Supporting Women Without Epidurals

Presentation at the Virtua Voorhees Hospital

by Cathy Daub,  PT

I recently gave two presentations on “Supporting Women Without Epidurals” at Virtua Voorhees, the local hospital in Marlton, NJ. The hospital has approximately 5,500 births per year and  a 43% cesarean rate.  New Jersey and Florida have the highest cesarean rates in the country.  My audience consisted of doctors, midwives, doulas, labor and delivery nurses, and the nursing supervisor.  One doctor stayed for both presentations.  At the end she stood up and said to everyone, “I think it is time for Virtua and BirthWorks to have a relationship with each other.” 

They were very interested in hearing what it means to have an emotional preparation for birth as well as an academic preparation.  Human values, pelvic bodywork, grieving and healing, and primal health are not part of their current childbirth preparation curriculum. They do not see underwater births because they have no birthing pools.  So many women give birth with epidurals there, that they are not as familiar with the fetal ejection reflex and behaviors of hormones. 

The need to present such a topic as this indicates that with such a high epidural rate, many nurses and caregivers are not witnessing women giving birth normally and naturally anymore.  They only see birth as a medical event that is treated with medical procedures and obstetrical drugs.  They do not see women moving around, working with their bodies, and having euphoric endorphin expressions that come with feeling the experience of birth.   

I presented three surveys on the topic.  The first was an informal BirthWorks survey with 55 responses that addressed the following questions:

1. Where do you feel safe giving birth?
2. I want to be engaged in my birth and am choosing not to have an epidural.  Some tools and strategies for my birth are?
3. If you have previously given birth without an epidural, what kind of things made your pain better (less)?
4. What can birth professionals and hospital staff do for women who choose not to have an epidural?
5. Do birth professionals and hospital staff need training not currently being provided?  If yes, what type?

The second was a small Facebook survey with 16 responses, and the third was the Listening to Mothers II survey¹ with over 1500 responses.  The surveys presented all pointed to the same conclusions as the Listening to Mothers II survey

•         Our maternity care system is profoundly failing to provide care that many mothers told us they want and that is in the best interest of themselves and their babies.

•         Safe and effective maternity practices are available but not being used by enough pregnant women. The goal is to increase childbirth preparation for all childbearing women and their families so more can achieve safe vaginal birth. 

•         Health professionals need to become educated in normal birth and improve their care and skills to help more women achieve safe vaginal birth.

•         Research must seek ways to translate current knowledge about safe and effective maternity care practices, so they are easily understandable, and can be put into practice by not only childbearing women and their families, but also health professionals. 

Few women used highly rated nonmedical methods of pain relief such as:

1. Fetal monitoring with handheld devices rather than electronic fetal monitoring,
2. Drinking or eating during labor,
3. Freedom of movement during labor,
4. Pushing and giving birth in non-supine positions, and
5. Supportive rather than directive bearing down. 

The Listening to Mother’s II survey concluded:

• Nurses should be very concerned that care practices known to support normal birth are apparently unavailable to the majority of healthy childbearing women in the United States.
• The challenge is to take seriously and respond to the disregard for care practices that support normal birth apparent in the experiences of women reported in Listening to Mothers II.

These conclusions point to three concerns:

1. We need more childbirth educators.
2. We are not reaching enough pregnant women and their families with good quality consumer oriented childbirth education.
3. Birthing women need to learn about non-pharmacological ways of coping with labor that are proven to be effective and safe.
4. Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant.
5. Essential topics such as pelvic bodywork and human values are missing  from most traditional childbirth education classes.

Consider becoming a childbirth educator today.  Contact BirthWorks International to begin a career helping women and their families to have more positive birthing experiences.

Reference:

1.  Declercq, E.R., C. Sakala, M.P. Corry, and S. Applebaum.  2006.  Listening to Mothers II: Report of the Second National survey of Women’s childbearing Experiences.  New York: childbirth Connection. Available at http://www.childbirthconnection.org/listeningtomothers

Birth Panel

by Anna Holder CCE(BWI)

Truth, like surgery, may hurt, but it cures.
- Han Suyin

The fourth annual Hudson Valley Birth Options panel took an especially hard look at the truth this year. As in previous years a number of childbirth educators, doulas, midwives and mothers form a panel for local families to explore their birth options. Families from a wide range of backgrounds and birth experiences attend in hopes of connecting with providers and to better understand the choices in pregnancy and birth.

It is interesting to note that the hospital with the highest cesarean section rate (58%) once again failed to send a representatives and that two Ob/gyns who were slated to appear did not. This year’s panel experience was different in that many of the women in the audience were moved to tears. A brunette raised her hand and began to speak

. “ This question is for any of you, I am just wondering if I have any options; I am 8 weeks pregnant and I have had multiple c-sections and it was so horrible that I didn’t want to have any more children and now i find myself pregnant and I just….”

She began to sob and was unable to continue. Luckily she was in a room full of support and love and thus was quickly surrounded by hugs and tissues. The most interesting development was from one of the older homebirth midwives in the area.

