A
perfect birth?
Hummingbird
Berreyesa makes her living as a doula, which means
"mother to the mother." Her
work is to support the mother-to-be through her
pregnancy and during the birth.
"What
gets in the way of childbirth," said Humm, as she is
generally called, "is fear."
In
her presence, fear doesn't stand a chance. Everything
about her is reassuring, from the sweep of her long
grey hair to her generous bosom. There's a safety and
comfort in her presence that is like a grandmother's
love. Mother of six, four of them born at home, she
knows whereof she speaks.
Seated
at the butcher block table in the center of her
country kitchen, we sip ginger green tea and talk
about giving birth, one of every mother's favorite
topics.
What
would an ideal birth look like? I ask her.
"Where
the mother is left alone to have her baby. Where she
is not hurried. Where she doesn't have her cervix
checked constantly, which can make the waters break
prematurely.
"A
really nice birth would be at home with your partner,
if you have one, and the women whom you love and who
love you. Your mom, your auntie, your sisters, your
best friend.
"It's
everything to have other women with you. It's helpful
for the men as well. They have more of an
understanding that there's nothing scary, that this
mom really does know how to birth the baby and the
baby knows how to be born.
"It's
the most natural thing in the world. This is the gift
women have been given. Generally they'll just go in
there and birth their babies.
"Mom
needs to move about, be in any position, with nothing
to encumber her. No clothes if she doesn't want to
wear clothes, no monitor chords and IVs. Some want to
squat, some sit, some dance.
"Lying
is the absolutely worst position to be in. Movement is
essential.
"She
needs to be well hydrated. Let her eat when she wants
to. Then generally she'll have the stamina to deliver
the baby even if it's a very long labor.
"And
babies need to be with their mom right after to birth.
Skin to skin. That's very important. And left there!
They don't need procedures or suctioning.
"As
the baby comes over the pubic bone, the bone will push
on the baby's chest and the baby will expel most of
that mucus."
Nature
takes care of her own.
Medical
interventions becoming more common.
If
Humm's description doesn't resemble the typical
hospital birth, it should not surprise us. What is
surprising -- and distressing -- is that hospital
birthing styles have become more invasive.
Despite
the enormous changes in hospital birthing that took
place in response to the natural birthing movement of
the 1970s, hospital interventions have increased
during the past decade; most of them are unnecessary,
leading to "complications where there should be none,"
according to midwife Suzanne Arms, author of
Immaculate Deception, a book which challenged and help
transform the American way of birth during the 70s.
"It means high-tech and hazardous invasive procedures
where low-tech and hands-on human care would work
better or at least equally well."
Epidurals,
for example, commonly known as spinal blocks, tend to
slow labor, according to a study reported in the
Journal of Obstetrics and Gynecology; prolonged labor
more often leads to Cesarean sections because it
causes fetal stress.
In
America, the land of supreme technology, 25 percent of
births are C-sections - far above the World Health
Organization's estimation that 7 percent is an
"extreme" number. They are, however, very profitable.
Arms estimates that unnecessary Cesareans add $20
billion a year to healthcare costs.
Epidurals
have other consequences, which affect the baby's well
being. Arms reports that 96 percent of women who have
a fever during labor have had an epidural, and 86
percent of the babies who are put on full-spectrum
antibiotics have been born to mothers who had
epidurals. In addition, babies' mouths seem to be numb
after an epidural, which may explain their difficulty
in starting breast feeding.
Yet
the good news for anesthesiologists is that despite
the side effects, the use of epidurals has actually
risen markedly in the past decade. According to Joy
Hawkins, MD, speaking to American Society of
Anesthesiologists in 1998, the use of epidurals
tripled from 1981 to 1997. "Sixty-six percent of women
in the largest hospitals received regional analgesia
in 1997 versus 55 percent in 1992 and 22 percent in
1981." That's a hefty climb.
But,
I had to ask, don't these and other medical
interventions save lives?
Hummingbird
doesn't think so. If women died in childbirth more
often in the past, it was probably due to poor
nutrition or sanitation.
"Interventions
are needed sometimes and I am glad they are there for
those times. However, in the medical model of
childbirth these interventions are routinely used
instead of allowing the mother to labor naturally and
take the time to have her baby." If the mother is
overweight, for example, and the monitor is
ineffective, doctors will sometimes screw it into the
baby's head through the cervix. Can that really be
necessary? Humm is not convinced. She does know that
it often ruptures the membranes which "sets her up for
all these other interventions. If labor does not
proceed, they'll want to induce it with
pitossin."
Pitossin
jolts my memory, and I have to share my own birthing
story. So far as I was concerned, pitossin wrecked
what might have been for me a perfectly natural birth.
