Monthly Archives: January 2012

What exactly is “natural birth” anyway?

I’m done with my residency interviews. On to the rank list. So, as a distraction, how about diving in?

Last week on Twitter, one of the people whose feed I follow posted that it annoyed her when people refer to vaginal birth with analgesia as “natural birth”. I replied that I am annoyed when people, including health care practitioners, refer to any vaginal delivery, regardless of any interventions, as a “natural birth.” Looking back, I think she was reacting to Beyonce and Jay Z’s press release that their baby was “delivered naturally”, which may have been in response to rumors that the singer had a scheduled elective cesarean.

It is bad enough when the term is used by lay people. I have seen countless residents and even attending physicians conduct an obstetrical history on a patient by asking “was that a cesarean or natural birth?” (I’ve even seen it done in Spanish – cesario or parto natural?) Since I have been guessing others’ motives this whole post so far, I’ll throw in another assumption. I think these history takers are avoiding the term “vaginal” because of some level of squeamishness or decorum. I have yet to see “natural birth” instead of “vaginal delivery” on a medical history template, thank goodness.

It’s a nonspecific euphemism that means something different to everyone, and, to some, carries judgment or bias. It is not a medical term, and does not belong in a medical history. I don’t begrudge Beyonce and Jay Z’s people for using the term, but it does bother me when it is used by someone in the health care profession.

Or, someone who used to be in the health care profession. Especially when it is used to capitalize on the judgment tied in with the connotation purposely. The more imprecise and loaded a term is, the easier it is to demonize it.

So, when Amanda Marcotte linked to an article on Grantley Dick-Read being a misogynist, I clicked through unwittingly. I was halfway through the article when I began to get suspicious by the familiar straw man argumentation tactics. Then I scrolled up and saw who the author was.

Now, I am not here to defend the so-called father of natural childbirth and his views on the modern woman of the 1940’s any more than I feel the need to defend all of Margaret Sanger’s views. Dr. Tutuer’s claim that the central tenets of so-called natural childbirth advocacy is therefore built on sexism and racism is as ridiculous as saying modern reproductive rights advocacy has central tenets of racism and eugenics.

Like the terms we use to describe childbirth itself, the discussion of birth advocacy and birth choices is improved with nuance, not sweeping generalizations, stereotypes and villainization. Speaking as someone who considers herself to be part of the birth advocacy cloud, I have never, ever heard a privileged, first world so-called natural birth advocate use Read’s arguments about the pain of childbirth being a punishment for uppity career seeking women who don’t know their place as baby factories. It is hardly a central tenet in the movement. In fact, one of the most common criticisms of opting for an analgesia free birth is that one is choosing to suffer like a primitive woman from a developing country, with frequent conjuring of women of color squatting in huts, and batting about of the term “animal”. I find those comparisons to be more sexist and racist than advocating for birth choices.

I also don’t agree that a central tenet of so-called natural birth advocates that the pain of childbirth is “empowering” (which contradicts the argument that it is a punishment for being empowered). I do think that autonomy in birthing choices and true informed consent can be empowering. Accomplishing something thought of as difficult, such as an unmedicated labor and birth, can feel empowering to some women. But, the actual pain? No. Is a longer labor more “empowering” than a precipitous labor? Persistent occipital posterior with back labor the most empowering? Ridiculous.

Finally, although I do think planning on an analgesia free birth with preparation makes it a more tolerable experience than, say, having a analgesia free birth when one planned on an epidural but is somehow unable to receive one. But, do most “natural” childbirth advocates say that adequate preparation means a pain free labor? Absolutely not. That is a fabrication, as Dr. Tuteur deems it to be, but it is a fabrication on her part that it is a common claim in the “natural” community. I had two analgesia free labors, and they hurt. A lot. And, again, this contradicts with what she says is the other central tenet of “natural” birth advocates, that the pain is empowering. Is the labor pain free or is it painful and therefore empowering? Boy, we “natural” birth advocates sound like idiots!

Dr. Tuteur would be hard pressed to find contemporaries of Dr. Dick-Read who were not sexist and racist, considering how sexist and racist American society was at the time. If you read articles written at the time about twilight sleep, the main standard of care for “pain free” birth, you will also see troubling justifications and, frankly, fabrications. From the linked article “Twilight Sleep: the Dammerschlaf of the Germans” in the Canadian Medical Association Journal:

One can imagine what a special paradise of salvation this promise conveyed to that vast number of women who, as matrimonial candidates, are consciously unwilling, or unfit, for the claims of parturition; that vast array of modern womankind with no physical or mental training for the demands of motherhood; who are enmeshed, as Walt Whitman so well describes it, “in the incredible holds and webs of silliness, millinery, and every kind of dyspeptic depletion.” For such a prospective mother this method afforded a glimpse into a maternal paradise.

