The Over-Medicalisation of Birth – What’s the Problem?

Birth. The mind conjures images of women screaming in agony, the sound of dramatic midwives shouting at women to ‘PUSH’, beepy machines, white coats, stirrups, women pushing ‘uphill’ on their backs, episiotomies and tears. We are told during pregnancy not to smoke, not to drink, not to dye our hair, most pain killers are out of bounds, no sushi or unpasteurised milk. However, the second we go into labour we are pumped full of drugs, told to give birth in hospital as our bodies are no longer trusted to do their job unsupervised. We are connected to machines and experience uncomfortable vaginal exams. We are put on a time scale acceptable for the hospital, experience trauma as a standard and we have become conditioned to think it’s normal?

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So why on earth has a physiological process been handed over to a medical team? Is birth inherently dangerous? As an experienced birth worker, I would say a profound no!

It saddens me to see countless women handing over their births to the medical profession. Hospital births have become standard and we have lost trust in our bodies. We have lost touch with our instinctive wisdom. Why do we fear childbirth so much? When did this happen and how? I must stress, we are very lucky to have medical intervention when we need it. For the most part midwives are doing an exceptional job. I am not discussing the hard working birth workers here, only the ‘system’ in which they work. I have the utmost respect for birth workers, be it independent or NHS. They are mostly wonderful, caring individuals who just want to help. This article is not about these individuals, but the failing maternity system.

I recall over the years, while discussing homebirth, people asking “What if something goes wrong? women used to die in childbirth”. To answer the former, we first need to understand why things ‘go right’ in birth. The best way to answer this is to compare birth with sex. Babies are created in love and born in love (well that’s the ideal scenario) We must bear in mind that the same hormones we release during sex are also the hormones we release during birth. Oxytocin, the ‘love hormone’ being the most important.

So imagine you are making love to your partner, you are in a blissful, beautiful and euphoric state. You are in the moment, it is private and such a wonderful experience. Now picture some bloke in a white coat slams open your door, turns on the lights, storms in followed by a couple of women wearing scrubs and masks and start observing you while saying “You can probably do this yourself, but we are here just in case you can’t, i’m just going to take your blood pressure and fiddle about a bit with your genitals. Don’t worry I do this all the time, it’s normal. “ Do you think you would be able to return to bliss after that rude and arrogant display? Unlikely. Birth is no different. Oxytocin is released when we are calm and feel safe. If we release adrenaline, it will significantly compromise oxytocin flow.

Our bodies will not labour as intended if our adrenaline levels are telling us we have to fight or fly. All the blood needed in our uterus will simply leg it to our extremities. Guess what stimulates adrenaline? Bright lights, feelings of being observed, strangers and being prodded! Where does all of the above take place?Is it any wonder why so many women arrive at hospital and their labour slows or completely stops? This is where you will hear that vile phrase ‘Failure to progress”. This is just basic birth physiology! So why is this not hard wired into our brains instead of fear and trauma associated with birth?

It is not uncommon to be told “women used to die in childbirth”. In the late 19th century, women feared ‘childbed fever”. We had no understanding of bacteria or hand washing until Semmelweis discovered women were dying at the hands of doctors. They would perform surgery then deliver babies without washing their hands. He ordered his staff to wash their hands without understanding why it was working, but maternal death rates significantly dropped. After evidence emerged about bacteria, childbed fever virtually disappeared. Being that poverty is one of the leading causes of maternal death, it is not surprising that as poverty rates decreased over the years, so did maternal and infant deaths. Issues such as overcrowding and malnourishment were no longer a common risk factor for women.

After the second world war, there was a mass shift from home to hospital without any evidence whatsoever that it improved safety. It became a status symbol to give birth in hospital. So rather than just the ‘high risk’ women giving birth in hospital, it became common practice for all women. We lost community midwives and more importantly, we lost continuity of carer. This is probably one of the biggest travesties in obstetrics.

So, why has birth become steadily ‘safer’ over the years as birth has moved to hospital? The answer is simple. Along with poverty reduction, cesarean operations are now safer, thanks to antibiotics. The mass exodus from home to hospital has not made a difference in safety outcomes, more that, the very few women who do face complications now have the option for a ‘safe’ cesarean operation. In recent times caesareans have become safer. For example, they are now quicker and doctors make a transverse incision by your bikini line rather than a vertical incision. This does not mean however that c-sections are a safe alternative. Far from it.

You might raise an eyebrow to the statement “very few women who do face complications”. Some may not believe such a small percentage of women experience complications. After all, the horror stories that everyone has heard, the amount of women you know who have ‘needed’ a c-section can’t all be without reason surley? I would not blame you for reaching the conclusion that birth is inherently dangerous.

