What Makes Birth “Safe”? | Indie Birth

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What Makes Birth “Safe”?

January 11, 2013

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_MG_2975What makes birth “safe”?

The answer to this depends on so many things…who is answering, what their beliefs may be and how they see the world.

It’s that controversial; and the answers to this question have created fear in some women, empowerment in others. It is the question that has led to the licensing of midwives, and the governmental control of Birth as an industry. It is also yet another divisive argument between caregivers of all kinds that work with women and birth.

To me, it’s a trick question. Because nothing makes birth safer than it already is. In it’s truest form, of course. The delicate dance of mom and baby, to complete a sequence that is normal and physiological. It’s already “safe”; at least, as safe as anything else that our bodies are programmed to do. Eating, sleeping, eliminating. We don’t question that these processes are “safe” for the average person. They just are. We don’t ask “what” makes them what they are.

But things are not this simple in the birth world. The medical world argues that certain PEOPLE make birth safe. And to make it even more complicated, they want to also specify WHO make birth “safe” and label them as for us.

It’s just all backwards. The normal, healthy pregnant woman does not need all this. She may not know that, because for as long as she can remember, she’s been told that birth is dangerous and that it cannot be accomplished without an “approved” handler present. Does that not sound SO ridiculous?? Do we get a recommendation for an “approved” neurologist to make sure that we are sleeping safely? Or from an approved gastroentorologist to make sure we are digesting normally? The average person does not.

The problem is the thought that birth NEEDS to be made any safer than it already is. But it’s actually not “safe” that many people are after; it’s birth being infallible.

How is this possible? How can we erase the possibility of death from birth? We cannot. They are two sides of the same coin, but this is an uncomfortable subject and not addressed by those that think other humans or special machines can save every baby and every mama. That is not real, and that is not life, unfortunately. There is an element of risk in everything we do in life; whether it’s crossing the street, or driving our car. Birth is no different.

But if I HAD to answer it, birth is safest when left to the natural order of things. We know this to be true in the animal world, and so it is with people, too. A healthy woman that feels safe, loved; no matter how much she “knows” about birth intellectually, will birth her baby her way, on her terms. It may be easy or difficult, it may be an awe inspiring experience or just another day for her! But the mechanism is there for birth to work.

And as far as the WHO is “safe”; well, I don’t think it’s any of our business to determine this for ANY woman. There is no way to quantify risk, TRULY, for another person. We cannot know what a woman is weighing as HER risks and benefits to choosing a breech vaginal birth, or a home birth with a preterm baby. There is no research in the world that can take into account the emotional and psychological and spiritual assessment that each woman will do to make the proper choices for herself and her baby.

We do not need third parties looking in and deciding this for us; I refuse to participate. I truly trust that birth is safe; and even if I didn’t, I truly trust each woman to make the choice that she needs to make. I can offer education, research, or just be her sounding board. But when she chooses an unassisted birth after several cesareans, for example, I am confident that SHE has done her own risk assessment and assessed herself in a way that no one else ever could. She may or may not want input, information, research from me to make her decision. What this woman (and any woman needs!) is support. I am here with you. I will stand by you. I can’t see the future or guarantee you a specific outcome. But I respect your choice and I trust in the inherent safety of the birth process. I do not control life or death. No one does.

But it’s not just the obstetricians that have decided when and with who birth is “safe”. Now midwives, the “guardians of normal birth” are arrogantly assuming the same thing. A doctor insisting that birth is safer at a hospital with a surgeon in charge is no different than midwives believing that only certain midwives make birth safe, and that just having a midwife makes birth safer than not having a midwife! Has anyone realized the irony of this stance? We say we believe that birth is normal, but then suddenly, it’s only “safe” if we are there to save it. Not every birth is uneventful or perfect, but many caregivers end up creating the problem or complication they were afraid of in the first place.

So, let’s end this on a positive note. Walking with women is the TRUE job of a midwife. And this walk is done differently from midwife to midwife. Ideally, all midwives would be educated, compassionate, up on current research, a wonderful counselor, etc. But even when not, we must trust that a woman will choose who she needs to accompany her on her journey. It does not matter what anyone else thinks, and birth is not less safe when this choice comes from her heart.

