Birth, Sex & Risk

“The place a child is going to be born must be as similar as possible to the place he/she was made.” -Sheila Kitzinger

Often I hear of couples who opt not to homebirth for fear of the risks of birth and the possibility that they may need medical assistance (despite the fact that about 90% of women are capable of safely giving birth without anyone present, let alone intervening). To an unhindered birth advocate like me this kind of fear of birth is almost laughable. When I think of birth I think of a normal physiological process women were perfectly designed to do. For someone to suggest women need help birthing is like saying the majority of human beings require help pooing. To highlight what I mean read the following play from Spontaneous Creation 101.

"HUSBAND and WIFE passionately take off each other's clothes. WIFE reacts with alarm to HUSBAND's potbelly.

WIFE: How many French fries did you eat tonight?!

HUSBAND: Oh, about 200 . . .

WIFE: How many have you eaten since childhood?

HUSBAND: Uh, I don't know.

WIFE: You could die of a heart attack at any time! You could die tonight while we're making high-aerobic love! And I could die from a broken rib, you're so heavy!

HUSBAND: I've gained a lot of weight since high school.

WIFE: I don't think a heart attack for you or a punctured lung for me sounds too good, do you?

HUSBAND: No.

WIFE: I think our lovemaking has become just too risky, dear. I've been thinking . . .

HUSBAND: You have?

WIFE: Actually, no. I haven't been thinking. I've been talking with my friends. And my friends say that the best thing to do in a high-risk lovemaking situation is to go to the hospital.

HUSBAND: Huh?

WIFE: We're talking about life-threatening love, here, honey! Our home has become too dangerous for us safely to engage in our usual acrobatic sacred union. What better place than the hospital to make worry-free gymnastic love?

HUSBAND: Uh . . .

WIFE: We'll pack our things, bundle ourselves in the car, and drive to the hospital! It'll be fun, like a camping trip! We'll rent one of those hygienic operating rooms for two or three hours. Professionals will be bustling about on errands of mercy, and you and I will descend into our animal selves. Are we a zebra? Are we a lion? Nurses to take care of our every need! "Have a glass of water" . . . "Have some anesthesia." I think it would be just plain foolish to suffer painful injury just because we didn't bite the financial bullet and hire the necessary technicians to stand guard over our chandelier-swinging copulations.

HUSBAND: Uh . . .

WIFE: And once we feel truly safe – as one always does in the hospital – we can plumb the deep depths of our sexual natures! We can push the envelope of the sexual experience in a way that's impossible for fearful home-bound lovers to do! We can create our own Kama Sutra! We'll call it Calmly Sutured! Wow, I just made that up! I'm a neologist as well as an ideologue! ha ha! I've always loved the feel of starched sheets on my bare bottom! Talk about primal! I'm getting excited just thinking about hospital love!

HUSBAND: Honey?

WIFE: Yes?

HUSBAND: Uh . . .

WIFE: Could you hurry up? Our sex lives are ticking away!

HUSBAND: The thing is . . . I don't know if I can make love with strangers watching.

WIFE: Strangers!! They're not strangers, dear, they're professionals! Anyway, if you can't get it up, we'll just have you induced.

HUSBAND: Induced?

WIFE: Jody's husband gets shots. But you can have pills. Whatever. Any drug will do to get the "engine" running! Just stick your butt in the air or lie on your back and open your mouth, and five minutes later you're ready to roll! And if the drugs don't work, one of the surgeons can make a little cut in your penis . . .

HUSBAND: Uh . . .

WIFE: Not a big cut, dear, just a little cut. A little cut to insert a state-of-the-art inflation device. Some quick stitches, pump you up, and you're ready to go! There are all sorts of things doctors can do these days to keep your pathological shyness from ruining our sex lives. It's the technological age!

HUSBAND: You know, honey, the more I think about it, the more the idea of making love in our own bed sounds pretty good.

WIFE: But we're high risk, darling! Can't you see? We shouldn't have to miss out on all that safety just because you want to make love in your comfy old bed! Why do you think lovemaking technology exists in the first place? So people can ignore it and have sex at home? We have to take advantage of our high-tech culture's arsenal of drugs, tools, and procedures for the betterment of the health of love! We have to be modern!

HUSBAND: What if I get an infection from that "little cut"?

WIFE: Don't worry about it!

HUSBAND: Oh. Okay. But how risky is my potbelly, really?

WIFE: It's not just your potbelly, dear, it's the whole gamut! Anything can happen! We could fall off the bed and get concussions! We could die! There are all sorts of ways to see home-based love as high risk.

HUSBAND: Okay, well, let's say we did make love in the hospital. Do you think the staff would let us dim the lights?

WIFE: Of course not! How would they know when to intervene if they couldn't see every inch of our flesh at all times? How would they know what tools to ready, what machines to switch on, what lotions to warm, if they couldn't witness every detail of our lovemaking sessions from every angle, acute and obtuse? Call me an exhibitionist, but I think you'll have to agree that it would be downright dangerous not to have the brightest possible fluorescent lights illuminating our deepest crevices and offering for public view our every conjugal entanglement. Do you remember that night when you hit me in the eye with your elbow?

HUSBAND: I regret it to this day.

WIFE: It's just not safe to make the beast with two backs without some serious medical technology around! Even the Bible says sex is dangerous!

HUSBAND: It does?

