This morning as I was flipping channels while on the elliptical (AM TV leaves much to be desired!), I landed on two episodes of Discovery Health’s Birth Day. I generally avoid watching shows about birth as they so frequently offer only a highly medicalized, overly-dramatic portrayal of birth. But I’m glad I caught these episodes as they offered an interesting contrast in what birth can be like.
The first, I caught about halfway through – at this point, the mama-to-be was already pushing, flat on her back in bed, wearing an oxygen mask an assisted by a male OB and a team of nurses (the OB and one of the nurses were holding her legs back and instructing her on when to push). Since I didn’t see the first part, I don’t know what the mama’s history was or whether or not she had an epidural or anything else. In any case, she did deliver vaginally. The baby was blue and not breathing at first due to the cord being wrapped around his neck. As expected, a team of specialists was standing by; the cord was clamped, baby was rushed over to the other side of the room and given oxygen; mama was left questioning what was happening. As typically happens in these cases, baby just needed that little extra help, started breathing quickly on his own and all was well.
The second episode featured a second time mama delivering med-free in a birth center and attended by a midwife. The room she was in was homey, her family was around her (including her young daughter), and the environment seemed very relaxed. They made a point of showing her eating (the midwife pointed out the amount of energy needed for labor) and she was shown in a variety of laboring positions. When she felt like it was time to push, she got in the birthing tub to deliver and was told to push when she felt like it and rest when she didn’t. The midwife explained to the TV audience that since babies do not take their first breath until they hit air, a water birth is a very safe way to go (in other words, babies born in water can’t drown!). She also pointed out that many mamas find the warm water relaxing and that the buoyancy can ease the stress of labor.
As baby began to make her entrance, the midwife realized that instead of being in the posterior position (face down), baby was face up. Knowing that this would mean a slightly trickier delivery, she drained the tub and helped mama into a better position to deliver a face up baby. As in the previous episode, this baby was born blue and not breathing right away. Instead of whisking her away in a hushed panic as in the first episode, this baby was placed on mama’s chest. The midwife instructed mama to rub the baby’s back as she supplied oxygen to the baby. The cord was left un-clamped (as the midwife later explained, this allows the baby to continue to receive oxygen from the mother allowing for a quicker transition to self breathing than would happen with just an oxygen mask alone). Within moments, baby was pink and breathing normally.
A few things struck me about these two episodes beyond the very different settings in which these mamas labored and delivered. The difference in how the “blue” baby was treated was especially interesting. It’s certainly terrifying for any new mama to realize her baby isn’t breathing/crying at birth. And while it may be a relatively common occurrence, it’s not something any medical professional would take lightly. In the hospital birth, baby was immediately whisked away while mama was left calling out from the bed, frantically wondering what was happening. In the birth center birth, the midwife used mama’s help (both in terms of leaving the cord intact and using mama’s body heat and breathing to stabilize baby) while offering the same oxygen treatment the hospital-birth baby received. Both babies recovered quickly, but the birth center birth remained much calmer and utilized nature’s safeguards (the intact cord and mama as incubator) in tandem with medical technology.
I also appreciated that a birth center birth that had a “complication” was shown – both as a demonstration that even “normal” births sometimes have challenges and to show that midwives are trained medical professionals who have a heck of a lot of knowledge about birth – they do far more than just catch babies! As the midwife in this episode discussed, birth center based midwives carefully monitor patients for potential complications throughout pregnancy and during labor and delivery. If at any time it appears there may be a complication beyond what the birth center is equipped to handle, then mama is transferred to a hospital. I think there are a number of misconceptions about birth centers and midwives in general, so it was really nice to see such a positive portrayal of them and their competence as medical professionals.
One final thing that I found rather telling about the difference in the OB model of care and the midwifery model of care that came out in these episodes was the way in which each provider communicated – both with the laboring mama and with the audience (during cut-aways filmed after the birth). The midwife explained everything – why she was doing what she was doing, the importance of it, the different options, etc. The OB just stated things in a rather matter-of-fact way; “this is how it is.” Granted, these differences could just be the difference in personality in these two professionals, and there are always exceptions (as in mama-centered OBs and medicalized midwives). But, intentionally or not, they do mesh with the overall philosophies behind each model of care: Obstetrics tends to view everything through a lens of pathology (what’s wrong with this birth that we can fix) while midwifery focuses on what’s going on with mama and baby and centers care around those needs more closely.
There will certainly always be a place for obstetrics and a need for medical intervention in difficult births. It’s wonderful that technology allows so many babies to safely enter the world and so many mamas to survive childbirth who might not have 100 or even 50 years ago. But the truth is, the vast majority of births are “normal” – they don’t require fancy technology, just the sage guidance and supervision of a practiced professional. Women today have more choices in how they wish to give birth than ever before; it’s nice to see – even if only occasionally – a positive portrayal of a less medicalized birth.