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, 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 truly supportive environment for that process.

Giving birth is the manifestation of a woman's deepest self-respect, self-love, and self-
trust 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.