Informed Choice for Women Part II

Informed Choice for Women

Part II:
Birthing Environments for Healthy Women
by Mary Ceallaigh

Introduction: Nature, Nurture, and Birth

For healthy, well-nourished women, bringing a child into the world can be an experience of
GIVING birth, or, in contrast, of being DELIVERED - or some combination of the two, as
Jeannine Parvati (the author of Prenatal Yoga & Natural Childbirth) has so eloquently written
of. Navigating labor and giving birth in a drug-free, fully embodied manner is the original 'Power
Yoga' for women - and the DEGREE of this embodiment consequently sets the tone for
women's maternal attunement as well as impacts future sexual health.

The birthing environment directly influences a laboring woman's relaxation
energies and their potential hormonal manifestation as responsive movement, emotional
coping, and dilation progress during physiological (spontaneous-natural) labor. The quality of
mother-baby unity consciousness upon birth and during the primal period (the first six weeks
postpartum) is likewise linked to the consciousness of the birthing environment's protocols,
physical supports, and primal-instinctive birth facilitation skills of caregivers.

Birthing environment options include a range of hospitals and birth centers, as well as a
woman's own home.

Letting a baby come forth is a primal experience of vulnerability, intimacy, and tremendous
neuroendocrine transformation. All the hormonal orchestrations of human labor and birth (and
indeed, all mammals) are highly sensitized to environmental factors, many that we are not even
aware of. For example, at any given moment in an environment that is not our usual habitat,
there are about 2000 new scent signals registered by the brain, as well as many other microbial
triggers.

Simply entering an environment other than one's habitat in labor switches on the neo-cortex
and triggers adrenaline, regardless of any interventions. Likewise, being unsupported, and
stressing or obsessing in one's own home, can also create adrenaline!   Adrenaline is the
enemy of a laboring woman, unless she truly needs to sprint away from danger. Adrenaline is
the hormonal message of the "fight-flight" reaction which causes the body to shut down
circulation to the extremities in a glandular alarm. This creates catecholamines to boost muscle
tension and thus reduce the labor pain threshold dramatically while increasing anxiety and
fear.

The art of consciously choosing and preparing one's laboring & birthing environment is an art
of self-care.

Instinctive, or "unmedicated" birth is a sensory experience of embodiment, wherever it occurs. It
is often said among midwives and doulas, as well as mothers who have created natural births
for themselves, that the best environment to labor in is one which would also be conducive to
making love! It is as tender as it is passionate, as sensual as it is sacred. As the
ancients say, it is a giving of the gift of life.

Most women agree that the thought of making love under florescent lights where you are
expected to stay in a metal railed twin sized bed in a chilly room where strangers observe you,
intercoms talk, computer screens flicker, and sick & infectious people are above and/or below
you, is unappealing at best, and definitely not relaxing! Dim the lights, and it's still not that
pleasant.

Most women agree that the elements that invite relaxation are not metallic, and not cold, and
there are no bleeping noises. When visualizing a birthing environment conducive to instinctive
responses, we find ourselves selecting the very same things we would naturally enjoy in a self-
care environment such as a spa, or our own home: cosiness, dim light/candeliight, warm water
tubs, floor cushions and pillows, a double bed, warm floors, tasty food, soft spokenness,
pampering, and pitchers of water with lemon slices or rose petals! Why not? A woman who
knows her worth, knows that self-nurturing and self-care are top priority for her well-being as a
mother and a partner.

Birthing environments are also the welcoming world for the baby's first experience outside the
womb, and healthy babies (even ones needing a bit of stimulation to rouse them as they
transition into breathing) prefer immediate 'Skin-to-Skin' reunion at the maternal heart,
regardless of locale of birth! (for more scientific information on this, see the "Skin-to-Skin
Protocols" article in this library).

In some settings, babies are born in water, and immediately unfold in buoyant warmth as they
are lifted up to the mother's bosom. In other settings, babies slide out on "dry land" and into
the hands of their own mother or father. In some institutional environments, many precious
seconds and even minutes go by as babies are unnecessarily separated from their mothers,
and emotionally imprinted with this traumatic separation during "cleaning" and
suctioning/stimulation by medical personnel (an outdated practice circa 1970 which is still
normal obstetric training in many schools - current science supports "in-arms" reunion for any
basic procedures, and the postponement of most "basic" procedures).

