Have you ever found it difficult to explain to a physician or to a pregnant woman why some women give birth with ease, whereas others seem to require extraordinary measures in order to give birth? For over half a century, authors of obstetrical textbooks have explained this difference by invoking the so-called 'Law of the 3 Ps', the Ps being the passage (the woman), the passenger (the baby) and the powers (the quality and frequency of uterine contractions). This mechanical explanation has not changed at all over the last 75 years, although the rate of medical interventions in childbirth has increased drastically in most industrialized countries during that same period.
This situation has led some to put forth the hypothesis that the pace of evolution of human beings has suddenly accelerated, in that human heads are said to have become much larger than they were a generation ago, with no corresponding enlargement in the maternal pelvis. This tortured hypothesis is, so far, the only explanation that the scientific community has offered to explain a physiological basis for the trend of increasing medical interventions in the birth.
However, the experience of our midwifery group from the very beginning taught me that the Law of the 3 Ps is essentially flawed, as our experience, like that of all traditional people who have maintained sustainable cultures over millenia, tells us that almost every healthy woman of childbearing age can have her baby vaginally, given the right care and preparation during pregnancy and the correct treatment during labour.
To just consider our first 500 births at the Farm Midwifery Center, for instance, when a woman did need a Caesarean section (only three women did), it was for reasons that had nothing to do with the 3 Ps (a transverse lie and two partially abrupted placentas). The caesarean rate for our first 500 births was 0.6%, counting from the first birth I ever saw and including all of the births that constituted our midwifery training program, which is, I venture to say, not bad for a group of midwives whose formal educations were primarily in English literature and art.
How can the Law of the 3 Ps be considered a law if it apparently was not in effect in the large number of birth we have attended over the years? Our Caesarean rate has never reached 2%, even after we opened the doors of our midwifery center to women who were not members of our community. Our combined rates of ventouse [vacuum extractor] and forceps deliveries amount to less than 0.5%. Surely, if human heads have really increased in size and women's pelvic proportions have shrunk, some of these women would have found their way to our midwifery service in Tennessee, given that we never turned away any woman on the basis that we thought that her pelvic measurements might not permit vaginal birth?
With all of this in mind, I believe that it is possible to articulate a law of birth physiology that better explains why some women give birth easily while others seem to require the assistance of medical intervention. For ease of explanation, I have decided to call it 'Sphincter Law'.
My central thesis is that in those maternity services in which rates of Caesarean section and mechanical deliveries have increased above the levels recommended by the World Health Organization in 1985 (10-15%), the explanation has been—at least in part—the failure on the part of those organizing the services to understand the basics of Sphincter Law (WHO, 1985).
To explain what I mean by this statement, I will start with the observation that the vagina and the cervix—not just the anus and the urethra—are sphincters, that is, the circular muscles surrounding the opening of organs which are called upon to empty themselves at appropriate times. These openings ordinarily remain closed but have the ability to open as widely as needed when necessary. Each of the organs that I have referred to is able to contract rhythmically as it fills, until it reaches the point of urgency that the sphincter relaxes so that urination, defecation, or birth, takes place.
For anyone dealing with or organizing maternity care, probably the most important feature of sphincters to understand is that they function according to several factors:
Posted @ 21:16:06 on 12 February 2012 back to top
Postpartum Depression for Men?
I am very involved in my family and find that my life revolves around them no matter what I do. I lie down with the younger two kids at night and, if I’m home, for naps during the day. I draw for my son and play superheroes and tag with him often (though not often enough by his standards, which would be 24/7/365), and I’m constantly teaching my oldest the differences between right and wrong as she begins getting older and discovering new language and behaviors (that we aren’t always thrilled about). I recently had to quit a steady job that demanded too much time away from family and I am now currently starting up my own business where I can make my hours revolve around my family.
With all that being said, it should not came as a surprise that I am very involved with the ins and outs of Mrs. BWF’s pregnancies and births. When she goes through trying times, I go through trying times.
Birth trauma is a very real thing for women. In fact, I will go so far as to say that birth trauma can account for much of the postpartum depression that happens in our society. It just never gets addressed because the very ones women trusted to guide them through childbirth and violated that trust have placed themselves on a holier-than-thou pedestal. It wasn’t anything the OB or the nurse or the midwife did, it is all in the new mom’s head. Her experience, good or bad, happened all by random chance and nothing the “expert” care providers did, right? It is up to the new mom to deal with it all by herself after, many times, no would leave her alone when she needed it most. Nice logic.
I say this because I have seen it first hand with Mrs. BWF. I have watched her move on past the trauma and postpartum depression by herself. I was there, but I am not a trained counselor or therapist. There’s only so much emotional support I can offer because I have never experienced it first hand.
But what about me? What about the husbands reading this or the husbands of the women reading this? What happens to them when they see their wife’s plans go up in smoke, when the hospital staff mistreats or violates their wife, when these supposed childbirth care providers instill their ignorant fears and hospital protocol on humans in a one-size-fits-all manner? What happens when we are there to support our wives through the thick and thin, but can’t because only she can birth her baby?
I was there to support Mrs. BWF, but I never realized I needed someone there to support me.
Deer in the Headlights
I was there, supporting Mrs. BWF throughout her first pregnancy, when she literally vomited every single day. So much so, that we had to take her to the Outpatient Center to get IVs so she could stay hydrated. I was there when three different midwives palpated and said the baby’s head was down, only to find out at 36 weeks that the baby was Frank Breech. Not nearly as natural minded as we are now, we opted for the c-section, believing that a Frank Breech was impossible to birth naturally.
After planning a natural birth at a birthing center for months, it was a huge disappointment to go this route.
