Monday, 11 June 2012

Childbirth and the Science of Woo


I spotted a notice today for a free childbirth workshop, I took a look and immediately wished I hadn't. On the plus side it may have gone some way to improving my low blood pressure!

The notice said you would learn (amongst other things) how to avoid the need for pain and unnecessary interventions and how to breath, rather than push your baby out. It reminded me very much of my NCT classes.

I've heard very differing reports of NCT classes. A while ago I did a rough survey of friends with scientific and medical backgrounds who had attended them and although some felt they had been given balanced and useful information, others thought that a natural birth agenda had been pushed far too hard. This was certainly the case with the classes I attended. We were told, as fact, that we were just like any other mammal, perfectly capable of going off alone into a corner of our cow field and gently mooing until our baby arrived. We were also told that all doctors had a hidden agenda to medicalise our births (basically letting one anywhere near us was tantamount to inviting a physical assault). Home birth was strongly encouraged and one couple (both doctors) were forced to justify their choice of a hospital birth at our very first class.

To be clear, I'm not against natural childbirth or homebirth in the right circumstances. I have friends who have had wonderful experiences of both and had aimed for a doctor and intervention free waterbirth with E. What I am against is people in a position of authority talking nonsense.

We are not just like any other mammal, we are uniquely bad at giving birth. Human childbirth is a finely balanced compromise; in order to walk upright our hips and pelvises are proportionally far narrower than those of our mammal cousins, at the same time we have utterly enormous brains and thus heads. To allow for this the mothers pelvis can stretch a little during birth and the babies skull can safely squish a bit. We also have our babies when they are far less developed than most other mammal young and the baby comes out facing in the opposite direction to it's mother. The latter adaptation means it has to perform complicated turns to get through the pelvis but it's less likely to get stuck. Thanks to all these adaptations the majority of births are safe and straightforward, the continued existence of the human race is testimony to this - but it isn't proof that "all women are exquisitely designed to give birth easily and naturally" as I have read far too many times. The benefits of being smart and bipedal are so great that even if a small percentage of women die in childbirth as a result, it's still worth it for the rest of the species.

I learnt all this studying human evolution at university, as far as I know it's not particularly controversial in scientific circles but it seems to be a complete taboo to some childbirth educators. The over-riding concern is that all women are terrified of giving birth and must be eased towards the event with a relentlessly positive, almost pseudo-spiritual, message.

I'm not saying for a minute that an anxious pregnant woman should be sat down and lectured on the shortcomings of her anatomy. Being confident and calm in labour is undoubtedly helpful but can't we just assume that most pregnant women are intelligent adults and give them accurate information? Here is the message I wish I'd been given:

For the vast majority of healthy women childbirth is painful, but perfectly safe. For a few it will actually be easy, even enjoyable and for a few others it will be difficult, scary and exhausting. But even if you are in that last group the chances of anything going really, horribly wrong are utterly tiny. Doctors aren't lurking in the doorway desperate to cut you open, but if things go wrong you are immensely fortunate to live in a country where you and your baby will be saved. You can do a lot to prevent being in this group, be informed and have a good birth partner, keep healthy, eat well, don't smoke or get obese but also know that if it doesn't end up how you'd wanted it to, that's just bad luck and there are people there to help you. Basically, you'll be fine.

What's so bad, so dis-empowering, about all that?

I did the hypnobirthing, the NCT, yoga, swimming, birthing pool etc. etc. but in the end I could no more breath out my baby than the burly surgeon could yank her out with his full body weight and a sink plunger. It wasn't because I was afraid, or had no faith in my intuitive maternal powers, I was just unlucky. But I was also lucky enough that ultimately non of that mattered, my baby and I would have been fine whatever happened. No well meaning lies, no denial of basic biology, and absolutely no woo* required.

SB
PS. of course this time around I will be placing my faith in a Koi assisted birth - the universe is telling me to.

*Woo-woo (or just plain woo) refers to ideas considered irrational or based on extremely flimsy evidence or that appeal to mysterious occult forces or powers.
Definition from the Skeptic's dictionary

3 comments:

  1. "But even if you are in that last group the chances of anything going really, horribly wrong are utterly tiny."

    I think this is simply false. The chances are pretty darn good, as a matter of fact. Besides the risk of death to mother and baby, which historically is very high, there are risks of serious morbidities, like obstetrical fistulas. The WHO had previously estimated that about 15% of births experienced a significant complication, but they now note that this is likely an underestimate. See here, page 38 (48 if going by PDF page number rather than the numbers printed on the pages): http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf A rate of 15% of births experiencing a serious complication is not "tiny" in the least. Perhaps you just meant the risk of death is now tiny?

    The mortality and morbidity rates are low now only because of modern medicine. Moreover, the rates of complications aren't as much under our control as you are indicating. Staying active and eating a good diet only has a modest effect on the rate of most complications.

    So, overall I liked this post, except that you are still being swayed by the woo, even if you aren't aware of it.

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    1. Hello Becky, thanks for commenting.

      Perhaps I should have made it clearer that this particular post was talking specifically about the situation here in the UK where all pregnant women have free access to generally high quality modern health care and as a result the probability of any individual suffering death or serious, untreatable disability is very low.

      You are of course correct that for much of the rest of the world the risks of childbirth are far from tiny, and I have discussed this previously elsewhere on the blog, but for the sake of not making a very long post even longer I decided not to go into it again here.

      There are some UK childbirth classes which assume that all pregnant women are terrified of birth and teach that childbirth can be completely safe, even easy, if only you have faith in your own abilities and avoid all contact with modern medicine. I think this is at best patronising and at worst dangerous. Hence my statement that I would rather women be told that they will probably be fine and that if they are not help will be at hand. If only the same were true for all women around the world.

      I should also add that had I given birth in another time or place I would not have survived and am only here because of a awful lot of modern medicine so I am eternally grateful to be one of the lucky few!

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    2. Ah, OK. I had felt like you were saying that the chance of a serious complication needing intervention by a doctor was tiny, rather than the risks of a horrible complication were low with doctor intervention and appropriate medical care. It seemed to me part of an argument that goes something like, "Modern medicine is great, but intervention is only needed in a small, small number of deliveries," which tends to minimize the safety of interventions, even demonizing them, while exaggerating the safety of "natural" childbirth.

      I see that I misunderstood you, and I do agree with what you were saying. I think women need a healthy respect for the dangers of childbirth, but not an intense fear. If you want to see some scary woo, check out the Trust Birth movement.

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