Thursday, June 9, 2011

Midwife? What happened to the hospital?

In the first post, I casually mentioned that we had chosen to get our prenatal and birth care through the Birth Center of Gainesville. Here I'll explain a little bit more in detail the reasons behind this.

The history of obstetrics, especially in the US, is fascinating*. Midwives, grannies, and other such sage-femme have aided women in giving birth at home (either in the house or quite nearby) since the beginning of mankind. To be certain, it is uneasy work giving birth to a human baby through these little hips suited to walking upright, though notions of how it should be treated have shifted dramatically in the past century and a half. After English settlers arrived to New England and set up shop, they existed for a century without any medical schools. Because of this, colonial Americans were going back to Europe to be trained as physicians, then bringing those skills to the colonies. This was great, though combined with the smear campaign against midwives as "witches" and doctors' meager  experience with live birth, these changes effectively had women checking into "lying-in" centers and hospitals. For some statistics: in 1900, 95% of US women gave birth with the aid of a midwife at home. In 1945, half of US women were giving birth in hospitals. In 1960, that number had reached 99%. Now, it hovers around 95% after the natural birthing movements of the 1970s and 1980s.

Maternal deaths in the ages of midwives hovered around 1% or much less, depending on the culture. In early US "lying-in" centers, they reached as high as 5% (on average, some hospitals were much higher) due to misunderstandings of disease and how it is spread. This is not to say that giving birth in a modern hospital is terrifying or even dangerous. In fact, it is quite safe, and can be comfortable. However, the road to modern obstetrics and the loss of trained midwives has taken its toll on our culture and how we think about birth. My insurance covers it "as any other illness."  Some doctors continue to see birth as a condition that must be overcome with medical aid; it is far from that. 

*Most of my numbers and facts have come from Birth: The Surprising History of How We Are Born by Tina Cassidy.

So, how can we use that information to make the best decision? This time, I started with stories. Stories?

Whether you are a humanist, a Christian, a communist, or even a "Birther," you have to know that womens' bodies were designed to be able to give birth. In general, women give birth through a series of hormone signals, muscle contractions, some will power, and a little bit of magic. Therefore, it can't be all bad. The first thing I wanted to do was find the positive birth stories - not the tragedies, not the horror stories, not the "barely remember it" ones. There are very positive birth stories from women in all walks of life, giving birth in many different ways both in hospitals and elsewhere. Women feel empowered and in awe after giving birth in positive environments.

In my reading, I have come across some factors common to all the positive birth stories. Here they are:

- the woman and her supporters believe that she can do it, and that her body is capable
- the environment was relaxing and supportive enough to allow labor to progress
- very few interventions were needed

So, that is what we want. We'd like to have a supportive environment in which I (Alison) am supported in my capacities, and where I can relax. We'd like enough time, and intermittent (rather than continuous) monitoring, by a single person. We'd like short recovery time and unlimited bonding time. We'd like to honor the midwives throughout history and here in town. Most of all, we'd like the least distress and the best chance for little baby Rickshaw who will challenge and delight us. And we think these things will be most possible at the birth center.

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