Let’s examine why birth is still predominantly taking place in hospitals.

First of all we must not confuse the word ‘common’ with ‘normal’. For example, a breech presentation is most certainly a variation of normal, and delivering your baby vaginally as such is also normal. With a skilled midwife who is experienced in breech birth, you should expect a safe outcome. This does not mean breech birth is ‘common’. Conversely, induction of labour is ‘common’, but does not mean the practice is ‘normal’.

Let’s use the United States as an example going forward. Although statistics will differ from country to country, America’s obstetric practice is where we are all heading if we do not take heed to warnings made by countless professionals such as ‘Michel Odent’.

The WHO states that if a hospital’s cesarean rate exceeds 10% there is no better outcome for mother and baby. So why do 1 in 3 humans ‘need’ surgery to be born? Research is clear. Home birth is safer for healthy women (Hutton et al 2019) In fact we have evidence to suggest that home birth isn’t just for the lucky few who manage to tick all the boxes for ‘low risk’. Studies show that home birth is also safer for ‘high risk’ women. (Li et al 2015 ) and (Halfdansdottir et al 2015)

I must pause for reflection on how offensive, unhelpful and even inaccurate this language of ‘high risk’ can be. For example, being told you are ‘high risk’ because of your age, is laughable. We must take into consideration that hospital guidelines are as low as 9% evidence based. In 1979 Professor Cochrane stated that obstetrics was the least evidenced based medical speciality. Studies that suggest ‘older’ women are high risk are based on the assumption that as we get older our health naturally declines. Yes of course this can be true, but to label every woman over 35 ‘high risk’ is insulting. It is more helpful for practitioners to look away from their piece of paper and look at the woman in front of them. A 42 year old yoga instructor with an impeccable diet will certainly not fall into this category of ‘high risk’ just because she happens to fall into this age bracket. So ladies, please question everything! It is not up to you to prove your body will work normally, it is up to them to prove it wont! You are not on trial! Anyway I digress.

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Let’s examine the forever growing Cesarean section rate. Over the years, cesareans have been performed as a safe alternative for no apparent medical reason. Women are able to schedule a c-section, just because they want to. While I support any woman’s decision to birth exactly how they like, including an elective cesarean section, I highly doubt the majority of the decisions are informed. Informed consent is critical. Women should have autonomy over their bodies, and should they choose to birth in the woods, in water with dolphins or book an elective cesarean, that is their choice and should not be judged! Do women really have informed consent? In my humble opinion. No.

“Cesareans are associated with short and long term risk which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies.” (WHO 2015)

Cesareans are safer than they have ever been when genuinely needed, however when this type of surgery is overused the harm certainly outweighs the benefits. Women are seldom told (and in my experience, NEVER told by the hospital) about the critical role of the Human Microbiome. The microbiome jump starts your baby’s immune system, digestive system and helps to prevent infection. This process takes place during birth. The baby is covered in this good bacteria inside the birth canal, after that skin to skin contact and breastfeeding continues to seed your baby with good bacteria. A cesarean severely compromises this process. “This bacterial coloniser-immune system link — together with other factors — could explain why caesarean section babies are statistically more prone to develop allergies, chronic inflammatory diseases and metabolic diseases.” (Wampach et al 2018)

Babies born by caesarean are more likely to suffer with childhood allergies, eczema and asthma. Unless you are inclined to do your own research, hire a Doula or just stumble across this information, the chances of your doctor volunteering this information are almost zero.

So as we can see, the evidence is piling up in favour of natural birth at home and pointing away from unnecessary medical intervention. So why is the intervention rate so high if most women will not experience complications? Well here is an interesting fact. According to ‘Statistica’ the market size of obstetrics and gynecology is $24.4 billion a year!

While there are many reasons for the overuse of medical intervention, it does appear there is a financial incentive for the use of cesareans. A paper published by The Nation Bureau of economic research states “doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more.” (Johnson and Rehavi) To quote an article in NPR “Johnson and Rehavi decided to explore the reasons for the increased number of surgical childbirth procedures via an unusual tack: They hypothesized that obstetricians would be less likely to be swayed by financial incentives when patients themselves had significant medical expertise and knowledge. By contrast, the researchers figured, such incentives might play a larger role in medical decision-making when patients knew very little. In some ways, this is analogous to what happens when people take their cars to mechanics. People who are knowledgeable about cars are likely to push back against unnecessary repairs, whereas those who don’t know much about cars are less likely to take issue with the mechanic’s advice.

