Natural Birth and Homebirth Thoughts by Michel Odent

This is a post by Michel Odent relating to natural birth and homebirth which I found at http://www.mothering.com/sections/experts/odent-archive1.html#natural-birth

My sister and I were discussing childbirth. She is very influenced by her friend, a nurse, to have an intrusive, medicalized birth. What kind of resources can I share with her to show her that a natural childbirth is a wonderful and safe birth choice?

Michel Odent: You might first explain to your sister and her friend that a natural childbirth is not a choice. This term can only be used in retrospect, when a woman has given birth without any drug and without any intervention. The environment where you give birth is the real choice. You must explain that your main objective is safety and that according to common sense an easy birth is safer than a difficult birth. So your priority is to make the birth as easy as possible thanks to an environment that can satisfy your basic needs when you are in labor.

Your basic needs are easy to explain in the current scientific context. Physiologists, scientists who study the body functions, tell us that adrenaline (the emergency hormone we release in particular when we are scared or when we are cold) makes difficult the release of oxytocin, the hormone necessary for effective uterine contractions. You can explain that you release a lot of adrenaline when you are in an unfamiliar and clinical environment. You can add that, in contrast, you can imagine yourself giving birth in a familiar environment, with - for example - nobody else around than an experienced, motherly, low profile and silent midwife knitting in a corner. It is probable that in such an environment your body will work well.

The second aspect of the safety preoccupation is: what to do if there is something wrong? In the age of the safe c-section and widespread cell-phones, there is usually an easy answer to this question, which should always be the second one.

Many health professionals need to learn to think in terms of 'ratio of benefits to risks'. Where out of hospital births are concerned, they immediately ask: 'what will you do if…' instead of asking first: 'how to make the birth as easy as possible'.

You are asking what kind of resources you can share. You might share data about the Dutch birth statistics. In Holland, where 82% of the midwives are independent primary care givers, about 31% of the births occur at home, and an autonomous midwife attends many of the hospital births. The rates of c-sections are around 10% for the whole country and more than 90% of the laboring women do not need an epidural anesthesia. The birth outcomes are much better than in the USA (number of babies alive and healthy at birth).

Do not recommend books about 'natural childbirth' because they are usually written for the converted. Instead you might suggest updated books focusing on one of the main aspects of industrialized childbirth, such as 'The Caesarean. Free Association Books 2004'. In order to help your sister and friend to learn to think long term, you might indicate the 'Primal Health Research Data Base' that is specialized in studies exploring the long term consequences of what happened at the beginning of our life. It appears that the way we are born has life long consequences and that, today, in spite of the safe caesarean, we have good reasons to try to rediscover the basic needs of women in labor and of newborn babies.

YFFM Meeting, Saturday, March 1

Come out and have a voice in what happens with midwifery in the Yukon! Babies & children are welcome – since we are meeting in the library, I would suggest bringing toys for them to play with.

When: Saturday, March 1, 2008 @ 10:30 am
Where: Whitehorse Public Library, Meeting Room 1

My Prenatal Experiences with a Yukon Midwife

***by Asheya Hennessey***

When a home pregnancy test confirmed my pregnancy with my second child this past summer, one of the first people I called with the good news was Christina Kaiser. Christina is one of two practicing midwives in the Yukon, where midwifery services are currently not funded by the government and not integrated into the health care system. Christina was happy to hear my news, and we booked an appointment for a few weeks later. She has been my primary health care provider during this pregnancy ever since.

I am now seven months pregnant, and I thought it was about time that I shared my experiences. There are so many things I enjoy about having a midwife for my prenatal care, it's hard to know where to begin! I think this will end up being a bit of a compare and contrast, as a doctor was my primary health care provider for my first pregnancy, and I can't help but see the differences. I think my previous experience with a doctor has also helped me to appreciate Christina's care all the more.

