Important Considerations for Expecting Parents

May/June 2011

Christian parents want the best for their children. When they are expecting a baby, they are full of anticipation, and they pick out just the right name, shop for the layette, paint the nursery, and even begin a savings fund for the child.

But many women today do not plan for the birth process of their child, leaving that to the "experts." There is a trend in this country, in this current generation, not to feel the need to prepare, learn, study, and seek out options for a good birth for the child and mother. But there is no part of a child's life that is not under the loving hand of God; He has planned out the life of this child from the very beginning. Jeremiah 1:5 declares, "Before I formed you in the womb I knew you, and before you were born I consecrated you" (NASB). Psalm 139:13 concurs, "For You formed my inward parts; You wove me in my mother's womb" (NASB). Shouldn't parents take as much care in planning for the birth as they do for the child's future education?

Hollywood and popular television programming portray birth as a very fast and extremely painful process with women screaming in anguish. The truth about the quality and nature of pain in childbirth is much less dramatic and probably wouldn't sell as many sensational programs. If most of what a woman believes about childbirth comes from these sources, she will be convinced that the only way to survive childbirth is to have as much pain medication as is "safe" and hope for the best. Women have believed that lie for generations with disastrous results in terms of the health and well-being of their babies and their own bodies.

Many women do not know the details of the history of childbirth in this country. Perhaps if they did, they would make better choices as to how their babies and their bodies are cared for during childbirth.

Until the early part of the twentieth century, most births in the United States, as elsewhere around the world, occurred at home just as they had since Eve gave birth to her first child. Women in labor and during birth were attended by female relatives and often a midwife, which means "with woman." Today, a midwife is a health care professional educated and trained to provide prenatal, labor, delivery, and postpartum care for a healthy woman who is having a baby. Midwives are fully equipped to handle most common birth emergencies and know when they need to refer to a surgeon. For most women, pregnancy is not a disease, and childbirth is not a dangerous journey. A woman's body is designed by its Creator to work very well during the development of the baby in her womb and during childbirth, which is a normal physiological process.

Similarly, breastfeeding is a relatively new word in our culture. A few generations ago, a baby would simply be fed immediately after birth as part of its usual care, and only the absence or extreme illness of the mother would require artificial feedings. Yet today both a woman's body and her God-designed means of feeding her baby are considered defective and require a specialist's intervention for a safe passage. It wasn't always that way.

Before the early decades of the last century, most women wouldn't even think about having their babies with a physician, much less in a hospital. Hospitals were considered a place to go if there was no other hope, a place to die.

For royalty, childbirth was another matter. These women were attended by their own private physicians. Queen Victoria used chloroform for pain relief during the birth of her third and subsequent babies. This became a symbol of status, and more women began to demand medications for pain during labor and delivery, requiring the move from home to hospital and the need to be under a physician's care. Gradually, it became a sign of prestige and wealth to be accompanied by a physician for childbirth. During this time physicians worked to discredit and eventually disenfranchise midwives.¹ Even today the public is largely unaware that the claims made against midwives are largely untrue.

Deaths related to pregnancy and childbirth dropped drastically in the United States from the late 1930s to the mid 1980s.² This change has been heralded as a triumph of medical science as the move was made from the home to the hospital. However, tremendous strides in the standard of living, such as improved sanitation, better housing and working conditions, improved diet, and more widespread health education are more likely causes of these improvements.³ This was happening all over the industrialized world.

Even so, rates for disease and death during childbirth, both for mother and baby, were higher in the United States than for many other industrialized countries. According to a study in the 1920s, more mothers and babies died in hospitals than at home with births attended by midwives. A closer examination of the statistics reveals that a larger percentage of those who died were upper class and wealthier women as opposed to the poorer women. The women who could afford to be attended by physicians also suffered more medically unnecessary interference with the normal labor and delivery process.

In fact, a national study published in 1932 concludes:

That untrained midwives approach and trained midwives surpass the record of physicians in normal deliveries has been ascribed to several factors. Chief among these is the fact that the circumstances of modern practice induce many physicians to employ procedures which are calculated to hasten delivery, but which sometimes result harmfully to mother and child. On her part, the midwife is not permitted to and does not employ such procedures. She waits patiently and lets nature take its course.⁴

Obstetricians are surgeons who are trained in pathology and trained to care for the abnormal in pregnancy and childbirth. These physicians in the early part of the twentieth century felt that labor was a dangerous passage and required specialized care. They often used medical procedures and instruments to speed up labor and delivery. Many times these caused harm to the mother or the baby, and a large percentage of infant deaths during this time were a result of birth injuries.⁵

A colorful example of this dichotomy is the story of Mary Breckinridge and her Frontier Nursing Service in the Appalachians in Kentucky. During the 1920s and 1930s this mountainous area of the United States was one of the most impoverished in the country. Many areas were accessible only by horseback. Mrs. Breckinridge trained nurse midwives to provide basic prenatal care and nursing services to poor women who otherwise would have no care during childbirth. Her remarkable improvements in the health and well-being of mothers and infants in this poor, rural area surpassed those in hospitals in the nearby cities and across the entire United States, achieving about ten times lower rates of maternal death related to childbirth.6

Just before World War II, there was a significant drop in the rates of death and illness of mothers and babies with the introduction of the class of antibiotics called sulfonamides, which prevented deaths from puerperal fever.7 (Back in the 1840s physicians had a much higher rate of patients with this deadly infection, commonly called "childbed fever," than did midwives, even under the same hospital roof: midwives washed their hands before examining a woman in labor and performed fewer vaginal exams overall.) Later, with the introduction of penicillin and better obstetric care, the rates of death and disease for mothers and babies dropped even further.

