How birth has changed


As recently as the 1930s, women and babies died regularly in childbirth, usually from infections. Intense efforts from the medical community led to vast improvements in survival rates.

But as more births moved into the operating room, and doctors worked to eliminate risk, the natural process became increasingly an expert-mediated procedure, according to local midwife Faith Gibson.

Gibson, who worked as a nurse in an obstetrics ward in the 1960s, tells harrowing tales of women strapped to a table, drugged and unconscious, waking up in agonizing pain without knowing what was causing the pain.

The experiences motivated her to advocate passionately for "physiological" childbirth, a birth determined by the needs of the mother's and baby's bodies.

But having a baby in a hospital isn't like that anymore, according to Deirdre Lyell, an assistant professor of obstetrics and gynecology at Stanford Medical School.

"There's definitely more patient autonomy and a great deal of respect for her choices throughout the process," Lyell said.


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Posted by NavelgazingMidwife
a resident of another community
on Jan 8, 2008 at 10:16 pm

Deirdre Lyell needs to see a homebirth before she can say that birth in the hospital isn't "harrowing." Women might not be unknowingly drugged, but "autonomy" is NEVER a word I would use to describe a laboring woman's choices in any L&D I've been in since 1983. Even the most progressive hospitals and fabulous doctors are at the mercy of protocols and rules that take Herculian efforts to avoid.

When one sees the true autonomy of a woman at home - where everyone is a guest but the birthing family - there is no way to flagrantly use the term "autonomous" for a woman birthing in the institution called "a hospital."

Barbara E. Herrera, LM, CPM

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Posted by SkepticAl
a resident of Ventura
on Jan 9, 2008 at 7:26 pm

Barbara (or anyone else who knows) -

In a homebirth situation, are there any fetal heart monitors? What are other indications of delivery complications and how do you know what needs to be done, and how quickly? What can you do if there is excessive bleeding when the placenta separates? I want to ask about this in an open-minded way, but I have a cousin who is alive today because he was delivered by C-section when his apparently smooth delivery went bad in an instant, and they were able to start the C-section fast. Likewise, I've heard about totally smooth, normal deliveries followed by some anxious moments when they realize that bleeding hasn't slowed or stopped enough.

These complications may be a small, small minority, but it seems to me I could be talking about two deaths right now instead of two complicated cases, if these women had opted for home delivery. Hospitals may have their downsides, but I'd take a less-than-fully "autonomous" experience rather than a lifetime of regret any day. I'd gladly give up some autonomy to be in the hands of people prepared to save a life on the spot in an instant.

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Posted by Mom
a resident of Midtown
on Jan 9, 2008 at 7:40 pm

I agree with SkepticAl .. when things are going fine, smooth - it seems like a no brainer to deliver a baby at home. However things can go wrong in an instant.

I had a very smooth delivery. Two hours after the delivery, when things seemed absolutely fine, I started hemorrhaging badly. The nurse couldn't find a vein to get IV in - they had to call the chief anesthetist on the staff (long episode .. ) -- the point is, there is a reason to deliver in the hospital. You don't want things to go wrong, but when they do - you better be sure there is trained staff around to take care of you.

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Posted by mike
a resident of Old Palo Alto
on Jan 9, 2008 at 10:11 pm

We have had two home births and they both have been perfect -- with no problems whatsoever. The midwives in this area are superb and very professional (We used Faith Ginson & Donna Driscoll).

The experience is amazing and it really wonderfully magical to have your newborn with you right after the birth.

Also, I have met at least 2 mothers who had awful bacterial infections from having birth at the hospitial, which caused them to have to actually have long hospital stays later.

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Posted by SkepticAl
a resident of Ventura
on Jan 9, 2008 at 11:11 pm

Mike -

Congratulations on the two perfect home births. Could you enlighten me about what the midwives would have been able to do if anything had gone wrong, and how early they would have been able to determine that there were complications? How did you and your wife decide that the benefits outweighed the risks?

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Posted by local mom
a resident of Another Palo Alto neighborhood
on Jan 9, 2008 at 11:36 pm

There used to be a midwifery option at Lucille Packard. This was the best of both worlds, I felt. When my pregnancy had late second-trimester complications, my midwife warned that she might have to turn me over to Stanford's care, at least temporarily. The birth went full-term and without further complications, with her at my side at Stanford Hospital.

It was FAR more pleasant than my previous doctor-attend birth, and it had fewer complications than the first because she didn't revert to common procedures that can be harmful to mother. However, there was the safety net of a hospital staff and equipment, should the need arise.

I believe they did away with the midwifery option in the early 2000s. What a shame, as it was a perfect compromise between personal midwife care vs. hospital technology.

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Posted by OB nurse/mother of four
a resident of another community
on Jan 23, 2008 at 10:54 am

This interesting conversation about how birth setting has changed over the years peaks my curiosity as to how it continues to change.

As a women who gave birth in the late 60's in the "uninformed/uneducated about birth/labor/early nurturing of the newborn period" and in my own personal quest to reverse this scene,I have been observing the changes over forty years. It appears to me to be entirely possible to provide autonomy of the birth family and respect there wishes in a safe medical setting. "Best Practices Guidelines" by all professional groups working in this area actually recommend this. The focus should be in immediate attention of all involved--healthcare professionals (prenatal, inhospital, and postpartum, and parents to require the application of such practices as support for birth decisions of the parents (with medical interventions as needed), non separation of mother and baby (and family), and optimal support and teaching of breastfeeding and lactation support! A call to action is needed by those who care.

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