WIFE: Phyllis said so. Anyway, if we're able to avoid the perils of high-risk lovemaking, we're not just helping ourselves, we're helping others. Think of our children! Where would they be if we got injured or died during one of our nightly cucarachas? Black eyes! Broken ribs! Cardiac arrests! In the hospital, if my heart stops during one of my myriad bone-cracking orgasms, the nurses can just jam one of those big needles into my chest! Don't you see? The hospital institution is our culture's answer to the phenomenal dangers of hot sex! They have ice packs and everything! I can honestly say that I look forward to atrial dysfunction, and its attendant loss of consciousness, so that I can be magically revived by cutting-edge technology!

HUSBAND: Dear, I guess I just have to say that, after much thought, I'm not really ready for hospital lovemaking.

WIFE: Then we're never having sex again.

HUSBAND: I'll pack my jockstrap.

WIFE: The sweaty one from high school? I adore it! I'll pack my cheerleading outfit! Remember that night?

HUSBAND: It burns in my mind.

WIFE: I truly admire your newfound devotion to copulatory technology, honey. You're a man of your age.

HUSBAND: You're my inspiration, darling.

WIFE: I can't wait to find out what the nurses think of your jockstrap! Now, let's get to the hospital and have some really hot, really safe, sex!"

While this play is amusing there is also some truth to it. It is easy to laugh at the notion that you need to have sex in the presence of medical professionals in order to be safe. This is because as a society we trust our bodies to know what they are doing and we understand that sex is a normal function of the body. The reality is that birth too is a normal function of the human (female) body. Marsden Wagner MD MS says that having a highly trained surgeon (which is what an obstetrician is) present at a normal bith is "analogous to having a pediatric surgeon babysit a healthy 2-year-old" (Wagner). It is a fear-based choice that makes no sense.

Having sex under flurescent lights, surrounded by strangers wearing surgical attire, machines hooked up to you to monitor your every move, professionals coming and going as they please, interupting you and your partner to check how you're doing, measure and rate your sexual progress (as they have been doing for tens of couples down the hall for their entire shift), is hardly conducive to a pleasurable experience. It is the same for birth. The majority of women require certain conditions in order to let go, open and enable an orgasm to ocurr, during sex and during birth+. Scientific evidence supports this.

Research with mice shows that births are longer and harder when mice birth in unfamiliar environments and it is similar for human women (Davis). When a woman is in unfamiliar surroundings, lacks privacy and stability she becomes tense or afraid (Davis). This tenseness/fear causes the body to release high levels of adrenaline which divert blood flow from the contracting uterus which in turn causes the cervix to become rigid (Davis). Adrenaline also reduces blood flow to the baby's placenta, thus reducing the amount of oxygen the baby receives (Buckley). During the first stage of labour adrenaline inhibits the production of oxytocin, which is the hormone that stimulates contractions (Buckley). This is because, like any other mamal, humans are designed so that if a threat or danger is perceived during labour the body naturally reacts by stalling the labour and allowing the mother to find safety again before bringing her young into the world (Buckley)*.

In the 1920s Grantly Dick-Read OB discovered the fear>tension>pain cycle. He attended a woman's homebirth and noticed that she experienced no pain during the labour. He asked her about this and the woman replied that she wasn't aware of the social belief that childbirth should hurt. Dick-Read went on to write a book in which he argued that it is the fear of childbirth which creates tension in the woman's body which leads to pain in labour. Today this belief underpins the work of hypnobirth and calmbirth practitioners around the world who focus on relaxation techniques for labour.

Just like during sex, the hormone oxytocin is released during birth. Oxytocin is the hormone of love, it has been shown to increase feelings of love, altruism and trust (Buckley). The levels of oxytocin increase throughout labour, peaking around the time of birth when mother and child first "meet" (Buckley). The oxytocin peak is caused by the stimulation of receptors in the vagina during second stage labour, if the mother has been unmedicated and is able to feel and respond to this stimulation (Buckley). One of the roles oxytocin plays is aiding human ejection relfexes such as those experienced during orgasm and second stage labour (Buckley).

Physiologically and hormonally birth is obviously very similar to sex in what happens during each process and what women need in order to let go and enjoy themselves. But birth and sex are even more similar than most people realise because both experiences have the potential to illcit an orgasm in a woman. Laura Shanley's Unassisted Childbirth website includes a page full of quotations from women who have experienced orgasms while giving birth, this is just one:

"It was then I began to scream, but not with pain - with joy. With release. I felt an enormous all-body orgasm as I bore down, again, and again, and again, crying out with lust and happiness. The baby was coming, and so was I."

Thanks to women's bodies being perfectly designed for birth and specifically the hormones released during labour every woman has the potential to orgasm at birth. This is explored at length in the documentary Orgasmic Birth. In an interview about the documentary, director Debra Pascali-Bornaro stated:

Birth is a continuation of a woman’s sexuality. So a woman who is in touch with her body, who gives birth in a private setting, feeling safe, protected and without disturbance is more likely to experience birth as orgasmic. With only those people with her that she trust and who trust her ability to give birth. Creating an environment that you might have for intimacy, dim lights, soft music, nice smells, and a safe, sensuous environment. When we are intimate we secrete oxytocin the “love hormone”. This is the same hormone we need to have flowing in labor and birth, so as Sheila Kitzinger, world-renowned writer and speaker says, “The place a child is going to be born must be as similar as possible to the place he/she was made.”(Pascali-Bonaro)

Birthing a baby into the world is an act of love, just like the act of conceiving a baby, sex. Just as is the case for sex, if you create a loving space and only invite someone you can trust into that space, there is little to fear and you can experience an intimate and orgasmic birth experience.



