Birth Myth and Misconceptions and the Facts
Myth
Birth is too risky and dangerous to be allowed to occur naturally.
Fact
Childbirth is a highly evolved process that normally requires only the physical good health of the mother, adequate emotional support and privacy in labor, and the watchful attention of a skilled birth attendant. Given this, changing prevailing modern attitudes and practices regarding what is natural and normal in birth is essential.
Myth
No birth can be viewed as normal except in retrospect because pregnancy and birth are medical conditions.
Fact
The majority of complications in pregnancy are related to socio-economic factors (inadequate diet, drugs and environmental toxins, and psychological factors such as excessive stress, abuse or neglect).
Research shows that the majority of complications in labor can be anticipated prior to the onset of labor and most of them can be avoided or successfully handled without medical intervention if a woman comes to birth in good physical health with a positive mental attitude and is attended by a skilled birth attendant.
Myth
The modern hospital is the safest place for all women to give birth. All other sites for birth are too dangerous. The bigger the hospital, and the bigger the baby intensive care unit, the safer the birth.
Fact
Despite 75 years of routine hospitalization for birth there are still no reputable studies or scientific evidence showing that hospitals are the safest option.
In fact, there are numerous reputable studies showing the various risks and hazards of hospital birth. For example, the mere presence of a laboring woman in a hospital has been proven to increase the likelihood that she and her baby will be subjected to routine tests and procedures. These interventions are based on convenience and hospital protocols rather than need. In addition, routine hospitalization for birth is extremely costly and leads to the inappropriate use of specialist physicians, medicine, and technology. The problems associated with hospital birth increase with the size of the hospital, especially those problems related to impersonalized care and the overuse and abuse of technology and medicine.
Fact
Hospitals are not safe places for newborns, whose liver, brain and immune systems are too immature to ward off the noxious or toxic effects of routine procedures and hospital-born infections. Today there are 25 strains of pathogens completely resistant to all known antibiotics and most of these are found in hospitals. Babies who are physically separated from their mothers and do not receive breast milk after birth are at increased risk.
Fact
A healthy woman, entering labor with no complications, is safest birthing in her own home, assuming a skilled midwife attends her with hospital backup. Freestanding birth centers have also proven to be safer than hospitals for this population of healthy women, who are at low risk for complications in birth and comprises 80% of all birthing women in America.
Fact
As many as 20% of our nation’s full-term healthy newborns currently spend some time (hours, days or weeks) in intensive care nurseries (known as NICUs) for no medical reason. Most of them are there for “observation” or “just-in-case” treatment because of drugs or procedures done on their mothers. While in these NICUs, infants experience not only separation from the mother/parents but also high levels of stress from the bright lights and invasive and often painful procedures.
Fact
The more aggressive the management of newborns in such nurseries, the greater the potential for long-term trauma.
Fact
The additional cost of each day a baby spends in intensive care runs $2,500-$7,500. Intensive care baby units usually have a 90% or higher occupancy rate. As soon as an intensive care unit is expanded, the number of babies sent to it increases because there is little incentive to keep babies out of ICUs, especially in big teaching hospitals.
Myth
Modern medical management and intervention in birth improves outcomes and therefore should therefore be applied to all birthing women and their babies. The more technology used in birth, the safer the birth and the healthier the mother and baby.
Fact
There is now a large and growing body of scientific evidence to the contrary. The entire medical management approach to birth in the hospital – including each and every obstetrical intervention (from confining a laboring woman to bed to denying/or limiting food and drink to hooking her body up to electronic fetal monitoring to the “hep-lock” put into her vein in case she might have a cesarean surgery or the routine intravenous drip to the common practice of artificially rupturing the membranes to speed up labor, to the artificial hormones (pharmaceutical oxytocin) to induce or stimulate labor or other drugs (narcotics, sedatives and anesthesia) to the surgical incision in the mother’s perineum to enlarge the outlet (episiotomy) to early clamping and cutting of the baby’s umbilical cord, to the routine separation of mother and baby after birth (often just done to “observe” the baby)…These each carry significant risk of harm, both to the natural physiological process itself, by interrupting the flow, and also to the mother and/or baby. These risks are both immediate and long-term in nature. In addition, the use of any single intervention tends to lead to other interventions, in a cascading effect. Once any intervention is used, it is likely to alter the natural course of the rest of the woman’s labor.
