Wednesday, January 10, 2007

Extreme childbirth

Mama Mid(Wife) Madness has transcribed a recent article from The New Scientist magazine of Jan. 6, entitled Extreme Childbirth: Freebirthing. It reports on unassisted childbirth, and also includes a great deal of information about homebirth in general.

You can read the article here.


There were several parts that I found relevant to our discussions about homebirth. For example, the freebirthers (to use the term that the article uses) insist that they are giving birth in the "natural" way:
So do the freebirthers' claims stack up? Are they in fact giving birth the natural way?..

"Birth is not as simple or straightforward as it is in other animals," says Wenda Trevathan, a medical anthropologist at the New Mexico State University in Las Cruces. "Freebirthers say birth is inherently safe and relatively painless provided you don't interfere by using doctors or midwives" The shape of the pelvis may have led to another feature of human births.Thanks to the twisting and cramped interior of the birth canal, human babies, unlike those of other primates, tend to turn mid-birth and exit the vagina facing their mother's spine. This makes it harder for the mother to clear mucus from the baby's mouth after its head emerges. And if she pulls the baby out too forcefully she may bend the spine and neck against its natural curve.

That's why Trevathan argues that some form of birth attendant may have been de rigeur since bipedalism began to evolve 5 million years ago. "In most cases, the mother and the baby benefit from some form of assistance," she says.

A glance through anthropological studies reveals that in almost all hunter-gatherer cultures, women tend to have some form of birth attendant. Even among the !Kung people of southern Africa, who say the ideal birth is a solitary (and silent) one, in practice women usually have help, at least until they have a previous birth or two under their belt.Of course a birth attendant who merely helps the baby out and clears their airways hardly requires midwifery training. But it does suggest that freebirthers who set their hearts on complete privacy may be striving for something that rarely happens "in nature".
So freebirthers are passionately committed to their own version of "natural" childbirth and yet there is no evidence that freebirth occured in nature. Freebirth is a social construct of a very small subgroup of people. Simply put, they made it up.

Homebirth advocates have done something very similar. Their concept of "natural" childbirth is also made up. Childbirth in nature never included prenatal care, blood pressure monitoring, fetal heart checks, resucitation equipment, etc. It never included waterbirth and it never included allowing children to be present. Kaptchuck pointed this out in his article about the persuasive power of alternative health: 'The metaphor is pliable, relative, and honorific; anything in the alternative alliance is allowed this approbation. Thus, acupuncture needles, megavitamins, and meditation are all "natural."' Similarly, "natural" childbirth includes decidedly non-natural practices. Basically, all it takes for something to be considered "natural" is for it to be countercultural. That culture can be the medical culture or the larger culture.

Is birth in nature inherently safe?
What does happen in nature? The World Health Organization estimates that worldwide 15 per cent of labours have a life-threatening complication. It has also been estimated that the "natural" rate of maternal death from childbirth is between 1 and 1.5 per cent [That's 1000-1500/100,000 as compared to less than 10/100,000 in the US, more than 100 times higher!]. The biggest risk is uncontrollable bleeding, even when women give birth in hospital.

Birth is even riskier if it is you that is being born: in some developing countries the neonatal death rate can be 10 per cent [That is 100/1000 compared to approximately 7/1000 in the US, more than 12 times higher]. The chief danger to the baby is lack of oxygen, for example due to blood flow through the placenta being restricted in a long and difficult labour.
As I have argued repeatedly, birth in nature is inherently dangerous.

On the importance of the Johnson and Daviss study:
One of the biggest and best studies in this field was published last June,(BMJ, vol 330, p 1416). It attempted to follow every North American woman planning a home birth under the care of a certified midwife in the year 2000 and ended up including 5418 births. No mothers died and the infant death rate was 1.7 per 1000 - a similar figure to low-risk hospital births in the US. Home-birth campaigners have hailed these results as vindication of their stance. Critics, on the other hand, point out that 12 per cent of the women had to be transferred to hospital, usually for maternal exhaustion or because their labour wasn't progressing. And 3.4 per cent were admitted as an emergency, mainly for fetal distress or maternal haemorrhage.
That does not even take into account the fact that Johnson and Daviss used the wrong comparison group to make the homebirth data look better. At a minimum, the neonatal death rate at homebirth is more than double that of hospital birth.


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