In many settings today, including some attended homebirths, babies are being brought to the
point of fully distressed screaming and rapid chest breathing before given back to the mother -
their original squall becoming cries, the cries becoming a full body communication of
emotional/spiritual distress, often uninterpreted and ignored by desensitized adults who think,
unfoundedly, that babies need to scream. There are some birthing environments however
where Pre & Perinatal psychology and/or Primal Health is taken into account, and the baby is
gently welcomed and respectfully reunited with the mother with a short squall upon first breath,
perhaps a few snuffles, then a sacred silence that envelopes the mother-baby.

The quality of mother-baby integrity, peace, and exhaltation can significantly vary according to
one's Birth Intentions (or 'birth plan'), one's labor support, and the orientation of the birthing
environment towards facilitating a woman's informed choice and birthing/postpartum intentions.
For a woman who has a heartfelt desire to experience unhindered, active labor & birth and a
highly attuned, even rapturous reunion with her fully aware baby, it is essential to become fully
informed of one's birthing environment options.

Making informed choices - before, during, and after birth, can prevent the loss of precious
energy that typically occurs when women are dependent upon anti-intuitive circumstances.
Becoming a passive, childlike patient in some form of mind-body dissociation
when having a baby is a common experience of modern American women, but
it needn't be.

Giving birth can be an opportunity to deeply respond to Life and co-create a win-win situation of
healing embodiment and psychological transformation.   Giving birth is the manifestation of a
woman's inmost self during the most physically intimate, emotionally vulnerable, and spiritually
demanding journey of her life.

Hospitals

Hospital births are where about 90% of American babies enter the world, into the hands of
obstetricians. The #1 reason for hospital admissions in this country is "normal childbirth," at
great profit to hospital administrations, technical & pharmaceutical corporations, and
malpractice insurance companies.   Though studies show that attended homebirth for healthy
women is as safe, and even possibly safer, than hospital birth, many North Americans plan to
arrive early in labor at the hospital, under the assumption that it is not.

Many women are under the mistaken impression that hospitals are all the same, as if the best
standards of "woman friendly" improvements have been instituted across America since the
feminist women's health movement obstetrical reforms of the 1970s and 1980s. Unfortunately,
reality is much different. Hospital environments for birthing women can vary greatly in just one
city. And this variation can have profound and lasting impact women and families.

Realistically speaking, many hospital maternity wards have changed very little over the last few
decades, except for fresh wallpaper, fancier en-suite televisions, and the required lactation
consultant on duty...   They continue the scientifically outdated practice of maintaining well baby
"nursuries" and continue to allow and unconsciously promote separation of well mothers and
babies, despite double talk about "rooming in" policies. The Maternity Ward hallways are
searingly bright with flourescent lights, uninviting for women who want to walk alot in labor. And
it may be decades more before hospitals go to the lengths of installing birthing pools, double
beds, and doula-friendly provisions for long labors!

Some hospitals have nurses that work 8 hour shifts, others 12, which has tremendous effects
on patients and the nurses themselves.   Some hospitals have private luxury birth recovery
suites with double beds, while others have very cramped quarters with barely room for a chair
beside the bed! Most hospitals have cleaning crews and cafeteria workers (doing their job as
directed) that routinely enter labor and recovery rooms to do their tasks, regardless of the
profoundly personal and private things obviously taking place. Most importantly and
dramatically, some hospitals have birthing pool jacuzzis that they actually encourage healthy
women to use, while others not only have none, but are opposed to any water immersion for
healthy women.

Such differences in hospital environments can make them like different planets, as concerns
the impact upon the laboring woman's process, particularly the woman who is keen to give birth
in an empowered and instinctively liberated fashion. It is not difficult to understand how the
desire for a lovely, "non-medical hospital birth" can take on the illusion of being impossible to
any laboring woman who has not strategically prepared in advance with her doula and birth
partner by interviewing different hospitals, touring different wards, and prenatally addressing
her fears and becoming informed about instinctive labor coping skills.

Indeed, some women overcome the environmental challenges of the average hospital
environment and succeed in giving birth without drugs and various other interventions, such as
the pop singer Cindi Lauper did at New York Hospital with her first baby at the age of 42!

Professional prenatal and labor doula support, by phone and in-person, can greatly help
healthy women to progress well in very early labor unattended and to enter early and
established middle labor labor at home, thus achieving their goal of elevating their natural
coping & relaxation hormones and arriving at the hospital in established late first stage labor
(unstoppable contractions 2-3 minutes apart). This can greatly enhance a laboring woman's
self-syncopation and reduce the likelihood of medical interventions. It can also increase
personal empowerment for the laboring woman's calm progress through "second stage labor",
when the baby starts moving down and emerging through the pelvis.