For all of these reasons, as well as the impact interventions can have on the mother and baby’s psychic well-being, intervention should only be applied in instances of true complications and, ideally, after safe, non-interventive measures have been tried.
Myth
Electronic fetal monitoring is necessary to insure the safety of the baby.
Fact
Electronic fetal monitoring has never been scientifically proven either safe or effective for determining the well-being of a baby during labor or for preventing complications ~ even among women at high-risk for complications. Extensive research, done as early as 1985, including a Harvard study of 10,000 consecutively monitored women in labor, showed no more than one baby’s life might be saved for every 10,000 women electronically monitored. This needs to be balanced against all of the risks of monitoring, most importantly the fact that it dramatically increases the anxiety level of nurses, midwives and physicians and results in decisions to perform an immediate (“emergency”) cesarean, which is major surgery and entail numerous risks (immediate and long-terms), including depriving the baby of important health bacteria from the mother and valuable stimulation of its central nervous system. In addition, internal monitoring (the kind done most commonly) requires rupturing the woman’s amniotic sac and screwing a scalp electrode into her baby’s head, both of which are risky and can cause harm.
Fact
This expensive device was first introduced into hospitals in the early 1970’s and, following an aggressive marketing campaign by the monitor companies, in which nurses were hired to promote its “safety”. As a result, electronic monitors were bought by every hospital in the USA and in many urban hospital across the world (following the US lead) within a few years. In most hospitals such monitoring is still being used routinely on every laboring woman. Hospital administrators see the monitor as a way to cut down on the nursing staff and prevent law suits.
Fact
The reliance on electronic fetal monitoring rather than nursing or midwifery care was largely responsible for the 300% increase in the U.S. cesarean rate during the 1970s and 80s. Currently, hospital attorneys and administrators – as well as most obstetricians – continue to insist upon electronic monitoring for malpractice protection. Once a new device or practice has been introduced into hospitals and made routine, it is very difficult to get rid of it!
Myth
The length of a woman’s labor, the existence of medical complications requiring drugs, mechanical or surgical intervention, as well as her desire for medication in labor, has to do with factors often beyond a woman’s control (e.g. her innate pain threshold, her body’s ability to function properly, her physical build and genetic predisposition).
Fact
Numerous recent studies have shown that all of these hospital interventions can be dramatically affected by the nature of the birthing environment (e.g. the dominant presence of equipment, and the lack of privacy or support). The attitudes of the mother and her caretakers are even more important with regard to how many interventions are done in the course of her labor, birth and first postpartum hours. Every person who comes in contact with a birthing woman either increases or diminishes her levels of fear and self-confidence. And that of course profoundly affects the course of her labor and the experiences that the baby is having! Both doula and midwifery studies have shown that the rate of medical intervention, as well as length of labor and the mother’s perception of pain, are dramatically reduced with competent doula or midwifery care. NOTE: A physician can provide “the midwifery model of care”, just as a midwife can be highly interventionist. The difference has to do with training, attitude, and the system in which they work. In traditional, patriarchal, physician-dominant obstetric units, midwives often are very limited in what they can do in the way of protecting and supporting natural, physiologically-normal births.
Myth
Any birth that is not a cesarean is a normal birth.
Fact
This is what many people believe. This year more than 60% of birthing women in many USA hospitals will have their labors attempt to be artificially induced or speeded up with drugs. 90% of women in labor will be hooked to electronic fetal monitors. Approximately 80% of all women who have vaginal births will receive pharmaceutical drugs of some kind (often a number of them) and/or be anesthetized for pain relief; and an equal number will have an episiotomy. In addition, and this practice is equally significant for its immediate and long-term harm, 75% of our mothers and babies will then be separated before breastfeeding has even initiated.
