Cover Story	Getting Off Our Backs by Lindsay Berman

Midwife Eileen Stewart

How women are reclaiming birth, one midwife at a time

Eileen is not coming to your house with a bottle of gin,” says Eileen Stewart.

The director of Buffalo Midwifery Services and a certified nurse midwife, Stewart is one of many midwives across the country trying to demystify the public’s image of midwifery, including the notion that it is an old-world holdout whose method of choice is liquor. Stewart says her mission is to help women understand their birthing options, their bodies, and their rights.

This focus on the re-empowerment of birthing mothers and the firm belief in the mental and physical control women can have over birth breeds contention between the traditional medical community and midwives, naturalists, and women seeking alternatives to medicalized birth.

“I don’t deliver babies, I attend birth,” Stewart says. From her non-interventionist perspective, women birth and babies are born. For her, the role of the birth attendant is solely to observe, support, and provide medical intervention when absolutely necessary.

Historically, labor has been handled at home by pregnant women and their birth attendants. But in the US over the past two centuries, the medical community has claimed birth as its own. It is now treated from a pathological perspective: Women have been forced into hospitals, put on their backs, over-medicated, and submitted to major surgery in the name of good medicine.

The documentary The Business of Being Born explores the roots of this shift and the consequences for women and their babies. In interviews, OB/GYNs, midwives, and academics trace the monopoly doctors hold on birth to the early 1900s, when the medical community launched a collective smear campaign against midwives. Doctors in the growing field of obstetrics needed jobs and won the competition for clients by capitalizing on the public’s trust in doctors and mothers’ fear. Flyers portrayed midwives as illiterate, filthy, and drunk immigrants standing in the way of scientific progress. The medical community convinced the nation that hospitals equipped with obstetricians and the latest technology were the only safe environments in which to give birth, at a time when statistics proved the opposite. Doctors were experimenting with torturous and often lethal procedures, such as tying women down to beds or using straitjackets and administering untested medications that produced horrendous birth defects.

The campaign worked and the stereotypes it created continue today. Women’s trust in midwives was broken, and many women are convinced that they need doctors to birth. In 1900, 95 percent of births in the US took place in the home. Today, it is under than one percent. In less than a century, birthing changed from highly decentralized homebirths to a billion-dollar industry, a radical trend that has gone largely unquestioned.

This medical model, a unique phenomenon amongst industrialized nations, has not made birthing safer. The US has the second-worst newborn death rate and one of the highest maternal mortality rates in the developed world.

Rachel Zeller and daughters

While Americans are content to stereotype and mistrust midwives, as well as to valorize medical intervention in childbirth, figures reveal that something has gone horribly wrong with our treatment of pregnant women. The 2007 Mothers’ Index, based on global measurements of maternal and infant mortality rates, life expectancy, access to healthcare, and many other determinants of wellness, ranked the US 26th. Other countries are achieving substantially better birthing outcomes by employing basic models of care, common antibiotics, and midwives—while Americans spend about twice as much per capita on medical expenditures.

In an interview for The Business of Being Born, Dr. Marsden Wagner, former director of the Women’s and Children’s Health division of the World Health Organization, argued against the country’s insistence on shunning midwives. “Go to all the highly developed countries where they are losing fewer women and fewer babies around the time of birth and what do you see? You see midwives attending 70 to 80 percent of the births…That is the proven system around the world, and the US stands alone.”

Today in the US, midwives attend fewer than eight percent of births. When a woman goes into labor in a traditional hospital environment in America, she will likely encounter some part of what has been termed the “intervention domino effect,” a process caused by excessive drug and surgical intervention. Many women, and surprisingly many doctors, have never seen a full natural birth or spoken to someone who has.

