unassisited childbirth-what do you think?

br0k3n said:
I would be very interested in any opinion or information you have on this subject, as my wife planning a "natural birth" and she is now 35 weeks....
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Katana, above in post 33, shares her experiences with water births. Maybe you too can hold the poop net. Blick.
 
My wife delivered all three of her children using only midwives (actually the same midwife for all), and the thing that I noticed (only the last child was mine, so it is the only process that I witnessed, although I am told that all three were very similar in prenatal midwife care) is the absoloute insistance of the midwife that the mother-to-be follow the health guidelines standard to the area. My wife chose natural birth (I can only accept that some intervention by midwives is natural; as explained above, our peculiar physiology makes human childbirth strangely dangerous) largely because she has a fear of needles. The midwife's calm explanation that any complication (from poor nutrition, excessive weight gain, etc.) would result in transport to the nearest hospital was very helpful in her optimal health during her pegnancies.

As a father, I can also attest to the unbelievable feeling of participation allowed me by my wife's choice. I was not only in the room, I was next to the woman I loved, on the bed, holding and caressing her, and right in the thick of things when my son was born.

At the same time, there were trained personnel there, who would no doubt have sent us off to the ER if the situation warrented.
 
A Pediatric opinion on water birthing

I won't repeat what Katana has stated already, so I'll tell you my concerns about water birthing from the pediatric end.

My chief concern with water birth in particular is the aspiration of the birthing tub's water with the first breaths of life. If the delivery goes smoothly and the child does not take a breath before being brought to the surface, I have no serious objection, but this cannot be assured. This water is not pure once the mother gets into it (even if it started that way). Bacteria from the skin, anus, and vagina all enter into the fluid. These are all organisms the child would be exposed to during normal birthing as well, but not in the lungs. This is a prime setup for pneumonia and sepsis.

Furthermore, water, even purified, is far from innocuous when aspirated into the lung. It disrupts the action of surfactant (essential for the normal function of the lung and notably absent/deficient in premies) and can cause a chemical pneumonitis. A child is capable of aspirating too great a volume of fluid in one breath to be reabsorbed before it causes significant respiratory distress (this is commonly known as drowning!)

Depending on the fluid aspirated, significant electrolyte derangements can also result from aspiration, most notably hyponatremia which carries the very real risk of seizures.

As to it being "more natural," it's a bunch of woo-woo. It makes as much physiologic sense and trying to breathe underwater as an adult because hundreds of millions of years ago we had aquatic ancestors who could do so.

We are lucky in pediatrics that things usually turn out so well. Children are resilient, and most births will go well no matter what we do (the survival of the species is testament to that). Sometimes they don't. Having cared for more children than I care to think of who have sustained mental retardation and cerebral palsy from normal births gone tragically awry, I encourage everyone to stack the odds in your child's favor. That means not taking unnecessary risks. This is one professional's opinion, take it for what you will.

Br0k3n, best of luck, and congratulations on your upcoming birth!
 
A water birth could not be described as 'natural' by any stretch of the imagination.
No land mammals give birth in water. Even seals have enough sense to do it on land.
 
Silly Green Monkey said:
It's how humans did it for millions of years, but the infant mortality rate was hellaciously high. Lots of things can go wrong with birth.
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As is maternal fatality rate.

While there are clear differences, this Independent Lens film I saw the other day, Motherland, Afghanistan, followed a doctor who tried to provide medical care returning to his homeland. The maternal deaths and the infants who died for lack of basic medical care was the most striking aspect of the absence of health care .
In Afghanistan, perhaps the only thing more dangerous than being a woman is being a pregnant woman in need of medical care. A 2002 survey counted 1,600 maternal deaths per 100,000 live births. The cause of death was most often hemorrhaging or obstructed delivery, both preventable if skilled health care is available.

The contrast is staggering: in 2005, maternal mortality in four Afghan provinces ranked 130 times higher than the United States, with a reported 50 to 70 mothers dying every day from complications at birth. Nearly half the deaths among Afghan women of child-bearing age have been pregnancy-related and preventable.
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autumn1971 said:
My wife delivered all three of her children using only midwives (actually the same midwife for all),... My wife chose natural birth (I can only accept that some intervention by midwives is natural....
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That comes close to saying "just a midwife" so as a nurse practitioner sensitive to the "just a nurse" phrase heard often, might I suggest some alternative adjectives? Excellent midwives for example, skilled, competent, wonderful, etc.

And midwives attending births has indeed been the practice for millennia. It's not easy to give birth alone despite the rest of the animal kingdom having adapted to it. Who knows when the first helpers became the norm but I imagine it was near the dawn of humankind. Midwives were actually discouraged by physicians and laws for a while then in the early 70s resurfaced along with the rest of advanced practice nurses.

