“The first intervention in natural childbirth is the one that a healthy woman does herself
when she walks out the front door of her own home in labor.”
Michael Rosenthal, OB/GYN
This quote is an attention grabber and one that should set us all to thinking. We know about the “cascade of interventions” that sends most North American births down a tunnel of medical mishaps– strip membranes, Pitocin gel induction, continuous fetal heart monitoring, pain medications, distress in the infant, cesarean, post-surgical infection, breastfeeding problems, postpartum depression, etc., etc., etc. Iatrogenic meddlesomeness at its most blatant is easy to spot and condemn.
We like to shake our heads, point our fingers and tut-tut-tut about this type of intervention.
But what of the interventions that we don’t see, the ones we are guilty of ourselves? The Oxford dictionary defines intervene:
“to interfere, modify course or result of events.”
Something that seems as small as turning on a light could be classified as “an intervention.” Is it an intervention to wear perfume to a birth? To monitor the heartbeat of the baby every half-hour? To leave a clock within the mother’s view? To watch the mother? To speak to the mother?
To ask her to take a walk outside? To tell her husband to get in the water tub with her? Do midwives take any time at all to ask themselves these questions?
What would “the course of events” be like if we weren’t there? How could we possibly know?
Recently I came into possession of an amazing video. This video is the raw home movie footage of the births that are shown in the unassisted birth film” A Clear Road to Birth”. There is no attendant present at the births.
The families have, for the most part, just put the video camera on a tripod and let it run. The result is an amazing view into a place that I have never been privileged to enter–a birth that follows the natural course of events.
I found it difficult to watch because it is so very intimate, and I wasn’t sure that they’d want me to ogle their beautiful, private family moments. It is a sacred film. I came away from it with questions about how my presence at a birth affects the behavior of all the participants. The women on this film are not asking, “How much longer will it be?”
They are not saying, “I can’t do it anymore.” There is no illusion or possibility of some other woman “saving” them.
They are going to do it themselves, and they seem to have an inner core of resolve about it. Their husbands and children mostly seem “surprised” that the baby is really there. This is unlike births where there is an “expert” present, and the waiting and watching seem to go on forever.
This film of unattended births leads me to question,
“What about women who have unassisted prenatal care?”
We are told that prenatal care is essential. We believe it is a cornerstone of good maternal/natal health.
But is this true? Are there interventions that take place in childbirth classes that are subtle and affect the course of events? If we think of the spoken word as “an intervention,” we must wonder if we are causing changes in the course of the birth long before the membranes release. I cringe at some of the “meddlesome midwifery messages” that women are given at prenatal checkups. Messages can be imparted both verbally and nonverbally. I remember when I took prenatal classes 25 years ago, the nurse managed to impart the message that she didn’t approve of breastfeeding with just the look on her face when she said, “How many of you are planning to breastfeed?”. Her attitude changed the course of events for a lot of the women in that class. It was absolutely an intervention.
I have learned a lot about how to question my own interference in birth from listening to Michel Odent. His message is repeated over and over: “The most important thing is do not disturb the birthing mother.” What does a nice midwife do that would disturb? Several years ago, I went to a birth as assistant to the midwife. I was assigned to take a video of the birth and so I familiarized myself with the family’s camera and began to do a little filming of the mother while she was in the water tub. I was getting some nice footage when, all of a sudden, the room went completely black, and I couldn’t get an image in the camera. I looked up to see what had happened: the brother-in-law of the birthing mother had turned out the lights. I went over and turned them back on so I could get on with filming and, presently, the man came back and turned them out again! I was very annoyed and, in that moment, I realized that he was right! He was more in tune with what his sister-in-law needed than I was. Birth seems to flow best for human beings in the same conditions as most other mammals. Darkness, familiar smells, privacy and quiet are the main ingredients for a smooth birth.
Who in North America can give these simple things to a birthing mother? Are we willing to trade monitoring and charting for births that truly flow along smoothly? Are we willing to sit, out of view of the woman, completely still while she focuses inward and makes her own journey to meeting her child? Can we forgo the acknowledgement and appreciation for all we “do” and be deeply satisfied with “being” unobtrusive?
… I believe that the “3 Ps” of obstetrics should be “patience, patience, patience” and not “passage, passenger and powers.”
I am fond of the Buddhist words from
The Tao of Leadership
Being a Midwife
Remember that you are facilitating another person’s process. It is not your process. Do not intrude. Do not control.
Do not force your own needs and insights into the foreground. If you do not trust a person’s process, that person will not trust you. Imagine that you are a midwife; you are assisting at someone else’s birth. Do good without show or fuss.
Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: “We did it ourselves!”
–The Tao of Leadership by John Heider
This is an exerpt from an article originally published in Midwifery Today (22 September 2002).