Over Labor Day weekend, ImprovingBirth.org coordinated the third annual nation-wide Rally to Improve Birth. Thousands of mothers and supporters rallied at 115 locations. The Rally to Improve Birth Oahu was organized locally by Hapai Hawai'i.
What is the Rally to Improve Birth About?
While rallying on the corner of Paki Ave and Monsarrat Ave with an array of messages including, "Your body, Your baby, Your birth", "Lower the Cesarean Section Rate", and "Birth Matters", people passing by were having a difficult time figuring out what cause we were supporting. Some saw the word "birth" and "choice" and jumped to the conclusion that it must be about abortion. I think next year we should hang a banner that reads, "Improving Birth for Moms and Babies."
Here is the official description of the Rally to Improve Birth movement:
"This movement isn’t about natural birth vs. medicated birth. It’s not about hospital birth vs. homebirth or birth center birth.
It’s about women being capable of making safer, more informed decisions about their care and that of their babies, when they are given full and accurate information about their care options, including the potential harms, benefits, and alternatives. It’s about respect for women and their decisions in childbirth, including how, where, and with whom they give birth; and the right to be treated with dignity and compassion."
Why do I Rally to Improve Birth?
In 2013, while I was pregnant with my son, I rallied for "Informed Childbirth: Because it's the most important day of my child's life". In 2014 my baby boy and I rallied together for "Informed and Empowered Childbirth: Best for moms, best for babies".
At this year's rally another participant asked me how I was involved with the cause. "Are you a doula? midwife? lactation consultant?" "No," I replied, "I'm just a mom who cared passionately about having a positive birth experience for my son". "Oh, so you're an activist?" she responded. Yes, that is right, I am an activist campaigning for social change.
I rally for informed childbirth because women can make the best decisions for themselves and their babies when they are fully informed of their options and the risks and benefits associated with those options. I rally for empowering women by allowing them to be decision makers during maternity care and childbirth.
Because we have a right to INFORMED CONSENT
I feel passionately about this cause, because honoring a woman's right to informed consent during pregnancy and childbirth boils down to respecting her fundamental human rights. "All citizens have the right to informed consent in healthcare, and that includes the right to refuse medical interventions."[2. Informed Consent in Childbirth: Making Rights Into Reality, http://www.improvingbirth.org/2013/07/informed-consent-in-childbirth/, viewed 09/07/14.]
Human Rights in Childbirth explains the right to informed consent in the following manner:
The right to informed consent is a fundamental healthcare right grounded, like the right of refusal, in the right of every human being to autonomy and authority over their own body. When a doctor or other healthcare provider recommends an intervention or treatment, they have a legal obligation to inform the patient of the risks and benefits of the full range of options available to that patient. The patient is entitled to evidence-based, individualized recommendations, and to be supported in the exercise of genuine consent – that is, the choice to accept the recommendation or decline it—on the basis of the patient’s personal needs and values. The right to informed consent is a right to evidence-based care—or the right to be informed that the recommendations under discussion have no basis in evidence."[3. Right to Informed Consent, Human Rights in Childbirth, http://humanrightsinchildbirth.com/human-rights/right-to-informed-consent/, viewed 09/06/14.]
During law school, informed consent was portrayed as a sacred fundamental right. But as soon as I started watching documentaries on childbirth, like The Business of Being Born, and reading about having a natural childbirth in a hospital setting, I realized that as a pregnant woman I would need to be on guard to stand up for this right at every turn. Somehow, much of the healthcare system in the United States seems to have not yet realized that pregnant women are citizens and are entitled to informed consent. "Examinations, interventions and procedures that pose risks to both mothers and their babies are routinely performed without informed consent, or through coerced compliance via threats or fear."[4. Who Makes the Decisions in Childbirth?, Human Rights in Childbirth, http://humanrightsinchildbirth.com/, viewed 09/06/14]
Many doctors hurry through their standard birthing protocol without stopping to inform about the procedures they are about to perform or to ask for consent. The doctor may think that preforming a routine episiotomy or instantly clamping an umbilical cord are no big deal, but these actions may be against the wishes of the individual woman. To the doctor it may be just another delivery, but to the woman it is her body, her baby, her birth.
It is a sad state of health care when women need to be prepared to fight for their rights during maternity care and labor. Many women may not even realize that they have the right to refuse procedures that are advised by their doctor. While others may know in the back of their mind that it is their decision to make, but during a vulnerable time are coerced into something they do not want.
Informed consent does not mean telling a woman that she is going to have a particular procedure and handing her a piece of paper that she must sign stating that she agrees to the procedure. It is not simply, "You've been informed, now you must consent." It does not qualify as informed consent unless she has the ability to choose an alternative other than the one the provider recommends.
As a citizen, she is entitled to be informed of all of her options and the risks and benefits associated with each option and then allowed to select the option that fits her personal values. Her decision to refuse a doctor's offer of treatment does not need to seem reasonable.
