What birth needs now...

Writing this article I was reminded of that song that says 'what the world needs now, is love...'. Maybe what birth needs now is love....

I recently read an article written by the Australian Medical Association, its title was ‘Maternity care needs to be obstetrician led’. Even without reading the text my immediate thought was ‘NO NO NO!’. I went on to read the article and my thoughts didn’t change.

And I have now just read an article about a device that has been developed to help better detect a baby in distress. My first reaction to this was – “how about we stop distressing these babies by not inducing labour without a clear medical need?”. Yes intervention is sometimes warranted, but not on the scale we currently have. This device needs to be used in established labour and is used to test the baby’s blood to detect low oxygen levels, so it won’t help distinguish between those who need to be born before labour starts.

Going back to the first article - ‘midwife’ means ‘with woman’, and obstetrician means ‘to stand by’. Obstetricians were ‘invented’ to help those who needed medical intervention to save their lives during labour and birth. Midwives have been trained to look at pregnancy and birth as 'normal' and so if something looks 'abnormal' they will ask for help. During their training obstetricians will usually only be called to assess a pregnancy or birth that is looking 'abnormal', and so they start to think that all pregnancy and births will have issues (because that is all they have seen).

I understand this personally - having worked in NICU for 5 years before training as a midwife I thought all babies were born with issues and so the first few births I attended I found that I was watching the baby waiting for them to show signs of being sick!

And I can guarantee you that even if you employ a private obstetrician it will be a midwife who will care for you during labour and afterwards.

Secondly, the females of our species have been giving birth since we first evolved. Yes, babies and mothers died, just like all animals do. But do you know what? The species has survived, and even thrived. They didn’t die in such high numbers that our species was on the verge of going extinct before doctors started intervening. Places like India, Africa, and China wouldn’t have populations over 1 billion if we were.

I have worked in Ghana and Sri Lanka – the vast majority of women and babies survived. In fact, in 3 weeks in each place I didn’t see a single mother or baby die - I saw over 40 women give birth in each place, some with twins. And the care was midwifery led (the majority of the time in Sri Lanka the doctor was sitting at the desk with his feet up playing games on his phone)….

Recently I saw statistics released by the NSW Department of Health (the information was based on 2017 reports). Caesarean sections and inductions have increased in the last few years. HOWEVER, the perinatal death rates have NOT decreased. They have remained steady at about 8 in 1000 (perinatal deaths include stillbirths and babies dying in the first 28 days of life). And in fact, according to other statistic recently released, the rate of Apgar scores less than 7 has increased, meaning that more babies are being born in distress.

The increase in caesareans and inductions are often blamed on healthcare providers trying to reduce perinatal deaths and poor outcomes….however, these statistics say to me that it is just not working, and it might in fact be causing more harm.

A colleague I was venting my frustrations to recently asked “but has this increase in intervention caused an increase in adverse outcomes?”. So in the interest of providing an honest summary I have gone back to the stats and looked at the postpartum haemorrhage rates and maternal death rates. They have remained the same. But I don’t think we should be getting too excited about this. Just because the initial outcomes are ok doesn’t mean we should continue. And I’ll add here that the USA has high rates of intervention and they are one of 3 countries where the maternal death rate is increasing – the other 2 being Afghanistan and I believe Ecuador….

Surely we want to improve outcomes, not just keep them the same? And if the increase in intervention isn’t working then maybe it is time to look at a different approach. (Isn’t the definition of insanity doing the same thing over and over and expecting a different outcome?)

And what about the long term physical and mental health of the mother and baby? The issues that maybe stick around for months or years, or only present themselves later on in life? Issues that are beyond the reports these stats are based on and our currently understanding.

Michel Odent has a theory that all the synthetic oxytocin use is actually changing the biology of our species. Natural oxytocin is released from the pituitary gland, and during labour ‘bathes’ the mother’s brain which causes us to feel love and bliss (as long as she also isn’t fearful of the labour and birth and therefore releasing large amounts of adrenaline, which will counteract the oxytocin - to read an article on oxytocin vs adrenaline click here). Synthetic oxytocin might be the same on a chemical level, but it is inserted into the mother’s blood via an IV and does not cross the blood-brain-barrier. Therefore, it doesn’t give the same ‘blissed out’ or loved up feeling (I often tell my HypnoBirthing couples that I’ve never heard of it being used to induce orgasms ;) ). He theorises that natural oxytocin will also work on the baby’s brain the same way as the mother's, but synthetic oxytocin does not. However, studies to prove or disprove this theory would take decades to do. And who would it benefit? Certainly not the pharmaceutical companies that make synthetic oxytocin….

Studies into the gut microbiome are also starting to emerge, and that gut health may be directly linked to mental health. What if the increase in depression, allergies, and autism (just to name a few) has been caused by our interventions during birth? And before you say 'I had a C/S and my child is fine', look up epigenetics - it might not affect your child but their child.

During a seminar on physiological birth vs inductions, the presenter Rachel Reed (a midwife with a PhD) said that studies into low intervention births, or improving outcomes by not intervening, on the scale needed to change practices, will probably never be done because studies cost money and no one really wants to fund studies that isn’t going to make them money afterwards (ie in the sale of medical devices or drugs).

However, studies have been done into the outcomes of midwifery led care. And these have shown time and again that this type of care improves outcomes for mothers and babies – they reduce stillbirths, preterm birth, and low birth weights. If you examine the statistics for homebirths and midwifery led birth centres you will find that their C/S rates are often significantly lower than the national average, and their rates of Apgar scores are high, and their perinatal death rates low.

So perhaps what we need is not more intervention, but in fact less. Yes, having doctors on standby, and the ability to intervene should something happen, is great, but we need to stop thinking of birth as a medical event, and rather as a natural one that occasionally needs medical intervention.