During the 1940s and 1950s women demanded the ability to receive a medication called "Twilight Sleep," a combination of morphine and scopolamine that dulled pain and left the woman with no memory of the childbirth. Women labored alone, without husband or other women for support, and were often tied to the bed so they wouldn't jump out and break their teeth on the edge of the metal bed under the hallucinogenic effects of the drugs. Some of this medication crossed the placental barrier to affect the baby, leaving it sleepy and with breathing and feeding difficulties. Babies were taken to separate nurseries to be fed scientifically developed formula and cared for by nurses until their mothers were free of the drugs and healed enough to care for themselves, often several days or even weeks after birth.

An article appeared in the 1958 Ladies' Home Journal entitled "Cruelty in Maternity Wards," describing inhumane treatment of women while medicated in labor.8 During this time there was a public outcry and reforms were instituted. Today, well into the twenty-first century, concerns are still being raised about the treatment of women and infants during labor and delivery and the use of medications to eliminate pain in childbirth.⁹

The American Society for Psychoprophylaxis in Obstetrics (ASPO) was formed in 1960, whose goal was to educate women to be better prepared for better birth outcomes and healthier babies. Later this organization became Lamaze International.¹⁰

Also in the 1960s, electronic fetal monitoring was introduced, and it is commonly used today. Yet fifty years later there are no quality studies that show the effectiveness of its routine use.¹¹ Add to that the frequent use of epidural anesthesia, the frequent augmentation or induction of labor with an artificial oxytocin (Pitocin), and 33 percent cesarean-section rates climbing to nearly one in every two childbirths in some hospital settings, and birth in this country has become anything but "normal."

We are told that these are best care practices, yet with some of the most expensive medical care in the world, the United States has worse pregnancy outcomes than most of her industrialized neighbors, coming in at a ranking of forty-first in maternal deaths, according to the World Health Organization.¹² California recently reported an increase in maternal deaths that may partially be due to the increase in elective C-sections performed there.¹³

In countries where birth is treated as a normal, natural process, and where it is attended mostly by midwives, birth is safer with less risk of death or damage to mother and baby. That is much of the rest of the industrialized world. Yet America, as a formerly Christian nation that has been blessed with tremendous medical and technological advances in the past few decades, treats pregnant women and their children as if the marvelous creation of the woman's body is defective and needs highly specialized interventions and interference to function.

Christian parents must wake up and recognize that without arming themselves with the truth about the process of childbirth, and by submitting to these interferences ignorantly, they are exposing both baby and mother to potentially life-threatening dangers. When choosing a birthplace for their child and a professional to attend the birth, couples should ask questions about the risks and benefits to the mother and baby for every intervention and option. The birth of the child, as well as the child's later care and education, belong firmly in the control of the parents.

1. American Association for Study and Prevention of Infant Mortality Transactions of the First Annual Meeting. Johns Hopkins University, Baltimore, November 9-11, 1910; Neal Devitt, "The Statistical Case for the Elimination of the Midwife: Fact versus Prejudice, 1890-1935," Women and Health, Vol. 4, 1 (1979): 81-96.
2. Donna L. Hoyert, Maternal Mortality and Related Concepts, National Center for Health Statistics. Vital Health Stat 3(33) (2007).
3. Irvine Loudon, "Maternal Mortality in the Past and Its Relevance to Developing Countries Today," American Journal of Clinical Nutrition (2000), 72, 241S-6S.
4. Louis S. Reed, The Costs of Medicine: Midwives, Chiropodists, and Optometrists (Chicago: University of Chicago Press, 1932).
5. American Association for Study and Prevention of Infant Mortality. First Annual Meeting, Baltimore, Maryland. November 9-11, 1910; W. Seeley, "The Effects of Interference in Obstetrical Cases." Read before the Child Hygiene Section of the American Public Health Association at the Fifty-Third Annual Meeting at Detroit, Michigan, October 21, 1924.
6. Loudon, "Maternal Mortality," 243S.
7. Ibid.
8. Gladys Denny Schultz, "Cruelty in Maternity Wards," Ladies' Home Journal, May 1958, 44-45, 152-155.
9. Henci Goer, "Cruelty in Maternity Wards: Fifty Years Later," The Journal of Perinatal Education, 19 (3), 33-42.
10. Judith Lothian and Charlotte DeVries, The Official Lamaze Guide: Giving Birth With Confidence, 2nd ed. (Minnetonka, MN: Meadowbrook Press, 2010), 16.
11. P. Steer, "Has Electronic Fetal Heart Rate Monitoring Made a Difference?" Seminars in Fetal & Neonatal Medicine, February 2008, 13(1): 2-7 (34 ref).
12. "Women and Health: Today's Evidence, Tomorrow's Agenda," World Health Organization, November 2009, http://whqlibdoc.who.int/publications/2009/9789241563857_eng.pdf
13. Nathanael Johnson, "It's Now More Dangerous to Give Birth in California Than It Is in Kuwait or Bosnia," California Watch, February 2, 2010, http://www.alternet.org/investigations/145524/df