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.
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:
- The attitude to pregnancyis 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.
- 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.
- Obstetrical practicehas introduced an array of hi-tech tests and equipment into pregnancy, labour and birth.
- 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.
- 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.
- 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!
- 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.
- 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.
- 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.
- Social bonds and feelings in human beings has been given ago-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.
- First and foremost, it should be recognized thatChildbirth is indeed a natural process. Nature has performed this exercise over millennia and we need to harmonize modern living with it.
- We need tobring 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.
- 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 Modelwhere 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:
- Make birthing undisturbedand 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.
- 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.
- 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.
- 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.
- Babies should be placed close to the motherand 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.
- Begin breastfeedingimmediately/ 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!
- Make natural vaginal birth the rule– C Sections, Forceps, Episiotomy, Electronic Foetal monitoring cause trauma more often than helping the mother or child.
- 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.
- 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.
- “Stage Three Mind-Body Practice” mentioned by Robert Bruce Newman is an exampleHolistic 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!