It might seem hard to believe but relatively recently, in 1900, 95% of all babies were born at home. In 1938, the rate had dropped to 50% and by 1955, 99% of all babies were born in the hospital. While hospital births seem perfectly normal to us today, the truth is that women have been helping other women have babies at home for hundreds of thousands of years, and the move to medicalize the birthing process is a very recent development in human history.
Birthing Becomes Business
Prior to 1950, most babies were born at home with the assistance of a midwife, a woman specifically trained in the birthing process and needs of the female body. The word midwife comes from the Old English term meaning with woman. As hospitals were formed and later grew into profit-based entities, the push was on to reframe childbirth as a medical procedure that required oversight instead of a natural process of the female body conducted at home. As childbirth moved out of the home and into the hospital it became more systematized and less personalized.
In healthcare today, time is money, so birthing rooms can’t be occupied for too long. Extended labors aren’t encouraged. While most women are given an epidural for pain, this slows down the dilation process. In response, they’re usually administered Pitocin, which induces longer, stronger, and more frequent contractions. The return of their pain requires another epidural, which then necessitates more Pitocin to speed up dilation and contractions again. This cycle often leads to contractions so severe that the baby’s heart and respiration rates become distressed with the doctor recommending a C-section that was caused mostly by unnecessary medical interventions.
Health Risks, Financial Returns
Because of this vicious cycle, the number of healthy women with no pregnancy complications having C-sections has risen dramatically. Research from the American College of Obstetricians and Gynecologists (ACOG) has shown that the risk of needing a C-section rises sharply when labor is induced, especially if it’s the first child. Unfortunately, as hospitals rush to be more competitive and serve more patients, the number of C-section births has continued to rise. Today, one in every three U.S. babies, 1.4 million, is born via C-section.
C-section births have become so common now that most of us don’t think twice when we hear someone we know has had one, but the truth is that a C-section is classified as major surgery. Lots of complications can occur including hemorrhaging and blood clots for the mother, or the baby requiring intensive care for various issues. Even though these risks increase with subsequent procedures,, C-sections are now the most common surgery performed in hospitals. Unfortunately, women are often told that a vaginal delivery is no longer possible after a C-section. This isn’t quite accurate. Additional research from the ACOG shows that 60% to 80% of women can have a successful vaginal birth after a C-section. Perhaps the reason for this misinformation is that C-sections, being surgery, cost about $20,000 more than a vaginal delivery.
This isn’t to say that C-sections are bad. They save lives when they’re absolutely necessary. The real issue is why and how they become “necessary” for so many otherwise healthy women who choose a hospital birth.
Another concern with C-sections is that because the baby does not travel through the birth canal, there is no trigger for a surge of oxytocin (the bonding hormone) in the mother’s body. Although she’ll produce additional oxytocin during later skin-to-skin contact with the baby, this important hormone rush doesn’t happen.
Passing through the birth canal also allows the baby to become covered in its mucosal lining that’s populated with billions vital probiotics. When ingested by the baby during birth, they act as the first inoculation of the baby’s gut, establishing the primary culture for its intestinal health and immune system. This also doesn’t happen in a C-section.
Priorities & Process
As hospital birthing continues to become more mechanized, increasing numbers of women are looking to give birth at home.
In general, a midwife remains with an expectant mother throughout her entire pregnancy, monitoring her physical and emotional wellbeing, providing individualized education, counseling and prenatal care, gynecological exams, hands-on assistance during labor, delivery and postpartum support while minimizing all technological interventions when possible, lactation consultation, and providing referrals for additional obstetric care.
A midwife may practice independently or in association with a doctor’s office. A woman can also use a midwife in addition to the care she’s already receiving from her OBGYN, whether she chooses of have a home birth or not. Midwives are qualified to deliver babies at home, in the hospital, or at separate birthing centers. Midwifery is currently overseen by the American College of Nurse Midwives (ACNM), Midwives Alliance of North America (MANA), North American Registry of Midwives (NARM) and the Midwifery Education Accreditation Council, along with the support group, Citizens for Midwifery.
