January’s over and my New Year’s resolutions are already a month old. Have you reflected on and declared any New Year’s intentions and resolutions? How are they holding up?
My 2015 intention is to speak truth about birthing and to continue championing normal physiological birth. To honour this intention I intend to write an occasional blog on the theme ‘What does it mean for birthing?’
‘Birth’ is the lens through which I view the, social, cultural and relational world around me. The query, ‘what does it mean for birthing?’ is the open-ended question that shapes my reflections and ponderings on social trends and cultural shifts and drives my passion for birth work, education and activism.
I’m a product of the 70s movement to reclaim ‘natural’ birth. I’ve held fast to my passion for championing natural birth—or, as I now call it, normal physiological birth—through the changed social and cultural conditions that have eroded birthing capacity.
I, along with many others, have become dispirited over the years as these changes have affected birth. These changes include second wave feminism, where the unintended consequence of the pushback against biological determinism was a weakening of our celebration of women’s biological power; post-modernism; commercialism; commodification; medicalization; sedentary, comfort-seeking, pain-avoiding lifestyles; and pharmacological and technological invasions into the birth space. All have had an eroding impact.
The latest ‘Australia’s mothers and babies 2012’ report (birth stats have a two-year lag time) from the Australian Institute of Health and Welfare gives little to raise the spirits of any who understand the importance of normal physiological birth. That is, who understand the importance of a birth starting, continuing and being completed by the undisturbed finely tuned hormonal physiology shared by the mother and baby.
[For those of you not convinced of this importance please check out Dr Sarah Buckley’s recent report: ‘Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies and Maternity Care’.]
Here’s just a glimpse of what’s happening according to these latest Australian stats. Firstly, let’s look at the onset of labour, the beginnings of the intricate hormonal birth dance between the mother and baby. According to latest figures only 55.6% of births start spontaneously, 26.3% are induced using synthetic hormones and 19.4% are elective caesareans without any flow of birth hormones involved at all.
Next, what happens during the labour itself? Well, of the 55.6% of births that start spontaneously, a third of these go on to be augmented or speeded up with synthetic hormones. Medical pain relief is used by 76.5% of all women who labour (86.7% for first labours) and if we add in the 19.4% of women having elective caesareans the reality is more like 81% of all births involve medical pain relief. Now obviously some of this medical pain relief is an absolute necessity, but so often it comes down to medical pain relief just being the default setting in our birth culture.
[For more discussion on this, as well as pain, power, pain dynamics and support issues see my book ‘Birth with Confidence: savvy choices for normal birth’.]
Now, onto the actual method of birth: the caesarean rate over all is 32.4% (elective and emergency), leaving 67.6% vaginal births. However instrumental vaginal births (forceps/vacuum) are 12.4%, leaving a non-instrumental vaginal birth rate of only 55.3%. But even that low percentage does not represent the figures for normal physiological birth as that 55.3% non-instrumental vaginal birth figure can include any or all of the following interventions and disturbances: induction, augmentation, synthetic hormones, medical pain relief, continuous fetal monitoring, scalp electrodes, just-in-case antibiotics, episiotomy, and so on.
Finally, what happens with the delivery of the placenta and the precious moments of surging hormones facilitating the loving gaze, bonding and breastfeeding? Well the stats don’t cover whether this third stage of labor unfolds physiologically or is routinely managed as a medical procedure involving synthetic hormones and disturbance of those precious moments of the mother’s and baby’s earliest connection. Perhaps the report doesn’t bother to mention it because it’s pretty well medically managed across the board.
So you see that not too many mothers and babies get through with anything looking like normal physiological birth. We are well and truly playing around with the biological, physiological foundations of human birth and by default of bonding and breastfeeding.
What does this mean for birthing?
It’s definitely not an encouraging picture. In fact, it’s so discouraging that we might say that normal physiological birth is now an endangered activity and place it alongside all manner of other endangered activities, species and habitats.
In Australia, we have to estimate the rate for normal physiological birth—where the birth starts, continues and is completed by the undisturbed finely tuned hormonal physiology shared by the mother and baby—because it doesn’t even register in these official stats. The best estimate for normal physiological birth is only 1 to 5%. (I’m basing this estimation on adding together the figures for births that we can probably assume are close to normal physiological birth: birth centre births, 2.3%; home births, 0.4%; and ‘back seat of the car’, ‘nature strip’, ‘door stop’ births and the like, that are officially documented as ‘other’ in the stats, 0.4%.)
So I definitely feel we can call normal physiological birth an ‘endangered human activity’.
You may already know about the IUCN: International Union for Conservation of Nature’s ‘red list’ of endangered species. Their red list describes vulnerable species along a continuum: ‘least concern’, ‘near threatened’, ‘vulnerable’, ‘endangered’, ‘critically endangered’, ‘extinct in the wild’ and ‘extinct’.
Well, I’ve taken liberties with their continuum and adapted it to represent the present state of birthing in Australia and many other developed nations.
Normal physiological birth, it’s a clumsy phrase I know, but at the very least it needs naming … normal physiological birth, normal physiological birth, normal physiological birth … it also critically needs all the passionate championing it can get.
A call to action is urgently required, so I’m borrowing from these words by poet and social activist Drew Dillenger in his powerful poem and call to action on the environment –
‘Hieroglypic Stairway’ – Drew Dillenger
It’s 3.23 in the morning, and I’m awake
Because my great, great grandchildren won’t-let-me-sleep
My great, great grandchildren ask me in dreams
what did you do, while the planet was plundered?
what did you do, while the earth was unravelling?
surely you did something, when the seasons started failing
as the mammals, reptiles, and birds were all dying?
did you fill the streets with protest when democracy was stolen?
what did you do
‘Birthing Urgency’ – Rhea Dempsey
Drew, I too am awakened at 3.23 in the morning
because my great, great grandchildren won’t-let-me-sleep
They implore me in my dreams
what did you do while our instinctive birthing legacy was plundered?
what did you do when the biological, hormonal foundation of human loving connection was unravelling?
surely you did something when women’s bodies started failing
as physiological birth, bonding and breastfeeding were dying?
did you fill the streets with protest when women’s birthing power was stolen?
what did you do