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170 LIVING RESISTANCE Doula-Assisted Childbirth Helping Her Birth Her Way Angela Horn Birth in the United States is a medical event. But it hasn’t always been that way. At the turn of the twentieth century, only a small percentage of women gave birth in hospitals. Today, nearly all women birth in the hospital and, while there, they are unlikely to experience a natural birth (Rooks 1997). For instance, over 75 percent of women in the United States give birth with epidural medication (Declercq et al. 2006), one in four labors is induced (Zhang, Joseph, and Kramer 2010), and one in three women has her baby by cesarean surgery (Menacker and Hamilton 2010)—one of the most commonly performed surgeries on women. This means that all but a very few women begin motherhood with stitches, postbirth pain, and in many cases disorientation and anxiety stemming from their overmedicated births. The standard medicalized birth does not bode well for babies either. Despite advanced technologies and the exorbitant funds pumped into maternal healthcare, the United States ranks a dismal forty-fifth in infant mortality (CIA 2010). This means that for every one thousand babies born, six will die in the first year (MacDorman and Matthews 2008). I am a doula, a woman who provides expectant families with educational and informational support and aids in the relief of labor discomfort, typically through massage and labor-facilitating positions. The most challenging clients I work with are those who birth simply and naturally, that is, in contrast to accepted medical norms. After all, allowing labor to start naturally and eschewing pain medication are now considered “alternative” practices. And birthing at home or in freestanding birth centers is uncommon. In my work, women tell me about their experiences with (what is now considered ) conventional obstetrics. Often providers are supportive of a woman’s choices to birth her way, but near her due date, things begin to shift. Doctors often withdraw support for the mother’s wish to wait for labor to begin spontaneously once the due date passes. Even though the best evidence shows that the normal length of pregnancy in a first-time mother is forty-one weeks plus one day (Mittendorf et al. 1990), many providers induce labor at forty weeks if the woman has not begun labor. What’s the problem with that? Well, induction is not risk-free: induced labors often require the use of medication to stimulate contractions or soften the cervix, and the resulting contractions are often longer and more painful and more often end in cesarean surgery— a major operation that itself increases the risk to mother and baby. Provider disapproval surfaces at other times, too. When it is suspected that a woman is carrying a “large baby,” induction or elective cesarean or both often fol- Doula-Assisted Childbirth 171 low. Ultrasound, however, is not an accurate way to predict fetal size; sonographers and physicians I have worked with indicate that estimations can be off by up to two pounds! Yet, in the final weeks of pregnancy, many providers suggest an ultrasound to check the baby’s position and size. In my practice, I witness countless situations in which women, desiring to birth as naturally as possible, encounter resistance from their care provider and sometimes even family and friends. Women are repeatedly reminded of potential health risks, reinforcing fears (often unfounded) about complications and undermining confidence. In some ways, anxieties are not unexpected. Birthing in a hospital, flat on the back (supine), with fetal monitoring and epidural anesthesia to numb the body from just under the breasts down is practically the only birth we hear about in America. But there are other birth stories and there can be more. As a certified doula, my role is to help women who want a different birthing experience to actually have one. But it is also my responsibility to preserve a woman’s faith and trust in her care provider. This means I must walk a very fine line. When a woman is being pressured into an intervention she may not need, I have to squelch my desire to scream, “You are being lied to! You are being duped!” Instead, I provide her with evidence-based information, help her formulate questions, and if she wants, role-play ways she can advocate for herself. I recently worked with two clients who were being pressured into scheduled cesarean births because their providers suspected large babies. In both cases I educated the women and...

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