By Donna Balo, CNM, ARNP, MS   

A woman learns about her powerful and amazing body during pregnancy, labor and birth.  Importantly, women experience the wonder, exhilaration and accomplishment of birth when they are not numbed to the laboring and birthing sensation.   

For most women, labor is incredibly hard work, but the pain of labor has value for both the woman and her infant.  Natural childbirth facilitates labor both psychologically and physiologically.  Adrenalines and endorphins are released to help her cope with labor, while exuding the exhilaration of a job well done.   
  
Throughout history and in most countries, a woman actively labors and births. Listening to her body, she will walk, rest, toilet, bathe, eat, and drink.  Loved ones will rally around to assist and encourage her. So, why as a society today, do we cheer and celebrate athletes in their physical abilities, yet blunt the appreciation of a woman’s ability to birth?   

Just as the media depicts birth as anything but a normal, natural and healthy process that women’s bodies were designed for, so in recent years has the popularity of the epidural become a common means to escape the pain of labor and birth.  Although not everyone gets the relief they desire from an epidural, most women feel little or no pain. Anything that is so powerful that it takes away the body’s perception of pain is too powerful not to have side effects. Serious complications such as neurological injury or life threatening complications are rare, but other side effects are common. 
An epidural can give rise to a cascade of other interventions, like a domino-type effect, as it interferes with the birth process.  Routinely with an epidural, a laboring woman must lie in bed, have an IV, blood pressure and oxygen monitor, and a catheter in her bladder. Continuous monitoring of the baby’s heart rate is required because epidurals can lower blood pressure resulting in a drop in blood (and oxygen) flow to the baby; therefore, intravenous medicine is used to counteract this side effect.  

In addition, an epidural often means a longer labor and then a different medication, called Pitocin, is administered to speed up contractions.  Many women develop an unexplained temperature after an epidural resulting in a course of antibiotics not only for the woman (and therefore the baby) but also requiring the baby to have a work-up including a blood draw, IV antibiotics, a longer hospital stay, and sometimes a lumbar puncture. In addition, with an epidural the baby doesn’t have the benefit of mom’s muscles working at full capacity aligning the infant into the best position for birth. Thus, there is an increased likelihood of an operative delivery: forceps, vacuum extraction or cesarean delivery. 

Furthermore, although it is not well understood it is well documented that after an epidural, it may take a baby days or weeks to breastfeed well.   

Epidurals can be a useful tool and are medically necessary for some women, but there are also serious complications. Epidurals are one of many options for labor and birth. Before making a personal decision it makes sense for women to carefully weigh the risks and benefits of epidural use.   


Donna Balo is a CNM whose expertise stems from working in many different types of facilities, including an independent, midwife-owned practice, a non-profit CNM practice, and a number of hospital-owned and MD-owned practices.  For almost two decades, Donna has been developing and facilitating classes in early pregnancy, childbirth preparation, sibling preparation and parenting.  She is also a frequent speaker on preventative health and has published numerous articles for local publications.  Donna currently practices at Advanced Women's Health Specialists. In addition, she is an adjunct OB Clinical Instructor at Daytona Beach Community College and is the Florida representative for the American College of Nurse-Midwives for THRIVE (Teen Health Requires Interaction, Values & Education).

 
 
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  A Talk with Jennifer Block
   Author of Pushed 








In writing Pushed, you traveled across the country to witness births. What aspect of maternity care did you find most surprising in your research? 

I think what is most surprising is that the majority of U.S. women are not having optimal birth experiences. We know from decades of research that the best experience for both mother and baby is a spontaneous labor with minimal intervention that is supported both physically and emotionally. And what I found out is that many common, routine maternity practices in the United States actually hinder this process. For instance, most women, once they are admitted to the hospital, are immobilized in bed for labor and they give birth lying on their backs. This is not based on science. Women need to be free to move about and give birth in intuitive, physiological positions.  


What else are women experiencing, and why should we be concerned about it? 

Nearly one third of American women are giving birth via major abdominal surgery; more than half of women are receiving artificial hormones to induce or accelerate labor; one third of women who give birth vaginally have their vaginas cut. All of these practices can cause short-term and long-term health problems, and yet there’s been no sign of any net benefit from such aggressive intervention. So we have to examine this system in terms of not only mothers’ health, but also babies’ health. Scientists have confirmed that babies participate in the birth process, and that they help initiate labor when their lungs are mature. So what are the consequences of so many babies being born before they’ve given that signal?

