pissed off by all the people who said "childbirth is a natural thing and hospitals are so unnatural... surely you don't want to have your child in a hospital?" And all I could think was "you know what's natural? Dying in childbirth. I'll take a hospital thankyouverymuch."

    I'd be interested now to hear your thoughts on VBAC. My hospital system doesn't do it so when time comes to have my next child I'll have to choose whether to have another c-section or whether to switch away from my hospital which I really really love.

  3. Thank you. As someone who has a negative and positive outcome during deliveries, it drives me *up a tree* when people complain about or threaten to refuse medically necessary monitoring and interventions. We almost clocked a woman complaining about IVs during a hospital tour before our second daughter was born (and then decided we needed to stay away from uninformed pregnant couples for the remainder of my pregnancy for our sanity).

  4. As I'm sure you know, I loved this. Thank you. Well said! M

  5. Meghan MacLean WeirJuly 23, 2011 at 6:10 PM

    Thanks for all the fabulous comments! Theresa, I'm sure Merielle has much more informed opinions on VBAC than I do, but I think in the Boston area it's becoming more common. I hope I can go that way when the time comes...so I'll keep you posted!