The article also presents claims that twilight sleep analgesia in labor reverses the biblical curse of original sin on women. The author also acknowledges the technique is inconsistent and does not always provide an actual pain free experience, but that the amnesiac qualities of the scopalamine solved that problem. Considering many of these women would receive episioproctotomies and mid to high forceps deliveries, I doubt the recovery was easy or pain free, much less a glimpse into maternal paradise. Does this mean that obstetric analgesia is built on central tenets of sexism and fabrication?

There is no such thing as “natural” birth. There is spontaneous onset of labor, there is labor without augmentation, there is labor and birth without analgesic medication, there is spontaneous vaginal delivery, there are births in which the moms are allowed to position themselves freely, there are births in which the moms push at will instead of being coached or forced into closed glottis Valsalva pushing, there are births where the cord is allowed to pulsate and blood transfer is allowed to occur instead of immediate clamping, there are births in which the baby is delivered on to the mom’s skin instead of a blue “sterile” drape and then is whisked to a warmer.

My first birth, I went into labor on my own. I was given Pitocin augmentation, labored on my back in a bed with continuous monitoring, amniotomy, had coached pushing, also on my back, immediate cord clamping, and my baby was taken from me immediately, and I didn’t get to see or hold him for more than four hours. I sure didn’t have any medical analgesia, and it hurt like hell. I didn’t feel empowered, and don’t think the term “natural” applies to that birth. My second birth, I went into labor spontaneously, I was able to change positions, I had no augmentation, had intermittent monitoring, but I pushed the baby out flat on my back, against my will with no urge to push, while being yelled at to hold my breath and push for a count of ten. Was that more “natural”? More empowering?

I think I share motives with many in the birth advocacy community. I think women should have autonomy in their birth choices. I think the burden of proof should be on interventions, which should ONLY be employed when medically indicated, and then should be offered with adequate informed consent. If I had to rank my priorities or “central tenets”, I am much more concerned about early elective inductions, forced repeat cesareans in good candidates of trials of labor after cesarean, routine episiotomy, routine deprivation of oral nutrition during labor, routine amniotomy, routine continuous monitoring, routine augmentation, routine episiotomy, aggressively coached Valsalva pushing without laboring down, and routine pushing in the lithotomy position than I am worried about epidurals. I am much more worried about women simply being told that Stadol “will just take the edge off” and epidurals “don’t affect the baby”, both of which I have heard as the entire informed consent for each.

ETA: Sorry I ended it so abruptly, but lunch break was over at the clinic.

We need more nuance, not more generalization. We need more empathy, not more vilification. I am all for critiquing historical figures through the lenses of feminism and anti-racism. But, let’s focus on truly empowering women instead of tearing them down.

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Back with something too cool to let by

Whew! 2012! How did that happen?

So, yeah, 2012. Lots of big stuff lined up this year. More interviews. Step 2 clinical skills board exam – my last medical school board exam. Rank list. Match. Graduation. (if all goes according to plan for those last two!)

I finished an interesting month at my local residency institution. It was great. I was pleasantly surprised with how much the residents and attendings liked to teach. I have an iPad now, and when I access my blog from it, the cover picture is the one from Papanicolaou Way. It always makes me smile.

I am now doing a family med rotation, one of my last core rotations. When I went through the requisite getting to know you questioning with the other people at the site, someone made a “yuck” face when I said I was going into obstetrics and gynecology. As usual. I don’t get it. There are plenty of specialties I would not enjoy, some of which I would be grossed out by if I had to do them. Dentist? Uh, no way. Heebie jeebies. But, I am sure happy that there are people who enjoy that line of work, and would never stick my tongue out and grimace like a kid who just ate cod liver oil if someone told me that’s what they were planning to do! I swear, it happens all the time. Even worse, it’s pretty evenly distributed, regardless of gender. Let’s not hate on our vaginas so much, ok?

Finally, the cool thing. Planned Parenthood has a series about STIs that included this article about intestinal parasites. Never thought of them as STIs. And wow, that capsule on a string with the bag that hangs out in your intestines until you fish it back up? SO COOL!

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