Crone, noun
A wizened elderly woman. Feminine version of sage.

It’s Halloween, and since I happen to be a certifiable crone, I’ll begin this last chapter of the series on birthing options with some tales of witchcraft and bloody deeds of persecution that at one time threatened to eradicate the very existence of the ‘Medicine Women’ who traditionally attended the birth of new generations. The wise crones and grandmothers who tended the health, love lives and fertility of mothers, daughters and sisters back when the patriarchs of shamanism believed women to be chattel property like horses or goats, untouchable in their fertile ‘curse’ and dutifully banished from the household entirely for the duration of their menses.

It’s not a pretty history. From Witches, Midwives, and Nurses by Barbara Ehrenreich and Deirdre English:

“Women have always been healers. They were the unlicensed doctors and anatomists of western history. They were abortionists, nurses and counsellors. They were pharmacists, cultivating healing herbs and exchanging the secrets of their uses. They were midwives, traveling from home to home and village to village. For centuries women were doctors without degrees, barred from books and lectures, learning from each other and passing on experience from neighbor to neighbor and mother to daughter. They were called “wise women” by the people, witches or charlatans by the authorities. Medicine is part of our heritage as women, our history, our birthright.”

Medicine women – primarily midwives – were persecuted mercilessly by the Medieval church that controlled medical education and practice on behalf of the ruling classes. This persecution lasted well into the so-called “Age of Reason” [14th through 17th centuries] and swept Europe before it again reared its ugly head in the American colonies with the famous witch-trials of Massachusetts.

The extent of the persecution is breathtaking. In the late fifteenth and early sixteenth centuries there were tens of thousands of executions – usually live burning at the stake – and some historians claim millions were eventually killed. 85-90 percent of those killed were women.

As the feudal and religious war against women healers waned in the 18th century, the rise of male-dominated allopathic medicine took place and the battle against midwives was taken over by the medical profession and its control of regulatory law. Beginning in 1896, the U.S. medical community embarked on well-documented, well-coordinated and well-financed campaign to eliminate the midwife from the practice of her own profession.

To pull this off doctors had to re-define pregnancy and childbirth as disease rather than normal reproduction not fundamentally dangerous to mother or child if properly managed. By the 1920s a shift from home birth to hospital births had taken place, and the death rates for both mothers and babies soared as a result of routine medical and surgical interventions in the birth process. To this day the United States ranks at the bottom of all industrialized nations in infant and maternal mortality rates.

Yet there is good news, even though the war against midwives continued unabated medically and legislatively through the last part of the 20th century. States are again licensing midwives to attend uncomplicated births at birthing centers and in homes, as the statistics have demonstrated that healthier mothers and babies result from treating the birthing process as a normal organic function rather than a dread disease.

Homebirth 101 offers a sobering look at those statistics, and how they compare with hospital outcomes of overly medicated, overly managed birth. The American Pregnancy Association offers a fine list of questions and answers relating to the decision to give birth at home, what conditions would indicate that hospital birth would be safer, and what to expect if one chooses to give birth at home.

The first home birth I attended was when my little sister gave birth to my niece in Florida in 1984. I couldn’t imagine how she’d get through it without painkillers, as it was her first baby and she had a history of ER visits once a month just for menstrual cramps ever since she was a teenager. Yet the OB who had partnered with the only licensed midwife in the northern part of the state was forced to pull out of his partnership by peer pressure, and it was too late for the pregnant women who had already paid for the service to get other doctors. They had no choice – it was ER births or home with the overworked midwife who no longer had a clinic.

Surprisingly to me, the labor and birth went without a hitch even though the midwife (who had attended three other births that day) didn’t show up until it was pretty much over. We’d done our Bradley classes and were well prepared to manage the entire process if we had to. My second home birth experience was when my elder daughter gave birth to #1 grandson in my baby sister’s guest bedroom. Different midwife, and baby sister is an R.N., there was a last minute complication (cord strangulation) that I am quite sure would have resulted in a dead baby if we’d been at a hospital. Our midwife handled it quickly and ably, and that grandson starts college next fall.

