You can read today’s post before or after you watch this amazing and very funny “R-rated” educational video. Personally suggest watching first.
Just scroll down a few inches to watch the 7-minute Italian video “The Performance“, or you can go to YouTube.
Be sure to keep watching until the very end — the “kicker” comes at 6 min: 29 sec.
The $64,000 question: What if the intense medicalization of normal childbirth currently used in most developed countries was bumped up to the next obvious level: medical control of conceptual sex, based on the notion that hospital-based management of intercourse by doctors and nurses was the safer, better and more satisfactory way for women to get pregnant?
With 4 millions births in the US each year, the financial rewards of this new market would be compelling. For the last century the provision of maternity services has been the leading reason for hospitalization in the United States. 1 Currently there are 8 million annual hospitalizations for childbirth, which includes four million laboring women/new mothers and admission of their 4 million new babies.
As a new area of reproductive services, the medical management of normal intercourse would easily double the pregnancy-related hospitalizations each year to 12-16 million, assuming at least 1 or 2 ‘tries’ for each pregnancy so conceived. Like childbirth, this would also be very profitable, since it is the biological parents who ultimately do all the heavy lifting, and actually ‘deliver the goods’ (in-vitro fertilization and Cesarean surgery excepted).
What if future “fathers-to-be” became the focus of the same costly, impersonal, malpractice-ridden, biologically-disruptive ‘micro-managing’ of sexual procreation that is already the case for laboring women?
How about the “politically-correct” vocabulary by hospital personnel that goes along with this intensely medicalized care? After the idea of ‘natural childbirth’ became popular, obstetricians and L&D nurses developed a sympathetic and reassuring patter about how they (or their hospitals) respected and enthusiastically ‘supported’ natural birth, and just loved to see women have a “natural” birth.
But the slip betwixt that “cup and lip” is that institutional policies and protocols don’t, in any practical or effective way, support the normal biology of spontaneous labor and birth — no more than the methods used on the male partner in “The Performance” were effective (or even relevant) to their stated goal.
When healthy women who had given birth in the previous year** were surveyed about the care they received during a labor and birth, 99% reported the use of one or more medical interventions, such IVs and being kept in bed while hooked up to a continuous EFM. An astonishing 93% of hospitalized maternity patients had an average of seven substantial medical and surgical interventions.
** Listening to Mothers Surveys @ Childbirthconnection.com
Over the last hundred years, the routine medicalization of biological childbirth has become the legal standard in the US and many other industrialized countries. While the multiple ‘interruptions’ this entails were meant to be helpful, the practical effect of these policies and protocols are experienced by laboring women as a perpetual stream of interruptions, time- and performance-pressures, repeated administration of drugs, continuous electronic fetal monitoring, other medical interventions and far too often, the ultimate obstetrical procedure — surgical delivery by Cesarean section (current rate in the US is 33%).
How could we be surprised that this intensely interruptive process gets in the way at each and every step in the biological process of normal childbirth?
Whether applied to the fanciful notion of medically-controlled conception, or the very real interventions used routinely during normal childbirth, the result is to artificially-create “needs” that require more medical interventions to be used on previously normal and healthy individuals. Sometimes this leads to a real emergency that needlessly exposes them to the increased dangers and expense of invasive procedures and surgery.
“The Performance ~ Sex like Birth” video exposes the specific nature — the core issue — of these historically wrong assumptions, which systematically ignores the hormonally-driven biology of normal sexual reproduction. Whether the issue is conception, labor, birth or breastfeeding, all of these normal biological events require a highly orchestrated interplay of biology and hormones that requires a dependable level of personal privacy for optimal functioning.
Every childbearing woman and/or newborn baby pays a heavy personal price when the institutional system that claims to provide a substantially safer and better care is systematically erecting stumbling blocks instead of stepping stones to provide support for the normal biological process of childbirth.
To avoid interrupting or otherwise disturbing this biological process, the mother-to-be has a biological need for psychological privacy whenever possible. This requires a protected environment with reasonable freedom from uninvited strangers and repeated interruptions. It also requires that all birth attendants understand the principles of physiologic childbirth and embrace their role as guardians of this process. If deprived of this support, the rate of interventions and associated medical complications goes way up for both mother and baby.
After watching this 7-minute video, you’ll never again be fooled into thinking that our current obstetrical standard — the routine medicalization of normal labor and birth in healthy women– is the ‘best care that money can buy’, or even a reasonable 2nd-level choice.
What we are doing not is obviously not working. It is a problematic system that needs to be corrected as quickly as possible.
Everyone who watches this video can help just by re-posting the link or emailing it to as many individuals, groups and websites as possible.
Be sure to watch all the way to the end, as the “kicker” comes at 6 mins & 29 seconds!
What a cost-effective, “mother-baby-father-friendly” maternity care system would look like:
This remarkable video allows almost anyone to immediately understand the biological imperatives for normal childbirth, while simultaneously exposing important reasons why our current system does not, and in its current configuration, cannot meet the needs of healthy childbearing women.