Sources Consulted:

The Sexuality of Birth by Elizabeth Davis BA CPM

Ecstatic Birth - nature's hormonal blueprint for labour by Sarah Buckley MD

Orgasmic Childbirth: the fun doesn't end at conception! by Laura Shanley

Orgasmic Birth - an interview with Debra Pascali-Bonaro

Fish Can't See Water: the need to humanize birth by Marsden Wagner MD MS

+"As Ina May Gaskin a famous midwife says in the film, “Orgasmic Births are one of the best kept secrets.” In a poll she conducted in Tennessee she found of 151 women, 32 reported having at least one orgasmic birth."

*This applies to first stage labour. In second stage labour adrenaline plays a positive role in giving the birthing woman a surge of the hormone so that she has the energy to push her baby out. Adrenaline also plays a role in activating the foetal ejection reflex in unhindered birth. If a threat is perceived during this later stage of birth adrenaline acts to expel the baby from the mother's body as quickly as possible.

What Is Birth?

Recently I began (as I often do) speaking to an acquaitence about birth. She cut me off before I could finish my sentence to tell me that she had no interest in "biology" and wanted a change of topic. I was rather shocked because I don't have a great interest in biology either, and I had no intention of discussing the biological aspects of birth. This encounter made me realise that my definition of birth is not the same as everyone else's definitions.

Clearly this acquaintence defines birth soley in terms of biological function and physiology: a baby leaving its mother's uterus. That's it. To me birth is so much more than that! I feel that defining birth as the removal of a baby from a body is dangerous because it devalues birth so much that it enables and legitimates unnecessary interventions and even unnecessary caesareans, because who cares? the baby got out and that's all that matters. Which leaves me with the question: how do I define birth?

Birth is physical, emotional, psychological, spiritual, and energetic. The physical aspects are obvious, we can see them in the way the birthing woman moves, the look on her face, the sounds she makes. We know that she dilates and then she pushes, we know that a baby moves down from her womb into her vagina and out. The emotional aspects of birth are also visible. If challenged and she reaches a crisis of confidence the birthing woman might cry and verbalise her feelings. Or she might weap tears of joy because she is so moved by her experience and knowing her baby is almost earthside. For some women giving birth involves a lot of touch, cuddling and kissing their partners, enjoying massage from trusted attendants or loved ones, holding hands etc.

Often a woman's physical and emotional limits are tested during childbirth, and like a marathon runner she will face the psychological challenges of feeling defeated, exhausted, and doubting her ability to see it through. If adequately supported and prepared (like any athlete) she will break through this barrier and triumphantly reach the finish line. And this makes birth athletic. Some women have long labours and others have long pre and early labours, cramping frequently for weeks before established labour. These experiences can be very psychological for the birthing woman. One of the most important parts of childbirth is surrendering to the process, to quit questioning, doubting, trying to guess when it will start or finish, whether it will get harder and if so how much harder and at what point will it get too hard? To stop from "psyching" themselves out, birthing women must let go of these musings and focus on the present moment.

Birth is spiritual in that it is the act of bringing another soul into the world and the final phase in the human creation process. Because birth demands of a woman that she be completely present to the moment it can be likened to meditation, and indeed the hormonal altered states of consciousness that come with having an unhindered birth can be experienced as spiritual.


As for the energetic aspect of birth, when you enter a birth space that the birthing woman has made her own the mood and feel of the environment is unlike any other you might encounter. At my own unhindered birth my doula's breasts began pouring milk into her bra when my baby entered the world. At my friend's birth my baby slept peacefully through her loud vocalising and my friend's toddlers were undisturbed by their mother's screaming, the mood of the birth space was peaceful and normal and the children picked up on that.

Birth is also very intimate and sexual. When women birth unhindered they do so naked, and each woman has a unique "birth song" (meaning the sounds they make during labour). Some women sing their birth song very loudly, others do so without parting their lips. Whenever I see an unhindered birth I am struck by how much birth is like sex. A lot of the noises women make during birth are orgasmic sounds. Indeed, some women experience orgasm during labour.

Birth is a beginning. The beginning of life in a new world for the baby. The beginning of parenting a new person. The beginning of new family dynamics. Potentially the beginning of a new family line should that baby decide to have children of her or his own later in life.

Birth is also an ending. The end of pregnancy. A farewell to the sacred time when mother and baby were physically one, when only mother could touch and feel her baby.

Birth is a welcoming. Whether we admit it or not a baby's birth day is her/his welcome to the world. There is no other moment like this in our lives, those first moments are precious and can never be repeated. No parent forgets the moment they first laid eyes on their child, the first time they held her or him, and the first time they heard their baby's cry. But parents are not always the one's who get to have the first hold, and not all babies get a true welcome to the world. Many babies are held by strangers first, are whisked away to be tested and measured, wiped, and wrapped up before their parents get a chance to say hello. Some mothers are separated from their babies for recovery from the procedures routinely carried out in hospitals and do not get to welcome thier babies for hours after birth. My own mother was so high on pethidine that at my own welcome to the world she didn't recognise me as her own.

Birth is an opportunity. It is an opportunity for women to realise the great depths of their strength, and for their partners and families to witness the awesome power of their loved one. It is also an opportunity for couples to become more intimate and bonded to one another, much like sex. Birth is another act of love making.