At present, there are four types of midwife designations: Certified Nurse Midwives (CNM) hold either a bachelors or Master’s degree in nursing and have passed a national certification exam administered by the ACNM, earning them a state license to practice; Certified Midwives (CM) also receive their certification from the ACNM, but hold degrees in areas other than nursing; Certified Professional Midwives (CPM) are trained midwives who have been certified through NARM. The credential requires re-certification every three years; and Direct Entry Midwives (DEM) may or may not hold a college degree, but have trained in apprenticeship and other instructional programs, which include attending home births and those at birthing centers. Whether you are interested in becoming a midwife or using a midwife’s services, it’s very important to find out which certifications your state recognizes. You can do this by reaching out to your state midwifery organization through contact information provided by Citizens for Midwifery. Always be sure your midwife is certified with ample experience. Ask lots of questions, and always check references with previous mothers they have served. Interview potential midwives in person. A successful experience depends equally on how your personalities and philosophy match up as much as credentials. Additional information can be obtained from contacting ACNM and NARM, as well.
What about midwife safety? Hospital birthing has to be safer because it’s in the hospital…right? Actually, the world was populated long before hospitals, but let’s look at some recent statistics.
As of 2017, the U.S. ranked 55th internationally in infant mortality with a rate of nearly six deaths per 1,000 live births, far behind nearly every other industrialized nation. Because 99% of all births today take place in hospitals, these mortality rates can’t be coming from babies born at home.
On the contrary, a study following more than 5,000 expectant mothers in North America who chose a home birth with a certified nurse midwife showed they required substantially less of almost every medical intervention including epidurals, episiotomy, forceps, vacuum extraction and C-section, and experienced virtually no neonatal or intrapartum mortality.
The NARM website provides quite a few research studies published by internationally recognized medical journals that consistently confirm the high rate of safety and positive outcomes for low-risk women birthing at home with the assistance of a midwife. One study, published in the Journal of Midwifery and Women’s Health examined outcomes of nearly 17,000 women who planned to give birth at home between 2004 and 2009. Of that total, 89.1% had a successful home birth. The majority of the women who had to be transferred to the hospital arrived for “failure to progress” with only 4.5% of the total sample requiring Pitocin to induce labor and/or an epidural. A vaginal birth was accomplished by 93.6%, assisted vaginal birth by 1.2%, while just 5.2% had a C-section, a far cry from the national average of 33%. Of the 1,054 women in the sample who attempted a vaginal birth after a previous C-section, 87% were successful.
A study from the National Center for Health Statistics followed all single vaginal births in the U.S. in 1991 attended by either a physician or certified nurse midwife (CNM). It stated that mortality rates in the births overseen by midwives showed “excellent outcomes”. In fact, the risk of infant death was 19% lower for births assisted by a CNM than they were for births conducted by physicians. The risk of neonatal mortality (infant death in the first 28 days after birth) was 33% lower with a CNM than with a doctor, while the risk for low birth weight was 31% lower.
Exceeding Standard Practice
Although some uninformed doctors might display a competitive attitude toward midwives, most OBGYN’s know and respect their patients’ wishes. They’re more than willing to work with a midwife throughout a woman’s pregnancy and be ready to meet them at the hospital if a transfer from home happens to be necessary, which is very rare.
What many doctors weren’t taught to recognize was how a woman interacts synergistically with her unborn baby and even her own body during the pregnancy and birth process. Midwives bring this nuance to their style of care. Women deserve this kind of birth experience that accentuates the sacredness of what it means to bring another human being into this world, surely a woman’s greatest gift. With a little more focus on personalization instead of profit, we can provide that kind of experience for every woman. Even within an imperfect healthcare system, we can work together to give each mother and child what they deserve, a real personal delivery.
For more health insights from Dr. Sadeghi, please visit Behiveofhealing.com to sign up for the monthly newsletter or check out his annual health and well-being journal, MegaZEN here. For daily messages of encouragement and humor, follow him on Twitter at Behiveofhealing.