 
How did you become interested in the topic of childbirth in America? 

I’ve always been interested in women’s health. As a journalist, I was especially drawn to stories where health and politics intersect. Childbirth had never struck me as much of a political issue, but early in my research I realized that it is very much a women’s “choice” issue. I talked with women who felt that they had no choice in how, where, and with whom they gave birth, or felt they had no choice in the treatment they received while they were giving birth. 


Is the way we give birth a feminist issue? 

I think it is. Because it is an issue of a woman’s autonomy to make decisions about her health care. For a woman seeking a vaginal birth after cesarean (VBAC), for instance, in many cases she practically has no choice but repeat surgery. Hundreds of hospitals have banned VBACs, and some doctors are prohibited by their malpractice insurers from attending VBACs. Caught in such a bind, I spoke to women who felt they were forced into surgery, which not only goes against medical ethics, but our constitutional rights.  


How does childbirth in the U.S. differ from childbirth in other countries? 

Many countries are seeing their rate of cesarean section go up, but one central difference I’ve noticed is that in the rest of the industrialized world, women are encouraged to support the birth process, which means waiting for spontaneous labor, staying mobile during labor, and giving birth with the continuous support of a care provider, usually a midwife. In most European countries, midwives are the primary maternity care providers—women only see an obstetrician if there is a complication. Many mothers give birth outside of the hospital, in a birthing center or at home. In the Netherlands, around 30% of women give birth at home. England is currently moving toward this model. Home birth and even midwives are regarded with suspicion in the U.S., but these European countries have fewer cesareans, fewer maternal deaths, and fewer baby deaths.  


You state in your book that in some states, midwives who attend home birth are illegal. In others, they’re allowed and even encouraged by health care providers. Is this a red-state/blue-state thing? 

There’s no logical explanation for the variation in laws or the hostility of some state governments toward midwifery and home birth. I found this variation fascinating—that in Alabama a certified midwife could be criminally prosecuted for attending a home birth, but next door in Tennessee, she is providing a service covered by Medicaid. And the issue really crosses over party lines. Just recently in Missouri, for instance, a conservative state senator snuck an amendment that will allow midwives to be licensed into a healthcare finance bill. The lead opponent of this measure turns out to be a pro-choice democrat.  


How do you think OB/GYNs will respond to the book? Does it condemn them? 

Obstetricians are under tremendous pressure these days—many are practicing under the constant threat of a lawsuit. Even residents and nurses can be named in lawsuits in today’s climate. At the same time, OBs feel that malpractice insurers are milking them dry, and the threat of a higher premium is held over their heads. This system encourages defensive medicine, which is not the same as fact-based medicine, nor ethical medicine. I spoke with many doctors who recognize this and detest it. This book represents their concerns as well.  


You’ve not had children yourself. Was that a help or a hindrance as you wrote and researched this book? 

Having never experienced childbirth, I had to recognize early on that I was approaching this issue as an outsider, as a journalist. And I think that perspective has been enormously helpful in my research and reporting. I was able to investigate the issue objectively, without a personal experience coloring my view one way or another. At the same time, I’m a woman. I have friends and family who are giving birth, and I hope to have children someday myself. So I also have a vested interest.  


Knowing what you know now about childbirth, do you have any advice for women who are facing it? 

I think women should seek out an optimal, evidence-based birth experience, and they need to know that, statistically, they are not likely to have that experience in this country unless they are proactive about it. Unfortunately, women need to start from that “painful truth.” Doulas are a great resource, not only during labor and delivery but during pregnancy. They can help women access providers and environments that support physiological birth. Reading books, taking childbirth education classes, hiring a doula, finding a provider who’s on the same page—all those are tremendously helpful. But the best advice I’ve heard is very simple: trust your body and trust the birth process. 


If a woman wants to find out more about her birth options, what particular organizations can she turn to? 

Here’s is [Jennifer's] short list:

Childbirth Connection—www.childbirthconnection.org 
Lamaze International—www.Lamaze.org 
Citizens for Midwifery—www.cfmidwifery.org
International Cesarean Awareness Network—www.ican-online.org 
Waterbirth International—www.waterbirth.org 
DONA International (formerly Doulas of North America)—www.dona.org 
ALACE (Association of Labor Assistants and Childbirth Educators)—www.alace.org