Each woman is a unique individual, and so is each new baby entering the world.
"One-size-fits-all, protocol-dictated, assembly line maternity care violates the right to informed consent and fails to promote health and well-being. Genuine informed consent recognizes the patient as an intelligent, autonomous human being capable of making decisions about their body."[5. Right to Informed Consent, Human Rights in Childbirth, http://humanrightsinchildbirth.com/human-rights/right-to-informed-consent/, viewed 09/06/14.]
Because there is ROOM FOR IMPROVEMENT in American maternity care
Many pregnant women across the nation assume that their care provider has their best interest and the best interest of their soon-to-be-born baby in mind. In reality, when it comes to childbirth, the practices of many health care providers and policies of hospitals are based more on avoiding liability for medical malpractice claims and watching out for their bottom line than on what is best for mom and baby.[7. VBAC Bans: The Insanity of Mandatory Surgery, Excerpt from the eBook Vaginal Birth Bans in America: The Insanity of Mandatory Surgery, by Cristen Pascucci, http://www.improvingbirth.org/2014/04/bans/, viewed September 6, 2014]
"Across the United States and around the world, people are waking up to the fact that obstetric care could do better for women and babies. The ever-increasing imposition of expensive technological, pharmaceutical, and surgical interventions in pregnancy and childbirth does not result in better outcomes. Life-saving technologies are great when they save lives. However, their use in cases when they are unnecessary is not only inefficient, but risky. Few would deny that life-saving technologies are being used on many women who are not in an emergency and could have given birth without those technologies."[8. Informed Consent in Childbirth: Making Rights into Reality, http://www.improvingbirth.org/2013/07/informed-consent-in-childbirth/, viewed 09/06/14.]
The handout above, from Evidence Based Birth, contrasts Routine U.S. Maternity Care vs. Evidence Based Care. There is a huge divide between the routine care woman receive and the type of care that is supported by evidence. I was shocked to read these statistics. Please take a moment to read through the table.
The most worrisome statistic mentioned is that roughly one third of births in the U.S. occur by Caesarean section (33% overall and 27% of first-time mothers) . In contrast, "the World Health Organization recommends that the caesarean section rate should not be higher than 15%" for first-time mothers. [9. Bulletin of the World Health Organization, http://www.who.int/bulletin/volumes/85/10/06-039289/en/, viewed 09/06/14.]
Women have been giving birth throughout the existence of humanity, so why now are one third of the births in the U.S. occurring through major abdominal surgery? One contributing factor is that labor is artificially induced for 42% of first-time mothers, which doubles their risk of a c-section delivery. Some inductions are medically necessary, but many are done just for the convenience of the doctor or the soon-to-be parents. Before becoming more informed, I had thought that an induction to avoid a Christmas baby might be a good idea. But after learning more, I realized that forcing a baby to be born early can result in the baby not being fully developed and ready to meet the challenges of the outside world. Although estimated due dates are set at 40 weeks, and many care providers do not want a pregnancy to go past 42 weeks, some healthy labors spontaneously begin at 43 week or later, when left to proceed naturally.[15. Gaskin, Ina May. Ina May's Guide to Childbirth. New York: Bantam Books Trade Paperbacks, 2003. Kindle File, location 3716.] We should allow the baby to choose their own birthday.
The reverse side of the flyer highlighted some other attention-grabbing points, including that, "We spend the most money in the world on maternity care, and have one of the worst maternal mortality rates of all developed countries".[10. Deadly Delivery: The Maternal Healthcare Crisis in the U.S, http://www.amnestyusa.org/sites/default/files/pdfs/deadlydelivery.pdf, viewed 09/06/14.]
We deserve better. We deserve evidence-based maternity care that puts the wellbeing of the mother and baby first.
When giving birth in a hospital setting, we shouldn't have to fight our way through an onslaught of unnecessary medical interventions. Natural birth should be the default, with interventions only suggested when medically prudent or requested by the patient.
We should not receive maternity care that increases risks to moms and babies just because that care makes more money for insurance companies or is more convenient for doctors.
Because BIRTH MATTERS
Birth matters for both mother and baby.
A positive birthing experience can make a mother feel empowered and strong. If she can give birth to a baby, she can do anything!
On the other hand, a birth where her wishes are ignored or she is bullied into unnecessary procedures can leave her traumatized or feeling empty and robbed, like a piece of her and her baby are missing. Many women who suffer from childbirth trauma only heal when they are later able to birth their way. Having read some of these traumatic birth stories on ImprovingBirth.org, I was determined to a have a positive childbirth experience with my first baby. Plus, I was not sure if I would choose to birth another baby, so I wanted to do it right the first time.
I was fortunate to be present for two births before it was my turn to give birth- one vaginal delivery and one scheduled Cesarean section, due to Baby being in a transverse lie position. I had the opportunity to see how two laboring women and their newborn babies were treated by the doctors and nursing staff in two different hospitals.