My pregnant younger daughter hasn’t informed me of her birthing decision yet, probably hasn’t entirely made up her mind. But if she wants to have Sunshine at home, I’ll certainly be there to help. And I won’t be too scared to know what to do. I can help with cleaning and food, I can help distract her from hard labor, I can keep the water boiling and can even catch that baby if Daddy passes out. I’ve attended 6 other home births since, they all worked out fine.

After all, I am a certifiable crone.

Links:

Is Homebirth for You?

Home Birth

The Fall of Midwives

The war on midwives (part 3)

Historians as Demonologists: The Myth of the Midwife-Witch

I talked a little bit about hospital birth in the last installment, so now it’s time to discuss another option – giving birth at an efficient, home-style “Birthing Center” attended by licensed midwives and with a physician or two as partners on call.

Again, it’s vitally important for a mother-to-be to receive frequent and committed prenatal care from a doctor or midwife trained to spot potential problems before they get too far along. It’s also important for expectant parents to commit themselves to a proven birth educational program, and I have recommended the one I am most familiar with – The Bradley System.

If the pregnancy is developing normally and the mother is healthy and fit and confident of what she wants for herself and her baby as far as a birthing experience goes, it’s time to do some research on birthing centers near home and make some appointments to tour facilities and question staff.

If the parents have already chosen a midwife or midwifery group to provide prenatal care, they no doubt already have a list of birthing centers where those midwives are associated. Maybe even met a doctor who partners with the center. If not, there are resources on the web to help with the search.

The Online Birth Center offers a large collection of articles related to all things of concern to expectant and new parents. There is educational information about midwifery so you can better evaluate those you meet, a careful evaluation of common herbs your midwife might suggest you take and how those may affect you and your baby, even some newsgroups and forums where you can connect with other expectant mothers and couples for friendship, advice and some sympathetic eyes.

The American Pregnancy Association offers a fine list of questions to ask when you’re visiting birthing centers in your area. This is very valuable information, such as what you should expect from any birthing center to even consider it for your own experience:

• A relaxed and warm setting.
• Liberty to return home shortly after birth if you wish.
• Health care providers that include nurse-midwives, direct-entry midwives and/or nurses working with a listed, board certified obstetrician.

And to this add the proximity to a hospital, either attached or affiliated, just in case. The site also offers links to educational material and articles about planning and preparing for birth, fetal development, multiples, labor and birth, health and safety issues, prenatal testing, complications and birth control options. A very good source of information and useful methodology for choosing just the right birthing center.

Finally, the American Association of Birth Centers offers a mission statement, a list of frequently asked questions, tips on finding an association center near you, a well-stocked library and bookstore, and lots of educational material.

Unless something goes wrong – and potential problems are not always apparent before labor begins – birthing centers have a good record of helping to improve the mortality statistics in this country over what they were when most births occurred in hospitals or at home unattended. The welcome presence and encouraged participation of family members in a home-like atmosphere makes the experience more pleasant for everyone involved, and one of the best things a mother can do to help ensure a healthy birth is to avoid drugs either to rush her labor or those to treat her pain that go straight into the baby’s system and depress normal responses at birth.

Birthing centers aren’t cheap, thus will not be an option for everyone. They are worth investigating as an option, and couples will feel much better all around about their choices if they’ve done the homework!

Links:

American Association of Birth Centers

Online Birth Center

American Pregnancy Association

In this and my next few posts I’ll be taking a look at some of the birthing options open to parents these days, along with statistical analysis of pros and cons for both mothers and infants. The first option is hospital birth.

To grandmothers (like me), it might seem odd to talk about hospital birth as an ‘option’, since back in ancient history when we were having our children, hospital births were the norm. Unless something strange happened – like giving birth in a taxi stuck in traffic, or in an elevator stuck between floors – almost everyone was born in a hospital.

