Protecting Your Wife in Childbirth
(What we learned the hard way!)
by David Crank

(From Volume 1 Issue 1, Unless the Lord ... Magazine)

WHEN we were having our first child, we knew very little about childbirth. I expected my wife to know all that was needed in this area and we both depended heavily on a doctor, whom we really knew little about. Well what we did not know could, and did hurt us! (See Our Story Part 1).

We didn't know much about cesarean deliveries, nor how prevalent they had become in this country. We assumed American medical practices concerning labor and delivery were among the best in the world. We even naively assumed that the doctor we chose would be entirely honest and forthright with us and would give us good advice, concerned much more about his patients' welfare than his own convenience or pocketbook. We were wrong on all counts! 

Husbands, how do you protect your wife and baby in this situation? With knowledge and wisdom! It is your duty to do all you reasonably can to protect your family from harm whether intentional or from medical and cultural practices that are harmful.

In our ignorance we allowed our first four children to be delivered by cesarean section and then we cut off the possibility of future children for many years, believing our doctors' warnings (the same ones given to many women). Only years later did we fully learn the lie we had been told and find the means to reverse our course and have two more children, born naturally at home with a midwife's assistance. We learned a lot about childbirth, but only after paying a high price for our prior ignorance.

So how do you gain knowledge in this area? You can start by reading what follows concerning American Childbirth Practices and Unnecessary Cesarean Sections and then looking into some of the resources at the end of this article.

Husbands protect your wives and children!

American Childbirth Practices

INFANT mortality rates for the years 1972 and 1973, indicate the U.S. ranked 16th or 17th among countries in terms of low infant mortality. The countries with the lowest rates (Sweden, Finland, Japan, the Netherlands) had rates between 9.6 and 11.5 infant deaths per thousand live births. The U.S. was sixteenth on the list with a rate of 17.7 in 1973 and 18.5 in 1972. In most of the countries with better rates, use of extraordinary measures to save extremely premature or deformed babies almost never occurs, unlike in the U.S., making our poor showing more remarkable.

What Explains the Difference?

Many researchers attribute this to American obstetric practices that have gradually become accepted as the norm, which are not favorable to successful childbirth. In the countries with significantly lower infant mortality, many of the babies are born under the care of trained midwives. Physicians are typically called upon only when the mother is ill or the birth is anticipated to be abnormal.

So What Do Midwives Do Differently? 

They manage the woman's labor, providing advice and support on how to most successfully deliver the baby without the use of medications. 

Following are some examples of specific practices common in the U.S. that hurt rather than help the labor and delivery process: (Taken from The Cultural Warping of Childbirth, A Special Report on U.S. Obstetrics prepared for the International Childbirth Education Association by Doris B. Haire, D.M.S.):

1) Sedation / anesthesia of the mother: In other countries most mothers give birth without the aid of drugs. Anesthesia risks respiratory problems and sometimes brain damage in the child, and interferes with the mother's labor making delivery more difficult.

2) Chemical induction or stimulation of labor: Inducing or stimulating labor increases hazards of premature births, prolapse of the umbilical cord, etc. Overdoses occur at times which increase risks of separation of the placenta, lacerations of the cervix and birth canal, postpartum hemorrhage and uterine rupture. 

3) Confinement to bed during the labor: In most other countries women are encouraged to walk about during labor. This helps distract the mother's attention from the discomfort while also helping the labor to progress more effectively.

4) Withholding food and drink: In other developed countries most women are allowed to eat and drink lightly during labor, helping to maintain their strength and comfort.

5) Requiring mothers to deliver babies flat on their backs (lithotomy position): This is the most convenient position for the doctor but obstructs the normal birth process, making delivery more difficult and sometimes requiring extraordinary measures. This position adversely affects the mother's blood pressure, decreases the normal intensity of contractions, inhibits the mother's efforts to push out her baby, increases the need for episiotomy, etc. Delivery is much easier, safer and effective in a semi-sitting or squatting position.

Unnecessary Cesarean Sections

It has been estimated that 3-5% of all births are complicated enough to benefit from a delivery by cesarean section. As recently as 1970 only 5.5% of births in the U.S. were by C-section. As of 1988 this rate had risen to 24.7% of all U.S. births! In 1989 it was reported that the C-section rate was running as high as 70% at some hospitals! What is going on here? A huge number of totally unnecessary surgeries! 

Possible Factors Contributing to Unnecessary Cesareans: 

1) Convenience for the doctor - he controls the timing of birth and can get on to tending to other patients (or to the golf course).

2) Few surprises - with surgery the doctor is in control of the process rather than waiting to see how the woman's body will function.

3) Malpractice suit risks - when the doctor is in control by doing surgery, he can avoid surprises / problems that might develop during labor while the doctor isn't present.

4) More money - The doctor and the hospital make more money.

5) Fear of labor - Some women want to avoid labor even if it means surgery.

