Sunday, July 31, 2011

"Primal" Birthing

I've been following the blog The Healthy Skeptic and love all Chris Kesser has to say on, well, everything!  I started following his blog to learn more about healthy eating, but now that he discusses natural childbirth, I love the blog even more! 

Lots of women I know are pregnant right now so I thought I'd post this tidbit on natural childbirth...

Natural childbirth III: why undisturbed birth?

July 21, 2011 in Fertility, Pregnancy & Childbirth

Spontaneous labor in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing reqired from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine – nil nocere [do no harm]

G.J. Kloosterman, The Universal Aspects of Childbirth

In the wild, mammals isolate themselves during labor.

A pregnant sheep, which is normally a herd dweller, will separate herself from the flock when birth becomes imminent. A rhesus monkey will move away from her group to the edge of the forest and choose a well-camoflauged hiding place in which to give birth. The rat, which is normally a nocturnal prowler, gives birth during the day to increase the chances that she’ll be unobserved. And the horse, which is normally a daytime grazer, gives birth during the night for the same reason.

Human beings are mammals

As often as we forget this, human beings are mammals. We share the same 175 million year evolutionary heritage of birth with other mammals. These similarities should be starting point when try understand the process of normal, undisturbed birth in our own species.

Like our mammalian relatives, human females are designed to give birth safely in the wild without supervision or medical intervention. It is as natural to us as eating, breathing, digestion, elimination and sleeping. It’s in our genes.

As physician and natural childbirth advocate Michel Odent reminds us:

When you consider birth as an involuntary process involving old, mammalian structures of the brain, you set aside the assumption that a woman must learn to give birth. It is implicit in the mammalian interpretation that one cannot actively help a woman to give birth. The goal is to avoid disturbing her unnecessarily. 1

Traditional humans also isolate themselves during labor

In a film about birht among the Eipos tribe of Papa New Guinea, ethologist Wulf Schniefenhovel documents mothers-to-be leaving their village and going into the bush just prior to giving birth.

Isolating oneself in this way has been the norm in traditional societies around the world, including the Kung San in Africa, the Turkomans in Central Asia and First Nations tribes in Canada.

In an eighteenth-century, firsthand account of birth practices in a tribe of Canadian Indians found in a Paris library, J-C B. explains1:

Women usually give birth by themselves and without any difficulty, and always away from their own homes in small huts which have been built in the forest for this purpose, 40 or 50 days beforehand. Sometimes they even give birth in their fields.

It’s worth noting that in these societies where women isolate themselves during labor, deliveries are often reported as being easy, almost to the point of seeming effortless to observers.

Why would this be? How does privacy and isolation contribute to easier and less complicated labor?

What kind of environment inhibits a female in labor?

To answer those questions, we can look at studies of mammalian birth carried out by Niles Newton in Chicago during the 1960s.

Newton studied birth in several mammals, but focused on mice in particular. She analyzed the factors that made deliveries longer, more difficult, and more dangerous.

She found that labor could be slowed or even stopped completely by:

  • Placing the laboring mother in an unfamiliar environment (a place where the sights and smells are not what she’s accustomed to).
  • Moving the mother from one place to another during birth.
  • Putting the mice in a transparent cage made of glass and observing them.

Does this sound familiar? Each of these things happens in a conventional hospital birth. The mother is moved during labor from her home, which is familiar, to a hospital, which is unfamiliar, and observed by a staff of people she has little connection to or experience with.

Although we are not mice, we do share similar needs as other mammals during labor. Anything that disturbs a laboring woman’s sense of safety and privacy will disrupt the birth process.

This definition unfortunately covers most of modern obstetrics, which has created an entire industry around the observation and monitoring of pregnant women. As Dr. Sarah Buckley observes 3:

Some of the techniques used are painful or uncomfortable, most involve some transgression of bodily or social boundaries, and almost all techniques are performed by people who are essentially strangers to the woman herself.

Underlying these procedures, Buckley says, is a fundamental distrust of women’s bodies and the natural processes of birth. This distrust has a powerful “nocebo” effect and becomes a self-fulfilling prophecy, where women are almost certain to need the interventions that the medical model provides and feel grateful for them no matter how traumatic the experience.

Because of this, many women in western culture have come to expect birth to be a medical emergency – rather than a natural, instinctual process – that requires medical management and intervention.

The hormonal orchestration of an undisturbed birth

The hormonal orchestration of birth is an exceedingly sophisticated and complex process that is still not well understood.

In fact, we still don’t know what causes the onset of birth. We know that estrogen, progesterone, cortisol and SP-A are all implicated, but we don’t know exactly how they work together. This is another reason why it’s so important to minimize interference in the natural birth process; we are more likely to cause problems with intervention than solve them.

A perfect example of this is fetal heart monitoring with ultrasound during labor. The pretense for this type of monitoring is that it will catch a potential problem and thus make the mother and baby safer.

However, studies show just the opposite is true. A large review published in Lancet in 1987 covering tens of thousands of births in Australia, Europe and the U.S. found that the only statistically significant effect of continuous fetal heart monitoring during labor was an increase in the rate of Caesarians and forceps deliveries.

The hormones involved in orchestrating mammalian birth are secreted by brain’s most primitive structure, the limbic system. The limbic system is not in our conscious control. For birth to happen optimally, we need to give this more primitive part of the brain precedence over the “rational brain” (the neocortex).

Anything that inhibits this shift of consciousness – including fetal heart monitoring, bright lighting, conversation, observation and expectations of “rational” behavior – will very likely interrupt the natural birth process.

Conversely, when we provide the right environment for a woman during labor – conditions in which she feels safe, private and unobserved – we facilitate the instinctual coordination of birth that is part of every woman’s genetic heritage.

Dr. Buckley observes4:

Undisturbed birth represents the smoothest hormonal orchestration of the birth process, and therefore the easiest transition possible; physiologically, hormonally, psychologically, and emotionally, from pregnancy and birth to new motherhood and lactation, for each woman. When a mother’s hormonal orchestration is undisturbed, her baby’s safety is also enhanced, not only during labor and delivery, but also in the critical postnatal transition from womb to world.

This, together with modern hygiene and the availability of advanced emergency medical techniques, give us a better chance of an easy and safe birth than any of our ancestors have had in the history of the human race.

In the next few articles in this series, we’ll be exploring the hormones involved in the birth process and how medical procedures such as epidurals and induction with synthetic oxytocin (pitocin) interfere with the exquisitely regulated (and still poorly understood) hormonal orchestration of undisturbed birth.

Odent M. Birth and breastfeeding: rediscovering the needs of women during pregnancy and childbirth. Clairview Books 2007. ↩

Odent M. Birth and breastfeeding: rediscovering the needs of women during pregnancy and childbirth. Clairview Books 2007. ↩

Buckley S. Gentle birth, gentle mothering: a doctor’s guide to natural childbirth and early parenting choices. Celestial Arts 2009. pp.96 ↩

Buckley S. Gentle birth, gentle mothering: a doctor’s guide to natural childbirth and early parenting choices. Celestial Arts 2009. pp.97 ↩

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