One of the first things that struck me as being different from the prenatal care I received from a doctor is that Christina comes to my home for appointments! I can remember waiting over an hour in the doctor's office for a fifteen minute appointment, but Christina sits in my living room and we usually talk for over an hour. I love having the time to tell her how I am feeling, both physically and emotionally, and to ask tons of questions about different pregnancy and birth related options, such as what remedies I can use for heartburn, or what the pros and cons of a water birth are. There are different things to discuss at each stage of the pregnancy, such as whether or not I want to get an ultrasound, or if I want to get tested for Strep B, or if I prefer an active or passive approach to the third stage of labour, and as each topic comes up I can ask Christina for information and then I get to make the decisions without pressure from her. With the doctor it was quite different: it was more of a 'this is the way things are done' and if I wanted something different I felt I had to argue my case.

I also really appreciate how Christina remembers what I've said in previous appointments. For instance, I knew I didn't want to listen to the baby's heartbeat with the Doppler, which is an ultrasound device. I was okay with waiting to hear the baby's heartbeat until it could be heard with a fetoscope. When I was pregnant the first time, I told my doctor right away that I didn't want to use the Doppler, but she kept forgetting and I had to keep saying 'no thanks,' which felt a bit awkward. Once I told Christina that I didn't want to use the Doppler it was never an issue, and I still felt that if I changed my mind I could always ask for it.

A typical appointment starts with Christina asking how I am feeling, so I share my different pregnancy related woes, such as nausea, heartburn, backache, fatigue, mild cramping, cravings or whatever else I have been experiencing. It's great having someone listen to you complain, and you know that it's actually part of what you are supposed to be doing! My sense is that asking how the woman is feeling is an important part of how a midwife takes care of her client, because not only does it make the woman feel cared for, but what the woman is feeling may reveal something that is a symptom of a problem, which will allow the midwife to catch it and be able to address the problem. My pregnancy is perfectly healthy and normal, but it's reassuring to know that I'm being listened to in case there is a problem.

After we discuss how I am feeling, we usually discuss some informational sort of topic that has to do with my options, such as remedies to treat my complaints, or tests in pregnancy, or options in childbirth.

Christina takes my blood pressure and my pulse at every visit, and she gives me the choice of whether or not I would like to be weighed. I always opt to be weighed because I like knowing how much weight I've gained in the pregnancy. Similar to how it's done at the doctor's, I pee in a jar and she checks my urine with one of those little strips of paper that gives information about pH and leukocytes and other things that could be indicators of potential problems. Once my belly got big enough, she started measuring it at each appointment.

I like how our appointments are casual, and if there's something I've been meaning to mention but forgot about, there's lots of time to remember. Another aspect of the care I'm receiving that I really appreciate is that I can call Christina if I have questions or concerns in between our appointments. I called her once because I had taken a bath with eucalyptus essential oil, and felt quite sick. I was concerned, because of course after I'd taken the bath I looked up eucalyptus and saw that it was contraindicated in pregnancy. She was able to provide me with information and advice over the phone. I've also called her when I've been feeling really emotional and scared that I was going to lose the baby - this has happened to me in both pregnancies around 22 weeks, and it was really nice to have a professional to talk to at length this time! I've called her with a few other concerns as well, and it's always so comforting to know that she is easily accessible.

Having my two year old son around for the appointments, in the familiarity of our own home, has also turned out to be a bonus that I didn't anticipate. He can play with his toys, get a snack etc. while we visit, and he also gets to participate in some of the 'new baby' activities, like using a stethoscope to listen to my heartbeat, measuring my belly, and listening to the baby's heartbeat with the fetoscope. I think that being part of caring for the baby while the baby is still inside me helps him to bond with the baby and feel even more excited about the birth of the baby. We are planning a homebirth, so I think it's also really great that he can get used to Christina being in our home, and it is helping to prepare him for her presence at the birth.

I believe that Christina's philosophy about pregnancy and childbirth is very similar to mine, which is that pregnancy and birth are a normal part of a woman's life, and it is better not to interfere or use interventions unless there are actual problems that need to be addressed. This is a pretty basic tenet of the midwifery model, while the medical model tends to come at pregnancy as an abnormal condition, which only makes sense because doctors are trained to address and find solutions for states of ill health. It's very relaxing for me to be working with a health professional who has a similar philosophy, because I don't feel that I have to convince her into my way of thinking or fight her about the decisions I make. I also don't feel intimidated by her; I can ask questions and express my thoughts without feeling like there is a hierarchy and I'm on the bottom. I think this sense of equality is demonstrated in something as basic as how I address her: I call her by her first name, whereas doctors are most commonly referred to by their last name with the title of 'Dr.' in front, which sets up the hierarchy before you even meet the person.

