Archive for May, 2011

Wide variation in C-Section rates: to those of us in the natural birth world this is NO surprise.

Here’s my suggestion: rather than try to “route out” the doctors who are doing too many C-Sections, let’s study the doctors with the ten percent rate of C-Sections and find out what they are doing differently. What are they doing RIGHT that could be copied by other doctors? Just slapping the hands of doctors doesn’t help. We need to point them in the right direction. Let’s focus on the best practices, not the worst.


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Alberta, Canada is home to one of the newest midwifery programs at Mount Royal University. Unlike the United States, Canada is experimenting much more with offering bachelor-level midwifery degrees. As at Ryerson University in Toronto, this new program will create what is called “entry-level” midwives. In the United States, unfortunately, aspiring midwives have few choices like the ones at Ryerson and now at Mt. Royal University. Aspiring midwives in the United States have to go through nursing school, usually, if they want to get a degree from a university. And midwifery degrees are usually post-graduate degrees (i.e. a master’s degree, see Bastyer University in Seattle), not undergraduate degrees. Though we have trained thousands of fabulous nurse-midwives in the United States, some of them find that the word “nurse” works against them in medical settings such as hospitals. There, “nurses” are rarely autonomous actors vis-a-vis physicians in the way that midwives need to be. Canada’s approach seems reasonable and long-overdue. Let’s train midwives well, and let’s assure their autonomy.

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Because my book, “Natural Hospital Birth: The Best of Both Worlds,” clearly focuses on achieving natural birth inside hospitals, homebirth midwives often ask me why this book has anything to do with them. Midwives can feel  annoyed and antagonized by the phrase, “The Best of Both Worlds.” One midwife said, “I just can’t support that. For a healthy woman, all evidence shows that the best place to give birth is at home.”

I get it. And I believe that the evidence of homebirth’s safety is unequivocal. Study after study proves that women give birth well outside of hospitals, often achieving the same or even better outcomes than their hospital counterparts… especially if we factor in the avoidance of medical interventions and the sense of empowerment that natural birth gives to women.

Yet, women in North America are clearly not choosing their place of birth based on scientific studies. They are basing their choice on something else entirely: a complex mix of cultural norms, a belief that hospitals are “modern” and therefore “better” than ancient ways, and a sense of “safety” that cannot be measured in any scientific study. This last one is important. Because I believe that a woman’s labor is significantly impacted by her feeling of safety — her perception of safety, not her actual safety — I have come to the conclusion that I must support women giving birth wherever they feel safest.

There is no reason that those of us who know the power and beauty of natural birth should throw up our hands and give up on hospital birth just because it takes place in a location that cannot be called “home.” Helping women give birth with their own power wherever they happen to be is more important to me than the name of the place. Yes, hospitals have lots of equipment. Yes, the doctors and nurses and hospital staff exert power and authority in hospitals that they do not exert in our own homes. But I am not willing to bow down to those realities as if they are more important than a birthing woman’s instinctive power. In Russia, I watched midwives and doctors honor birthing women’s ability to give birth naturally, without pharmaceutical drugs, over and over and over and over again.  They did not allow the medicalization of the birth place to medicalize the entire experience. Just because they could do a C-Section down the hallway didn’t mean that they overused that option. Just because there was an anethesiologist on call did not mean he should be called. It is not a done deal that hospital birth, by definition, MUST be full of interventions and must take a woman’s power away.

Quite the opposite. By refusing to allow this to be true, by insisting that women’s natural ability to give birth is the central truth of every birth (even a birth surrounded by medical professionals), by focusing on the beauty and magic and power of birth rather than our fears that something might go wrong, by accepting the real place of obstetrical care with gratitude (aware that modern obstetrical care is a wonderful invention in a small percentage of cases that would not turn out well without it), we can do something huge for the world. We can reclaim birth everywhere.

For birthing women. For babies. For fathers. For grandparents.

And also, as an amazing side effect, for obstetricians. For nurses. For hospital-based midwives. For anesthesiologists. For all hospital staff. They, too, will be positively impacted. If we bring natural birth to hospitals, we will expose everyone in the hospital to the miracle and power of women giving birth rather than being delivered. Far more than homebirth midwives (who serve a generally healthy, low-risk population), obstetricians, nurses, and hospital staff support the rare women who experience difficulties, obstructions, deaths, morbidity, and tragedy in birth. Sometimes their skills save lives; sometimes there is nothing that can be done.

Statistically, we know that there will always be a small percentage of tragedies that occur at a birth. But what a gift if we could grace the lives of medical experts with more of the magic of empowered natural birth. There is just nothing like being in the room when a powerful woman reaches to the deepest places of herself to bring forth new life. I cry with a humble joy and feeling of triumph every time.

I believe that the experience is transformative. And worth pursuing in any location where a birthing woman might happen to be.

If doctors, midwives, and nurses who work in hospitals get to experience natural birth more often, I have to believe that it will become easier for them to relax about birth in general. Slowly, more of them will come to understand why some women prefer homebirth. And slowly some of them will ease up on the fear-driven practices that tie everyone’s hands. Birthing women who insist on natural birth can give this gift to hospital staff.

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