Birth is an experience of self discovery! The journey to birth, and the birth itself can bring up a lot of personal issues for everyone involved, especially the woman. For women who have strained or absent relationships with their mothers these issues can arise during pregnancy and labour as they face becoming a mother themselves. For women with poor body image or who have experienced abuse in the past, these issues can rear their ugly heads on account of the physicality of birth. The process of learning what she does or does not want from those around her in her birth space helps the blossoming mother become clearer about who she is. She also learns what she is capable of. Birth is a rite of passage. Cara Muhlhahn (the midwife featured in Rikki Lake's documentary The Business of Being Born) said it best when she said:

A woman really doesn't need to be rescued, it's not the place for the knight in shining armour. It's the place for her to face her darkest moments and lay claim to her victory, so that she can lay claim to her victory after she's done it.

Birth can also be a catalyst for change in a woman's life. By experiencing her power a woman's view of herself can be forever changed. She may begin birth as a girl and emerge a grown woman. On the other hand, if a woman is robbed of experiencing that power she may still be forever changed, but in a negative sense.

Birth is a snapshot of our culture more generally. Our culture is presently facing a crisis of drug use, the vast majority of births involve drug use. Our culture relies heavily on experts' advice rather than following instinct, almost 100% of women give birth following the directions of experts rather than trusting themselves. Our culture has high rates of violence against women, women are routinely rendered immobile, cut, penetrated with fingers, hands, forceps etc. during birth.

Birth is a reflection of our lives. Where a woman chooses to birth, who she choose to attend her and how she chooses to birth (eg. vaginally, drug free, interventions free etc.) give insight into who the birthing woman is and how she lives her life more generally.

Birth is heroic. An experience that demands so much of a person in every way imaginable cannot help but be heroic. It calls for the birthing mother to display characteristics of the hero including bravery in the face of fear (if she had any), pain endurance and stamina. Is it any wonder that mothers are so keen to regail pregnant women with their "horror" birth stories? These stories are their tales of battle, and they crave recognition for this.

Birth is primal. At birth a woman's neocortex (thinking part of the brain) becomes subdued to allow her primal (sometimes called mamillion or middle brain) to dominate. Women don't need to learn how to give birth, they don't need to be directed during labour, they were born with this knowledge by virtue of their sex. If unhindered a woman will instictively adopt the most safe and effective positions to help her baby out. She will make sounds she's never heard before to aid the process - often similar to sounds from the animal kingdom. During birth she is one with all female mamals. She becomes pre-verbal and pre-social, she grunts and moans, she vomits, urinates and poops wherever necessary.

Birth is a normal physiological process. Women's bodies are designed for the act of giving birth, perfected over centuries of evolution. Our hormones cause our bodies to soften as we near labour so that we are more flexible and physically prepared for birth. Our hormones also give us pain relief, help bond us to our babies, and take us to an altered state of conscious necessary for birth. Our uteruses expand to house our babies for as long as necessary and then massage our baby down toward the cervix and vagina during birth. Our cervix thins and opens wide enough to allow our babies to leave our wombs and descend into our vaginas. Our pelvic bones soften and are flexible to allow room for our babies to exit our bodies. Our vagina's stretch as wide as our babies need. If given the freedom and support necessary, women can give birth safely without any medical assistance! And we are reminded of this with every baby born "before arrival", by the side of the road, in the back seat of a car or on the front lawn of a hospital.

Birth is so many different things to different women. Most importantly birth is far more than a simple biological event in which baby leaves mother's body. It is my wish that people in our society were more aware of this and valued birth for all that it is, rather than ignoring women's stories, or trying to change women's stories by needlessly interfering in the natural process.

Birth is.

Taken minutes after birth

ETA: Mere minutes after publishing this I came across the blog of another doula who wrote this:

Ten Reasons I Love Birth

Because it is unpredictable
Because it is edgy and freaks most people out
Because every person in the world has experienced it at least once
Because it is mysterious
Because it means that much hard work is complete
Because it can feel good
Because it points to Intelligent design
Because it is raw and powerful
Because no two are alike
Because it allows women who feel ordinary to become extraordinary

BirthKeeper

The term doula means "handmaiden" and as such I prefer the term birth servant to doula because technically a doula could be an attendant for anything. "Birth servant" more accurately sums up what it is I see as my role as a doula: to serve women at birth, families who are preparing for a birth, and families in the period after birth. Recently I also find myself more and more drawn to the term "birthkeeper".

Initially I was not a fan of the term "birthkeeper" because it made me imagine birth being put in a cage and guarded by some self-appointed authority. But I misunderstood what it meant. A birth keeper does not cage or tame birth, rather she protects normal birth from adversaries and attackers.

Jeannine Parvati Baker coined the term "birthkeeper", which was a marriage between the terms "birth" and "earth keeper". She wrote:

EarthKeeper is a Native American word for Eco-activists as well as holders of the sacred Earth-based wisdoms. Midwives can be the same, yet the term "Midwife" has been usurped by MEDwives and other medically-based perinatal professionals. At this point in time on Turtle Island, midwifery is an endangered species. Too many midwives have identified with the oppressor, learned to speak the conquerers language, and otherwise been vanquished to emerge as obstetrically-trained "Medwives". In other words, many Midwives have given up being guardians and keepers of natural birth at home, in order to survive as professionals.