Myth
Cesarean surgery is now very safe, poses a minimal risk, and is only done when medically necessary.
Fact
Cesarean surgery has become safe, for sure, because of changes in the type of anesthesia given to the mother – regional instead of general – Cesarean surgery carries the same immediate risks that all major surgery entails: 1) unstoppable bleeding, 2) unexpected and catastrophic drug reactions, and 3) infection in the mother…and additional ones for the both baby and the mother, and for their critical bond.
Cesarean surgery also denies the mother and baby the experience of completing the birth vaginally, which has numerous physiological and psychological benefits for their health and development. Cesarean born babies are much more likely to have immediate problems with breathing, for example, and often end up in intensive care separated from their mothers during the critical first hours after birth. When cesarean is performed by schedule – which means without any labor – there are even more risks, including the serious complication of the baby being pre-term. Cesarean-born babies are more likely to require intensive care after birth and to have more difficulty establishing breastfeeding. And cesarean babies, especially those born without labor, are deprived of the very important microbial organism of the mother’s vagina, which are designed for form the basic of the newborn baby’s “gut” flora. This impacts the baby’s development of its lifelong immune health.
For these reasons, and because cesarean requires the greatest expenditure of resources, it should only be done when medically necessary and other measures are not possible or have not worked. Research shows that there is little significant improvement in outcomes if an overall cesarean rate is higher than 7%.
Fact
This year 1 million babies – more than 1 out of every 3 in the USA and a number of other “post-modern, industrialized” countries or cities – will enter this world by abdominal surgery. 80% of these cesareans –more than 600,000 – will be medically unnecessary. In addition, the majority of these cesareans will be performed on healthy middle and upper class women, not poor women or pregnant teens, the ones at higher risk for problems.
Fact
Current obstetric texts state that the “expected” maternal death rate from vaginal birth is 6 per 100,000. The risk for maternal death from a cesarean is four to seven times more than that of a vaginal birth. In these same texts the expected death rate from cesarean is 100 per 100,000. Yet “once a cesarean always a cesarean” is still the norm, despite the fact that between 75% and 80% of women who have a cesarean can have a normal vaginal birth the next time.
Fact
The average American vaginal birth (including prenatal care) costs $8,000-$10,000 and the typical cesarean costs $12,000-$20,000 and much more if the baby is in an ICU for extra tests.
Myth
Modern women should not have to endure pain in labor; pain and discomfort in labor has no value.
Fact
The normal pain of labor serves several physiological functions: it alerts the pregnant woman that labor has begun and she needs to find a private, undisturbed place to birth. Natural, normal labor and delivery (physiological birth) fosters fiercely protective behavior on the part of the birthing and new mother. Interfering with this process tends to hinder the mother-infant bond and create worried, anxious or insecure mothers who are not confident in their own ability and doubt their innate knowing. When a mother lacks confidence in her own ability and judgment she is more likely to look to outside “experts” rather than pay close attention to what her own signals and her baby’s signals are telling her to do. Women who have had their mothering undermined in this way can regain their confidence and trust in themselves and their babies, but it is not the same as never having lost it in the first place.
Labor is physiologically designed to foster fiercely protective behavior in the birthing mother, without making her overly anxious. The pain of contractions is a result of the normal stretching of muscles and tissue. Anxiety and tension resulting from excessive fear intensifies the pain, makes contractions less effective and lengthens labor. Women can cope with labor pain if they have adequate privacy and support.
Fact
Physiologically, it is impossible to artificially diminish or numb the sensations of labor – which may, but doesn’t necessarily have to, include high levels of pain during some contractions and perhaps with pushing stage – without also diminishing the sensation of pleasure. However, our own natural hormones place a woman in an altered state where pain during contractions is easier to bear because the pleasure centers of the brain have been stimulated. And when either the pain or pleasure centers have been stimulated the other center is not dominant. We want the pleasure center to be the one that’s stimulated.