6) Unnecessary complications - Other bad labor and delivery practices that have become the norm which produce more birth complications;

7) False Concerns / Myths - doctors are overly concerned about longer labors or too quick to attribute a slow labor to a problem that will prevent a normal birth. Sometimes this is ignorance from poor medical school instruction and lack of practical experience of seeing many different labors in their entirety (such as mid-wives see). 
At other times it may be a misguided concern that the mother have a "good" birth experience and that it won't be "good" if it drags on for long or the labor is difficult in any way.

8) Once a C-section, always a C-section - The false belief of high risks for natural births following a cesarean section;

9) Ignorance of other techniques - Many obstetricians today have never been trained in non-surgical techniques (such as used in prior generations and by midwives today) to handle breech births, twin births and the like.

10) Fetal monitors - False indications of fetal distress from fetal monitors result in unnecessary c-sections. There are other less intrusive (but not automatic) means of monitoring that are safe and minimize false alarms!

11) Others? There are bound to be more possible explanations than I have listed!

Delivery by cesarean section is a big deal! Don't let a doctor convince you otherwise! Your wife faces the same risks as with any other sort of abdominal surgery. Risks include: uterine infection (my wife has had more than once!); urinary tract infection, anesthesia complications; severe pain from the surgery; blood clots; hemorrhage; pneumonia; fertility problems; longer recovery time; occasionally even death (5 times the death rate as from vaginal births)! The baby also experiences additional risks of respiratory distress (due to premature, mucus not being squeezed out while travelling down the birth canal, drug complications and oxygen deprivation).

Conditions Often Cited as Requiring a Cesarean Section That Often Do Not!

Failure to Progress. This describes any condition in which the labor is difficult and not progressing as expected. Diagnoses of "failure to progress" and resulting cesareans are often the result of doctors comparing the progress of a labor to a standard known as Friedman's curve which defines the normal progress per 1-2 hours of labor. The fallacy here is that of expecting each woman's labor to correspond to the average! A perfectly normal labor sometimes last anywhere from 2-3 hours to 3 days! Labor, especially a first labor, requires patience and an environment which supports and encourages the mother. Rarely is "failure to progress" a good reason for a cesarean.

Wrapped Cord. About one third of all babies are estimated to be born with the umbilical cord wrapped around their necks. This is rarely a cause for concern. Only when the cord is exceptionally short is there a cause for concern. 

CPD (cephalopelvic disproportion). CPD is a condition where the outlet through the pelvis is too small for the baby to pass through. When this is truly so, a cesarean section is required. But true CPD is really rare yet CPD is cited as the reason for 30% of all cesarean deliveries. Doctors often misdiagnose this condition as it is very hard to determine with certainty. Doctors underestimate the way a woman's connective tissues soften and relax during labor and how the baby's head molds itself to the shape needed for passage. It has also been demonstrated that a squatting position allows a woman's pelvis to open wider than normal to allow the baby through. Many women diagnosed with CPD have tried a full labor and found they were able to birth 9 and 10 pound babies.

Breech Lie. Delivering a breech baby vaginally is considerably more risky than a normal birth. Experienced midwives often know how to turn a baby during the final weeks of pregnancy, but it does not always work. A breech vaginal delivery is best attempted with a midwife or doctor well experienced in these. A cesarean delivery may be less risky than a vaginal delivery.

Multiple Pregnancy. Cesarean sections are usually performed for multiple births. This is because of increased risks of premature babies at birth and increased risks of cord prolapse or placenta abruptio during the delivery of the second birth. Twins or triplets can be birthed naturally, but special management is required and risks are increased of complications (which might require a cesarean section). 

Conditions Requiring a Cesarean Section.

Now there are a few conditions where a Cesarean Section may be truly required - but they truly are few.

Placenta Previa. This is where the placenta at the time of birth is low and covering the cervix. This condition can be detected well before birth and verified by ultrasound. However, this problem commonly corrects itself or sufficiently improves by the end of the pregnancy so as not to pose a serious problem. (The placenta moving higher in uterus as the pregnancy progresses).

Placenta Abruptio. This is where the placenta separates from the uterine wall causing massive hemorrhage and requiring an emergency cesarean unless the mother is already in the second stage of delivery. 

Prolapsed Cord. This is where the umbilical cord proceeds the baby down the birth canal (greater risk of this with a breech birth). This is a very dangerous situation for the baby which can sometimes be dealt with by other than surgical means, but is probably best dealt with by an emergency cesarean.

Transverse Lie. This is where the baby is laying horizontally, neither head first nor breech. If the baby becomes stuck in this position within the woman's pelvis during labor, a cesarean section is required.

Gential Herpes. Without a cesarean, there are high risks to the baby of infection while traveling down the birth canal.

Other conditions. Other conditions that may require a cesarean are a baby with life threatening birth defects or a mother with a life threatening health condition that could be impacted by labor.

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