DeLong 1 Shannon DeLong Professor Jane Blakelock Eng 2100 27 April 2014

Midwife or Hospital?

Our society is so uneducated on the choices they have in birthing and the benefits of doing so in their own home with a trained Midwife. These people do not know that they can have a child in the comfort of their home, and hold their baby as soon as its delivered, but our society is so set on these values or traditions that have been set for a little over fifty years. When women in our society plan (or dont plan) to have children, the first thing they do is call a doctor to confirm the pregnancy, do a dating ultrasound, and eventually talk about a birthing plan. When almost anyone thinks of childbirth they think of a hospital, viewing a baby through the glass wrapped tight in a blanket, and lots of doctors telling them what to do. Today in America, only 1% of births are done at home naturally versus one hundred years ago when almost every birth was performed in the home of the family. Hospitals have only recently become more popular to give childbirth since the 1970s and some of the things done in them, such as inducing labor, are very unnatural but go unquestioned because theyre a doctor so naturally we should trust them, right? As hospitals become more and more popular midwives are slowly starting to fade away but not completely, there are still many women out there who

DeLong 2 are practicing to be midwifes or doulas and highly encourage the entire process. The main reason people choose hospitals births over home births are because many women are not educated on the process of childbirth and think the only safe environment they can give birth in is at the hospital surrounded by doctors and nurses and lots of unneeded medication. The cost difference is substantial between a home birth and a hospital birth and most insurance companies will cover the cost of a home birth, and even if they do not it some doulas and midwives take donations only for births. Most people also dont know that Midwives are licensed health care providers and many of them go to school for nursing and are medically trained if things go awry during childbirth. Although many are not educated on the use of a midwife and home birthing, the actual process of it can be very beneficial to both mother and baby. What people worry about most is whether their insurance will cover certain things and the cost of childbirth. On average, in a hospital the cost of childbirth is 13,000$ (Epstein, 2007) while the average cost of a Midwife in home is around 4,000$ (Epstein, 2007). According to The American Association of Birth Centers the cost of having a child in the hospital done by cesarean instead of natural is almost 50% greater than the cost of having a child in a birthing centers or in their own homes (AABC, 2013). Women who do not medically need a Cesarean have an immediate bonding experience with their child after birth and also can recover up to 4 weeks earlier than women who opt for a C-Section. Many Midwives believe that Obstetricians are surgeons and are not trained in the natural birthing process (Epstein, 2007). Cesareans are more common in America than they ever have been with forty-six

DeLong 3 percent of births including a cesarean, these numbers have been rapidly increasing since 1996 and there are more than 1.4 million performed a year in the United States (Grady, 2010). Some are medically necessary while other cesareans are used as an excuse by the doctors to make their job easier if the actual labor is taking too long because when a mother is taking up a hospital room it is costing the hospital more money the longer she has to stay there. According to the New York Times, doctors have said that one in three women can give birth vaginally without have to go through major surgery to have a Cesarean (Grady, 2010). Less than six percent of Cesareans are actually medically necessary for the mother and child in which case a cord is wrapped around the child or both the mother and child go into distress, while the other forty percent are for convenience for the mother or the medical professionals (Grady, 2010). Studies show that cesareans can be riskier than giving birth vaginally because of the doctor cutting your abdomen and the risk for infection and bacteria getting inside of your body. The recovery from a C-section can take up to six weeks while a vaginal delivery your body can heal within one to two weeks post delivery (Narins, 2013). Even after recovery C-sections can pose threat for future pregnancies for the mother because they face a higher risk of placenta implantation problems, uterine rupture, bladder and bowel injuries, the need for future cesarean deliveries, and also the need for a hysterectomy (Narins, 2013). Some women choose on their own to do a caesarean that have family in town or just want their child born on a specific day, also some doctors have it as a convenience for them so they dont have to wait around for labor and delivery to happen (Narins, 2013).

DeLong 4 In a hospital, typically, immediately after birth the child is taken away from the mother to do certain procedures that they are required by the hospital to do like the antibiotic serum over the eyes, cleaning off the baby to make sure they are warm, and giving them a vitamin K shot to prevent blood clots (AAP, 2013). While some of these procedures help the baby, like the vitamin K, some are not necessary like cleaning off the baby because what is on them is called Vernix and its actually very helpful to moisturize their fragile skin and can keep them warm with just the Vernix on their skin. Nurses take away the baby to a nursery to give the mother rest after hours of labor, but in fact it can take away the immediate bonding that happens from skin to skin contact between mother and child which releases natural endorphins, prolactin, and oxytocin for both mother and child that can help with the post-partum process. However, if there is any hormonal or chemical inference, such as an epidural or pitocin, the skin to skin contact will not have the same natural affect. The oxytocin that is naturally released is released with the physical contact and increases nutrient absorption in mother and child and also can be released during the breastfeeding process. Prolactin is what promotes milk production in a mother, helps the mother relax during breastfeeding and promotes care-giving behaviors. Endorphins are secreted during many things including childbirth and breastfeeding. This hormone induces feelings of pleasure and euphoria in the mother and can actually reduce the perception of pain (Epstein, 2007). Midwives, unlike doctors, allow their patient to walk around or do whatever is necessary to make the mothers more comfortable to ease the pain of labor, whether it be in a birthing tub, their own personal bathtub inside of their home, or