Since my practice crosses into the medical field yet is grounded in the nursing field, it's my opinion there is a medical model of care and a nursing model of care. Both professions draw from both models but each "grew up' in their own field and our practices reflect that. The biggest difference is how much control is given the patient. The nursing model is to educate the patient about the choices and let them decide. The medical model is to educate the patient to the choices then tell them what you recommend.

Not all situations lend themselves to following the model perfectly. And many providers, as I said, use the alternate model more often.

The midwife plans to be with you, providing nursing care until delivery then takes on the physician role of delivery and any minor repairs of tearing, etc. Whereas it is not uncommon for nurses to care for a patient in labor with the physician making visits then coming in for the delivery. People are generally very satisfied with midwife care in labor and delivery, as long as there is back up medical care for major emergencies.
 
skeptigirl said:
That comes close to saying "just a midwife" so as a nurse practitioner sensitive to the "just a nurse" phrase heard often, might I suggest some alternative adjectives? Excellent midwives for example, skilled, competent, wonderful, etc.
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I suspect he intended the phrase "only midwives" to imply "midwives and not others". It is the more natural reading of the phrase.
 
JeffJ said:
...if I was a woman I think I'd feel 1000 times safer giving birth where "it's managed, controlled, and manipulated by the medical establishment" with proper "drugs, machinery and medical personnel" rather than by myself somewhere unsafe.
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Not if you were my wife. Four kids, all delivered at home, no drugs (not even 'gas and air'), no intervention. Longest labour was the first (as usual) and that was only 2 hours - I've had more traumatic trips to the lavatory! ;o).

We did, of course, have mid-wives present - we're not nutters! ;o).

There is plenty of evidence to suggest that intervention prolongs the whole process (travelling to hospital can slow and even suspend birth as a natural bodily defence - we're moving, must be in danger - painkillers dulling bodily responses etc).

Also home birth gives you 2 mid-wives whereas hospital birth means many of you share one (one friend who gave birth at a similar time to our first was left alone for hours and had to scream for a mid-wife when the head started coming out!). Any suggestion that home-birth is more dangerous than hospital is simply not supported by the statistics.

Of course many people are more comfortable with intervention and good luck to them. Had things not gone smoothly we'd have taken any intervention necessary, believe me. That's the important thing - that the mother can do what is comfortable for her...though going without even a mid-wife would seem to be taking things too far.
 
I think one factor that gives ammunition to the arguments from the natural birthing crowd is the huge variability in competence of members of the medical profession (in the NHS). Having several close relatives seeing doctors and consultants for different conditions, I would estimate ~1 in 2 of these “experts” were competent enough to do their job. I’d be interested to hear what you think of your medical professionals or colleagues if you work in the medical industry. I'll add that this estimate appears (to me) to be true for other professionals I've come accross, such as teachers/lecturers and engineers.

Having said that, IMO the instant access to medical technology and being surrounded by a large number of people who do know what they’re doing in a hospital is much better than taking your chances with a bucket of hot water and some towels:)
 
What irritates me about these kinds of sites are statements like
Drugs, machinery, and medical personnel are no match for a woman's own intellect and intuition.
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That's total nonsense, otherwise female paedeatric doctors wouldn't be subject to the same training as males, and we would never see deaths of children from mothers who fed them too much salt, or allowed them to become obese or malnourished. Women are not automatic wonder-mothers, and particularly when it comes to medical issues like birth.

I was terrified of some of the choices I was given when pregnant, because I wasn't sufficiently qualified to make them. I was lucky to have good doctors who discussed my concerns, so those choices were made either by me with appropriate advice (usually from a male doctor), or by the doctor with my trust.

So I'm a woman - yes - that doesn't automatically give me the skills and knowledge to birth my own child, let alone be an expert for anyone else.
 
While I agree that it is irresposible to plan an unassisted or "free" birth, this should not be extended to home births. When applied to low risk groups, attended by midwives who can assess whether a transfer to hospital might be needed (and access to the means for transfer) - then home births are no more or less risky than hospital births for low risk groups.

http://www.bmj.com/cgi/content/full/318/7185/721

In my first labour, I used a pool and found it excellent for pain relief (I had a back labour due to baby being in a posterior position and it hurt like hell), but probably wouldn't have given birth in it as I wasn't 100% sure that the midwives had had enough training in water births. As it turned out I had to get out anyway as my labour wasn't progressing and there was some foetal distress, so we had to go high tech. Someone said that they are probably better for early labour. I'm pretty sure that the evidence is that if you use it in early labour it can slow down the progression of the labour. I wasn't allowed to use it until I had hit 6-7 cm dilated. I didn't use a pool for my second labour, as I gave birth 5 minutes after arriving at the ward, but I would have had no hesitation in doing so.
 