...BIRTHKEEPER...

Healing Birth is Healing the Earth. (Parvati Baker)

Like Parvati Baker, I see honouring birth in its most pure, unhindered and natural state (and working to protect birth from intervention and interruption) as a very important part of the birth servant's role. I believe that in serving, honouring and protecting birth in this way, birthkeepers serve womankind by assisting them to realise their innate strength and power. They do this by nurturing the mother through the intensity of labour and providing her with the encouragement she might need if she begins to doubt herself.

There are doulas who rather than using their role to serve birth, enable the current anti-birth maternity system. These doulas understand their role to be supporting pregnant and birthing women's choices, regardless of what those choices might mean for birth, women, and babies. If this is what the world thinks a doula is: an enabler of any and every choice, then I am no doula, nor shall I ever be one. I don't believe all choices are equal, or that all choices are deserving of respect. I didn't go down this path out of a love for choice, rather a love for birth, women, and more specifically women's power in birth.

I don't believe that kind of "support all choices" doula is necessary at birth. Women have their friends, families and care providers to support them in making popular choices. What is lacking is a voice for normal birth and someone in the birth space never wavering in their faith in the birthing woman's body! What is needed now more than ever, with such high rates of unnecessary intervention in birth, is someone willing to "hold the space" - that is, give birth the time and the space to be whatever she needs to be, free from intervention and interruption, and someone to give the mother freedom to get on with the business of labour rather than having to negotiate with or rage against a system unwilling to sit on its hands.

It's quite common these days for people to confuse respect for a person with respect for a choice that person made. They are not the same thing. I believe it is thanks to our capitalist society that many people have grown so attached to the concept of "choice", indeed it is often worshiped. Those of us willing to dig a little deeper and critique choice are often received with a hostility that brings to mind the fury of another time, when someone dared to say the world was round.

Simply because someone chooses a certain choice does not mean they're choice is above critique. Making a choice does not equal being empowered, for example an individual can be held at gunpoint and told to choose between handing over their possessions or being murdered. They may make a choice, but it's hardly an empowered one! Likewise pregnant and birthing women make choices left, right and centre. But whether those choices are based on accurate information and for the right reasons depends on her preparation and the quality of care providers she has surrounded herself with (eg. making a choice out of fear or because someone else made that choice are not good reasons to committ to a particular birth option!).

I have no interest in supporting choices. I wish to support women, and that means assisting them in becoming informed and subsequently empowered. "Supporting" a woman in making choices based on fear and a lack of information or handing her power over to someone else is not supportive in my view! It is dishonest and patronising.

Protecting and serving normal unhindered birth protects and serves birthing women. A normal unhindered birth means mother and baby are safe from the risks and consequences of interventions that are not necessary 90% of the time and gives the mother the oppotunity to see and feel the great depths of her strength! This means that she begins mothering a new child filled with self-respect and confidence.

Related Pages:

Personal is Political

What Does "Support" Mean?

Interview with Birth Activist Janet Fraser

The Wisdom of Ani DiFranco

Your Childbirth Options


This post was a long time coming, initially inspired by the thoughts of Michelle The Herbwyfe. Upon first reading Michelle's thoughts on identifying as a birth keeper rather than a doula I really didn't understand where she was coming from. I couldn't see how the term "doula" was lacking but having more exposure to the western world's maternity systems I now see more clearly..

Doula's Don't Deliver (No Body Does!)

"De·liv·er. 1. The carrying and turning over of letters, goods, etc., to a designated recipient or recipients."

Vs

"Birth. 1. The act or process of bearing or bringing forth offspring; childbirth; parturition."

I was on the phone to a relative catching up on what had happened in our lives in the weeks since we had last spoken and I told him I had attended a friends' freebirth (homebirth without a midwife). Not entirely familiar with the birth serving aspect of my life, my relative asked "Oh so did you help deliver the baby did you?" The answer was no, of course not. I didn't help deliver a baby. Neither did my friends' husband deliver the baby. The fact is that no body delivers a baby, the mother simply gives birth!

At no point did a postal worker knock at the door and ask us to sign for a baby. Mum laboured! Her cervix opened up, her uterus gently massaged her baby downwards, her baby nudged forward head first (at this particular birth), entered the vagina and then Mum's vagina stretched enough for baby's head and body to moved down and out into the world. A birth is nothing like a delivery.

"Deliver" is in no way an equal term to birth and it does not mean the same thing as birth. When birth is referred to as a delivery the pregnant and birthing woman is rendered passive vessel which contains the baby, and the medical staff make themselves the active agents of birth. They "deliver" the baby, the woman and her body are merely the raw material with which these active experts produce an outcome and product: that is a healthy baby.

Birthing women are active! Birth is an act that women do. It is not a process in which they are passive, naturally. Therefore the term "delivery" is misleading and inept in its application to childbirth. As the definition provided above alludes, to call a birth a delivery is to call a mother a designated recipient of goods.



(Definitions from dictionary.com)

Lemay-zing Insights

If you haven't checked out Gloria Lemay's writing do yourself a favour and follow the links below. She consistently impresses me with not just what she has to say, but how she says it as well. Take her blog entry from today for example:

Recipe For a Caesarean Section

1 nice, well behaved woman
1 impatient obstetrician
½ doula
Minced birth plan
2 tsp prostaglandin gel
2 tbsp pitocin (do not use the authentic oxytocin)

Mix together slowly, monitoring as you go along. Once pain is intolerable, add

1 generous epidural (to freeze the well behaved woman from her breasts to her toes. )

Check with an ice cube for sensation. This epidural will be helpful in the cutting process to follow.

