Maternity Care Advocacy: A Questionable Agenda?
The following is an excerpt from the article, Saving babies: why c-section is not a dirty word, which appeared in Redbook on October 1, 1996.
A QUESTIONABLE AGENDA
No one would argue that natural childbirth advocates intentionally mislead pregnant women by sidestepping the subject of cesareans. In fact, the patient who goes the nurse-midwife route often does so because she already wants to lower the odds of having a cesarean. “We try to give women strategies that will distract them from the pains of labor and counsel them not to request an epidural either too early or in too high a dose - both of which can increase the likelihood of a having a cesarean,” says Deanne Williams, director of professional services for the American College of Nurse Midwives in Washington, D.C. “When a woman is anxious and uncomfortable in labor, she naturally seeks the hospital as a haven, a safe place to be. So early on, we suggest showers, tub baths, walking around the block, back rubs-anything that will distract her from the discomfort fort and keep her home as long as possible so technology is kept away from the natural process of giving birth.”
Laurie Grant, M.D., an obstetrician-gynecologist at Hudson Valley Hospital Medical Center in Peekskill, New York, who uses some of these techniques in her own practice, agrees that they can make labor more comfortable; a woman who walks around during labor, for instance, uses gravity as her ally in bringing the baby down, increases the strength and quality of her contractions, and ultimately hastens labor along. But they won’t stave off a cesarean. “If you’re going to have a C-section, it’ll happen no matter what you do,” she says. Adds Dr. Cole, “C-sections are based on a baby’s or mother’s medical condition, not on the comfort of the mother.”
Certainly many nurse-midwives will call for a cesarean when a routine delivery becomes particularly rocky. What concerns doctors are those practitioners who are so vehemently committed to natural childbirth that they put off suggesting sections to laboring women who really need them. “I know of one woman who purposely had a lay midwife [not a certified nurse-midwife] attend her home birth, and when things started to go wrong they waited too long to come to the hospital,” says Dr. Grant. “They had to medivac the baby to a neonatal intensive care unit.”
Doctors also worry about the messages sages sent by some childbirth education groups, in particular the Bradley Method, that make women suspicious of medical intervention. The American Academy of Husband-.Coached Childbirth, as the Bradley Method is formally called, is a California-based childbirth education group with 1,000 instructors nationwide who endorse natural childbirth without drugs and eschew the routine use of medical intervention during birth. “We attract a different sort of woman than Lamaze instruction, a woman who prefers not to use drugs of any kind during childbirth and who looks for a heavy involvement from her husband as a coach,” says Bradley Method executive director Marjie Hathaway.
According to Hathaway, more than 30,000 women a year attend the Bradley Method’s twelve-week course, based on the teachings of retired Denver obstetrician Robert Bradley. “He started off being a Kansas farm boy, and when went to medical school he wondered why all these women were screaming and yelling during childbirth - he never saw the animals on the farm do that,” explains Hathaway.”So he started applying the same principles of relaxation an abdominal breathing and found out women could give birth naturally almost always, without drugs or intervention.
“We’re not against intervention if it’s done appropriately,” explains Hathaway “but too often it’s done without a medical reason, which can set a up for failure.”
Dr. Flamm argues that routine medical procedures can pick up minor problems before they become major ones. He recalls a woman schooled in the Bradley Method who arrived at the hospital to have her first baby and refused even the simplest medical procedures: “No fetal monitoring, no pelvic exams, nothing. When doctors finally persuaded her to let them listen with a stethoscope, the baby’s heartbeat was horrendous. But still she refused surgery, and the baby died.”
Dr. Grant concurs that her experience with some Bradley graduates is not good. “I have a patient right now who is taking Bradley who won’t let me do a sonogram because they showed her a video-tape in which a doctor said it could be harmful - and that’s never been proven.”
“The health of the baby and the mother are our primary concerns,” counters Hathaway. “But we also think a woman should do whatever she can to avoid major surgery during childbirth if there are questions about her really needing it.”