But it was actually while reading about breastfeeding that I realized just how much birth matters. It is important to begin breastfeeding soon after birth, while Baby is alert and energetic. Medications given during labor can cause Baby to be drowsy and less able to begin nursing. Interventions, trauma, and a feeling of defeat can interfere with the natural hormone release and bonding process and impose hurdles at the start of the breastfeeding relationship. The Womanly Art of Breastfeeding by La Leche League International explains that, "A complex hormonal sequence during labor sets us and our babies up to take on our roles with confidence and enthusiams, and if that sequence is disrupted too much, both early motherhood and breastfeeding can be harder."[11. La Leche League International. The Womanly Art of Breastfeeding 8th Ed. New York: Ballantine Books, 2010. Kindle file, location 957.]
Since switching to a Primal lifestyle, I have discovered another benefit of vaginal birth over an unnecessary Cesarean section. A vaginal birth exposes the baby to beneficial bacterial during the journey through Mother's birth canal. This begins to establish a gut micro biome that plays an important role in gut health for the rest of the newborn's life. As opposed to vaginal deliveries, "babies born to c-sections are more likely to have decreased microbial diversity, impaired immune responses to stimuli, and lower colonization by beneficial bacteria."[12. How to Establish a Healthy Gut in Your Primal Baby, http://www.marksdailyapple.com/how-to-establish-a-healthy-gut-in-your-primal-baby/#axzz3CrnSSLVn, viewed 09/08/14.]
One third of the babies born today are being set up for poor gut health, which in turn effects many other areas of health. In order to promote living a healthy lifestyle, one of the first steps is to look right at where it all begins and work to lower the c-section rate, so that the c-section rate is more in line with a medically necessary rate of 10-15% of births.
Because it's time to feel EMPOWERED, rather than fear childbirth
Giving birth can be the most empowering right of passage in a woman's life. It is amazing that we can grow a baby inside our uterus and then bring that baby out into the world. Childbirth is an awe-inspiring natural process, not a medical illness.
When women feel empowered to make their own decisions during pregnancy and childbirth and supported in those decisions, they are better able to pull upon their inner strength during labor. When women are fully informed and understand their options and feel knowledgable about the birthing process, they are better prepared to face the challenges of childbirth with a positive mindset.
On the contrary, fearing the unknown process of childbirth and fearing being bullied during labor increase the experience of pain.
An important way to help empower women to have joyous birth experiences is to share inspirational birth stories. We should turn the spotlight to illuminate strong empowered childbirth. For me, information and preparation helped me achieve a rewarding natural hospital birth.
What Can You Do to Improve Birth?
It's time we all stand up and rally for improving birth. Whether you had a positive birth experience and wish the same for other women or had a regrettable birth experience and know first hand that there is room for improvement, this cause matters. Birth matters. It matters not only to the women giving birth, but to their children, partners, and loved ones. Let's all rally together to improve birth! Find ways to help on ImprovingBirth.org.
Moms and Moms-to-be Can:
Despite our right to informed consent, we cannot idly sit back and expect our health care providers to educate us as to all of our options in childbirth and the risks and benefits associated with those options. In reality, it is up to you to take an active role in learning about childbirth, so that you will know your options. It is important to realize that one intervention can lead to another, culminating in a c-section that would not have been necessary.
- Become informed of evidence-based maternity care.
- The risks of being uninformed are too great. Unnecessary interventions are commonly used in hospital settings and can greatly increase the chance of needing a c-section delivery. And since many hospital policies and care providers do not support vaginal birth after Cesarean (VBAC), one c-section could lead to mandatory surgery for all future births. You can start gaining information at ImprovingBirth.org and Evidence Based Birth.
- Read at least one book about natural childbirth.
- It is important to envision what birth looks like when it is allowed to proceed naturally, rather than focusing only on things that could go wrong.
- While I was preparing to give birth to my son, reading both Ina May's Guide to Childbirth and Posh Push: Modern Girls Reveal Secrets for a More Natural Birth helped me realize that I would be able to achieve natural birth, free from pain medications.
- Take a childbirth preparation class.
- Take prenatal yoga classes to prepare your mind and body for labor and delivery.
- Choose a comfortable birth setting.
- Options include your home (while attended by a midwife), a birth center, or a hospital.
- Choose a supportive caregiver.
- Midwives have extensive training in attending mothers in normal birth, preventive care, and some interventions and emergency procedures.
- Obstetricians are surgeons with special training in intervention methods for complications that may or may not arise in pregnancy, labor and birth.
- Find an experienced birth helper, such as a doula to provide emotional support during labor.
Becoming more informed can help you make better decision regarding your care during pregnancy and childbirth and the care of your newborn baby.
Do you feel informed about the options available during childbirth?