An external fetal monitor and contraction belt will help to move the process along. Once distress is induced in the inner cavity of the well-behaved woman, an amni hook can be used to puncture the protective lining. Some cooks prefer to insert a spiral screw into the scalp of the infant within the cavity to insure a certain outcome.

When it comes time to insert a knife, have all gadgets and implements for removing the infant at hand.
Cover well behaved woman with green cloths and screens exposing only a small strip of belly area.

Watch the finished product carefully for several hours after completion of the cesarean section to make sure that the recipe has performed as promised.

Information all women should have, that all natural birth activists spread as far and wide as they can, presented in a new light.

During my own pregnancy I felt very inspired by certain extracts from Gloria's work, namely:

I also find it valuable to view birth as an "elimination process" like other elimination processes-coughing, pooping, peeing, crying and sweating. All are valuable (like giving birth is) for maintaining the health of the body. They all require removing the thinking mind and changing one's "state." My friend Leilah is fond of saying, "Birth is a no brainer." After all "elimination processes" are finished, we feel a lot better until the next time. Each individual is competent to handle her bodily elimination functions without a lot of input from others. Birth complications, especially in the first-time mother, are often the result of helpful tampering with something that simply needs time and privacy to unfold as intended. (From "Pushing for First Time Moms)

Knowing from experience that my body was excellent at coughing, pooping, peeing, crying and sweating without any "help" from others or conscious effort on my own part, I went into labour confident that by trusting my body I was in very safe hands.

I am thrilled that Gloria is now keeping a blog, so we can all benefit from regular installments of her insights.

Lemayzing Work:

Pushing for First Time Moms

Pelvises I Have Known and Loved

Gloria's Blog

Concerns Regarding Cord Blood Harvesting

Cord blood harvesting (more commonly known as cord blood donation) involves taking the blood from a new born baby's umbilical cord immediately after birth to farm the stem cells from the baby's blood for the purpose of scientific research (and supposedly to save lives and cure terminal illnesses, although research has shown stem cells can be collected from other sources, and the usefulness of stem cells for these theraputic purposes remains contested).

As an advocate of normal physiological birth and a supporter of lotus birth (leaving baby, cord and placenta intact for the first week of the baby's life until such time as it naturally detaches from the baby's belly button), cord blood donation makes me uneasy. My primary concern is that it is not possible to donate cord blood to science and allow mother and baby to have a natural third stage of labour (the period between when the baby is born and when the placenta is born). Another significant concern I have is that the blood in a baby's umbilical cord belongs to the baby. When one considers that stem cell therapy is still largely experimental, what must be done to the mother to harvest cord blood, and that a baby is deprived of his or her own blood, I don't believe the possible benefits of cord blood donation outweigh the inherent risks.

Natural (or physiological) 3rd Stage

When a mother first sees her baby, holds her baby, feels her baby's skin against her own, and breathes the scent of her baby in, her body responds by releasing the "love" hormone: oxytocin. Oxytocin stimulates the uterus causing contractions, which are not usually as strong or uncomfortable as those of the first two stages of labour (more like menstrual cramps). During these contractions the placenta detaches from the walls of the uterus, drops into the mother's vagina and is subsequently born.

Before the oxytocin causes the mother's uterus to contract, nature usually gives her a rest period. The length of this rest period will vary for different women. The placenta can stay within the mother's uterus for hours not causing harm to her. But if the mother becomes anxious and wants to do something to help her placenta detach from her uterus nipple stimulation is a natural way of stimulating uterine contractions. Often mother's find that feeding their babies in those first few minutes or hours will bring on contractions. Quite often if the mother is in an upright position the placenta will fall out of her vagina effortlessly rather than requiring her to push.

The mother's hormones do some quite magical things during this immediate babymoon period including; help bond her to her child forever which ensures she will have a drive to nurture and protect her youngin, and act to prevent haemorrhage. If baby is given adequate skin to skin time with mother she or he may use this time to work his or her way to the breast and use instinct to nuzzle and latch on for the first feed (this is known as baby led attachment).

Third Stage When Cord Blood is Harvested

For blood to be harvested from a baby's umbilical cord, mother and baby must have an actively managed third stage of labour. "Active management" is the term given when a natural third stage of labour is interfered with by care providers. This interference involves routinely involves:

• Injecting the mother with a narcotic called Syntocinon. While usually this injection is given after the baby has been born, some care providers administer the drug while the mother is still pushing (in second stage labour). Syntocinon can also be administered intravenously via a drip if the mother already has a drip line in place.

• Clamping and cutting the baby's umbilical cord immediately (or within a few minutes) after birth.

• Pulling on the umbilical cord (which is attached to the placenta, which is still inside the mother's womb) to force the placenta to separate from the mother's uterine walls and subsequently be delivered quicker.

If blood is to be harvested from the baby's umbilical cord the first two steps of active management will be taken and then a needle will be inserted into the vein of the umbilical cord. The needle is connected to a collection bag and blood fills this bag for approximately five minutes while the placenta is still inside the mother's womb. For cord blood collection to be worthwhile for research at least 100mls must be taken.

