I’m reading a fascinating book right now – Birth, by Tina Cassidy. Ms. Cassidy gave birth in 2004 in a standard hospital setting, culminating in a cesarean and a healthy baby. Afterwards, she was intrigued by the cultural and historical influences on the process by which every one of us arrived on this planet. Her research is impressive, with a 15 page bibliography at the end of the book.
Since I’m pregnant as I’m reading the book, I’m finding it particularly interesting. Humans are unique in our fear of childbirth and seem to have the most painful births of any mammals. This is due in part to our intellectual grasp of exactly what is happening and our ability to anticipate pain before it occurs. But it also stems from the fact that our two primary evolutionary advancements – walking upright and having a large brain – are somewhat incompatible when it comes to childbirth. Our brains are disproportionately larger when compared with other mammals’ and at the same time our pelvises are narrower to facilitate bipedalism. Works great once we’re born, but makes the birth process quite a challenge for the laboring mother.
Ms. Cassidy’s book delves deep into cultural and medical norms surrounding birth over the last half-millennia. Over the years, birth has been regarded as a natural process and considered a pathology, depending on the prevalent ideas of the time. It is a very common process, and yet for a pregnant woman it can seem like the most fearful of obstacles.
I have mentioned already that Jay and I have hired a midwife and will be having our baby at home. I’m not oblivious to the fact that sometimes things do go wrong during pregnancy and birth. We’re getting detailed prenatal care with our midwife, and if something were to seem amiss, she would refer us to an obstetrician for further care. And if something were to go wrong during the birth, we would transfer to a hospital about 10 minutes from home. This is a very rare occurrence in planned home births though, as the vast majority of them do not include complications that require hospitalization, and the outcomes for low-risk mothers are better at home than in a hospital.
I’m grateful that health insurance in Colorado is required to cover complications of pregnancy. I find it interesting however that the vast majority of health insurance policies that cover routine maternity care do not cover home birth midwives. Midwives charge $3000 to $4000 for prenatal care and delivery, while an obstetrician and hospital can easily charge three times that amount. It seems that it would benefit health insurance companies to allow a low-risk insured to use a licensed home birth midwife (midwives make sure that expectant mothers are indeed low risk before taking them on as patients).
We have come a long way from the days of Twilight Sleep and leg stirrups, but pregnancy and birth in most developed countries is still regarded as a pathology, requiring extensive medical intervention. I find it interesting to see how many treatments have been used over the years that were subsequently determined to cause harm to the mother and/or baby. Before there was a scientific understanding of germs and microbial transmission of disease, women died in great numbers from childbed fever, spread by doctors from one woman to the next because hands were not washed between patients. In the 20th century, X-rays were routinely used – until 1960 – to determine things like the width of the mother’s pelvis and the condition of the fetus. In the late 50s and early 60s, Thalidomide was routinely prescribed to pregnant women to prevent morning sickness and help them sleep. Diethylstilbestrol (DES) was prescribed to prevent miscarriages between 1938 and 1971. We look back on all of these things and shudder, glad that we live in the 21st century. But obstetrics has a sad history of finding out after the fact that certain interventions and drugs are harmful. That’s good for the people who haven’t yet given birth, but little comfort to the mothers and babies who have already been treated.
We are not planning to have an ultrasound during pregnancy, and we chose not to use the Doppler to listen to our baby’s heartbeat – we’re waiting until our next visit when we’ll be able to hear the heartbeat with a regular old fetoscope. My pregnancy is considered low risk, and that means that statistically, I’ll have a better outcome using a midwife, delivering at home, and employing minimal intervention during pregnancy. I cannot see the future, but I doubt that in 2007 we have reached the pinnacle of obstetric research. I am confident that 30 years from now, we’ll look back on at least some of the things that are currently done on a routine basis during pregnancy – and paid for by health insurance companies – and shake our heads in dismay. I’m sure that I will learn of things that I wish I had known now. That’s part of life. But I’m choosing to avoid anything that is not clearly proven beyond a shadow of a doubt to not cause harm. I hope that I do not have to look back on my pregnancy and say “I wish I hadn’t done…”