“ You have to leave the state. I can’t tell you what your birth will be like but if you want an honest chance at a vaginal birth, then you have to leave the state.”

            Even sadder is that the entire room full of women knew she was right. What kind of society are we living in where it is easier to schedule a major surgery with its inherent risks, than it is to have a natural, physiological birth?  What kind of society are we living in where mothers fear having more children because of trauma from previous births? What kind of society are we living in where a woman is told that her only option for a VBAC is to leave her home, children and familiar surroundings to go to another state? Someone brought up the familiar OB saying,” I don’t get sued for doing the C-section”

If the upper limit of the World Health Organization (WHO)  recommended rate is 15% then we can conclude that the other 23% in New York State and 17% nationally are more likely than not unnecessary.  Doctors are failing to practice by their governing bodies (ACOG) guidelines, which state that women should be given a trial of labor even after multiple cesarean sections.

The evening further explored:

• Suing for non urgent or emergent primary cesareans
• The limited availability of skilled providers to attend breech vaginal births and the failure to recognize breech as another variation of normal
• The fact that even positive birth stories can be detrimental by “setting the bar too high “ and influencing a mothers idea of a “good birth”

 It is clear that the climate of birth is changing, at least in New York State.

In a time when we are facing an ever-increasing C-section rate, there is a small but not discountable group of women rallying against it saying “We are taking back birth,” but  we need to remember is that we never gave it away in the first place!

The Power of a Birth Circle

By Molly S. Wales CCE(BWI)

Our small town of Athens, Ohio is home to a consumer birth group called The Birth Circle.  Over the ten years since it began, The Birth Circle has grown from a handful of mothers who got together to share their birth stories, to a powerful community organization that has made a substantial difference in the lives of birthing families, and in our local birthing climate as a whole.  We share information, offer support, and build friendships. We do not endorse or judge.  And as the director of this group, I have the great honor of witnessing how, every single time we gather together, whether to talk about potty training or pain management in labor, or to share a meal, or to grieve a childbearing loss, we lift each other up, and give each other courage, simply by being present.

Let me give you two examples of this from recent meetings.  A few months back, a new couple joined us for a discussion about gentle discipline.  They quickly shook my hand, took a seat, didn’t engage with anyone around them, and in general gave an impression of being very shy and conservative.  She was pregnant for the first time, and new to Athens, and I hoped that this meeting would open some doors for them, in terms of building community and answering questions about birth and parenting.  About halfway through the meeting, a mom seated on the floor across from them pulled her breast up and out of her shirt, and began to nurse her baby.  The dad looked at his wife with wide eyes, clearly a little shocked at how she displayed her breast.  Within seconds, the mother’s toddler came over, and she tandem nursed them for a while, the baby laying in her lap while the toddler kneeled and wiggled.  The new parents tried not to stare, but their discomfort was obvious.  I thought to myself, “We’ve lost them.”  When the meeting adjourned they rushed out, and I didn’t expect to see them again.  But to my great surprise and delight, at our next meeting a month later, there they were.  And at the next meeting, and the next.  They never spoke up, but they came to every meeting, and along the way their demeanor relaxed a little.  I don’t know what sort of birth they had, nor the sex of their baby, nor if they’re even still in town.  But I think of them often, and how their decision to return showed openness and courage, and I think of that mom, too, who tandem nursed so nonchalantly in public, and never knew how she’d so beautifully exposed this couple to a new idea.

Another example.  Every April we dedicate our meeting to sharing birth stories.  This last time was heavy with home births, with hospital birth stories (both natural and with interventions) interspersed in between.  After the meeting I got a call at home from a mom who was 38-weeks pregnant, who had decided, after that meeting, to change her care provider.  She was tired of “impersonal, rough OB care.”  She wanted to know about midwifery options.  I encouraged her to interview local midwives, and a few days later she called back to let me know she’d taken the plunge.  She had chosen a home birth team, had collected her records from her OB office, and was ready to come pick up a birth pool (we loan them out for free).  When she showed up with her husband, she was glowing.  They smiled ear to ear.  It seemed such a bold to move, to change caregivers so late in her pregnancy, and I commended her for her bravery.  “I would never have thought I could do it,” she said, “if I hadn’t heard those birth stories.”  What exactly was said that empowered her, I don’t know.  But that’s not really important.  She heard something that helped her take a critical look at how she was being treated, that helped her see and feel her own personal truth, and that emboldened her to make a decision that her  extended family perceived to be reckless, yet which was absolutely right for her and her baby.  Those are the times that I think, “Wow, we are changing the world.”

And that is the power of a birth circle.  The power of women and their families getting together to talk.  Not to compare, but to share.  We lift each other up.  We are challenged.  We teach and learn.  And with every tiny bit of support that is exchanged, intentional or not, we become more fulfilled people, and better parents for our babies.

Molly S. Wales is the director of operations of The Birth Circle in Athens, Ohio. 

www.athensbirthcircle.com