I am very happy that the health professional who will be attending the birth of my baby is someone who I have gotten to know and like, and that she similarly knows me. When I gave birth to my son in the hospital I was quite anxious because I didn't know who would be my nurse or even which doctor would be attending. And I knew that they wouldn't know me, which would make it harder for me to communicate my choices. I am eagerly anticipating birthing this child at home, surrounded by people who know me and who I know. And not having to drive to the hospital when I am having contractions is just a bonus! I trust Christina, and I think this is very important. I know that research indicates that fear can make labours longer and harder, and so I am very grateful to be able to give birth in an environment where I feel safe, and where I trust that my health professional will listen to me.

If you would like to know more about Christina and how to contact her, you can visit www.yffm.ca/midwives.htm

Clara's Birth Story

Here's a birth story that was sent to me by a friend in southern B.C. Clara is her first daughter and she was born at home this past summer.

It's interesting to read about what midwives do in other places and to see the range in philosphies. For example, Paige mentions that her midwives considered doing an episiotomy, a procedure our two Yukon midwives probably rarely (if ever) practice. As we move forward in the regulation process, we're trying to ensure that we leave as many options open as possible so that women will be able to have the kinds of births they want, and midwives with all sorts of different philosophies will feel comfortable.

Here's Clara's birth story:
The home-birth went amazingly well, and definitely because of the amazing support we've had from our mid-wives. I can't say enough about the care we received from them, and wish you all the best in advocating for them in the Yukon.

Our home birth was planned (phew!). I was at 41 weeks and 3 days, so was due for a 'non-stress test' at the hospital in the afternoon. Fortunately, we'd had an appointment the day before where the mid-wife did a 'stretch and sweep', gave us some evening primrose oil capsules (one to take orally, and one internally by the cervix) and provided the recipe for the labour 'cocktail' to help promote labour. It worked!

I had my first contraction at about 4am, although I was able to stay sleeping until about 6am when I normally woke up in the summer. My water broke at that point, although not as a big gush, so I wasn't sure of it at the time. After that, it was obvious that I was having contractions, although not in any particular regular pattern. I made up the cocktail and took that - vile, but did the trick! My contractions became quite regular by about 10am.

We called the mid-wife to cancel the non-stress test, and she came by at about noon. While all this was going on, the rest of the farm folk had gathered outside for their regular lunch, and I could hear their excitement in the background - "here we are eating lunch, and Paige is in labour up there!". I got in the pool sometime after that, and eventually got out of it again because I was too relaxed in there. After some moving around, I settled on our couch (safely covered in a plastic sheet) and fairly quickly gave birth to little Clara (who was not so little, after all!).

Our regular mid-wife had called her back-up at some point. I recall her showing up while I was in the pool, although I was too concentrated to really see her. I could hear them consulting and recording every time they monitored the baby's heartbeat, and there was a little concern that it was going slowly (I ended up pushing for nearly two and a half hours). Once I made it to the couch, the second mid-wife took the lead in coaching me, and I remember her voice cutting through and being really clear - push NOW! HOLD IT! PUSH AGAIN! I couldn't believe it when the baby slipped out (at 5:04pm).

They'd frozen my perineum in preparation for cutting, but fortunately didn't end up needing to. I tore a bit, but not badly. They also had to give me a shot of pitocin to encourage contractions to deliver the placenta, but I was on such an adrenalin rush and so relieved that labour was over, I hardly noticed. The placenta delivered fine, and they put me back on the couch with Clara on my chest where she started nursing while they sewed me up. What a trip!

Chris had started calling family by then. My mom was with us, which was great, and Chris' folks got to hear some of her first cries, which they were pretty over the moon about. That moment when you go from being pregnant to having a baby on your chest is so incredibly miraculous. I remember stroking her, hearing her crying, seeing Chris crying, telling her we loved her and were glad she had arrived safely, and just being so amazed that I was done with labour. The preparation we'd had with the midwives about labour was so helpful. I don't remember it as being particularly painful exactly, because I was able to experience it as the culminating event of pregnancy and the process of my baby's arrival. Mind over matter, indeed!