The birth wars - Page 4
From Griffith REVIEW Edition 22: MoneySexPower
© Copyright Griffith University & the author.
Written by Mary-Rose MacColl
IN THE 1970s, FRENCH OBSTITRICIAN MICHEL ODENT established a three-way partnership among doctors, midwives and women at Pithiviers Hospital outside Paris. Odent and his partners worked together to provide safe care that also respected women and their families. The organics and the mechanics of birth co-existed. Women came from all over Europe to have their babies at Pithiviers. Odent's book, The Farmer and the Obstetrician (Free Association Books, 2002), compares the industrialisation of birth to the industrialisation of agriculture. He says both have damaged society, but childbirth hasn't yet experienced anything on the scale of mad cow disease or foot and mouth, which might bring about a revolution in practice.
Odent brings together research from many disparate disciplines and makes intuitive leaps. He suggests most contemporary hospital environments have no appreciation of the physiology of birth and the bodily needs of a birthing woman who is, at her core, a mammal; no appreciation of the child whose project is love as well as survival. He objects to the routine use of Syntocinin and other artificial hormones that mirror oxytocin, which he says is one of the hormones of love. He says interfering with birth hormones interferes with love. He believes those first few hours and days between mother and child are critical.
Odent says that when he wants to know how safe he will be in a city in the world, he looks at the birth practices there. He says crimes of violence will be high in places where birth and its natural rhythms are not respected. In some warring African cultures, women are forbidden to look into the eyes of their newborn babies for several days. Odent believes these cultures know why they do this, to make their babies grow into warriors, not human beings.
According to Odent, bright lights, foetal monitors, interventions and noise will engender release of the hormone adrenalin that can slow or stop labour. This is of key importance when failure to progress in labour is the most common reason for caesareans among first-time mothers. Odent tells the story of a caesarean he performed early in his career which saved a child's life. The midwife looked at him afterwards and said, ‘Oh Doctor, what a marvellous rescue operation'. This is what caesareans are, he says, but they are for rescue, not routine.
WE CANNOT GO BACK TO BIRTH on my grandmother's farm with Mrs Fryer because Mrs Fryer is gone. But right now, there is no clear way forward for maternity care in Australia either. Hospital care is not meeting the needs of women and their families and doctors are powerful. Every time changes to maternity care are suggested, the College of Obstetricians raises the spectre of safety and ends all debate. The alternatives that have emerged in Australia – birth centres and a new generation of independent homebirth midwives – can only exist by locking out the more powerful profession of medicine. They deliver a different brand of ideology, one that is no less damaging. A Cochrane review of research into the outcomes of maternity care in home-like settings conducted in 2005 pointed to a higher rate of baby death in home-like settings compared with low-risk birth in hospital settings. The study was not powerful enough to draw conclusions, and ‘home-like' settings are not the same as birth centres and other models of midwifery-led care, but the researchers were concerned enough to warn that ‘an over-emphasis on normality may lead to delayed recognition of or action regarding complications'. The most tragic story I came across during the review of maternity services I worked on was the death of a baby girl named Lillienne which was at least partly the result of midwives in a birth centre and doctors in a birth suite within one hospital failing to work together to provide care. The family of this baby, her mother, her father, her siblings, will be affected by their loss for their lifetimes.
The birth wars matter. One way or another, we are involved in a conflict that will result in the most significant social changes the next generation of mothers will see, on a scale akin to the rise of the nuclear family and the move en masse to institutional child care. How we care for pregnant women and babies speaks not only the society we are but the one we will be. Childbirth is a moment of heightened risk and it is a moment of epiphany. And yet maternity care in Australia cannot accommodate these two moments at once. The Commonwealth review of maternity services, expected to report in December 2008, headed by the Chief Nurse and Midwifery Officer, is leaning heavily towards increasing midwifery-led care. This will do nothing to address the fundamental conflict at the heart of the birth wars. It may make matters worse. The organics and the mechanics should be working together to provide safe, responsive care, but in Australia the birth wars show no sign of ending, despite their awful and ongoing casualties. ♦