PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 8
LABOUR AND BIRTH
- Shivakumar Belavadi, PPNE, Bangalore, India
TOPIC - Prepare a short essay explaining how birth
trauma can happen and ways that babies and people can recover from it.
At the outset, I will endeavour to create an overall context
for childbirth. Thereafter, the edifice is easier to construct and appreciate.
Introduction
The Universe has been in existence for billions of years.
Since time immemorial, there is an order and method in which the universe,
nature and living species have conducted themselves. The visible order of LIFE,
as we have seen it, has three parts viz. Creation Sustenance and Dissolution. What has sustained Nature in Her Entirety
over time is the Joy of Creation. Creation must be a creative process – one of
fulfilment, purpose and progress. Thereby it ensures “Continuity of Life”. This
‘continuity’ is viewed in many cultures and societies – like for Hindus and
Buddhists - as a circular process, wherein, birth follows death.
Procreation and
Childbirth
The process of creation of the next generation of the
species is commonly known as Procreation. The urge to procreate is seen in
plants, animals and human species – in fact in all life forms. It is
interesting to see the addition of the suffix PRO to CREATION. “Pro” is usually
understood to indicate ‘forward, front or
advance’. The Latin root of the term Pro is more pregnant with meaning – ‘on behalf of, in place of, in exchange for,
just as’. It is very evident that there is a larger role that procreation
has, in the continuity chain. The perfect and continuing order in universe
requires sustenance through replacement or substitution, even within the same
species. This indeed is the pristine sanctity in the process of birth.
Procreation in all of nature happens for this reason. And
usually, in a particular season. It is all in the realm of the natural. Homo
sapiens, being highly evolved, have been bestowed with the ability to procreate
in any season. Hence, childbirth forms a part and parcel of the procreating
impulse in Nature.
The Creative
Urge in Mankind to Progress
Human beings are creative by design. Procreation is not just
an act that falls within the mammalian laws that govern part of our existence.
It is a much more meaningful process that holds within it the capacity to
redefine and refine our lives. One cannot isolate the natural creative
potential of a human being from the act of procreation and the process of child
birth.
Since the period of Renaissance and advent of the Industrial
Revolution, the ‘scientific temperament’ has become dominant. One of the first
purposes of science, as quoted by Dr Bruce Lipton was – “To dominate
nature”. Technology, skills and
professions have endeavoured to cause human betterment by controlling and
dominating nature. This is visible in the ability to tackle hunger, disease,
drought, physical construction of dams, hydel power stations and the like.
It is only natural that the same would happen with labour
and childbirth as well. This is evident when
we look at the dramatically lowered Infant and Maternal Mortality (IMR and MMR)
for the world as a whole, especially in the developed world.
Skills, technology and profession have played their part.
But if we do a complete reckoning, there seems to be a huge distancing of man
from nature. Child bearing, pregnancy,
labour and birth as also child rearing seem to have moved too far away from
their true essence. This is clear when Dr.Thomas Verny quotes Maurice L. Druzin, Director of obstetrics at
New York Hospital-Cornell Medical Centre, “Natural childbirth is alive, but it
has become a marriage of biology and technology." It is easy to visualize this if we see a woman
lying on her back in Lithotomy in the labour room, with her legs lifted up on
stirrups, fully wired into the surrounding gadgets which are beeping – an
evidently unnatural and patently unhealthy practice while giving birth to an
offspring.
Birth Trauma
– An Epidemic
The roots of
trauma are not difficult to fathom, if we bear in mind the words above. Stress
is normal – it comes in and wanes. But it could progress into trauma and shock.
We witness this in the process of pregnancy and childbirth. Trauma, not only
causes problems in these processes and shows up randomly, but also has a
cascading effect on the child through the course of infancy, childhood and
adulthood – indeed the whole of life. It may even carry forward over
generations, as epigenetics now reveals. This has surely vitiated the entire
sanctity in the processes of birth. And
now trauma has acquired the proportions of an epidemic.
William
Emerson states “Using four separate
measures of birth trauma, my colleagues and I found that 45 percent of babies
experience high levels of birth trauma, and these traumas require specialized
treatment. Another 50 percent of babies experience some degree of birth trauma,
usually ranging from mild to moderate, and babies are usually able to adapt to
mild levels of trauma, and may require little or no specialized treatment.”
These words
not only indicate the extent of the problem, but also give a ray of hope that
trauma at mild levels, is normal, tolerable and handle-able.
