Birth Models That Work

INTRODUCTION

1 Introduction Robbie Davis-Floyd, Lesley Barclay, Betty-Anne Daviss, and Jan Tritten The humanization of birth does not represent a romantic return to the past, nor a devaluation of technology. Rather, it offers an ecological and sustainable pathway to the future. ricardo herbert jones, obstetrician Birth is one of the most powerful of all human experiences, yet it can also be one of the most disempowering. Around the world, there are examples of societies and systems that provide women with true choice, where their desires and wishes and the normal physiology of labor and birth are honored , respected, and trusted. In these places, interventions are applied solely in cases of real need so that their potential misuse does not cause harm. Even though these are only lighthouses in an ocean of over-medicalized care across the globe, their existence shows us that good birth models work—they can combine the best of obstetrical care with the best of contemporary scientific research, ancient wisdom, basic common sense, and compassion to create systems of knowledge, skills, and practice that truly serve mothers, babies, and families. This book is about those lighthouses and their role as beacons for those searching for philosophical and concrete ways to improve maternity care. BIRTH MODELS THAT DON’T WORK: A BRIEF SYNOPSIS Characteristics of Birth Models That Don’t Work For years birth activists have been saying it: “That doesn’t work; it just doesn’t work.” By “doesn’t work,” they mean the contemporary obstetrical treatment of birth around the world. It doesn’t work. Yes, babies get born and lives that could have been lost get saved through modern obstetrics, but the price in both money and collateral damage to the mother and baby is increasingly high. This price shouldn’t have to be paid, because it is based on misinformation and misunderstanding of the normal physiology of birth and how best to support it. It comes from a system that seeks 2 introduction to avoid mortality through the excess application of interventions while failing to recognize that those very interventions when overused cause unnecessary morbidity—and increasingly, even mortality itself—to the mother or baby. Intervention is now associated with increased maternal and perinatal mortality figures due in part to the excess use of cesarean section in many countries: the increased rate of cesareans has become the unwitting accomplice to the mortality this operation is designed to avoid (see below). As the models described in this volume demonstrate, it is not necessary to “trade off” the morbidity associated with interventions for avoidance of mortality—decreasing intervention and increasing support of normal physiological birth both serve to avoid mortality. Indeed, as we will show in these pages, some low-intervention models of birth can demonstrate lower morbidity and equivalent (or lower) mortality than highintervention tertiary care. We have extrapolated the following characteristics of models that don’t work from the enormous body of literature written by epidemiologists , midwives, obstetricians, nurses, and social scientists that describes and critiques the scientific, humanistic, and economic deficiencies of contemporary obstetrics in dozens of countries. (See for summaries the Cochrane Library;1 Advancing Normal Birth 2007; Downe 2008; Goer 1999; Kroeger and Smith 2004; Enkin et al. 2000; Rooks 1997; Walsh 2007; the Millbank Report coauthored by Sakala and Corry 2008; and the many resources provided by Childbirth Connection2 and by the World Health Organization.) In brief, the characteristics of birth models that don’t work include: Unnecessary iatrogenic physical, social, and emotional damage resulting from the overuse of drugs and technologies such as labor induction, oxytocin augmentation, electronic fetal monitoring, episiotomy , and cesarean section Disregard for the scientific evidence that does not support the routine use of such procedures Concomitant disregard for the scientific evidence that demonstrates better outcomes from humanistic, woman-centered, and physiologically effective birth techniques such as labor companionship and upright positions for birth Interference with the establishment of breastfeeding through the use of drugs during birth and by separating mother and baby after birth The technocratic and patriarchal ideology that assumes women’s bodies are dysfunctional machines, and that birth is a problematic and risky process, justifying the overuse of technology in practitioners ’ minds • • • • • introduction 3 Hospitalrulesandhierarchiesthatstiflecreativethinkingandacceptance of the scientific evidence supporting noninterventionist approaches Focus on status or economic gain for institutions and professionals rather than a focus on the mother and baby Educational models...