Although great strides have been made in some hospitals to make low-risk birth more “home-
like” with the popularization of some less clinical-looking maternity wards and doula-friendly staff
orientations, birth is still viewed more like a medical procedure for illness rather than a natural
physiology.   After all, a hospital is a medical center of infectious diseases! Overzealous and
premature use of labor inducing and augmentation medication, and the sequelae from other
interventions increases the rate of cesarean surgery in this population, as opposed to birth
center and homebirth transport rate statistics.

Of course, the technology to synthetically manage pain (namely epidural anesthesia) and to
perform surgery is readily available, and this is a main objective for many women who choose
hospital labor & birth.

Birth Centers

Freestanding birth centers have become much more popular in the last decade because they
provide a more natural environment and facilitate freedom for the birthing mother. Self-directed
birthing and natural labor coping techniques are definitely encouraged in the birth center
environment. Doulas are generally welcomed in birth centers, and the benefits of laboring at
home with continuous care before transferring environments, still apply.

There are 3 kinds of birth centers in the U.S., and each state's laws impact what may be
available where you live: freestanding yet hospital-adjacent normal obstetric centers run by
obstetricians; centers that are not associated with hospitals and are managed by independent
obstetricians and/or nurse-midwives (CNMs); and centers that are managed by state licensed
medically trained midwives who are not nurses (LMs, CPMs).

Birthing in a freestanding center is usually limited to only “low risk” women of good health, i.e.,
they cannot care for women who have diabetes, high blood pressure, or are anemic. Due to
legal issues, currently many birth centers do not offer VBAC services and must transfer out of
care persistent breeches or surprise breeches during labor.

Birth centers associated with hospitals have analgesia and anesthesia available if requested.
Non-hospital birth centers do not provide drugs for pain, and often have water pools and
continuous unmedicated labor support staffing skills. Non-hospital birth centers also attract
clients who would prefer to have a homebirth but are currently living in what they feel is an
unsuitable housing situation for their needs.

Birth centers have the skills to monitor and encourage the laboring mother-baby's well-being,
and medical protocols for the most common emergency-prevention situations (such as oxygen
administration, anti-hemorrhagic drugs, and neonatal resuscitation). Being in cities, birth
centers are most often located in close proximity to hospitals should complications arise that are
not able to be treated on the premises, emergency care is easily accessible.

The most common reason for transport to hospital is formally classified as non-urgent, and is
for dysfunctional labor/pain medication request. Non-urgent transports are accomplished by
clients and caregivers driving in cars. Urgent transport by ambulance occurs in such cases as
conservative management of maternal-fetal distress (high blood pressure, fever, cord prolapse,
and heart tone concerns) and newborn health issues (congenital birth defect issues, failure to
thrive).   Total transport rates for urban birth centers are commonly an average of 15-20% with
an urgent transport rate of around 5-7%. Their cesarean surgery and episiotomy outcomes are
typically around 5-7%. These numbers indicate that the vast majority of low-risk women
succeed in giving birth with "passive" labor management, and "active" labor support.

The time it takes from the moment the hospital is alerted by phone of an incoming birth center
transport to the time the attending obstetrician has arrived and the potential surgery team is
gathered is typically 30-40 minutes, just as when ward nurses alert their obstetrical supervisor
to patient health issues in the labor & delivery suite. Birth center transports are usually a 10-20
minute ambulance journey from the time of the phonecall.

Though most LM/CPM birth centers provide home visit care for all their clients for the three and
two week follow-ups, CNM/obstetrical birth centers do not. This is a significant issue to
consider, especially for those who plan to follow optimal mother-baby self care (40 Day Doula
Care) and want to be supported for full early postpartum recovery without the upheaval, stress,
and associated risks of all that it takes to journey out into the bustling world in an extremely
tender time.

Health insurance carriers range tremendously in coverage policies, but many centers offer
payment plans and, occasionally, a low-income special rate.

Homebirth

Home is where the heart is, as they say, and for those who choose homebirth, the emotional,
spiritual, and sexual aspects of healthy labor & birth are often an important deciding factor.
Cindy Crawford, Alice Walker, as well as Lucy Lawless (supermodel, famous author, and
actress respectively) chose homebirth, as have ordinary healthy women across the nation and
the world over.

