Sunday, May 2, 2010

Birth Attendant as Lifeguard

Clarification: I use the term "birth attendant" here to describe a maternity care provider such as a physician or midwife, not a doula. I don't often use this term, but I must have subconsciously chosen to use it while writing this post because it is most appropriate for the role I was trying to describe, the midwifery model's idea of a caregiver who "attends births" rather than "delivers babies."

Since writing my last post about lessons from the freebirth movement, I have been thinking more about the roles of birth attendants. A guest post at The Gift of Giving Life (one of my favorite blogs) written by Heatherlady called On Cows and Chickens, got me thinking even more.

I believe that women are created to be able to birth their babies. I have read a lot about how hormones control birth and how negative emotions affect hormones and thus interfere with birth. I think that when a birth attendant interferes with the delicately balanced natural process of birth, they risk doing more harm than good. And interfering can probably happen easier than we sometimes realize.

People who believe strongly in the natural process of birth, including unassisted birthers, often compare birth to other normal activities that have some small level of risk associated with them, such as driving a car, playing a sport, etc. They argue that we don't need immediate access to medical technology while doing these things, so we shouldn't need it for birth.

My husband hates analogies because people sometimes use things that are not similar enough to make a good comparison, and I often agree (for example, unmedicated childbirth is not like getting teeth drilled and has nothing to do with hitting yourself with a hammer). However, occasionally, I find a good anaolgy. One such analogy, which I originally got from the Hypnobabies program, compares the birth attendant to a lifeguard.

Although birthing is instinctual and swimming is a learned behavior for humans, there are still a lot of similarities between the two. Swimming is an everyday activity, and the risk of drowning is quite low. The website for the International Life Saving Foundation(ILS) cites a drowning rate of 1.2 million people per year. Worldwide, swimming is statistically safer than childbirth, as the World Health Organization statistics from 2005 give a stillbirth rate of about 3.3 million, and a neonatal death rate (during the first 28 days of life) of over 4 million (WHO World Health Report). Worldwide maternal mortality for 2005 was 536,000 (WHO maternal mortality)

Most people who know how to swim feel confident and comfortable doing so freely without immediate access to medical technology. We are cautious with our young children, for whom the risk of death is greater ( the ILS website states that children make up more than 50% of drowning victims). But with the proper precautions (such as careful supervision and use of flotation devices), swimming can be safe and enjoyable for young children as well.

Despite the relative safety of swimming, we have people trained to attempt to make it safer. According to the ILS website:
The terms “lifesaver” and “lifeguard” are used around the world to describe individuals with special training who are stationed to prevent accidents and to respond to life-threatening emergencies in the aquatic environment.
My older brother used to work summers as a lifeguard at one of the community pools in the area we lived. His job involved watching swimmers to make sure they were safe and reminding them the rules that would could protect them from danger (things like no running, no diving in the shallow end, and making sure the area below the diving board is clear before diving). He had special training and certifications for the job, and was paid for it. Life guarding is often over-dramatized in movies and television, where they are always jumping in to save people and doing CPR. My brother never had to rescue anyone, he mostly sat on his tower all day and worked on his tan, but he could have saved someone if he needed to.

The ILS website estimates that those trained in their lifesaving skills make over 1 million rescues a year. Considering the drowning rate of 1.2 million per year, that means they cause a significant reduction. Parents who take their children to a pool with a lifeguard might feel some assurance knowing that there is an extra layer of safety there--an extra pair of eyes watching for danger, someone who is trained in rescue swimming and has current CPR certification.

I like to think of a good birth attendant as being like a lifeguard. They are specially trained professionals who have the skills to save lives when things go wrong. Occasionally, they may remind a birthing mom to breathe deeply or help her relax, but mostly they should sit and watch for signs of problems. "Watching" could possibly include a variety of things (checking hearttones, recognizing pathological labors, checking for tears, monitoring blood loss, ect.), but it should not include routine unnecessary medical intervention (e.g. elective induction, IV drips, pitocin augmentation, artificial rupture of membranes, etc), telling the mother how to birth her baby, or making decisions for her. In the event that there are complications, birth attendants can save lives (by helping get shoulders unstuck, giving pitocin for bleeding, resuscitating an oxygen-deprived newborn, ect.) much like a lifeguard, but if lifeguards were to jump in and pull people out of the water who didn't need saving, they would likely interfere with people learning to swim on their own and ruin people's swimming experiences.

1 comment:

  1. In some respects I do like the comparison between life guard and midwife, in particular with respect to mainly watching and to be there and offer professional help in the - rare - event that something goes wrong. And this is probably the main point of your post, so agreed on that.

    Other aspects of your comparison I find less agreeable, because they do exactly what your husband dislikes, namely "use things that are not similar enough to make a good comparison". In particular the sentence "Worldwide, swimming is statistically safer than childbirth" disturbs me somewhat, being based on the fact that per year more people die during child birth than due to drowning. Firstly, you would have to look at the numbers in relation to the number of people engaging in the activity, and it may well be that the number of people giving birth all over the world each year is quite different from the number of people who swim. If you don't take that into account, you would probably come to the conclusion that BASE jumping (where people throw themselves off buildings and cliffs with a parachute) is much, much safer than both swimming and child birth, as actually comparatively few people (in absolute numbers!) die during this activity.

    That aside and more importantly though, drowning is in most cases not a result of swimming, but exactly the opposite: People drown because they don't/can't swim, and in most cases the reason for being in the water in the first place is not an intention to "go swimming" but an accident like falling into the water. So you can't really say much about how safe swimming is as an activity by the number of people who drown, because most of them weren't actually "swimming".

    OK, enough ranting now. I do understand what you're trying to say and I completely agree - and I really like your blog, so keep up the good work! :)