Birth is just as safe as it always has been, and will continue to be, if we allow women to lead.

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  1. Seili Wennam says:

    Oh.my.word.

    You all really must not get it.

    Is eating, sleeping or eliminating ever supposed to be painful? No. If it is, we get help. Now surely even if you believe birth should only be hard work or even occasional for some lucky woman, orgasmic, you can admit that it not supposed to just happen as effortlessly as eating, sleeping and eliminating, right?

    Also….and this is something that really, really sets birth aside from eliminating……there is another human involved to worry about! You know what…if poop was alive…yeah, I bet more of us WOULD be more concerned.

  2. Educate yourself about the physiological birth process.  Read how birth works and what can interfere.  Read Grantly Dick Read’s, “Childbirth Without Fear”.  To your dismay, you will discover there actually ARE women that have effortless births.  I’m not one of them, yet I believe in the way the body works and educate myself appropriately to NOT have any extra interference.  If you’ve had a traumatic birth experience that has led you to experience birth as a horrible, painful, event, it may be part of you healing to know that not all birth (or all of your births!) are that way.  This doesn’t mean that birth is perfect or that with a less than perfect experience, we have failed.  I am simply addressing the FACT that birth works really well, MOST OF THE TIME, when left to the natural process.  If you’d like resources on physiological birth to expand your point of view, please ask!

  3. Seili Wennam says:

     I have read all about the physiological birth process and I know that SOME women every once in a while might have a pretty effortless birth. It’s not the norm. It’s not the norm that it would or should be effortless like eating, sleeping and eliminating should be. I think the natural childbirth ideology has become (or had always been) very misleading.

  4. Thank you for the reminder! My daily work is that physiological birth DOES become the norm!  I am looking forward to the day…even if it’s not until my daughters or granddaughters birth.

  5. Seili Wennam says:

    If it was a norm, it would be happening as easily and widely as the ease that most have with eating, sleeping, and eliminating. I doubt it will ever have the expected norm of those things. If so, it will probably take much longer to attain than just your daughters or grand daughters. 

  6. Mrs. W says:

    Pooping, eating and sleeping have never been a leading cause of mortality or morbidity for women and their babies – birth is. Declaring a woman inherently knows that it will be safe for her is denying her the right to informed consent.

  7. Birth is inherently safe for most women.  That is the truth.  And when a woman takes responsibility for her birth and her health and her baby, this is called informed CHOICE.  Informed consent is a lame way of assuming a role in the woman’s decision making.  I fully support informed choice.

  8. Mrs. W says:

    You know when health care providers fail to give informed consent it is generally considered malpractice. Pretending birth is inherently safe does not make it so.

  9. Rachley99 says:

    “The normal healthy woman…”

    I’m not sure who she is but it seems to me there are many variations on the theme. In the end, there is no right answer. There is nothing wrong with embracing the new ways we have to make birthing safer, relieve pain and otherwise evolve an age old process. Would you also turn back the clock on antibiotics, vaccines and helmets?

  10. Alexis C. says:

    I think a huge number of women throughout history would beg to differ with the idea that childbirth is inherently safe.

  11. Carla says:

    Actually the work and even the pain of labor are part of the physiologic process for some women….pain in birth does not signify that anything is wrong most of the time…..study the work of the body and oxytocin production

  12. Jennifer says:

    I love how you mentions death!  Death is a part of life, and as such, also a part of birth and reproduction.  It’s time to face that fact.  Choosing to have babies means loss is always possible.

    However, intervention in a normal healthy pregnancy mama/baby only causes more complications. Get in touch with your body and your baby, take your health seriously (nutritionally, spiritually, and emotionally) trust your intuition, work through your fears, avoid untrusting birth attendants and your birth WILL be as safe as it can possibly be. 

  13. carla says:

    There would not be so many of us if birth were not inherently safe.

