It was 5 p.m. when Kelly Mochel’s water broke somewhere on New Zealand’s south island during a Southern Hemisphere spring. Whether it was the peace of the quiet late afternoon or, more likely, the months she had spent preparing for just this moment, she did not panic, nor did she grab her carefully packed overnight bag and waddle to the car to be rushed to the closest hospital. Until 3 a.m., she stayed home, waiting for her contractions to escalate before she made her way to the nearby birth center. Twelve hours later, her daughter was born, somewhat blue-ish in color, but healthy, vibrant and ready to keep her mother up most nights.
For months, Mochel, my childhood friend, had been sending me photos of her growing belly, set amidst the bucolic scenery where she and her husband, Robbie, had built their home. When she announced her intention to have her child in a birth center – a medical facility staffed by nurse-midwives and designed to provide a comfortable setting during childbirth – I was skeptical, but not surprised. Like other countries with socialized medicine, New Zealand’s midwife-attended birth centers are a first line of care for low-risk pregnant women; in the United States, however, that picture is quite different. Midwifery is a practice that has largely been disparaged over the last two centuries, favoring instead a medical-based approach to childbirth presided over by doctors and hospitals and evolving toward the goal of a pain-free experience that delivers perfect babies every time. Trouble is, it hasn’t exactly happened that way, and many women, like Mochel, who in the U.S. might have previously been considered a generation of fringe neo-hippies intent on debunking “modern” birth methods, are now at the forefront of a movement to take back the control and responsibility of childbirth.
The reasons are many, according to a March 2009 Journal of Midwifery and Women’s Health study on women’s motives for choosing alternative births. For most women questioned, the choice to give birth outside of a traditional hospital environment involved safety, along with the ability to have more control over the process. Many others cited a previous negative experience in a hospital or the desire to avoid unnecessary medical interventions that are common in hospital births. Mochel’s reasons were much the same.
“When I started investigating my options, I stumbled on active birth, which allows your body to respond to its urges and your birth as it progresses,” she says. “At most hospitals, you’re not allowed to do that; all of a sudden you’re held to a certain set of rules and time expectations.”
That’s not an inaccurate picture of the way that the modern Western world practices and views childbirth. America’s post-Colonial period involved changing beliefs regarding the capability of women in general and midwives in particular; as a result, childbirth, a previously natural – even social – rite became somewhat shameful, and the midwives who performed it were deemed outdated and primitive. At the same time, a move towards organized medicine was taking place, gradually popularizing physicians as providers of a higher standard of care, especially in the opinion of the upper class. The decline in midwifery also paralleled shifting social paradigms about a woman’s role in society, which became increasingly domestic in nature and encouraged women, once married, to remain exclusively in the home.
But the times, they are a-changin’. For many women like Mochel, who now lives in Southern California, the option to give birth naturally in a midwife-attended birth center in the United States is becoming more of a reality. Recent documentaries like Ricki Lake’s The Business of Being Born, which explores America’s current broken maternity care system, have brought attention to shocking statistics that support the conclusion that our country provides the world’s most expensive maternity care but has worse pregnancy outcomes than almost every other industrialized country. Pregnant in America, another recently released documentary, provides an even more scathing look at the dollars-and-cents-driven decisions behind every birth in the U.S. Whether because of this new wave of awareness surrounding childbirth options (or the lack thereof) or the growth in women’s demand for alternatives to the traditional hospital birth, American midwives and the few birth centers currently in operation are seeing a massive surge in interest in pursuing a natural birth experience.
For Lorri Walker, this is all good news. A self-described “childbirth junkie” who is the founder and director of Irvine-based South Coast Midwifery, Walker has been “catching” babies since 1985, after personal experience with her own children’s births led her to become interested in professionally pursuing alternative childbirth. As a registered nurse and certified nurse-midwife (CNM), Walker’s birth center is the only one in Orange County, and the third in California (one of 40 nationwide) to be accredited by The Commission for Accreditation of Birth Centers. But while the American College of Obstetricians and Gynecologists supports birth centers like South Coast Midwifery, Walker disagrees with the group’s stance that home births, a service utilized by more than half of her mothers, are unsafe.
“Labor and birth is a normal function; in most cases, your body knows how to do it,” she says. “But that being said, we do a lot of preparation.”
For many of today’s women, herein lies the sticking point. Midwifery is in the process of separating itself from the shackles of a reputation tarnished by centuries of misinformation and bad publicity (propagated by the “modern” medical community) implying that the practice is dangerous. Throughout the early 1900s, as the medical profession gained power and prestige, leading maternal care texts portrayed pregnancy as a “pathological” condition and sought to “protect” women from the evils of childbirth via sedation and control over the process through interventions. But by 1933, a report issued by the White House Conference on Child Health and Protection stated that maternal mortality had not declined between 1915 and 1930 despite “advanced” hospital deliveries, and the number of infant deaths from birth injuries actually increased from 40% to 50% from 1915 to 1929.
More current statistics, however, might be more troubling: Recent numbers from the Center for Disease Control and Prevention show that the United States has seen a dramatic increase in the infant mortality rate since 1960, and currently ranks below countries like Cuba, the Czech Republic and yes, New Zealand.
