Offering Better Choices for Childbirth (by Anna Almendrala)
In the first weekend of June I watched some au naturel how-to videos on the oldest profession in the world.
Anyone who's read The Red Tent, by Anita Diamant, knows that I'm talking about the ancient practice of women supporting other women in childbirth. The assisting woman, whom today we would call either a midwife (medical training) or a doula (comfort techniques training), makes her first appearance in the Bible in Genesis 35 for Rachel's labor with Benjamin. And everyone knows of the heroic midwives Shiphrah and Puah, who in Exodus 1 defy the pharaoh's orders to kill every Hebrew male infant they deliver.
I'm trying to get my DONA doula certification, a process that, on average, takes about two to three years to complete. I took my first step toward certification with a doula childbirth class from a modern-day Shiphrah named Marilyn Hildreth. She's attended more than 4,000 births, both as a registered nurse and as a certified doula. When she talks about women's rights in the birthing room and best practices for the health of the baby, her eyes get bright and her voice trembles slightly. You could say she's passionate. All weekend long we went over the stages of labor, analyzed medical care standards, and practiced comfort techniques such as massage, laboring positions, and verbal encouragement. We also watched a lot of freaky birthing videos.
Better labor experiences for women mean a lot to me. It wasn't until a few years ago that I asked my own mother about the story of my birth. She said it was something so frightening and painful that she wept with fear in her heart when she found out she was pregnant with my younger sister. For women who could pay, Filipino urban hospitals in the mid-'80s were paragons of Western medical practice. Everything was scrubbed, shaved, and sanitary, and my mom received every industrial-world benefit she could have hoped for: her own room, an epidural, and an enema. After 24 hours of numb, lonely (no dads in the room!) labor, she was too exhausted to deliver me so the doctor cut into her vagina (an episiotomy) and used forceps to pull me out. While she slept, I was scrubbed clean and sent off to the nursery. It was hours before she could get up to see me.
Her testimony may not shock most women who read this blog, but after my DONA training I know that a doula by her side would have made a world of difference. Doulas have been credited with reducing the length of labor by more than 50 percent, reducing epidural use for pain relief by more than 85 percent, and reducing forceps use by more than 65 percent for every birth they attend. Massage isn't the only thing responsible for these rates. Women who employ doulas also receive education on their rights in the delivery room and the benefits, risks, and alternatives to hospital protocol before the birth takes place. That way, the birthing woman has more control over her own body and labor, as opposed to feeling trapped by a doctor-patient power dynamic in the heat and chaos of a delivery room. Quoting John Kennell, M.D., from the book Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth, Marilyn claimed that "if a doula were a drug, it would be malpractice not to use it."
If you haven't yet, I encourage you to talk to your own mother about the story of your birth. You'll be surprised at what you find out. If you're a mother yourself, please consider this blog a place to share your own childbirth stories.
Anna Almendrala is the marketing and circulation assistant for Sojourners.
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Comments
actually, there are professions much older than "women supporting other women in childbirth." it seems that farming (if we are sticking to a strict biblical history) is first since Adam had to become one when they were expelled from the garden.
prostitution is a lot older than being a midwife as well. we see it much earlier than Genesis 35.
anyway... assisting in childbirth is a noble profession. i just think that, whenever possible, a medical doctor should also be present in case of any complications, which a trained midwife cannot handle, arise. let's not forget that many women still die during childbirth (even in the U.S. i think it is like 40 a year) not to mention all of the other possible things that can go wrong.
Posted by: dave | July 18, 2008 10:44 AM
I can't even put into words how excited I was to pull up "God's Politics" on my feed reader and see a post on childbirth!!
Dave has a good heart, just not much education on the area of natural childbirth. I think that's quite common. The average person assumes it's safer to have babies in hospitals, when, in fact, research shows that it's safer to have a natural birth attended by a mdiwife. If needed, you can relocate to a hospital with plenty of time - because you have a trained person already with you to determine your baby's needs. Even if you're in a hospital for your birth, you will have fewer complications if you utilize a doula or midwife to keep your birth as natural as possible.
God made us to give birth. Sometimes things go wrong, but that's not the norm. It's when we mess around with it that we complicate things more (on average).
Childbirth is a wonderful example of God making our bodies to work naturally in His world. It's miraculous.
Christine
www.welcometomybrain.net
Posted by: christine | July 18, 2008 11:13 AM
Timely blog, Anna! In a time when the rights of a mother to give birth as she pleases are being decided by the AMA and state nursing boards and when women are increasingly unaware of the difference a doula's presence makes.
