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Where do animals go to give birth?
They go to a warm, dark, safe and protected area. A private place. They seek shelter and safety. They seek peace and protection. Why do animals go to a safe protected calm place? Two purposes: to feel secure and safe enough to let their bodies give birth, and to protect and nurture their young. They are both in a vulnerable condition, not able to protect or defend themselves from predators, so must be in a place that provides that safety and shelter.
But where do people generally go? To a big scary building, with bright lights and lots of noise and activity. There are beeping machines all over the place, and wires, lines, and monitors placed all over you. You look like someone who is in grave danger, with some horrible disease going on. Rather than the peaceful, calm, secure, dark, warm environments our animals go to give birth in, humans go to places where we prey upon our mothers and babies. We put them in positions that stall their labors, do things to them that make them afraid and incapacitate them to do the work of birth, to do the things that are built into them to do. We incapacitate them from doing the work of birth and then call birth incompetent. Then we conclude that it needs medical intervention to be accomplished.
Why do we need to advocate so hard just to be “normal”? We have lost the image of what it is to birth and be a mother. We have to look to the animals. We have a higher functioning brain but unfortunately we have used it in harmful, rather than helpful, ways. When we or the animals are put in a scary place, what do our bodies do? Think of the fight or flight hormone. Adrenaline. What does it do physiologically? Competes with the same binding sites on the uterus as oxytocin. What does oxytocin do? Makes contractions, which are what does the work of birth to dilate the cervix and expel the fetus. So we stall our labors.
What do people do emotionally when put in a scary place or have scary things happen to them? They get scared. What do we do when we are scared? We want to end the scary thing or get away from it. So our attitude towards birth is like this. We are already afraid because it involves something uncertain and something we do not control. Uncertainty and lack of control are the two things that give rise to fear. And then we go to places that are scary and have scary things done to us by scary people and we make women more afraid. And so we increase adrenaline and further stall the natural process of birth as well as undermine maternal confidence.
The medical community it appears has to take over this event to make it safe and make it happen and in so doing in actuality we make it less safe and less competent. So we take over the work of birth once we have disabled the woman and disabled her body. And now that we have disabled them and taken over we have reframed birth itself as a scary and incompetent process and women themselves incompetent for this process so you must have it done for you. And you must be removed from the process. What do women do now once they are so scared and the process considered medical? Go to the hospital as soon as possible and get drugged, get anesthetized, or get surgery. When do we get anesthetized? When something happens that we cannot possibly go through such as surgery: having a lung removed or an appendectomy or something. What does getting drugged or anesthetized do to labor? Stalls it, so that it needs medical intervention. All these things: 1. Getting to the hospital early… 2. Getting drugged and anesthetized… …show higher rates of cesarean section. Why? Because you have things done to you that stall labor and increase intervention!
We will look at one example of the results of an unnecessary intervention in labor: continuous electronic fetal monitoring. When studying electronic fetal monitoring, just electronic fetal monitoring, we see that it can be an unnecessary intervention that leads to bad outcomes. Why? Because we see things on the monitor tracing and then do things we wouldn’t have done otherwise. We know that continuous electronic fetal monitoring (EFM) does not decrease the rate of perinatal complications and death, compared with checking the baby’s heart rate intermittently, and does increase the rate of cesarean section and operative delivery (vacuum extraction and forceps).
Studies show that there is a clear and consistent increase in the rate of cesareans and operative vaginal deliveries for mothers who have continuous EFM, with no clear benefit for babies (Goer et al., 2007; Thacker & Stroup, 2001). In most cases, continuous electronic fetal monitoring severely restricts maternal mobility, and it almost always restricts access to comfort measures like a shower, bath, or use of a birth ball. Both the governing organizations for obstetricians (ACOG, 2005) and the governing organization for obstetric nurses (Association of Women’s Health, Obstetric and Neonatal Nurses, “AWHONN,” 2008) recommend intermittent auscultation rather than continuous EFM for healthy women with no complications (JOGNN 2008, vol 37, issue 1), (AWHONN 4/2000).
Indeed, even the governmental agency called the United States Preventative Services Task Force, says:
“Routine intrapartum electronic fetal monitoring is not recommended for low risk women. There is insufficient evidence regarding its routine use in high risk pregnancies. Despite the lack of evidence on its positive impact on health outcomes and the 1996 USPSTF recommendation against its routine use, intrapartum electronic fetal monitoring has become common practice in the U.S. Based on currently available evidence, the USPSTF believes that updating its 1996 recommendation would have limited potential impact on clinical practice. The USPSTF will not update its 1996 recommendation.” This doesn’t seem to matter – that the governing organizations for obstetric practice recommend against routine continuous monitoring, and that a governmental agency for healthcare quality also recommends against it – it is still rampant and commonplace because obstetric practice is driven by fear. Fear of litigation, and fear of bad outcomes. The strange thing is that when we practice based on fear, we end up getting what we fear. (See above.) What is being dragged into court to testify against the obstetricians? Precisely the fetal monitor strip! So why are we fueling the enemy?
To summarize, typical obstetric care has the laboring woman disabled by being stuck in bed and incapacitated by being stuck on the monitor. Then we call this normal labor care but in reality she cannot do the work of birth. We increase her fear, etc. We see there truly is no benign intervention in labor. Everything we do to birth has an effect on the process, and an effect on the person.

(c) Marie Farver RN, BSN, IBCLC, RLC 2013

References:

  1. ACOG, July 2009: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. ACOG Practice Bulletin No. 106. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;114:192–202.
  2. Fetal Health Surveillance: Antepartum Intrapartum Consensus Guideline, No. 197 (Replaces No. 90 and 112), September 2007, SOGC CLINICAL PRACTICE GUIDELINE, Society of Obstetricians and Gynaecologists of Canada
  3. THE AMERICAN COLLEGE OF NURSE-MIDWIVES, Number 9, March 2007, Journal of Midwifery & Women’s Health: Intermittent Auscultation for Intrapartum Fetal Heart Rate Surveillance
  4. Evidence-Based Maternity Care: What It Is and What It Can Achieve; Childbirth Connection, Reforming States Group, and the Milibank Memorial Fund. Sakala, Corry; 2008.
  5. The US Dept of Health and Human Services: Agency for Healthcare Research and Quality: U.S. Preventive Services Task Force; Screening: Intrapartum Electronic Fetal Monitoring. 1996, 200
  6. FP Notebook, 2002, Efficacy: Continuous Electronic Fetal Monitoring (CEFM)
  7. Journal of Midwifery and Women’s Health, Vol 45 No 6, Nov/Dec 2000. FHR Monitoring: Interpretation and Collaborative Management, Fox, King, Parer, Kilpatrick.
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