Women who choose homebirth, as well as any medical or traditional midwives who attend
them, usually have a strong sense that giving birth is a natural, private process best
accomplished in one's own living quarters - and they appreciate the fact that their midwife's
care includes at least one prenatal appointment in the home setting, which helps create
personal relationship before the birth.

Women who choose homebirth strong have a strong desire for it to occur with minimal
intervention, and sometimes minimal observation as well.   The homebirth environment can
indeed be an optimal setting to facilitate maternal relaxation, protect mother-baby immune
systems, and establish full, uninterrupted primal bonding and attachment at birth and in the
hours and days afterwards.

In American culture there is an unfortunate misconception that it is unsafe to give birth
anywhere other than a hospital. This perception is ironic considering that fact that most
hospital births in otherwise healthy women are manipulated with unnecessary intervention, thus
increasing the risk of further complications, including fetal distress and the need for surgical
delivery. Women who choose homebirth may in fact be inclined to keep their homebirth choice
out of many conversations, as it may be stressful to educate, console, and otherwise deal with
the fears and well-meaning ignorance of the general public as well as some workmates and
family members.

The cash cost of attended homebirth is minimal compared to the cost of birthing in hospitals or
birthing centers and is usually limited to the fee of the birth attendant. Though homebirth is not
covered by insurance, for women who choose homebirth the cost is well worth it. The comfort
of the senses that a woman may need and want in order to create an instinctive birth & bonding
experience is indeed priceless, and with homebirth there is much less pressure to make
decisions she is not comfortable with, which often occurs in the hospital setting.

Contraindications for homebirth for otherwise "low risk" women include: women who have an
overwhelming fear of hospitals and are interested in homebirth solely out of fear rather than
love & health motives; women who are in unsafe or unsupported (emotionally and/or physically)
domestic environments; and women who have a strong preference for the hospital but are
choosing homebirth to please others.

Freebirth

Home is where the heart is, as already mentioned, and for women who choose freebirth,
unhindered personal empowerment and/or sustained intimacy with the partner-lover in late
labor is very appealing. Freebirth is homebirth attended by the laboring woman's own inner
guidance, own inner midwife. Freebirth is fully private, self-directed birth without paid
attendants in the home environment.   The absence of all observation creates a different
experience and a different environment thereby, as is noted in the annals of the zoological
sciences as well as the current realm of quantum science.

Contrary to the instant stereotypes that may rise about what sort of modern woman might
choose freebirth, the vast majority of these women are well educated, many of them holding
advance degrees! They tend to be among the most well-informed of all low-risk pregnant
women, many of them having studied pregnancy & birthing options before even conceiving.
Some of them are yoginis (the author Jeannine Parvati) or the daughters of physicians (the
author Laura Shanley), while others may be women from various walks of life inclined towards
birth as a sacred experience with the divine (whether that be Buddhist, Christian, Jewish, Hindu,
, Muslim, Sikh, etc.).

Among them are many women who have already given birth before (multiparas) without
interventions and have reached a place in their lives where they no longer fear birth for the
most part. Additionally, there are a smaller number of first-time birthing women, who, because
of their earth-based spirituality or yoga perspective, and/or because they have personally met
and become friends with freebirth mothers or been inspired by freebirth stories, truly feel that
they have also lost much of their fear and are following a call of love with their baby and
profound self-healing.

Thousands of modern, healthy women throughout the western world (particularly in the
U.S. and Australia) have chosen freebirth in the last few decades. This is a result of the
convergence of the women's health movement and natural childbirth reforms along with shifting
paradigms about mind-body health, leading some healthy women to reclaim full responsibility
for their birthing and no longer pay attendants to help them with managing fear.

In the freebirth environment, many women feel they are able to access their most private sexual
empowerment and emotional liberation and thus incorporate the benefits of true privacy,
instinctive movement, orgasmic states, lovemaking, and intuitive focus during labor.

There are few, if any, contraindications for freebirth in healthy, well-informed women who are
choosing this option out of love.   Women who choose freebirth have done research on
pregnancy and the physiology of childbirth, and are able to recognize possible complications
and act upon them accordingly. Thus, freebirth women are familiar with their local emergency
medicine back-up resources, as well as being very knowledgeable about basic self-care.

Prepared freebirth women have challenging moments in labor, like all women, however there is
a markedly reduced incidence of unresolved complications compared to attended women, which
is a subject of fascinating discussion in the freebirth community.

2500 B.C., India
From sculpted image