Both of my deliveries were attended by caring and nurturing midwives and my best friend, a doula, attended the first. Unfortunately for me, a birthing center was not option because it was a luxury for those with really, really good (expensive) insurance which is not possible for the self-employed. Home births are against the law in my state and I now regret that I did not just break them and say "oops!" Anyway, I appreciate your perspective and am excited to share this with others.
Posted by: Leah | July 18, 2008 3:18 PM
Great article, Anna! After having one birth in a hospital and two at home with a midwife and doula, I know that EVERYTHING goes much better when you feel comfortable, loved and listened to. The births of my last two children (at home) have been powerful spiritual experiences. Without medication and trusting in myself, the God who created me, my supportive husband, knowledgable midwife, and comforting doula, my children's transition into this world was so peaceful and beautiful. It was important to me not just to know the people who would help me give birth, but to love and respect them. Being able to be in water helped immensely. One of our childen was born in the water - very amazing! Anyone interested in natural birth or at-home birth should read Ina May's Guide to Childbirth, by Ina May Gaskin. I hope and pray that someday women in America would have as many birth options as women in Denmark do. (and yes, we did have a hospital 10 minutes away as a back-up).
Posted by: Jolene | July 18, 2008 5:29 PM
I am a certified doula (or CD - CBI) and a fellow journeyer on this road with Christ.
A couple of clarifications for those who might not realize: First of all, there is a difference between the role of a midwife and an OB. A midwife is a trained medical professional, whose 4-year training involves learning as much as possible about natural childbirth and when to natural childbirth becomes pathological. An OB is a medical professional, whose 6 - 10 year training involves learning as much as possible about the pathology (or 'what goes wrong') of childbirth. They are very good at intervening when things go wrong, but they may or may not be well trained in the art of giving birth without intervention. (Please note, this is a generalization - there are some amazing OB's out there who totally get this!) Unfortunately for some of the 40 women who die in the US during childbirth each year, their deaths are CAUSED by the interventions some OB's insist on (including the use of cytotec to induce labour).
The second comment is the difference between a midwife (see above) and a doula. A doula is a trained support individual. Her focus is on the emotional health of the mother - before, during and after the birth - and on assisting the mother to make informed choices about her care. Her role extends to providing physical comfort through presence, massage, positional changes, mental imagery, etc. She does not check fetal heart tones or cervical dilation.
All that being said, I applaud Anne (and the thousands of others like her) for becoming a doula. Women need doulas. But I think we can take our theology of the significance of doula's a little bit further. Jesus said, "For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and in prison and you visited me." (Matthew 25:35-36)
Because of the breakdown of extended communities - and even of individual families - many women facing childbirth in North America today do so alone. We see childbirth as messy and inconvenient - in some States in the US women are only given 6-12 weeks' maternity leave. There are often few family members (or church family members) available to encourage and support the mother on bedrest for three months, or the mother sleep deprived with a two-week-old.
With issues surrounding health insurance (both in the US, where many people don't have access to it, and in Canada, where it translates into limited resources) many women lack the personal care needed during their birth experience to have the support necessary for the healthy birth their body is (mostly) capable of. Instead, we expect fathers (who, if nothing else, we can guarantee have never physically birthed a baby!) to support the mothers (if they are still involved) - even as they are watching their partner go through some of the most intense hours of their life!
The reality is, today birth is an incredibly ostracizing event - along the same lines as the poverty described by Jesus ... especially for those women who are also homeless, hungry, thirsty, in need of clothes, sick and in prison ...
When I look at my role as a doula I see it as part of what God has called me to do. Just like the things on Jesus' list, it is neither a glamorous nor lucrative profession, but hopefully, piece by piece, we can restore community around women who are alone - and thereby love those God has called us to love.
Posted by: Heather | July 18, 2008 7:42 PM
christine,
thanks for the compliment about my heart. i sincerely mean that.
as for being "educated" in the area of natural childbirth... i would say that i am more educated than the average person. i mean... i did get the number of women who die per year in childbirth in the U.S. correct. i must at least have read something on the subject.
i think i made an extremely valid point which is supported by heather. a midwife is great to have. but in case of complications, a medical doctor is necessary. they have the training to be able to handle the complications. the midwife is great at delivering the baby but the doctor is great at dealing with anything that can go wrong. we must be willing to have a doctor present.
Posted by: dave | July 20, 2008 6:00 PM
@moderatelad
"My sister in England tells me that child birth in the UK is about 85% induced."
