Tuesday, June 19, 2007

Giving birth

Within the natural process a mother and baby must work together to open the womb and bring about the series of miracles that we call birth. The phrase “giving birth” indicates action, as does the word “labour”. Many mothers today will use words such as “my doctor delivered my baby”, or “the hospital midwife delivered him (or her)”. This is a sad reflection of our community’s attitude towards birth, as though pregnancy is a medical condition, and babies need to be extracted like a bad tooth.

I will state the obvious. Birth is not an illness. Birth has never been safer than it is today, yet many people are terribly fearful. Despite all the advances in technology and drugs and sanitation over the past hundred years or so, there is still no safer way to give birth than for a woman to come into spontaneous labour at Term (37-42 weeks of pregnancy), and to progress and give birth under her own amazing power, without any drugs or substances to make the labour stronger, or to ease the pain of labour. A woman who is labouring, and is attended by a midwife who she trusts, is able to engage with and accept the powerful and often demanding work of birthing.

A healthy woman in labour is like an athlete who is giving all she has to complete the course; who pays no attention to anything else, and presses on towards the finish line. The natural process is good, as natural, pain-relieving substances, endorphins, are made within her body in response to the work she is doing. The labour requires her to shut down her usual thinking capacity; to surrender her ideas and plans and allow her body to do its work.

Yet the natural process can be interrupted, and interfered with, leading to distress in the mother and the baby.

At any time in the pregnancy-birthing journey a mother or baby can experience problems that may even threaten life. Although birth is not an illness, there are many illnesses that can affect the mother or her baby. Some of these conditions can be treated, and the mother and baby monitored over a period of time, leading to good birthing outcomes – healthy mothers and babies. A mother with insulin dependent diabetes that would be life threatening if not treated, can carry her babies safely to Term, and give birth spontaneously. Diabetes is an illness – birth is not.

Some conditions can occur without any warning, and occasionally babies’ and mothers’ lives are in grave danger. The midwife or doctor who takes professional responsibility for a woman in pregnancy is often able to intervene appropriately if there are signs of complications.

Pain in childbearing is a point of debate. It is well accepted among Christians that our mother Eve received punishment for her actions when God said “I will greatly increase your pangs in childbearing; in pain you shall bring forth children …”. (Genesis 3: 16 NRSV). Another translation of Genesis 3:16, from the Geneva Bible of 1560, reads: “Unto the woman He said, I will greatly increase thy sorrows, and thy conceptions. In sorrow shalt thou bring forth children and thy desire shall be subject to thine husband, and he shall rule over thee.” This was the translation of William Tyndale, and the comparison between it and the more modern translations which use the word ‘pain’ rather than ‘sorrow’[1], gives an alternative understanding of the text.

The woman was not cursed. The serpent was cursed (3:14) and the ground was cursed (3:17), while Eve and her husband Adam suffered severe consequences for their disobedience. Although through the redeeming work of our Lord Jesus, the offspring of the woman (3:15) on the Cross we have been freed from the power of sin, we continue to bring forth our children with sorrows that are reminders of our dependence on our creator God.

Pain in labour is useful. A labouring woman who can accept the pain she is feeling, and engage actively in bringing her child to birth is labouring well and should not be disturbed. A midwife distinguishes between tolerable, productive pain, and intolerable pain. It’s only in the latter case that interventions are needed to attempt to relieve the pain.

God’s provision in the natural process of birth is good. This discussion does not attempt to give clinical information about decision making, but as a midwife the question in my mind when any assessment is being made is “Is the mother well; is the baby well.” It’s a double question, and as long as the answer is “yes-yes”, I know that we can continue working with the natural process. I am able to wait patiently without interrupting, as the labour and birth proceed.

Having established the fact that the created natural process is good, according to God the creator in Genesis 1, the present reality for us is that sin has marred it.

When I am practising midwifery, being with woman through her childbearing, I have a professional responsibility to observe for any sign of complications, and to obtain medical attention if that need arises. Complications can arise at any time, in any woman or baby. No mother can assume that she is exempt from possible complications. Yet, in supporting and protecting the natural process in childbearing, the midwife is able to minimise complications that would happen as a result of interferences and interventions into the natural process. The guideline that has been promoted globally by World Health Organisation is that “In normal birth there should be a valid reason to interfere with the natural process.”

[1] “Whether readers like the attitudes of the Jewish patriarchs or not, the word pain does not appear in this verse and indeed, the Hebrew word ‘etzev’, which so many translators since 1560 have felt impelled to translate to mean physical ‘pain’, is correctly translated here as “sorrow.” [From an unpublished paper ‘Pain in Childbirth’, written by L Dick-Read (personal communication, 2007).]

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