  14. Margo Nelson says:

     Do you any information to back that statement up Alexis?  Because all the best epidemiological evidence shows that birth became less safe when obstetricians began attending births in the age of industrialization.  Birth is safest when left alone.  That doesn’t mean we can’t also have trained attendants who are willing to leave it alone and then can help if something does come up.  BUT the first step in the process is reclaiming this understanding that birth works almost all the time, it is meant to work, and we shouldn’t be trying to “improve” upon the physiological process when we don’t fully understand it yet.  We can only observe the process and occasionally conservatively aid if it becomes unphysiological for some reason (environmental, nutritional, emotional, accidental), always giving the mama and baby the benefit of the doubt, particularly if she feels confident.    Even that is hard to really get behind since WE DON’T UNDERSTAND the intricacies of the process despite all of the textbooks and studies.  There is an element of mystery that is beyond us, and is best left alone as long as is reasonable. 

  15. Margo Nelson says:

     “evolve an age old process”.  I’m not sure you understand what evolve means.  We evolved so that birth would be safe- we as humans can not make ourselves evolve differently.  The pain involved in childbirth is important – if it weren’t, it wouldn’t be there.  Also, most women experience more pain because of the cultural myths we are told about birth being painful and terrible.  Women in the US expect and report more pain than women in Europe because they simply imagine it differently.  There is also probably a health component to it, an emotional component and a a cultural component.  We need to stop and think about what epidurals, c-sections and other remnants of technocratic birth are doing to our species, to our babies, and to our cultures.  We should not be taking this so lightly.

  16. Alexis C. says:

    Well, I’m not aware that anyone was conducting research studies on the topic in the Victorian era and before, but as an amateur genealogist, I’ve seen massive numbers of women who died in childbirth in my own family, and my husband’s.

    I don’t understand the insistence that “birth almost always works” when so many bodily processes DON’T. (Eyesight would be a great example.) Should I just “trust sight,” even though I’m legally blind without corrective lenses? Why is birth so magically different?

  17. me says:

    Strangely enough, it does when it’s not happening in a hospital. The further away from the hospital, the more low risk women stay low risk.

  18. Sara says:

    “Declaring a woman inherently knows that it will be safe for her is denying her the right to informed consent.”
    That doesn’t make sense. A woman is fully capable of making decisions about birth.  To imply that telling her that her body knows how to birth is depriving her in some way, of information, is ludicrous.  I would say  that telling a woman she is broken and needs to rely on the ritualistic use of errant machines, deprives her.

  19. me says:

    No, I simply don’t use them when they aren’t necessary or warranted. When they ARE necessary or warranted, I access them. Normal birth simply doesn’t require this kind of “overlord” mentality. It requires a watchful mentality and if something needs medical care, you access it. And if the cesarean and intervention rate at home is 3% while the hospitals around here are at 40-79%…that means about half of all women are going home with major morbidity and possibly mortality while the women who are homebirthing are just having babies with relatively few complications which are observed and then transferred in for a higher level of care.

  20. Sara says:

     I trust the way my body is working until it proves otherwise.  People typically know when they can’t see properly.  However, people with healthy eyes do not need glasses. 

  21. Seili Wennam says:

     Women often don’t want to admit when their bodies don’t work properly, though.

    For instance, if a doctor tells a women that her pelvis is small she won’t be able to birth vaginally….. they generally mean, it might not happen without lots of damage or death.

    However, I often see women saying ‘ I showed that doctor and had my VBAC!’. But they also sometimes had horrible 4th degree tearing or even, in rare cases, a baby that has died, but they still consider all of this as proving the doctor wrong because the baby came out of the vagina.

    It’s just unfortunate that women are so caught up in thinking that we are ‘made to birth’ but no one goes around thinking we are ‘made to see’.

  22. Seili Wennam says:

     Does it? Does it all go down as easily as eating and sleeping? ha ha. I just think this whole premise is pretty out there and ridiculous.

  23. Seili Wennam says:

    Exactly. However, easier bodily functions, like eating, sleeping and eliminating, should not be painful. That’s why they are not in the same category at all.