I'm British and I find this statistic hard to believe. Do you have anything to back this up? Google found a PDF of a medical journal article stating that "Statistics for 2005 show that in England around 48% of women having their baby in hospital have a normal birth, using the definition adopted by the Information Centre in England"
This definition excludes (among other things): induction, epidural, forceps, caeserian and episiotomy
Posted by: Richard Fannon | July 21, 2008 5:50 AM
Like Christina I was thrilled to see an article about the differences in what women experience during childbirth when they have experienced, trained, loving woman-to-woman support. This support in no way diminishes the father's role in the birth room. In fact, in my years as a doula, I often found my presence freed the father to give his wife support in whatever ways he felt comfortable, without the performance anxiety of trying to remember everything the childbirth instructor said. I have never felt so strongly in the presence of God as I have when seeing a baby born. It was a miracle every time. It is obvious to any person of faith that God could not have made so many mistakes in designing a woman's body to give birth that she just can't do it almost a third of the time. Yet the cesarean rate in the US is now over 30%, a statistic that is completely unjustified and should be intolerable to anyone who believes God in fact did a pretty good job with Creation.
Posted by: Beth Shearer | July 22, 2008 5:34 PM
I had my son by c-section after induction failed in 1982 in Canada. If I had a doula I would have stayed at home longer after my water broke and tried to start contractions on my own. We have more and more midwives practising in Vancouver, covered by gov't insurance.
Prenatal care by midwives is so important, especially in reducing premies and infant mortality for low income mothers. Dr's are not appropriate for community work.
Hospitals and Dr's are designed for illness and injury. They are looking for the abnormal, and are likely to see it. They are the place to be for IVF and all kinds of surgery, but having all births there "just in case" is the reason for the high c-section rate in the US. Having emergency help close by is great, but being far enough away to avoid hospital-spread infections is good too. God bless all the moms and babies; let's hope we all can afford good birthing care soon.
Posted by: Sandra | July 24, 2008 5:10 PM
I appreciate that THE RED TENT is mentioned; I always thought that book exposed everything that is wrong with women's realtionships in this day and age; we lack the phyical intimacy of our foremothers and therefore also lack the emotional and spiritual support that occured as well. I'm also glad to see that this topic is brought to the table here at sojo; I'd like to think that bringing my children into the world (naturally, with a midwife, thanks very much) was and is one of the most significant triumphs of being a woman! And I truly pity women who do not get to experience the full emotional and spiritual journey that is birth. Anyway, it was one of Jesus' best spiritual metaphors. . .
Posted by: christina | July 25, 2008 2:31 AM
It is very encouraging to see an article like this on the blog. I just recently had my second child. We had a completely natural birth with a midwife and hired a doula to support us this time around. It was an amazing experience that I know would have been different if a doctor were present. I respectfully disagree that women must be willing to have a doctor present. Often times, their mere presence is enough to slow a women's labor down because of the time frame and pressure that is put on laboring women in the hospitals by doctors and nurses. (Check Ina May's book for references to this) If there are no red flags, indications of problems or problems during the pregnancy, women should be able to labor as they please. Midwives always have back up plans and access to hospitals if some unexpected complication arises. I hope that women in America can learn that their bodies are designed to do this and the design is NOT flawed. I hope that more women get doulas and midwives and return to the days when doctors only intervened when it was absolutely necessary.
Posted by: Amanda Baughman | July 26, 2008 3:19 AM
my mother had 9 children, not one of which was born in a hospital, i've had 5 children, none born in a hospital, we had supportive doctors who actually believed that the best thing a doctor does for a laboring woman is sit on his hands and wait, unfortunately they are both dead now and their viewpoints are held by very few today except for midwifes, hospitals are indeed a great and needed place for those rare occasions when an emergency occurs, but there would be fewer emergencies if there were fewer hospital births,contray to current opinions most complications can be foreseen and transfer to a hospital does not have to be a rushed occurance.
birthing children is truly a blessed gift for our God. women need to reclaim it and not let others take this precious gift away
Posted by: lois ward | July 26, 2008 11:50 AM
my first baby was born in november in a hospital birthing center, my labor was attended by a midwife and a doula, and it was WONDERFUL. i wish all hospitals had midwives on staff. i felt cared for and listened to, our birth plan was honored, and doctors were available should we have needed. women who have no interest in giving birth at home can still benefit greatly from having a midwife deliver their child. even though my husband was an incredible support, having a doula's encouragement and presence during labor was invaluable.
Posted by: suzannah | July 27, 2008 4:40 PM
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