Monday, November 23, 2015

Natural: is it good, bad, neither, or both?

It has been months since I put (virtual) pen to (also virtual) paper in this blog.

I have needed time to reset my body clock; to recover from the exhaustion and burnout after many years of midwifery and related professional activism.  I don't know if I have fully recovered yet.  The reality of ageing gives much to ponder; a relentless march towards exhaustion.

In recent months, with no midwifery to absorb time and energy, I have taken up some new challenges.  These photos show the performance of the 'Human Knitting Machine' at the Kyneton Show.

performance of the 'Human Knitting Machine'

The finished product

I am enjoying our new home, and the rural Central Victorian lifestyle.  The daily patterns of weather; the sun and clouds and wind; the subtle changes in the seasons; the growth and change in the garden - these natural life factors add wonder as well as sometimes concern to our days.

We are often delighted, and sometimes concerned, by the little members of our family and friendship circle, as they proceed through their developmental milestones.  This is all part of natural processes: sometimes good, sometimes bad, sometimes neither, and sometimes both.

Just as with retirement from attending births my life has changed, so has my capacity for writing.  Blogging has, for me, been closely linked with practice.  In the past, as I pondered the events of my professional life, the thoughts that surfaced became seeds for comment in this blog.

I now find that I need to shift my point of view from that of a midwife who was intimately involved in the day by day decisions related to maternity care and the lives of mothers and babies, to a more distant view.  As a retired midwife, my view is that of guardianship of birthing within the bigger picture of living.  I care deeply about what my society does to mothers and babies.  My right to comment continues as in the past.  Readers will need to decide whether my thoughts are valid and useful, or not.

Today I would like to consider *natural* in the maternity context.  Previously I wrote:

Giving birth spontaneously is, in my mind, a woman's *natural right* (not a legal right), just as we have a natural right to breathe, or walk, or perform any other natural function of our bodies.  Women do have a natural right to birth their babies.  Midwives are in the unique position to protect and work with that natural process, giving the mother confidence as she navigates the most challenging terrain.  The only way we can achieve our natural right to birth is if we stay on that natural pathway, and for the majority of women, this is a wonderful and rewarding phenomenon, working with the amazing hormonal cocktail that sets up powerful maternal instincts and bonding/attachment for mother and baby. 

I know of no better way for birth than to proceed under the spontaneous, hormonally mediated natural process from conception to birth, and beyond to nurture and mothering of the infant - MOST of the time.

Natural pregnancy, birth, and nurture of our children is good - MOST of the time.  Regardless of race, wealth, or other social factors, our bodies and minds are set to the 'default' that whatever is natural will be, unless something is done to redirect the course of events.

Whether we apply this principle to maternity issues, or any other ordinary life event, *natural* can be awfully unpredictable, and unmanageable.  There is no therapy that can make it work better, or reign in the unpredictability.  There is no drug that will 'fix it'.  Modern Western medical management of maternity care seeks to minimise 'risk', and in so doing reduce the impact of the spontaneous natural process: to remove the 'MOST' element, and make maternity just another predictable, manageable medical event that complies with medical guidelines and protocols.

For the midwife who is committed to working in harmony with natural processes, except when there is a valid reason to interfere, the big challenge is to know when the natural process is likely to result in harm; when medical and other interventions are likely to lead to improved outcomes.  This requires clear thinking by the midwife or other primary care professional, and independent clear thinking by the woman who receives the advice that a process other than the natural one is being recommended.

I want to emphasize the need for independent thinking by the woman.  The first decision to interrupt the natural birthing process is profound, and the woman must take responsibility for it as her own decision.  It doesn't matter how much trust there is between the woman and her midwife, or doctor for that matter.  The first intervention, which can quickly cascade into a whole bunch of subsequent interventions, can be a life and death decision point.  As can the decision not to intervene!

I started this post by saying that
I know of no better way for birth than to proceed under the spontaneous, hormonally mediated natural process from conception to birth, and beyond to nurture and mothering of the infant - MOST of the time.

During the past couple of decades I have experienced progressive increases in reliance on medical intervention in maternity decisions, paralleled by loss by women in their ownership of their commitment to natural, spontaneous, unmedicated birth.  In Australia today, the woman's ability to make her own consumer choices has eclipsed any valuing of or protecting physiology.  This has made maternity decisions more like walking down the aisle in the supermarket and making selections based on price, packaging, or some other possibly insignificant factor.

I'm not wanting to suggest that I think maternity care was better 20 years ago, when I was busy with midwifery and maternity activism; or 40 years ago, when I was having my own babies; or even 60 years ago, when as a young child I learnt much about mothering from my own mother.

Twenty years ago we were working to demand that midwives be called midwives, not nurses, in hospitals.  We had supported the release of a Code of Practice for Midwives in Victoria.  We were promoting the Baby Friendly Hospital Initiative, through which maternity hospitals were supported in the protection, promotion and support of breastfeeding as the health promoting natural resource of mothers and their new babies.

As time has passed the indicator of reliance on medical rather than natural processes has been the consistently increasing rate of caesarean births in otherwise healthy pregnancies. 

Women don't, on the whole, choose caesarean surgery.  They enter systems of care that sets up the cascade of interventions, so that there is no safe alternative but to bring it all to a conclusion, and when that happens the most rational and helpful option is surgery.  Women, midwives and doctors play games that set up a mirage of choice as the prize, when in reality there is no choice.

Natural birthing can be very good, or very bad.  It can be neither good nor bad.  It can be both good and bad.  Society will either benefit or pay the price for its reliance on the natural physiological processes in maternity decisions.