After the placenta is born (which would most likely happen after care providers performed the third step of actively managing third stage of labour) cord blood collectors are likely to take another 20mls of blood from the placenta as well. Alternatively the entire harvest can be taken from the walls of the baby's placenta after the placenta is born.

The mother is required to have a blood test shortly after birth to determine whether she has HIV, AIDS, Hepatitis or other infectious diseases. Six months later she will be required to have another blood test for the same infections because some of these can be within the body for three months before detection.

A questionnaire regarding the mother's medical and family history is also required. Then the blood is taken (within thirty-six hours of harvesting) to a cord bank where it is frozen and stored in liquid nitrogen after it has been tested. The blood can be stored like this for twenty years, or until it is used for experimentation.

Effects on Mother

The most noteable effect of actively managing the third stage of labour on the mother is rushing her. The period immediately following the birth of her baby is an incredibly important time for both mother and baby. It is a time when the mother's natural hormones are ensuring she and her child bond which has great ramifications for both of them emotionally, psychologically, physically, and mentally.

It is a time for familiarising. Mother and baby get to know each other. They learn one another's smell, baby will most likely have his or her first suckle at the breast - thus letting the mother's body know it's time to begin milk production. What happens during this sacred time can have a big impact on how smoothly their breastfeeding relationship goes.

The primary motivation for routine managing the third stage of labour is to shorten the length of time it otherwise would have taken for the placenta to be born. There are some cases where active management of the third stage is necessary (for example if a woman has had a necessary caesarean , or if the mother has low levels of haemoglobin in her blood which could mean her blood's ability to clot may be delayed) but for the majority of women a natural third stage is safe and superior given the many risks active management carries with it.

Some of the risks of active management of the third stage include:

• Once syntocinon is administered to the mother there is an urgency to remove placenta from her womb because the narcotic causes the uterus to contract in size quite quickly (approximately ten minutes) and if this happens before the placenta has been born the placenta will remain trapped inside her and she will require surgery to remove it. If surgery is required the mother faces the risks of the anaesthetic, separation from her baby soon after birth, and that separation can lead to bonding and breastfeeding difficulties.
  

• Time limits are placed on the woman, and this sense of urgency can be very disruptive to mother/baby bonding and the first breastfeed.

• If the mother has undiagnosed twins, active management can lead to the second twin getting trapped inside the uterus, requiring a caesarean.

In addition to these, there are also the side effects of syntocinon to mother and baby, which include:

• It can cause intensely painful and unrelenting contractions of the uterus.
  

• Prolonged use can lead to a build up of the narcotic in the newborn's body (something worth considering if this narcotic was also used to induce or augment the mother's labour earlier), which can increase likelihood of the baby developing jaundice and requiring phototherapy.
  

• Prolonged use can cause a mother's kidneys to stop excreting water which reduces urine production. The body then retains water and in some cases causes fluid overload (fluid can accumulate in the lungs and cause pressure on the heart). This can be life threatening.

• Syntocinon (which is a synthetic form oxytocin) over-rides the body's ability to naturally release oxytocin, which can lead to problems with mother/baby bonding.
  

• It interferes with the natural oxytocin peak that happens at/after birth which prevents postpartum bleeding, therefore active management of labour poses a risk of increased or major bleeding in the mother.

• Natural oxytocin is released in response to a baby suckling at mother's breast, and therefore if this natural hormone is decreased or over-ridden by the synthetic version breastfeeding difficulties could be encountered.
  

The most significant risks to baby of harvesting cord blood are associated with premature clamping and cutting of the umbilical cord.

Clamping and Cutting the Umbilical Cord

The umbilical cord should not be cut until it has stopped pulsating because the baby is still receiving nutrient rich blood from his or her placenta. Some medicos don't regard this blood as important to the baby's well-being, however we know that it is rich in stem cells at the very least, given that there are those who wish to harvest it!

It is generally accepted that the baby's cord should be cut immediately in a couple of cases; when the cord is tightly around the baby's neck, if the baby is unwell, or if the cord is short. However, at the time of birth the baby is making that very important transition from relying on his or her placenta for oxygen to learning how to breathe using the lungs. The placenta was also responsible for regulating the flow of blood into the baby's body and during the first twenty minutes of life the baby's circulatory system is in a process of stabilising. Given this, I would argue that it is more important to maintain the baby's connection to cord and placenta in cases where the baby is unwell rather than to cut the cord.

Dr Sarah Buckley notes:

Adaptation to life outside the womb is the major physiological task for the baby in third stage. In utero, the wondrous placenta fulfills the functions of lungs, kidney, gut and liver for our babies. Blood flow to these organs is minimal until the baby takes a first breath, at which time huge changes begin in the organisation of the circulatory system

Within the baby's body, blood becomes, over several minutes, diverted away from the umbilical cord and placenta and, as the lungs fill with air, blood is sucked into the pulmonary (lung) circulation. Mother Nature ensures a reservoir of blood in the cord and placenta that provides the additional blood necessary for these newly-perfused pulmonary and organ systems

Immediate clamping and cutting of the cord at birth denies a baby up to half of his or her total blood volume (imagine the heamorrage an adult would have minus 50% of her blood volume!) and poses risks including:

• Causing anaemia in infancy due to baby not receiving all the iron intended for them from cord blood/placenta.

• Blood being sacrificed from other organs to establish blood flow to the lungs.

• Lack of blood which was meant for baby's vital organs.
  

• Respiratory stress.
  

• Fatality to babies who are low on blood and have not taken their first breath before severence.
  