DeLong 5 having a doula to massage their back to try and help ease the pain (Epstein, 2007). In the hospital, normally, if you are so far dilated they do not allow one to get up off the bed. This moving around actually helps decrease the time the mother is in labor and can ease contraction pains thus why home births do not take as long as a birth done inside a hospital. Also, the midwives are open to different positions in the labor process while in hospitals they require you to lay on your back simply for the convenience of the doctor, when in fact that is not the position a mother should be giving birth to her child because it can cause complications and distress the baby by depriving it of oxygen (Worsham, 2011). There are many different positions in which a mother can give birth and it still is very safe for both mother and child. Lying on our backs during childbirth and someone holding both of legs is one of the most unnatural positions and goes against natural instinct and even gravity (Worsham, 2011). Being on our backs in not the way nature intended us to deliver our babies but because we listen to these medical professionals we dont see it as an option to be in any other position. A woman lying on her back naturally delivering a child can cause contractions to worsen because the babys headputs pressure on pelvic nerves in the sacrum (Worshman, 2011). Also, if a woman is walking around or squatting she can dilate faster due to the pressure of the childs head on the mothers cervix (Worsham, 2011). While the hospital, typically does coached pushing laying on their back, since almost all patients receive an epidural and cannot feel contractions, Midwives will allow patients to be in whatever position deemed comfortable.

DeLong 6 Even though the United States is one of the most developed countries, we are twenty-ninth for infant mortality rate compared to the rest of the world (Fox, 2013). This can be caused from hemorrhaging from the mother laying on their back, the use of forceps during labor and harming the child, and unnecessary medicine and drugs given to mothers at the time of labor to try and ease their pain. According to NBC News, The three leading causes of infant death congenital malformations, low birth weight, and Sudden Infant Death Syndrome (SIDS) accounted for 46 percent of all infant deaths. In 2010, 35.2 percent of infant deaths were pretermrelated,(Fox, 2013). Also, many more infant deaths can be directly related to the mother having poor nutrition and diet throughout her pregnancy as well as those who did not receive prenatal care. I find it absolutely amazing that we are one of the top developed countries in the world yet we do not take care of ourselves and it factors in through our children and their health. There are several different types of pushing in the labor process, there is spontaneous pushing, exhale pushing, directed pushing and laboring down (Vanderlaan, 2013). During coached birthing or directed pushing, if a mother has had an epidural she needs to be coached because she cannot feel the natural urge to push and it can make labor harder on the mother and the baby if shes pushing when the baby is not ready. This type of pushing can also cause the mother to tear worse and increase fatigue in the mother, which lowers the oxygen levels to the baby. This can also cause stress in the baby, which can cause its heartbeat to rise or cause further complications (Vanderlaan, 2013). Spontaneous pushing is when a mother feels the natural urge to push on her own and this type of pushing is usually

DeLong 7 easier on mother and child and can decrease the risk of a bad tear. This type of pushing can also take much longer than the previous mentioned (Vanderlaan, 2013). Exhale pushing is used to decrease the strength of a push or release tension from the mother. This type of pushing is most definitely the slowest process because of the mother not holding the air in and trying to focus on exhaling during an urge to push (Vanderlaan, 2013). The final type is Laboring Down and it is the process of just letting the body push out the baby without the mother adding any kind of extra effort. The body will just naturally push the baby out itself and lower the child until it gets down to the pelvis in which she would start to actively push the child out (Vanderlaan, 2013). Birth is a very natural thing women have been doing for as long as history goes back and it wasnt until modern medicine stepped in that more complications started to happen. Giving birth in a hospital or anywhere besides the home was unheard of until about 1910 when birthing centers and clinics started to open up in the United States, the child birth process was always done in the home with an on call doctor or midwife (Rooks, 2014). Hospitals got normalized decades later because women and families thought it was the right thing to do for their child and also the healthiest, when in fact sometimes it is not always the best option. There poses no more of a risk having a child in a home versus having a child in a hospital because midwives are also trained in such areas as doctors and obstetricians are and are usually associated with a hospital incase there is a medical need for cesarean or any other dire complications. Just because as a society we think something is right or we must do it that way it is not always the case. There are so many debates on where a