When it comes to maternity services for a healthy population, routine medicalization simply does NOT work. Over the last 100 years, the number, frequency and invasiveness of medical interventions used routinely during normal childbirth has steadily increased without any associated benefit to healthy women with normal pregnancies.
As a matter of our national healthcare policy, the principles of physiological management for normal birth should be integrated with the best advances in obstetrical medicine to create a single, evidence-based standard of maternity care for all healthy women with normal pregnancies.
The individual management of a healthy woman’s pregnancy and birth should be determined by the health status of mother and unborn baby, in conjunction with the mother-to-be’s stated preferences, rather than the occupational status of the care provider (obstetrician, other physician, or midwife).
In practical and political terms, the cultural controversy over childbirth practices should never pit physicians and midwives against each other, nor pit obstetricians against family practice physicians.
Equally important, no healthy childbearing woman should ever be forced to choose between the care of an obstetrician or that of a midwife, or choose between a hospital or a home/freestanding birth center in order to have a physiologically-supported normal childbirth.
Whenever physiological support for normal labor is not available due to institutional policies, lack of training, or a physician’s personal preference for the medical model, or the physiological process is disturbed for whatever reason, the mother’s risk of developing a complication for herself or her unborn baby increases significantly.
Physiologic or ‘normal care for normal childbirth’ is a decidedly pro-active process. Physiological management is not merely a matter of refraining from the use of medical interventions or surgical procedures, that is, not giving IVs, not inducing labor, or not speeding up labor with Pitocin.
Effective use of physiological management begins by acquiring a through knowledge of normal biology, physiology, psychology and sociology/sexuality of childbearing. This educational process helps develop an informed attitude of trust that might best be described as “trust but verify”.
This relaxed but well-informed perspective leads to behaviors and actions such as ‘patience with nature’, respecting the mother’s psychological need for privacy, and making ‘right use of gravity’. These attributes all promote the biology and physiology of normal childbearing and help maintain the normal progression of labor.
Physiologic care includes the physical presence of the primary birth attendant during all active stages of labor and birth. The supportive process involves helpful suggestions, verbal encouragement, hands-on comfort measures, and recommending non-drug pain relief. Taken together, this pro-active care enhances the laboring woman’s natural ability to tolerate a normal labor, thus reducing the likelihood that drugs will be needed to speed up labor or invasive procedures become necessary to deliver the baby. (link to Science Principles of Physiological Care)
Mastery in normal childbirth services for healthy women with normal pregnancies means bringing about a good outcome without introducing any unnecessary harm or unproductive expense. This metric must factor in the full spectrum of morbidity (complications) and mortality over a woman’s reproductive life span, including all delayed and downstream problems, complications in subsequent pregnancies.
The ideal maternity care system seeks out the point of balance where the skillful support of the normal biology of pregnancy and childbirth, and adroit use of medical interventions when necessary, provides the best outcome with the fewest number of medical/surgical procedures and least expense to the health care system.
Ultimately, the care provided during pregnancy and normal childbirth is judged by its results — the number of mothers and babies who graduate from its ministration as healthy, or healthier, than when they started.
There is no reason why we cannot develop an evidenced-based “best practices” model for normal maternity care that is mutually acceptable to caregivers and patients alike, as well as being an economically self-supporting part of the mainstream health care system.
A physiologically-supportive model would includes policy changes that benefit all stakeholders, such as eliminating interventions long ago proven to be harmful and/or ineffective, and including the universal use of simple clinical practices known to improve outcomes, that are mother-baby-father friendly and also reduce the overall cost of health care.
NEEDED: a new non-surgical billing code & new legal definition of Physiologic care for healthy women as an appropriate and evidence-based standard
Reforms of our maternity care system would require integrating the principles of physiological management with the best advances in obstetrical medicine, which would automatically create a new and universal standard of care for healthy women with normal pregnancies.
In order for this new standard to become functional, a new, non-surgical billing code must be developed for the physiologic management of labor & birth. This is needed so physicians and midwives providing care in a hospital setting can be fairly reimbursed for the additional time required to provide physiologically-based care.
In addition, a new medical-legal definition of “informed consent” for childbearing couples relative to physiological management as the standard of care. This also entails a formal or legal acknowledgment of the changed role of professional birth attendants when providing physiologically-based care and bears on the legal issue of professional competency. This new medical-legal arrangement must identify and acknowledge non-medical, non-surgical physiologically-based supportive care as the ‘customary’ and appropriate (i.e. professionally competent) for healthy women who have not specifically requested for to be medically managed.
This is necessary so board-certified obstetricians who provide physiologic childbirth services cannot be inappropriately defined as negligent for having ‘failed’ to preemptively medicalized a healthy laboring woman. This would protect physicians, in particular obstetricians, from claims by hospital boards and the courts of having provided a “sub-standard” form of obstetrical care to a healthy maternity patient who asked for and consented to physiologically-based care during the intrapartum period of hospitalization.
