Seeking a Balance - Page 2

Author // Cathy Daub, P.T.

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In its reductionist view, the biomedical model encourages the development of new products to improve labor and birth. Take for example a relatively new product called the EPI-NO. It claims to reduce the risk of tearing and episiotomy, and to help condition the pelvic floor muscles before and after pregnancy. The kit comes with a contoured silicone balloon, a hand pump, a pressure display, an air-release valve and a flexible plastic tube. The balloon is inserted two-thirds of the way into the vagina and then gradually inflated from one training session to the next, each lasting 20 minutes.

The producers claim that the perineum normally achieves 8.5 cm to 10 cm over three to four weeks, and if 8.5 cm is achieved, the extra 1.5 cm will come when the head is crowning. This sounds attractive to women tired of being pregnant, but isn’t it just another way of trying to rush birth? I personally wouldn’t want to be walking around with a dilated perineum weeks before giving birth, and before it is ready to dilate itself. Furthermore, the hormonal state of a pregnant woman’s body is different three to four weeks before labor as opposed to the time of crowning. I believe that in labor, as long as the perineum is kept warm to ensure good blood supply and hard pushing is avoided, that it will open for birth, just as it is supposed to.

At first glance, the biomedical model may seem to be working, making many women and their caregivers happy. Women can give birth without feeling strong labor contractions. They can plan when they want to give birth and doctors don’t have to wait around. The use of medical procedures and obstetric drugs provides economic and financial incentives for the hospital. Legal consequences are minimized because a cesarean is the ultimate intervention; as far as the court is concerned there is nothing more that could have been done.

But balance is the key because we need both the biomedical and systems models of care in birth. Birthing families need better childbirth preparation so they can become informed to make wiser decisions, avoiding the routine uses of technology and obstetric drugs in birth, and also to learn when they would be necessary to ensure a healthy mother and baby. It is equally important to consider the role of other factors that might be keeping a labor from progressing, such as fear of pain, becoming a mother, and the sacrifices that will need to be made in the home and workplace.

Giving birth requires a woman to open her body completely and let go of all inhibitions. In order to do so, she needs to feel safe to let down her defenses. She is entirely vulnerable to the energies in the room. She needs to be in a place where she feels safe. I would like to see pregnant women be able to choose their safe place for giving birth and feel supported by their caregivers wherever that place may be.

It takes only one concerned look from a doctor to cause her to draw inward in a protective response. Midwife Ina May Gaskin says that even one negative word to a woman in labor can have the effect of undilating her cervix. She says, “I have never noticed anyone’s cervix remain tight and unyielding while speaking loving and positive words.” A woman in labor must have full trust and faith in her body’s ability to give birth and allow it to be her guide.

Good, quality childbirth preparation beginning early in pregnancy is needed now more than ever. Though some knowledge of birth is required, it is emotional preparation that will be the most useful to a woman in labor, because labor is an emotional, sacred event. For example, learning what things can increase oxytocin production to help labor progress is essential in any childbirth preparation class. If the entire birth team could keep the birthing environment full of love and compassion, the birthing woman could feel safe to let go and give birth. They would not keep asking her if she wants pain relief; they would affirm her innate power and wisdom in giving birth. Avoiding rational questions such as “Was that contraction stronger than the last one?”is a way to help her in her primal brain that already knows how to give birth. Women need to believe that they are born with the knowledge of how to give birth and that birth is instinctive, and birth teams need to know how to support them in this truth.

Although I am worried about the current trends in birth, I am also optimistic. As more women are training to become midwives and more midwives are being employed by hospitals and attending home births, and as good, quality childbirth preparation reaches more pregnant women and their families early in pregnancy, I hope that surely we will begin to see change toward a better balance in the biomedical and systems approaches to birth. Birth is and always will be a sacred event, a miracle—one that changes a woman’s life and our lives forever.

Pathways Issue 48 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #48.

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