  24. Seili Wennam says:

     :-/ Way too simple. Wow.

  25. me says:

    Yes, because what she’s getting in a HOSPITAL is informed consent??? “You can’t have a vbac in our hospital” “we won’t take you as a patient unless you agree to a cesarean” “you are over 40 weeks so your baby could die. We need to do an induction.” …yes….all these informed choices! 
    The difference is that when a woman takes her birth upon herself and accepts responsibility, she’s much more likely to make good choices than she is if she’s placed in fear relationships with providers who she cannot trust.

  26. Mrs. W says:

    So it’s all about the choices that mom makes and when mom or baby dies – it’s mom’s fault as she made the wrong choice or didn’t trust birth enough. I have no problems with women declining intervention – however, they need to know the real risk of doing so. A woman does not have to accept an intervention in a hospital (she can decline, and then doing it is a form of medical battery) – but at least then if the crap hits the fan (and it does) a mom can choose to have access to what is needed. In birth, sometimes a delay of even ten minutes can make the difference between a healthy baby and one who struggles with a lifetime of disability. It’s time to stop worrying about the cascade of intervention and to start worrying about what really matters – a healthy mom and a healthy baby. But I guess if you want to choose to avoid a csection even if it means the death of your child, it’s your choice – its just not a choice I could ever live with.

  27. Mrs. W says:

    It’s giving her the sense that birth does not have risk, when birth has very real risks (all be it small) to both herself and her child… She is entitled to know what those risks are and how her choice of birth attendent and location influence those risks. In Homebirth you might lower your risk of a cesarean – but at the increased risk that you or your child may die or face a lifetime of disability. I know I’d rtrade an increased risk of cesarean (actually I would go for a 100 percent risk of cesarean) if it meant a decreased risk of death or disability for my child.

  28. supermouse says:

     So would you support my decision to have my identical twins in the hospital with an OB, pitocin augmentation and an epidural?  All three of us made it out alive and healthy.  If you are saying that safety is in the eye of the beholder, then I believe it was safer to be in the hospital as well as having listened to OB suggestions/recommendations over the course of my complicated pregnancy. Of course, we will never know if all three of us would have ended up alive and healthy if they’d been born at home.  It is certainly possible, but based on my risk assessment, which was guided by my doctor’s risk assessment, it wasn’t likely. 

  29. Mrs. W says:

    That is not informed choice. Informed choice happens after a woman knows what risks she is taking with the options she has available and then freely chooses.

  30. Cindy Hetzer says:

    Wow.  Anyone who still uses the argument, “All that matters is a healthy mom and a healthy baby,” REALLY doesn’t get it.  Just wow.

  31. Cindy Hetzer says:

    And yet, Maryn never argues that birth is without risk.  Never.  Birth is as safe as life.  Life is not without risk.  Neither is birth.  

    Also, the risk associated with hospital birth is MUCH more than just the risk of cesarean surgery.  You and your child can die and face a lifetime of disability from all sorts of iatrogenic causes, not just cesarean.  

  32. Cindy Hetzer says:

    No, if a doctor tells a woman that her pelvis is small and she won’t be able to birth vaginally, he generally means, do what I say or else I’m playing the dead baby card.

    It’s kind of funny that so many here are either a. completely sold on the dead baby argument of b. playing the dead baby card for their own reasons.  

  33. Alexis C. says:

    Yes, and plenty of people COULD give birth just fine without help. But if you’re not one of them, the stakes are a lot higher than just “the TV is all fuzzy.”

  34. Alexis C. says:

    You do realize that sometimes there IS an actual dead baby, right? Because brushing it off as a “card” is incredibly disrespectful to families who did lose a child from preventable causes.

  35. Cindy Hetzer says:

    Of course.  I also know the stats in the US for both maternal and infant mortality are incredibly high, ridiculously high, for the nation that spends the most amount of money per capita on childbirth.  Considering that 99% of births occur in the hospital setting, it is quite clear that the our maternity care system does not serve the best interests of mothers and babies a staggering amount of time.

