Childbirth in the United States has gone through many different trends over the years. Before the early twentieth century, the vast majority of births were attended by midwives and took place in the home. During the early 1900s, after a shift in thinking within the medical community resulted in a campaign for physician-attended births, more and more babies were delivered in hospitals. As decades passed, many long-held childbirth trends and practices began to fall by the wayside. While most women in Oklahoma still choose to give birth in medical or hospital settings, more women are choosing alternative ways of bringing new life into the world, delivering their babies at home or in birthing centers, where the focus is on the natural process of childbirth within the family.
In many other developed countries, midwife-attended births are common in low-risk pregnancies, while the United States continues to hold fast to the medical model of childbirth. Sterile delivery rooms have given way to birthing suites in most hospitals, to make the experience more comfortable for new parents, and fathers and other family members are typically allowed to attend the birth of a new baby. But many statistics continue to raise eyebrows. For example, approximately 32 percent of all births in the country are carried out by Caesarean Section (c-section), or surgical delivery, while as recently as the mid-1970s, that number was only 4.5 percent. The World Health Organization acknowledges the dangers of judicious use of the technique, which involves a much longer recovery period for the mother and poses greater risks for complications. They recommend that the medical community worldwide should make an effort to reduce the number of c-section deliveries to 10–15 percent.
Why the Shift?
While c-section deliveries become more common, it is estimated that fewer than 10 percent of women delivering in hospitals experience natural childbirth, although nearly every doctor offers the option to low-risk patients. Why are the numbers for natural delivery so low and surgical delivery so high in a process that has been occurring since the beginning of time?
That question is one of the reasons expectant Edmond mother Deanna Norris is planning a home birth for her second child, due at the end of April. “There were many factors. With this being a surprise pregnancy and thinking I couldn’t have any more kids, I didn’t have maternity insurance,” she says. “I had to find the most cost-effective way to have a baby, and even without insurance, my out-of-pocket expense will be about $1,300 less than what it was to have my son in a hospital eight years ago when I had that type of insurance.”
While cost was a factor, Norris was primarily driven by her desire to experience natural childbirth. “It wasn’t until I got pregnant with this child that I realized how angry and hurt I was that my first birth didn’t go the way I wanted. In fact, it was taken away from me and completely reversed. I wanted a natural birth with my son (Will), no medical interventions. And until the very end, my doctor agreed to this. Then he started telling me that I was going to go over my due date, making things more difficult for me, that Will would be too big to push out, and that I could have any number of complications.”
Norris felt pressured by both her physician and her former husband to agree to an induction. “Unfortunately, once induced, it’s nearly impossible to have a natural birth. Pitocin (a synthetic hormone used to induce labor) causes very strong contractions, often putting the baby in distress due to lack of oxygen. Which leads to an epidural to ‘allow the mom to rest,’ however, she can’t feel anything and has no real concept of when to push. This usually stalls labor, which leads to c-sections. I don’t want that with this baby. When a friend recommended I see a midwife instead, I decided to look into it. A home birth just felt right to me,” says Norris.
Midwives and Home Birthing
Margarett Scott is a Certified Professional Midwife (CPM), and will be attending Deanna’s birth. She has been practicing midwifery since 1988, and has attended approximately 1,000 births. While she offers her clients the option of a birthing center, she estimates that approximately 95 percent choose a home birth. Scott explains that she felt called to become a midwife based largely on her own birth experiences, which resulted in two c-section deliveries. “Several of the women at the church I was attending at the time were using a midwife and doing homebirths.” Scott began training under this midwife, and “never looked back,” as she says.
In 2011, Scott had 55 mothers in her care, and already has 50 contracted with her for 2012 deliveries. Most of those mothers ended up with the safe home birth they had planned for. “We never promise a home birth.” Rather, Scott offers a safe experience that focuses on the mother’s choices and the family. Of those that contract with her, she estimates approximately 11 percent of her clients opt to transfer to the hospital prior to delivery. “The majority of them are first-time moms who simply aren’t as well prepared as they think. Long labors can lead to exhaustion, and sometimes women opt to transfer to the hospital.” Scott always respects that decision, pointing out that the experience is all about the mother’s choices being supported.
Other times, she will recommend a transfer if there are prolonged irregular heart tones during labor. “We don’t wait for an emergency. I’m not going to put a mom and baby in that situation.”
Scott also points out that of all of her patients, less than two percent end up having c-sections. “Oklahoma’s c-section rate is currently at 35 percent,” she notes, a number which is even higher than the national average. She also points out that infant morbidity is actually increasing. “I am not against technology. It saves lives, and I’m grateful it’s there,” she says. “What I AM against is applying to 100 percent of women what maybe five percent of them need.”
Deanna’s birth plan is fairly simple. “Basically, I want to go into labor at home, and move when I need to, and allow my body to guide me in what it needs it in order for this baby to come out as gently as possible. I’ll eat and drink as needed. I’ll labor in or out of the water, depending on what feels better. I will nurse immediately and leave the cord attached until the placenta is birthed and it stops pulsing. I will have soft music and dim lights. No loud voices. My son will be able to come and go as he pleases. My husband will be there along with a close personal friend acting as a doula. In the event of an emergency, I will be consulted first and my husband and I will make all decisions regarding transfer to a medical facility.”
Norris has total faith that she will be in excellent hands with Scott. “I instantly fell in love with Margarett. She has the sort of presence that makes your feel like you're home and are going to be taken care of.” Approximately six to eight weeks from delivery, Norris seems relaxed and confident in her ability.
Scott has every confidence in her as well. “Women were MADE to have babies. Most of the complications that commonly occur in hospital settings are the result of medical interventions that the mother probably didn’t need in the first place.” Scott feels that too many women have lost their confidence in the ability to do what they were created to do. In fact, she feels that there is a whole generation of women who don’t even understand what “normal” is when it comes to childbirth.
While home births remain common in most other developed countries, most people in the United States continue to take a medical approach to labor and delivery. However, other options are available for anyone interested in a home birth or a natural delivery. If you are considering a home birth with a CPM or a hospital delivery with a Certified Nurse Midwife or a physician or you feel passionate about a natural delivery, do your research. Most experts recommend that you write a birth plan and discuss it with your healthcare provider.
Shannon Fields is a freelance writer from Edmond and a Certified Pharmacy Technician at Innovative Pharmacy Solutions.