I always have to question the logic behind these arguments. Lot's of highly trained people and useful equipment -> bad. A couple of highly trained people and some basic things -> better. No-one who has a clue what they're doing and a bucket -> really good. Sometimes it really scares me how people can be so anti-everything without ever seeming to know what they are actually arguing against.
 
Ethan Thane Athen said:
Not if you were my wife. Four kids, all delivered at home, no drugs (not even 'gas and air'), no intervention. Longest labour was the first (as usual) and that was only 2 hours - I've had more traumatic trips to the lavatory! ;o).

We did, of course, have mid-wives present - we're not nutters! ;o).
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I don't think anyone is saying that home births can't go well, or even that they don't go well in the majority of cases. It's that there is a difference in how complications can be recognized and handled, taking into consideration timeliness is often critical to the baby. Since your wife did not experience complications, your story does not serve to illustrate that the concerns are unjustified.

I think physicians and other health professionals have a different perception of acceptable risk, since we see what happens when things go wrong. A one in 100 risk may not mean much to the individual because it is unlikely that they will ever experience that risk. But the physician has directly experienced that risk, and the despair that follows.

There is plenty of evidence to suggest that intervention prolongs the whole process (travelling to hospital can slow and even suspend birth as a natural bodily defence - we're moving, must be in danger - painkillers dulling bodily responses etc).

Also home birth gives you 2 mid-wives whereas hospital birth means many of you share one (one friend who gave birth at a similar time to our first was left alone for hours and had to scream for a mid-wife when the head started coming out!). Any suggestion that home-birth is more dangerous than hospital is simply not supported by the statistics.
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It is difficult to draw conclusions from non-experimental data. Home births represent a small sample of all births, carefully pre-selected as likely to do well. Women who are in labour long enough to travel to the hospital or long enough to ask for (or require) intervention selects those women who happen to have a longer labour. Data of this type is highly selected (whether or not someone falls into a particular group is due to individual factors rather than chance) meaning that any differences in outcome may be due to the selection process rather than the intervention.

Of course many people are more comfortable with intervention and good luck to them. Had things not gone smoothly we'd have taken any intervention necessary, believe me. That's the important thing - that the mother can do what is comfortable for her...though going without even a mid-wife would seem to be taking things too far.
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I've mentioned this before. I think part of the disconnect comes from a different hierarchy of priorities. The priorities of the physician are to prevent death, disability and disease, putting more of an emphasis on those things that the individual is unlikely to experience. Whereas, the individual is more concerned about those those things they are likely to experience - discomfort and dissatisfaction.

Linda
 
Cuddles said:
I always have to question the logic behind these arguments. Lot's of highly trained people and useful equipment -> bad. A couple of highly trained people and some basic things -> better. No-one who has a clue what they're doing and a bucket -> really good. Sometimes it really scares me how people can be so anti-everything without ever seeming to know what they are actually arguing against.
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However illogical it may seem to you, there is some truth at least in the first portion of the argument. Having lots of people around you that you don't know, and lots of high tech equipment, etc leads to some women feeling inhibited which can slow labour and cause complications, and they may feel like they can't move around in ways that help them to cope with the pain, so are more likely to need pain relief. And once you have one intervention, you are more likely to need another. For example if you choose an epidural, you are more likely to need an instrumental delivery or a C-section.

Imagine you and your partner are having sex in private. Now imagine you are trying to have sex while a man is hovering with a machine that will give you a guaranteed orgasm, just in case you can't manage it yourselves. Would that inhibit the natural process at all, do you think?
 
Ethan Thane Athen said:
Not if you were my wife. Four kids, all delivered at home, no drugs (not even 'gas and air'), no intervention. Longest labour was the first (as usual) and that was only 2 hours - I've had more traumatic trips to the lavatory! ;o).
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That's not the norm - I knew one woman whose labour lasted 40 minutes from first contraction to final push, but plenty of my friends have had 12-and 24-hour labours; my four labours were all between 8 and 12 hours.
And I was glad to be giving birth in hospitals. Again, several friends of mine have had wonderful home births. But they also had easy, uncomplicated labours. And other friends have had good hospital births.
It's all about choice.
 
sophia8 said:
That's not the norm - I knew one woman whose labour lasted 40 minutes from first contraction to final push, but plenty of my friends have had 12-and 24-hour labours; my four labours were all between 8 and 12 hours.
And I was glad to be giving birth in hospitals. Again, several friends of mine have had wonderful home births. But they also had easy, uncomplicated labours. And other friends have had good hospital births.
It's all about choice.
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Thats the thing - nobody advocating the right to home birth (apart from the loony fringe that nobody here would defend) would argue for a second that other people should not have the right to birth in hospital if they want to, or that it should be for anyone other than low risk groups, or that they shouldn't be transferred to hospital if things aren't going to plan.
 
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