Causes and Consequences of Trauma
In my
opinion, there are two main causes.
The
first is reflected in the lifestyles of the progressive world – of course aided
by technology. The prevailing beliefs, attitudes and culture, especially of
male dominated societies, have contributed enormously to causing trauma.
Second
is the morphing of the natural child birth process into a medical event. The
entire medical profession – the paraphernalia of doctors, nurses, equipment,
procedures and their attitudes have made trauma a huge by product of medical
procedure.
These
are illustrated by the following:
1. The
attitude to pregnancy is that it is a concomitant
result of sex, which is either understood as a basic necessity or a pleasure
seeking activity. Childbirth and Pregnancy are viewed as something that have to
be just ‘gone through’. Smoking, drinking, substance abuse, partying, lifestyles
of “hurry” abetted by technology and professional demands in vocations almost
up to the very end of the term of pregnancy are widely prevalent in society. There is no awareness of the sanctity in the
process of childbirth and the attitude is of ‘ignorance or taken for granted’. Mothers
and fathers hardly engage with the child and each other in the course of
pregnancy.
2. The
status of a woman has been belittled in a male dominated society.
She should be treated as a Goddess who engenders creation by giving birth to a
child. Instead she is treated as an object of medical attention who should
comply with the dictates of the medical profession and procedures. The mother
and the child in the womb are treated as objects or patients and only
incidentally taken care of. It dehumanises and de-naturalises the entire
process of child birth.
3. Obstetrical
practice has introduced an array of hi-tech tests and
equipment into pregnancy, labour and birth.
a. C-sections are now the maximum performed
surgeries the USA. Many other developed and developing countries are following
suit. Use of epidurals, usage of Pitocin and other drugs to for Induction and
Augmentation during labour, using forceps & vacuum suctioning and episiotomy,
are all done without relevance to the real need and requirements of the mother
or child.
b. Hardly any knowledge is shared
with the pregnant parents. There is little consideration if tests, procedures
or equipment usage are necessary. The ill-effects on the mother and child are
not given due consideration.
c. Dr.Thomas Verny speaks of
indiscriminate and large scale use of Ultrasound scans, Electronic Foetal
Monitoring, Chorionic Villi sampling, Amniocentesis – largely ignoring the
effects on DNA/Chromosomes, Liver, Brain and overall health. These not only
cause labour and birth trauma but could have serious lifelong consequences for
the child and the mother. Foetal period should not move towards becoming fatal!
d. Gestational diabetes and
hypertension have now become treatments offered in routine when it is not at
all necessary in most cases. These cause huge amount of stress and trauma
because of unnecessary medication.
e. The baby born is treated as a
non-sentient being. It is pulled, slapped, held upside down by the legs,
washed, and injected as a host of medical procedures are done. It is inhuman to
say the least. The baby needs recognition as a full human being who is
sentient.
f. Iatrogenic adversities are on
the rise. Hospital procedures are medically determined – not particularly
suited for pregnant woman or the child. Starting from the doctor to the labour
room and the procedures, they are all cold and impersonal. They are often
detrimental to conducive childbirth.
4. Social
bonds and feelings in human beings has been given a go-by! A human is innately social.
Animals give birth in isolation. But most human beings (except some tribal
cultures) need social and human attention/environments during labour and in the
course of pregnancy. Feelings of being wanted, caring , love , kindness and
compassion are conspicuously missing. Birthing is no more the domain of women.
Midwives have been eliminated and nurses and obstetricians call the shots.
In
essence, the sanctity in procreation has been betrayed. It should be no surprise
then that Trauma is increasing exponentially. The consequences are being faced
by the child, the parents and society at large. Ina May Gaskin makes it profound by stating that ‘what is at stake is
the future of mankind as a whole’!
The Way Forward
Experts
in the field of Prenatal and Perinatal psychology have been strongly advocating
the cause of the child in the womb and the new born. There are many things
which can be done to minimise trauma, if not eliminate it. This may require a
reorientation of the current practices and beliefs. The authoritative study of
Dr Robbie Davis-Floyd has shown that many cultures/countries including Sweden,
Japan and Netherlands have practices which are highly conducive to safe and
meaningful childbirth.
We
need to consider some overall approaches which can directionally yield positive
results. The following principles become relevant.
1. First and foremost, it should
be recognized that Childbirth is indeed a
natural process. Nature has performed this exercise over millennia and we
need to harmonize modern living with it.