I was angry for months after my first baby was born,
as if something had been stolen from me that should
have been rightfully mine!
Administered
to induce birth when contractions are slow, pitossin
takes the birth experience out of the mother's hands.
Contractions are more frequent and much more intense,
and there are no rest periods. It's pretty difficult
to practice Lamaze breathing under those rugged
circumstances, hence "It's hard to have a baby on
pitossin without an epidural."
And
so it goes.
After
recounting my story to Humm's sympathetic ear, I ask
her exactly what does the doula do?
"I
give emotional, physical and informational support to
the birthing mother and her family. I also work as an
advocate with the hospital staff if needed. Part of my
job is to facilitate communication between staff and
client so we will all see ourselves as a birth
team."
Hummingbird
works primarily with women birthing in hospitals,
because her help is really needed there. "People
assume nurses will be able to sit with them and be
there, but that's not a reality. Nurses are very, very
busy. They are often understaffed. They must put the
mom on the monitor and watch the monitor from the
screen at the nurses station.
"But
when you come in with a doula, it's really nice. You
don't have to be on a monitor, you can walk around
&endash; you don't want to get stuck in a bed. That's
the worst place to be. Spend time in the shower!
Showers are great." The doula serves as companion,
moral support and advocate for the mom. She also helps
out with nonmedical nursing chores, "but that's
another story."
Humm
meets with the mother before the birth to find out how
she envisions her birth, what she would like and would
not like, whether she wants to breast feed, what
interventions she will accept and under what
circumstances. Together, they write a birth plan which
will be presented to the doctor or midwife before the
birth.
The
birth plan
The
birth plan is a legal document which helps assure that
the mother's requests will be honored. Often the plan
is not read or is simply ignored; the doula is there
to remind the doctor what the mother wants.
Humm
asks about her client's relationship with her own
mother. "If she didn't get the nurturing she needed,
generally she'll be fearful she's going to be
inadequate or act out her mother's stuff. Often, it's
not conscious. The doula can reassure the mother if
she does have to wrestle a little with past issues
during labor. The feelings can often be worked through
enough to be put aside for the duration of
labor.
"A
history of sexual abuse can make labor very
difficult."
Does
she see a lot of cases like that? "You wouldn't
believe how many. At one point it was 80 percent. Now
it's about 50. Maybe abused women seek out a
doula.
"Then
there are the moms who don't remember the abuse and it
comes out in labor. In one difficult case, the mom
couldn't let anyone touch her. It was two hours before
I could touch her hand. She couldn't move her legs
apart or allow anyone to check her. Situations like
that often end up with a C-section. In this case we
managed to have a vaginal birth with the help of
patience and support for this new mom. "
Humm
stays in phone contact with her moms during labor
until it is clear that it's time to go to the
hospital. She meets her client there and remains with
her through the entire birth.
"I
always go to the birth in a loving space, to
facilitate communication. That way we become a
birthing team.
"I
have this little invisible bucket outside the labor
room and I dump all my 'stuff' in it and I pick it up
at the end. That way I can walk in in a neutral space
which will tend to bring other people into neutral
space as well.
"I
just keep smiling. I find the common denominator
between myself and the staff person. Sometimes it's
that we're human beings . . . That works!
"If
there's any adversarial relationship in the room, the
mother will clamp down."
A
woman's support is the key
"Nothing
is more helpful than a loving woman who understands
birth to be there with you." For Hummingbird, birth is
such an important rite that the mother deserves all
the loving care she can get.
Listening
to Humm made me wish she had attended my two births!
Faced with the authority of the medical world, my
tendency was to do as I was told. I chose a natural
birth, but despite the vast amount of information that
was available in the early 80s, I went to the hospital
poorly prepared. I was put on pitossin because the
waters had broken five hours earlier. My labor was
like riding a bucking bronco with hands and legs
firmly tied. Later I learned I could have waited 24
hours before there was any danger!
Although
I lacked the will to insist on what I wanted, I did
get to experience for the first time the feeling of my
own primal power. But near the end of labor, when it
was time to push, the pittosin IV popped out! Of
course the nurse dutifully reached over to hook it
back up. No way! From my heaving belly came a voice I
had never heard before. "NO!" I growled. Not more than
ten minutes later, I pushed my baby out.
We
were both utterly dazed, both somewhat
traumatized. But,
with my beautiful baby girl, I had given birth to my
will.
"Birth
is one of the most important experiences in a woman's
life. We learn about ourselves in such a profound way.
And you can call on that experience throughout your
life. When I feel I can't cope, I remember my births
and I know I can do whatever I have to do."
For
more information, contact Humm or the other doulas at
www.4r.net/birthingsupport/
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