Fact
Throughout history birthing women have always preferred to be cared for by another motherly woman who is familiar to her. However, even the presence of a woman who is a stranger and does nothing but sit silently in the room, commonly results in shorter, less painful and more effective labors. The woman’s experienced labor pain is directly related to how comfortable she is with her body and how much support and privacy she is given. In repeated studies by pediatricians Marshall Klaus and John Kennell, the continuous presence of a labor “doula” dramatically reduce the amount of drugs, anesthesia, cesarean surgery and the rate of all complication in labor in hospitals.
Myth
Drugs used in labor and delivery are necessary, safe and have no negative side effects on labor or on the well-being of babies.
Fact
Any drug – including artificial hormones to stop, induce or speed up labor – given to a mother in pregnancy, labor or while she is breastfeeding will get into her baby’s blood stream and settle in the baby’s liver and brain. Drugs in birth get to the baby in higher proportion than to the mother because of the baby’s small size. More than 80% of laboring women today get an epidural and most of them demand it.
Fact
The mother and baby (and remember they are physiologically one biological system) each produce hormones that prepare their bodies and emotions to go through the stress of labor in a positive way, by preparing them both for the enormous physiological and emotional changes they must go through after birth into to thrive.
Fact
The casual use of drugs in birth poses many immediate and long-term hazards, including compromising the establishment of breastfeeding and successful bonding.
Myth
Epidurals enhance normal birth and have no side effects.
Fact
Epidural anesthesia can cause a rapid drop in the laboring mother’s blood pressure, resulting in fetal distress and an emergency cesarian. An epidural can, and often does, also cause the baby to get “stuck” in the mother’s pelvis, unable to move into a favorable position for birth, leading directly to the need for forceps, vacuum extractor or cesarean. Babies whose mothers have had epidurals frequently have a difficult time getting breastfeeding started, which all too often results in their mothers quitting breastfeeding.
Fact
96% of women who get a fever in labor have had an epidural. Since a fever in the mother may signify a dangerous infection in the baby, their babies are routinely sent to the intensive care nursery and aggressively treated for possible infection. Once there, these babies endure frequent painful blood drawings, spinal taps, and are given full-spectrum antibiotics while tests are being done to determine whether they even have an infection. Epidurals often lengthen labor and cause problems for mothers and babies.
Fact
86% of all babies given antibiotics in the ICU have mothers who have had an epidural. Research has only begun in the long-term negative impacts of overuse of antibiotics, starting at the beginning of life, or in the womb.
Myth
Obstetricians are trained to handle complications and therefore should supervise and be in charge of all births to ensure the best outcome. No other health worker is sufficiently skilled.
Fact
Obstetricians are, in fact, not trained to approach birth as a normal process and have little or no training in providing the pregnancy support and counseling and labor support that inherently keeps birth safe and normal. Obstetrics is the practice of dealing with complications in the natural processes via the use of drugs and surgery. They are not specialists in normal, natural – i.e. physiological – births. They are also not given an understanding of how their own birth/primal trauma is likely to have affected their decision to become an obstetrician and their day-to-day practice in the field. In addition, the average obstetric training includes one or a couple of days on the study of nutrition, and no training on how to provide labor support for a woman, or how to prevent a tear in her perineum (without doing a surgical incision/episiotomy). Numerous studies show that physicians, especially specialists such as neonatologists and perinatologists, are best used as back-up technical support for primary care, community-based health workers, notably midwives and family physicians.
Fact
Most obstetricians do not show up at a birth until the woman is fully dilated and pushing. Because of this they are more likely to rush to judgment and treat any normal variation in a labor as a crisis.
Fact
In the USA currently reimbursement for physicians of all kinds is based upon how many tests they have done and how many proceeds and medical interventions, rather than paying them to keep patients healthy, or paying per client. Most US insurance companies and health maintenance organizations (called HMOs) pay more money to the obstetrician for each intervention he or she performs in a birth, and pay OBs much more when they do a cesarean. In addition, when a malpractice suit has been brought against a doctor, US juries tend to still believe that doing a cesarean proves that a physician has done everything possible for the mother and baby. So, there is little incentive, given the current system and climate, for using non-intervention labor aids and every incentive to doctors to intervene for personal preference or convenience, as well as protection against malpractice, and personal profit. It may be understandable, but it in no way constituted ethical or good medical practice!