None of this is news to Walker. As a board member of the American Association of Birth Centers, she is acutely aware of the hurdles women must overcome, both psychologically and culturally, when it comes to making choices about childbirth.
“Particularly in this country in the last century, all we knew was what we saw on TV,” she says. “[People] grabbed their bags and ran to the hospital. We don’t know what happened when they got there; all we know is that you run and then you go to the hospital and then you come back with a baby.” The implications in that portrayal, she says, are twofold: “Either you went to the hospital and did it the ‘normal’ way or you imagined hippies living in a teepee burning incense and patting somebody’s hand.”
But nothing could be further than the truth. Study after study has found that CNM-attended births among low-risk women dramatically improve the infant mortality rate, number of low birth weight babies and neo-natal mortality rate in both hospitals and birth centers when compared to physicians caring for equally low-risk women. At birth centers like Walker’s, the staff is highly trained for every type of foreseeable complication, doing mock emergency scenarios monthly and preparing for each birth as if it were high-risk (though the center only accepts low-risk women).
Yet, in today’s maternal care environment, treating pregnancy as if it were always a high-risk, life-threatening event is part of the problem. Fear of malpractice litigation amongst physicians and hospitals has forced many medical institutions to administer unnecessary care during childbirth, and simple greed (providers earn more if they order unneeded procedures) has encouraged an overly interventionist approach.
One glaring example is the high rate of cesarean sections – a major surgery that has become the most common operating room procedure in the U.S. While life-saving in a small percentage of cases, these select circumstances do nothing to justify the fact that, in 2006, according to a January 2009 report released by Childbirth Connection, The Reforming States Group and the Milbank Memorial Foundation, 31.1% of all births resulted in a c-section (double the maximum rate recommended by the World Health Organization), up from 20.7% in 1996 and 5% in 1970. C-section rates for CNM-attended births hover around 9%-12%. The report concludes that this variation is a result of differences in the professional practice of childbirth and other, more sinister factors such as financial incentives that favor surgery. (On average, a childbirth at a birth center costs 50%-75% less than at a hospital for the same low-risk woman.)
And for women like Mochel, those numbers just didn’t fit into her idea of a birth plan, which included, among other things, a non-invasive birth process. “In doing my research, I was struck by the 30%-40% c-section rate,” she says. “We swallow that statistic so easily, but we should be up in arms about it.”
But the increased acceptance of c-sections is also part of our cultural conditioning, says Walker. “We’re used to somebody else fixing our body, being told things like, ‘Your baby is too big, you should just have surgery,’” she says. “That’s feeding the assumption that women are dysfunctional and that we can’t do it right without the help of technology.”
Certainly, changing perceptions of women are one factor behind the increasing interest in birth centers. Mochel’s research revealed a lost tradition in the positive childbirth experience in America – something that has gone unquestioned for too many generations, and something she hopes to have restored in a small way by choosing to trust in her body’s ability at a birth center. For Walker, too, childbirth is more than a physiological process; it has the potential to be a life-changing experience that can empower women and lead to an increased responsibility for our bodies and our children.
“If a woman is low-risk, I think she ought to have the option to do whatever she wants, whether it’s walk around or eat or sit in a tub of warm water or have her loved ones with her – to not feel afraid,” she says.
To that end, South Coast Midwifery offers a variety of services designed to allow the family the opportunity to “customize” their childbirth with options like aromatherapy, soothing music and hot tubs. “We’re kind of like the wedding coordinator for the birth experience,” says Walker, joking about the à la carte menu of birth options. One of her greatest pleasures, she says, is involving the father in the birth, sometimes allowing him to “catch” his own baby if things are progressing normally. “That’s one of my greatest thrills at this stage of my career: to see a father weeping as he lifts his baby. That is joy for me.”
At its most basic, the birth center movement is really just a renewal of what we’ve always known: that women are designed to give birth and, in most cases, are capable of doing it with minimal intervention. “We’ve fallen into distrust with our bodies,” says Mochel. “But it’s about moving forward and doing the right thing for mothers and babies. We can set this right.”
For more information about birth centers or home births, contact South Coast Midwifery, 4650 Barranca Pkwy., Irvine, (949) 654-2727; southcoastmidwifery.com
Childbirth by the Numbers
132,286
Number of Certified Nurse-Midwife (CNM)-attended births in the U.S. in 1989 (3.2% of all U.S. births)
317,168
Number of CNM-attended births in the U.S. in 2006 (7.4% of all U.S. births)
Source: American College of Nurse-Midwives
12
The U.S.’s rank among developed countries in the lowest number of infant mortality cases in 1960
29
The U.S.’s rank among developed countries in the lowest number of infant mortality cases in 2004
Source: The New York Times
314
Millions of dollars that would be saved annually if 100,000 births occurred in birth centers rather than in hospitals, based on current costs
7.4
Millions of dollars that would be saved annually for every 1,000 women who avoid a cesarean section as a result of choosing a birth center
Source: American College of Nurse-Midwives