It was the end result of decades’ worth of efforts by the medical profession to both ease the pain of childbirth for mothers with strong drugs and ’save’ the greatest number of babies from the detrimental effects of those drugs. Women in labor were isolated and strapped to gurneys on their backs with labor-enhancing drugs flowing into their bloodstream from IV tubes to counter the labor-retarding effects of painkillers. When the time came Mom was wheeled into a sterile OR called the ‘Delivery Room’, where her peritoneum was sliced open and the baby pulled out with giant metal tongs called forceps. Which often left serious bruises on the baby’s head or cheeks.

The baby was promptly whisked away to a separate ward by nurses who cleaned it up, administered various tests, and immediately instigated formula feeding. If Mom did well, she could see the baby once every 4 or 6 hours for 15 minutes, so long as she didn’t have any visitors at the time. Dads could see their babies through thick glass for an hour or two a day, but were not allowed anywhere near enough to ‘contaminate’ the child until 3 or 4 days later, when he got to take Mom and baby home.

It wasn’t much fun, and for some strange reason doctors and others directly involved in the process didn’t warn first time parents about this dehumanizing situation. Perhaps because if they had, more women would have gone looking for something better. Still, it was the normal cultural means of birthing, the country enjoyed steadily decreasing maternal and infant mortality statistics, and most people accepted the doctor-inspired diagnosis that pregnancy and childbirth are disease, to be treated as disease.

However, infant and maternal mortality rates have not declined since 1982, and dangers associated with caesarian sections mandated for the convenience of the physician and hospital-contracted infections threaten progress that has been made. The US still ranks 37th in the world in infant mortality, and maternal deaths among minority women are at the level of many third world countries.

Hospital births are also the most expensive option, effectively out of the question for the tens of millions of uninsured in this country who aren’t poor enough to qualify for Medicaid and not rich enough to pay out of pocket.

That said, the expectant couple should keep in mind that even if they make alternative choices – a birthing center with nurse-midwives in attendance or a home birth with a licensed lay midwife – it is always possible that they may end up at the hospital for their birthing experience. Complications in labor, delivery and post-delivery may arise, so good pre-natal care is essential to spot problems as early as possible.

Still, many hospitals these days do accommodate couples’ choices as much as possible. Birthing wings are often kept quite separate from areas of hospitals where the danger of transmitted infections is minimal. Some offer ample “birthing suites” where couples and their families can manage their own labors and delivery with the ready help of on-staff nurse-midwives. If something does go wrong, there’s no need for a frantic trip to the hospital, as doctors are in-house and the OR is right down the hall. For many first-time parents this can take a load of worry off their minds.

No matter what choices are made for birthing, the expectant couple should definitely be as educated as possible about all aspects of pregnancy and childbirth. I’ve been designated birthing partner for my sister, my elder daughter and two friends in the last couple of decades, and the best recommendation I could give to any expectant couple is to join a local Bradley Class. Honestly, by the time you’re done with the 12 week course, you’ll know enough to deliver that baby yourselves if you have to (or just want to), and you’ll feel very empowered by the knowledge.

Sunshine’s Mom (my daughter) is already enrolled, she and her husband began classes this week. While I do plan to be there when the baby is born, I’m practicing up on staying out of the way. That way I’ll be there if needed, can fill in if Daddy needs a break for awhile, and can remind Mom that she’s Queen of the Universe when she’s feeling most exhausted and frightened.

Next we’ll take a look at some of those birthing centers, and some of the more ’spiritual’ methods of birthing that have become increasingly popular in the last decade or so. We’ve months and months to go, so there’s plenty of time!

Links:

Natural Childbirth the Bradley Way

Midwifery Today: Is Hospital Birth Better>

WebMD Childbirth Options: What’s Best?

American College of Domiciliary Midwives: Analysis