The analogy made about cars is a perfect example of how the medicalisation of childbirth has been able to continue. If women are not educated in birth physiology and they do not even realise they have rights, then of course this practice will long continue. Women have been indoctrinated with the belief that they must hand over their births to the experts. Autonomy is rare and we must speak up about this. As we do not realise we have the right to decline intervention or more to the point understand that many procedures offered to us are unnecessary, we continue to be coerced into a state of disempowerment. People conduct more research on buying their next car, or organising a wedding than they would on birth.

We must empower women to know they have autonomy over their bodies. We have the right to ask questions, we have the right to ask for evidence based research when told we ‘have’ to be induced, we ‘have’ to have a caesarean, or we ‘have’ to have a vaginal exam. You would not go to a hair salon, ask for a cut and blow dry, only to be told “sorry we only dye hair here so that’s what you are getting”. No! You would go elsewhere. So why are your childbirth options any different? Well, it does not appear many women realise they have options!

That is why I created ‘When Push Comes To Shove’. An EBE award nominated company. Not for profit and soon to be charity. We are a one stop shop for birth. We offer support world wide! (Please note we do not offer medical advice, only information to make informed decisions, but we do refer to medical practitioners) We offer :

Doula Support (Throughout the UK and are able to find traveling Doulas or international Doulas for you)
Online birth workshops to educate women on birth physiology and their rights in childbirth
Free weekly zoom meetings for emotional support
Free youtube content (interviews with professionals such as Doctors, Midwives and Doulas)
We help countless women navigate the system when their hospital has told them they are not ‘allowed’ to birth how they would like.
We offer a school education programme to teach children about childbirth. We aim to arm children with enough information so when they grow up and have families of their own, they are not fearful of their bodies.
Continuity of carer access fund for those on a low income. (Doulas or independent midwives)
A shop! Be proud to be a birth nerd and have a t-shirt that says so!

While there are other organisations such as the amazing ‘AIMS’ (Association for improvement in the maternity services) and ‘Birthrights’ few women know these exist.

When Push Comes To Shove takes a different approach. We hope to get the message of informed consent to pop culture and not just inside an echo chamber preaching to the converted. As well as an experienced birth worker I am also an accomplished singer/songwriter. I have released a single ‘Breathe Again’ which aims to spread the movement of ‘When Push Comes To Shove’ to a wider audience. The very emotive music video contains footage of real women in the moments soon after birth, as well as midwives singing along to the chorus! We want to empower women globally! Money earned from the sale of the song will go straight into ‘WPCTS’ so we can continue to serve women. We also rely on donations to help with the access fund. You can find our ‘go fund me’ page on our linktree.

I also urge women to buy the must have book on your rights. ‘Am I Allowed?’ 4th Edition by Beverely Lawrence Beech. This will be your birth rights bible! Every pregnant woman should have a copy! This will be available to buy on Amazon from 13th May.

To summarise, ladies, please step into your power, educate yourself, know what you want and ask questions. You are “Allowed” to birth however you see fit. We are here to help should you need support. If you would like to be interviewed for our youtube channel and tell your story please contact us on our website.

References:

About the author:

Nickita is an experienced Doula in association with ‘Maya Midwives’.

She has 2 children. Nickita began her journey in midwifery, but decided it had become over medicalised, and so her Doula journey began. She is also a student of Biomedical Science.

She started the campaign ‘When Push Comes To Shove’ after years of helping traumatised women. She aims to help spread awareness about informed consent in childbirth. Along with school education and Maternity services, WPCT will help any family navigate the birth system. WPCT have an access fund to serve low income families as well as free zoom sessions weekly for emotional support. Our youtube channel contains many videos that are helpful to anyone making informed decisions about their birth. We interview midwives, doulas, doctors and even celebs!

WPCTS is for women worldwide! As we offer zoom birth workshops, anyone can attend!

“When Push Comes To Shove chewed my leg out of one heck of a proverbial bear trap! After feeling coerced into a hospital birth I DID NOT want, I felt totally overwhelmed and disempowered. I was told a home birth was not possible due to my BMI. Well I contacted WPCTS & was blown away by how much information was given to me! I attended the course & managed to get the home birth of my DREAMS! I was armed with knowledge, knew my rights & stepped back into trusting my body. I felt like a birthing goddess!” Katie W

As well as a birth worker, Nickita is also an established singer/songwriter. She has written for big names in the industry for many years and was featured on MTV Brand new, as well as Sky News and the new Netflix show ’Sing on’. Her song ‘Breathe Again’ is available to buy on iTunes, Amazon, Google and various other platforms. You can also stream it on spotify.

You can see the video here: https://www.youtube.com/watch?v=5FlEUr7lK5Q

For more information about When Push Comes To Shove’ visit our website: www.whenpushcomestoshove.co.uk

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