  36. Victoria says:

    Knowing Mrs W’s experiences with birth I would say she gets it. And you Cindy? Would you rather avoid the cesarean to have a dead baby? You think everyone has to have a natural birth and will feel afterwards? Maybe you are the one that doesn’t ‘get it’.

  37. Victoria says:

    Infant mortality is the wrong statistic to bring into this conversation.

  38. Mrs. W says:

    Here’s a good overview of why what you are saying is at best misguided – http://www.quackometer.net/blog/2010/03/how-safe-are-home-births.html

  39. Alexis C. says:

    You realize that infant mortality is measured up to 1 year and has nothing to do with obstetrics, right?

  40. Seili Wennam says:

     No, I don’t think most doctors mean that at all. It is usually said to women that did have previous problems with CPD. Can women with CPD birth vaginally? Sure, probably most can at some point…but how difficult will it be? For a few, it will go fine, for many others, they are in the higher category of having either not successful VBAC’s or very difficult, damaging VBAC’s.

    And the dead baby card is never just a card, neither is a dead mom card. They all matter. If a woman tells me I am more likely to die during a c-section, I don’t tell her ‘you’re playing the dead mom card’. What she is saying may be right and I have no need to be defensive about it, but to instead take the information and weigh it in my situation and my baby’s situation.

  41. rs09 says:

    How is Maryn’s statement that women taking responsibility for their birthing process is also an act of informed decision making not true? Women have nineish months (if not more, for those who start their research while trying to conceive!) to inform themselves of their bodies and birth before deciding which avenue is best. And I’ve met women who, because they decide to home birth or birth with a low-intervention midwife, are more educated about the birthing process and their bodies than others who choose the hospital route. (And plenty of hospital birth moms who educate themselves as well and choose the more conventional hospital route for a number of reasons–breech, multiples, high risk mama health issues).

    Personally, I have not birthed and most likely would not choose to home birth, because I have a list of health issues that I would feel more comfortable having monitored by someone with medical training. But you better believe that, when the time comes, that final decision of where and how to birth will be an informed decision made after extensive research and discussion and soul searching. No matter what a woman’s choice, if it’s an educated one, then it’s “informed.”

  42. Jen Valencia says:

     Avoiding the cesarean does not = a dead baby.  Each woman must individually evaluate the risks and benefits of a trial of labor and the risks and benefits of a repeat cesarean.  The purpose of this original blog post was reminding women that birth is normal, unlike what we see in the media.  Yes, there are risks but there is also a risk to fearing birth- that in and of itself can stall a labor.  What the author spoke here were words of wisdom encouraging women to surround themselves with those of their choice who would provide support because above all, compassionate, loving support is what a woman in labor needs.  She may need her doula, to help get the baby in a better position, she may prefer an ob’s advice, but above all she needs trust because not every birth professional is going to give the advice that’s best for the mum; insurance fees and hospital protocol and fear of lawsuits greatly influence medical professionals who sometimes step in and create the very problem they feared or even greater problems such as unnecessary c-sections for a mom that may have birthed a perfectly healthy baby.  That, was the point.  Please, respect birth and the mother, above all.

  43. Jen says:

     Each woman should be supported in the choice she makes for her birth.  The author stated,
                    “And as far as the WHO is “safe”; well, I don’t think it’s any of our
    business to determine this for ANY woman. There is no way to quantify
    risk, TRULY, for another person. We cannot know what a woman is
    weighing as HER risks and benefits to choosing a breech vaginal birth,
    or a home birth with a preterm baby. There is no research in the world
    that can take into account the emotional and psychological and spiritual
    assessment that each woman will do to make the proper choices for
    herself and her baby.” 
    No one can ever know what would have happened with another situation, it can be speculated but that may drive a person mad.  You have to make the best choices for yourself in each situation and process each birth so that birth itself remains respected and safe.  Understand that it has been done safely without the intervention and respect that woman for her choice.  She examine her own risks and benefits and did what was best for her and her babies.
    http://birthwithoutfearblog.com/2011/12/21/home-birth-of-twins-born-past-41-weeks-one-footling-breech/ 