2. We need to bring the woman and child back to the centre of this process.
Medical science has its place – to support and aid, especially in times of distress,
emergency or aggravation. If not, the process must be left to nature and the
woman and baby who know things intuitively.
3. Humanise the process by
harmonising and integrating the roles of the child, pregnant woman, family and
society.
At this
juncture, the three paradigms mentioned by Robbie Davis Floyd are worth
recalling.
- In pregnancy, labour and birth we are currently practicing the Technocratic Model where the Mind and Body are separated, body is treated as a machine and the patient as an object and technology is superlatively valued and combines with aggressive medical interventions and management.
- The first level alternative is the Humanistic Model which recognises the Mind-Body connection by treating the body as an organism and patient as a person. Woman is heard and there is connection and caring between patient and caregiver. Science and Technology combine with Humanism.
- The superior alternative she speaks of is the Holistic Model. This recognises the Unity of Mind, Body and Spirit. Body is also a field of Energy (invoking the Quantum Science principles) and healing a person is in the holistic context. There is an essential oneness in the Patient-Caregiver relationship. Science and Technology are at the service of the individual. Care is consequently individualized (and not standardized) by including intuition and instinct.
Directionally,
what will help in prevention of trauma is the movement to the Holistic Model.
In this approach, prevention comes first and if at all there is trauma, it will
be minimized. It will also help in recovering from trauma at the earliest and
obliterating the ill-effects.
Some Specific Measures to Deal with Trauma and Help in
Recovery
Experts
have suggested many measures. A few of them are mentioned below:
1. Make
birthing undisturbed and in a comforting and secure
environment. Avoid bright lights, loud sounds, chattering and loud/unnecessary/cross
talk. The ‘mechanical and time bound procedural’ approach to pregnancy, labour
and childbirth are harmful to the mother and child. Mary Esther Malloy indicates
a precious tool - Slowing Down at Birth for Vulnerable New-borns. A ‘Birth
Pause’ is a valuable approach even in seemingly difficult situations.
2. Babies
needs to be welcomed in privacy without intrusions into their delicate psyche.
They should be given due respect as sentient human beings and not abused
physically. Care, delicate handling and love are essential ingredients in that.
This is sure to reduce trauma and foster bonding and self attachment.
3. Make
the ambience non-medical. Creating a home environment
or delivering at birthing centres as opposed to hospitals. Hospitals and
obstetricians should find a place in aggravated situations or in emergencies.
a. Make
use of the Golden Hour at birth. Birthing places must
facilitate post-partum mother-baby contact. Skin-to-skin
contact is essential. This will enhance bonding and eliminate birth stress
and trauma.
b. Babies
should be placed close to the mother and
not removed to a nursery or NICU in routine. Unless there is a real medical
requirement or a necessity, separation of mother and baby is detrimental to
both.
c. Begin
breastfeeding immediately/ as soon as possible after
birth. This will heal the baby and mother and promote health and welfare of
both. Continue breastfeeding frequently every day and for at least a year or
two!
d. Make
natural vaginal birth the rule – C Sections, Forceps,
Episiotomy, Electronic Foetal monitoring cause trauma more often than helping
the mother or child.
4. Using
the services of Doulas and Midwives. Dr
Michele Odent mentions that they play the role of the ‘mother’ for a pregnant woman. They are much more than mere
support. They surely bring in an informal and friendly approach. This will
comfort the mother and the child. Confidence of the mother is boosted. Trauma recovery is much faster with midwives
and doulas in attendance. Netherlands uses a model where midwives and medical
professionals (Obstetricians, Nurses and Hospitals) collaborate closely. Robbie
Davis-Floyd also makes a case for midwives.
5. Mathew Appleton has suggested
that we should ‘hear the story of a new
born– reflected through its body and sounds including crying’. Often it is
memory crying, re-living the trauma. If
we mirror the baby’s story and act on it, this will help in relieving stress
and eliminating trauma.
6. “Stage Three Mind-Body Practice”
mentioned by Robert Bruce Newman is an example Holistic Approach by harmonising
the mind-body-spirit. The major practice therein combines into a Complete
Meditative Approach and Strategy for minimising trauma and/or recovery from it.
In summary,
today most of the ‘medical and modern’ practices are causing, aiding or
abetting birth trauma. There are many methods, ways and means available by
which we can work at preventing and minimising trauma. A Holistic Approach
helps not only in prevention, minimisation and recovery after trauma – but
clearly redefines and brings back Humanism and Universality into the labour and
childbirth process.
The
Sanctity in Procreation needs to be restored!