The most extreme form of the intervention cycle looks something like this: A woman enters the hospital. She is given an epidural. She then needs a drug to induce dilating, typically Pitocin, because her body is not moving along fast enough (that is, on the hospital’s fast-paced schedule), even though this slow dilating is partially due to the epidural. The Pitocin brings on stronger, longer, and closer together contractions, drastically increasing the pain of labor and risk of tearing. This is usually that part in movies when a woman is on her back, legs in the air, screaming for more drugs. So, she needs more pain meds to keep her calm and then more drugs to keep dilating on the hospital’s schedule. But, as in far too many cases where a caesarean was not originally an absolute medical necessity, the drugs compromise the oxygen flow to the baby, it goes into distress, and an emergency C-section is performed.

“There is so much out there that is routine that does not need to be,” says Rachel Zeller of BuffaloBirth, a local educational and advocacy organization. “I encourage women to ask questions and find the path that’s right for them.”

Zeller says that the demand for change must come from patients. Otherwise the medical community has “no incentive to change.”

Without this demand, rates of procedures like caesarians are likely to continue to grow. In 2005, one in three births in the US involved a C-section and locally it’s even higher. The American public may not see a problem with such high rates, but the World Health Organization does. It advises that the rate of C-sections ought to be between 10-15 percent. “The risk of maternal death in caesarean deliveries is four times higher than the risk of death in a vaginal delivery,” Zeller says. “But most women don’t know that, and most doctors aren’t sharing that bit of information.”

C-sections are also credited with a recent increase in premature births.

Caesareans are doctor friendly. The procedure lasts around 20 minutes, while the average labor time is around 12 hours, and the risk of a potential lawsuit is substantially less. Reliance on C-sections is made possible because culturally the practice has come to be viewed more like a routine trip to the doctor, a quick and nearly painless in and out, than major abdominal surgery with serious risks of complication.

Another symptom that the medical community has gone too far in its control of women’s labor is the position into which women are forced when in labor. A woman on her back, while convenient for the doctor, is in possibly the least helpful and most painful position for laboring. Once on her back, a woman’s pelvis becomes smaller and she must struggle against the forces of gravity, making it more difficult to handle the pain of contractions, to push, and for the baby to move down into the birth canal.

“Almost no one lays down during birth willingly,” Stewart says. “The bed situation is for the doctor.” She believes that for the vast majority of women, a natural birth without vaginal tearing or other internal injuries is possible. But women need to at times be vertical, to move around, and to “intuitively figure out what works” for them. “The body is created to do this,” she says.

Many women believe that there are no other options for birthing and that what has become the norm in childbirth is their best and only option for their own health and the life of their child.

And women who oppose this dogmatic system are often chastised. Zeller cited a few alarming cases of women’s fights to carry out their natural birth plans at local hospitals: “They had to fight well-meaning family and friends who thought they were crazy and should just do what the doctor says…providers who thought that ‘natural’ just meant ‘vaginal’ and were surprised when their patient also meant that they did not want their water broken or did not want to be continuously monitored…nursing staff who rolled their eyes at their birth plans and pressure to perform in a particular timeframe before an intervention would be introduced. Some have even fought hospital administration and have been threatened with lawyers and asked to sign potentially incriminating consent forms.”

Yet even in these difficult cases, the hospital staff eventually backed off. “All women have choices,” Zeller says. “They can refuse anything that they’re being asked to consent to. They need to take it upon themselves to really understand what the ramifications are of what procedures they allow.”

Locally, there has been a significant increase in women’s birthing choices. The use of midwives for pre- and post-natal care and for the birth itself, either in the home or a hospital setting, is growing in popularity and acceptance. There are also plans for the opening of a local birthing center, Emerald Waters, which advocates that low-risk pregnancy and births be moved out of the hospital and into a home-like, familiar environment with personalized care. In November, organizers will host the Mother Baby International Film Festival. For the birthing center to be available to the community, legal and monetary barriers must be overcome as well as an increase in local support and awareness.

As Stewart like to say, “If you don’t know your options, you don’t have any.”

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