According to birth.com.au: "You can feel the cord 'pulsating' in rhythm with your baby's heart rate and you may notice your caregiver feeling the cord after the birth to make sure the rate is normal." Thus it is visible to the naked eye that the baby is still receiving something (literaly) dear to her heart!

Many people believe that when the umbilical cord stops pulsating it is safe to sever it from the baby, however just because we can't see it moving, doesn't mean it's not doing something for the baby. In her article on lotus birth Lisa Schuring notes:

Once blood volume reaches an optimal level in the baby (for that specific baby), the rest of the cord vessels will close off. Closure of all vessels DO NOT occur when the cord visibly stops pulsing! Umbilical cords can continue to pulse at the umbilicus (at the belly button) for much longer than the centre of the cord - about 2 to 3 hours longer!

The only way to ensure a baby gets the perfect volume and type of blood intended for her or him is to leave the umbilical cord to carry on with the excellent job it has been doing for months. I do wonder why nature would leave baby, cord and placenta attached for days after birth if the placenta and cord had nothing to offer the baby during this time? If there was no purpose, surely nature would have the cord naturally detach immediately after birth? In any case, the only way to be sure the placenta and cord have finished their work is to let them.

What About Stem Cell Storage For Baby Rather Than "Donation"?

Another reason some parents decide to harvest the blood from their baby's umbilical cord after birth is to store the stem cells within that blood for the baby in case the baby might require it later in life. However, if your child develops a rare blood disease that may benefit from stem cell therapy, for example leukemia, she or he could not use their own stored cord blood because their blood has a predisposition to leukemia. And this cord blood could not be donated to anyone else.

It is worth noting (in the words of Sarah Buckley, Gentle Birth, Gentle Mothering page 195) that "the likelihood of low-risk children needing their own stored cells has been estimated at 1 in 20, 0000 and cord blood donations are likely to be ineffective for the treatment of adults.". Buckley goes on to note that between 1998 and 2005 over 13,600 units of cord blood were stored in banks but only 7 units were used by those who donated the blood, and 16 units for sibling transplants (siblings have a 25% chance of being compatible).

If Stem Cells Are So Great, Why Can't Baby Have Them?

In her comprehensive outline of both the active management and the natural processes of the third stage of labour Sarah Buckley says:

The recent discovery of the amazing properties of cord blood, in particular the stem cells contained within it, heightens the need to ensure that a newborn baby gets its full quota. These cells are unique to this stage of development, and will migrate to the baby's bone morrow soon after birth, transforming themselves into various types of blood-making cells. (Emphasis added.)

Again, I wonder why nature would create these stem cells for the baby's body if they did not fill some purpose? I doubt it would! The reality is that those cells are intended for the baby.

For Further Consideration

Furthermore there are issues of informed consent and true freedom of choice. At my local hospital I know that some women are not told anything about cord blood donation until they are in the third stage of labour (or even after it has happened) but so-called "donations" have been taken from these women's babies regardless. It is worth noting that my local hospital is in a region populated by working class families with lower levels of education than other areas of Melbourne. One woman told me after her birth that she was exhausted and overwhelmed with all that had just happened to her when the midwives told her they had taken her baby's cord blood and that this made her baby a life-saver (and I believe to prevent her from taking legal action against them for performing this procedure without her consent).

It is dubious that the baby was a life-saver, if the midwives were being honest they would have said "your baby's blood is now being sent to a laboratory for scientific experimentation in the hope that a hypothesis some scientists have about the use of stem cell therapy may be successful and may cure some diseases". But that's not as catchy as "your baby is a life saver".

Even if she had have been informed about cord blood donation by the hospital prior to the harvesting taking place during third stage there is still the issue of how the information would most likely have been presented. For example, would parents simply be misinformed, as this woman was, that the procedure simply and unquestionably save lives? Would parents be told that stem cells can be harvested for medical research from other sources? Would the women actually have been asked if they wanted to donate their baby's cord blood, or would they be told that they should and simply expected to do so when the time came? The potential for coercion when it comes to participating in experiments that could cure life-threatening and debilitative diseases is huge. Even the way cord blood donation is written about on birth.com.au is politically charged. When explaining where blood is stored it states that it is kept there: "until required by a compatible child or adult needing a transplant for leukaemia or another rare blood disorder." No mention of experimentation or research, and it's not there for "someone" or a "person", they specifically mention a child suffering a disease.

The usefulness of stem cells may be one area of science worth researching for potential cures to terminal illnesses, but it is only one possible solution. While stem cell therapy remains by and large an experiment, the third stage of labour is not a test-run for each mother and each baby. A baby's blood cannot be harvested from his or her umbilical cord without the third stage of labour being unnecessarily interfered with, which poses health risks for both mother and child. Considering it is possible to harvest stem cells from sources other than a newborn baby's blood, stem cell therapy need not depend upon donations from cord blood.

Still receiving cord blood over three hours after birth.

Above is based on information obtained from:

Leaving well alone: a natural approach to the third stage of labour - Sarah Buckley

3rd Stage Labour - Birth.com.au

The Active Management of Third Stage - Birth International

Cord Blood Donation - Birth.com.au

Lotus Birth - Lisa Schuring

For more on this see:

Collecting Cord Blood - Gentle Birth Archives

Don't Cut The Cord - Gentle Birth Archives

Umbilical Cord Issues/Delayed Cord Clamping - Gentle Birth Archives