DeLong 8 mother should give birth and how she should do it not including the countless opinions from family members and friends. Hospitals are so normalized in our society that people do not even dare to look at other options that they have. In hospitals, medical professionals do not see a lot of natural childbirths because so many women opt out for epidurals and Pitocin or even cesareans if they cannot handle the pain any longer. An epidural is an anesthetic that blocks pain in a regional part of the body; they also block nerve impulses in the lower spine (APA, 2007). Epidurals can go wrong very quickly and can paralyze a woman and some will not take at all. A mothers blood pressure can also suddenly drop while receiving an epidural and this can cause and inadequate amount of blood flow to the baby. Some women experience the terrible side effect of having an epidural which includes having leakage of spinal fluid, nausea, difficulty using the bathroom, and shivering (APA, 2007). A mother can also harm her child when receiving an epidural and can cause difficulties with breastfeeding and the child not latching on properly. Another common drug used in childbirth is Pitocin, which is a synthetic of the labor hormone Oxytocin and is used to induce labor in a woman or quicken labor in which a labor has slowed down (Ashton, 2013). New studies are now showing that women who are given Pitocin can cause harm to their fetus and the outcome after delivery. This drug can cause fetal distress because it quickens labor and contractions so there are no breaks between contractions and it gives the uterus no time to relax and recover. Not only are there fetal complications used with these drugs but also maternal complications that occur very often in both mother and infant (Ashton, 2013). These medical interventions can cause post partum depression in mothers

DeLong 9 among all other problems. The FDA deems all of these countless drugs that are offered to mothers during labor safe but they also come with many side effects that many women are not warned about whether they be short term or long term. In conclusion, women who are pregnant or even if they are not pregnant should do their research on birthing and all of the different options that they have. Women have the right to choose everything from who delivers their baby to how they deliver their baby but most do not know that different options exist. There are so many different ways to give birth and so many details that go into a labor that one can simply not do research because there is no way one person knows every single fact and detail about a birth. If women do not do their research they are letting other people make their decisions for them in one of the most important days of their lives when bringing a child into this world. There are always things that can go wrong but there are also so many good things that come out of choosing a midwife and a natural pregnancy that I dont see how there could even be another option. Women of all ages should be educated on natural births and midwives and know that one does not have to choose a hospital because it is mainstream.

DeLong 10 Works Cited American Association of Birth Centers, . "Birth Centers Improve Outcomes." AABC. N.p., 31 01 2013. Web. <http://www.birthcenters.org/content/new-study-showsmidwife-led-birth-centers-improve-outcomes-and-lower-health-care-costs>. American Academy of Pediatrics. Delivery Room Procedures Following a Normal Vaginal Birth Healthy Children. N.p., 11 05 2013. Web. < http://www.healthychildren.org/English/ages-stages/prenatal/deliverybeyond/pages/Delivery-Room-Procedures-Following-a-Normal-VaginalBirth.aspx>. American Pregnancy Association , . "Home Birth." APA. N.p., n.d. Web. <http://americanpregnancy.org/labornbirth/homebirth.html>. Ashton, Jennifer. Study Raises Concern That Pitocin May Harm Babies. ABC News. N.p., 10 05 2013. Web. < http://abcnews.go.com/Health/study-pitocin-harmbabies/story?id=19148043>. Dancy, Rahima. "Advantages of Home Birth." Home birth Midwives of New York. N.p., n.d. Web. <http://nyhomebirth.com/advantages-of-homebirth/>. Epstein, Abby. (2007). Business of being born [DVD]. Fox, Maggie. US Infant Mortality Rate Drops Only a Little. NBC News. N.p., 18 12 2013. Web. < http://www.nbcnews.com/health/kids-health/us-infant-mortalityrate-drops-only-little-f2D11763970>. Grady, Denise. Cesarean Births Are at a High in U.S New York Times. N.p., 23 03 2010 Web. < http://www.nytimes.com/2010/03/24/health/24birth.html?_r=1&>. Kluger, Jeffrey. "Doctors Vs Midwives." Time: Health and Family. 16 05 2009: n. page.

DeLong 11 Print. <http://content.time.com/time/health/article/0,8599,1898316,00.html>. Mayo Clinic Staff, . "Home Birth." Mayo Clinic. N.p., n.d. Web. <http://www.mayoclinic.org/home-birth/art-20046878>. McMath, Judie. "Pros and Cons of Hospital Birth." Center of Unhindered Living. N.p., n.d. Web. <http://www.unhinderedliving.com/hospital.html>. Narins, Elizabeth. What You Dont Know About C-Sections. Womens Health Magazine. N.p., 23 07 2013. Web. < http://www.womenshealthmag.com/health/what-you-dont-know-about-csections>. Rooks, Judith. Pregnancy & Birth. Our Body Ourselves. N.p., 01 2014. Web. < http://www.ourbodiesourselves.org/book/companion.asp?id=21&compID=75>. Worshman, Sasha. "Babies should not be born to mothers on their backs." The Stir. N.p., 21 11 2011. Web. <http://thestir.cafemom.com/pregnancy/127644/babies_should_not_be_born>. Unknown, . "Essential facts about midwives." American College of Nurse Midwives. N.p., n.d. Web. <http://www.midwife.org/Essential-Facts-about-Midwives>. Vanderlaan, Jennifer. Birth Plans. Birthing Naturally. N.p., 2013. Web. < http://www.birthingnaturally.net/birthplan/options/push.html>.