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.

Lessons from the Freebirth Movement

I just finished reading the dissertation Born Free: Unassisted Childbirth in North America by Rixa Freeze, PhD, of Stand and Deliver. All 300+ pages of it. It was very interesting. I have understood for quite a while that some women give birth unassisted because they feel forced into it because of a lack of acceptable options (such as for a women who is going for a VBAC but the hospitals in her area have "banned" it, and DEMs are illegal in her state, or other situations like that) I used to not understand why some women choose unassisted birth (also called "freebirth") when a midwife-attended homebirth would be an option for them, though I always respected their right to choose it. I am ione who would, in the face of limited options, find the best attendant for a hospital I could and fight for the kind of birth I wanted over choosing to "go it alone" at home. Rixa's dissertation gave me insight into the way unassisted birthers think. Here are a few things I learned:

1) UCers believe, as do others in the NCB community, that intervention in the birth process increases the risk of complications occurring. Unlike the rest of the NCB community, they include things other than medical procedures as interventions. Instruction, support, or even the mere presence of a caregiver is seen by the UC community as disruptive to the birth process.

2) UCers highly value intuition. They believe that the parents of the child should be responsible to make all decisions about the birth. They trust that as they birth alone and as focused as possible on their bodies, intuition will guide them to seek out medical help if a need arises for it, which prevents anyone but them from deciding that an intervention is necessary.

3) They believe midwifery is misguided--midwives are trained to "do" too much at births. They also take issue with midwifery being a paid profession. They believe that ideally, birth knowledge would be freely shared among women so every woman can be her own midwife. There would be a few trusted experts who would sometimes provide assistance, but as a service and not a job.

There is a lot more in the dissertation, and I recommend reading it to anyone who is curious about it. I'm still not planning on having any of my own babies unassisted, but I do feel like I understand better where women who do it are coming from. Reading it also got me to think about some things I'd never thought about--questions about what role I would want a midwife to fill at a homebirth. Would I want her to coach me or stand back and watch? Be in the other room? Do I want cervical checks, occasional fetal heart monitoring monitoring, suctioning, etc? I always figured, if I had a homebirth, I'd avoid "unnecessary intervention" by being away from the hospital, but Rixa's dissertation helped me see that there is more to it than that.

So, Rixa, if you ever read this, thanks for sharing your dissertation and all of the insights in it.