Myth
Midwives are not as competent as doctors and need direct supervision.
Fact
It has been well proven around the world that wherever and whenever midwives are the ones to attend women throughout pregnancy that the rate of prematurely born and low-birth-weight babies, as well as infant mortality and the re-admission of babies to hospitals in the year after birth, is as much as 75% lower than for women who are seen by physicians, no matter what the woman’s risk level. Clearly there needs to be enough midwives for every childbearing woman to be cared for one, even if the woman at some point needs the technical expertise of a physician. And it is the responsibility of every society to train enough midwives and to create a system that supports and adequately pays midwifes for their valuable services, including their providing family planning and contraceptive education, support and services.
Fact
Midwives (and, where they exist, nurse practitioners and physician assistants) better provide primary care to mothers and babies and do so at greatly reduced cost and increased safety. They spend more time with their patients, which translates into better preventive care, more patient education, and a greatly reduced need for hospitalization and expensive (ad risky) hi-tech care. Simply put, midwifery is cost-effective and better in all ways! The midwifery model of care for birth has been proven optimal for immediate as well as long-term outcomes because midwifery care protects and promotes normalcy. The midwifery model of care includes training in preventing and treating complications in all sites, and using the least amount of medical intervention. NOTE: Midwives can be trained to provide competent emergency first aid care in any setting.
Fact
Midwives identify problems when they arise and handle them before they become serious complications or emergencies. They are trained to consult with physicians and transfer care to a physician when necessary.
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References for the above factual (evidence-based) data:
Chard, Tim & Richards, Martin, Editors. Benefits & Hazards of the New Obstetrics. William Heinemann Medical Books/JB Lippincott, 1977
Duran, AM. “The safety of home birth: the farm study”. Am J Public Health. 1992 Mar; 82(3):450-3
Enkin, M et al. A Guide to Effective Care in Pregnancy and Childbirth, second edition. Oxford University Press, 1995
Goer, H. The Thinking Woman’s Guide to a Better Birth. Perigee Press, 1999
Greulich, B et al. “Twelve years and more than 30,000 nurse-midwife-attended births: the Los Angeles County + University of Southern California Women’s Hospital Birth Center Experience”. J Nurse Midwifery 1994;39(4):185-96
Haire, DB and Elsberry, CC . “Maternity Care and Outcomes in a High-Risk Service: the North Central Bronx Hospital Experience”. Birth 1991;18(1):33-37
Harvey, S et al. “A randomized, controlled trial of nurse-midwifery care”. Birth 1996;23(3):128-35
Jabaaij, L, et al. “Home births in The Netherlands: midwifery-related factors of influence”. J Nurse Midwifery 1996 Sep;12(3):129-35
Klaus, Marshall, MD, Kennell, John, MD & Klaus, Phyllis, CSW, MFCC. Bonding. Addison-Wesley, 1995
MacDorman, MF, Singh, GK, 1998. “Midwifery care, social and medical risk factors, and birth outcomes in the USA”. J
Epidemiology and Community Health 1998 May;52(5):310-7
Mehl-Madrona, L et al. “Physician and midwife-attended home births. Effects of breech, twin and post-dates outcome data on mortality rates”. J Nurse Midwifery 1997, Mar-Apr;42(2):91-8
Rooks, J, CNM Midwifery and Childbirth in America. Temple University Press, 1997
Scott, DB & Tunstall, ME. “Serious Complications Associated with Epidural/Spinal Blockade in Obstetrics: a 2 Year Prospective Study”. Int J Obstet Anesth 1995;4:133-9
Spitzer, MC. “Birth Centers. Economy, safety, and empowerment”. J Nurse Midwifery 1995 Jul-Aug;40(4):371-5
Wagner, MD. Pursuing the Birth Machine: The Search for Appropriate Technology. Ace Graphics, 1994
World Health Organization. “Appropriate Technology for Birth”. Lancet 1985;2(8452):436-7