  44. Jen Valencia says:

     Just because it’s more difficult that eating sleeping and pooping doesn’t mean that it’s not a normal bodily function.  We were made to reproduce and that includes giving birth.    What’s misleading about childbirth is what we are presented with in our pop culture; it creates fear which creates pain; this cycle has been proven true.  Natural childbirth advocates, including the author of this blog, are not screaming at you to personally have an unassisted homebirth nor are they guaranteeing your outcome.. they are simply stating, well there’s no other way to put it, that it is a normal bodily function that in and of itself is safe.  Yes there are risks as there are with sleeping (sleep apnea) but we don’t put every person on a breathing machine at night just in case they stop breathing, just like every woman does not need medical intervention just in case something happens.

  45. Jen Valencia says:

     What women also need to know, besides the risks/benefits of declining an intervention are the risks/benefits of accepting an intervention. Far too often medical professionals are not giving women all of the information they need about an intervention to make a proper informed consent, not too mention, if she’s in labor, her mind is in a primal state and according to “informed consent” definition, not being in a clear state of mind means not making an informed choice.  Medical professionals have high degrees of concern for their finances and etc and will most often jump to a medical intervention first because it’s what they know.  For example, mom’s been at 7cm for 1.5hrs and the baby’s heart rate is dipping, so doc says it’s time for a c-section. Mom has been on her back for a while and on the monitors, not being allowed to move due to hospital worry/protocol.  Well, mom was probably pausing in dilation because that’s not what the contractions were doing at the time.  This was baby’s time to dance and get into a more optimal position before mom dilated more.  So perhaps lying on her left side would have leveled baby’s heart rate as lying on the back is known to cut off oxygen supply to baby and make it difficult for baby to rotate.  But instead of informing mom, ok, here’s the concern, let’s try this, and then walk stairs sideways, mom is informed of the baby being in danger and SHE better hurry up and progress or they’ll have to get the baby out-  placing fear in mom and making her “in charge” of her involuntary bodily process, creating unnecessary guilt in mom leading to postpartum depression.  Was she informed of that risk???  No!  In this example the hospital created the problem, blamed it on mom, and then “fixed” it with out telling mom of other options or risks/benefits of either scenario.  You said you couldn’t live with baby dying, and we may never know if that would have happened or if it would have been fine.. but do you remember, that c-sections are risky for babies too, also with the possibility of resulting in death and lacerations among other less serious risks.  Can you live with that?

  46. Jane says:

    Do you know what pain is? – it is a messaging system that you are meant to pay attention to. Birth does not have to painful. I had three children at home without pain. My first at 34 and my last at 42. I had them in water so I could  squat and the water support that position, because as a pampered westerner, despite  my yoga practice,  squatting is not the most comfortable position for me. My husband was my birth partner and filter. My first midwife was wonderful. Confidently and subtly managing the birth, so unobtrusive it was our event. The last midwife was a pain in the butt and I tried to get rid of her by sending her out to the car to get gas and air so my husband could lock the door on her. But to be fair a lot had changed. With my first birthing, home births were so rare that the community midwives and their activities went under the radar and they were left to their own devices and experience and judgement. By the time my second child was born there were enough home births for the obstetricians to want to get involved and make regulations and demands about the process. A little bit more monitoring a little bit more interference, a little bit more fear and a little bit more loosing ownership of my body and the experience. By the time my third child was born, home births were a lot more popular. There was a lot of pressure on community midwives, a lot more demands on their time and a lot more mistrust of their capability. They were leaving the profession in their droves. The midwife who attended my third birth should never have been in the job -she just wasn’t suited to it – far to neurotic. She was the main danger in that birth. Make no mistake – it is an intense internal process that demands your full attention. All animals find a safe environment in which to birth, if they feel threatened or in danger they go out of labour. Humans are the same. Safety comes from the type of support you receive. Paranoid expectations of trouble usually become  self fulfilling prophecies.

  47. Meagan says:

    There would be so many more of us if birth were inherently safe.

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