But I was there, by Mrs. BWF’s side, looking at her insides during the c-section as they tugged our first baby free. I was there in the hospital room the next three days, sleep deprived from the nurses barging in repeatedly to check Mrs. BWF’s vitals literally every single hour. I was there to watch her cry in frustration as the baby wouldn’t latch on, all because bonding couldn’t happen after the c-section.
Fears, Crackpot, Stress
I was there during Mrs. BWF’s second pregnancy when she had constant low back pain, despite going to a Chiropractor. I was there when she began labor for the first time. Labor continued for the next 54 hours unable to progress because of birth fears never addressed. I was there when the inconvenienced midwife thought Mrs. BWF was lying about the pain, asking me what I thought we should do. I was there when we rushed Mrs. BWF to the hospital and they said she had an infection (of which they never told us what)… and the midwife later admitted she thought Mrs. BWF was making it up (being in active labor).
I was there when the strung-out crackpot OB, on edge and jittery from at least two whole pots of coffee in the last thirty minutes, performed a hack job on my wife as I watched. I was there when my son had a fever and they wouldn’t let me or my wife touch him. I was there, for an hour, talking to him, unable to touch him, while he cried in the incubator until all his vitals settled down. I was there pleading with the nurse to bring him to his mom, so she could hold him for the first time… two hours later. I was there three days later, when the nurse wouldn’t let me carry my own son to the car in his car seat due to hospital protocol. So I ripped the car seat out of her hand, finally fed up, rudely explaining that he was MY son and I would carry him to MY car and buckle him in MYSELF, of which she obliged (my death stare is second to none).
I was there when the crackpot OB took the staples out of the incision five days later and told Mrs. BWF “You can never attempt a homebirth ever again.” I was there when the crackpot OB told Mrs. BWF that the numbness in her left thigh since the surgery was due to sciatica and not the anesthesia, simply to shut us up because she had another patient waiting.
I was there a week later when I had to take five exams in seven days (I was in grad school and could not miss any time). I was there, every night, studying, helping Mrs. BWF with the new baby and sleeping an average of an hour and a half each night for a week. I was there when, after too much stress and too little sleep, severe back spasms kept me from doing anything except lie on my back for a week. I was there feeling like scum that my wife, recovering from a traumatic emergency c-section, was taking care of me because I couldn’t move. I was there for the post-partum depression that lasted weeks and months because of the failed homebirth, emergency c-section, and lack of bonding between mother and baby.
Under the Table and Social Services
I was there for Mrs. BWF’s third pregnancy, which, actually, went very smooth. I was there when we hired a midwife, but had to keep it to ourselves because the state we lived in outlawed midwives attending homebirths for VBACs. I was there when the midwife dropped Mrs. BWF from care at 42 weeks because Mrs. BWF wouldn’t try to naturally induce, leaving us to figure out what to do. I was there when we had to find another midwife (because we felt we needed one), and when we did find one (a vile CNM), we couldn’t tell her anything, making us look like the most ignorant fools walking the planet.
I was there when Mrs. BWF went into labor again (at 43 weeks, six days) and tried to do it unassisted. I was there when she realized she hadn’t prepared for an unassisted birth and that we had to go to the hospital. I was there when, in the hospital, they wouldn’t let Mrs. BWF walk around or squat, again because of hospital protocol. I was there when the rude OB came in and, without introducing himself or saying much at all, gloved up and inserted his fingers in my wife’s vagina without asking, prompting her to scream “GET OUT OF ME!” I was there when he suggested a c-section and she shot him down immediately. I was there to watch her push (finally) and to tell her the baby was crowning. I was also there to watch the vile CNM reach in, pull the baby out, and tear Mrs. BWF so badly that I was stunned to see shredded bloody flesh where it should normally be smooth and pink. I was there to see Mrs. BWF realize they had given her pitocin to “help her uterus contract,” after she had explicitly told them not to.
I was there, not wanting a repeat of the helpless feeling we had with baby #2, belligerent and uncooperative with the nurses as they tried to run every test under the sun on our new baby (running a glucose test to check for diabetes on a six pound baby… seriously?). I was there when the vile CNM called social services on us because we (I) refused all the tests. They soon realized the vile CNM was a fool because we eventually had them done anyway (Mrs. BWF was exhausted, drugged, and didn’t want the confrontation so she gave in). I was there when the vile CNM admitted to Mrs. BWF that we made her tired because the nurses, not knowing the specifics of each test, had to go and repeatedly find out from her what exactly they were testing (shouldn’t they know that?).
The Hell With Them All & The Best Day of My Life
I was there to hear a leader in my profession speak about how her first four babies were born at home, just her and her husband and no one else. I was there to come home and bring it up to Mrs. BWF during the the first trimester of her fourth pregnancy (after she brought it up to me during her third pregnancy and I said “NO WAY!”). I was there to watch her gain confidence by reading books, blogging about it, and visualizing it. I was there at church where, because of the blog, people avoided her and pointed at her like she was a freak. I was there to hear our church leader say that other women in the church wanted him to do something because they were worried something bad would happen.
I was there when Mrs. BWF went into labor in our apartment. I was there when she went into transition in the bathtub, slipping off into a peaceful trance. I was there when she got up and stood over the toilet and pushed. I was there to see the baby crown.
I was there, finally, after so much heartache, and stress, and frustration, to catch my own baby.
I was also there to watch Mrs. BWF bond with our baby for the first time without anyone sticking their nose in our business. I was there to watch mom nurse the baby without any trouble. I was there to watch our kids wake up and realize that they had a new sister laying on mom as she sat on the family room couch. I was there to watch our oldest cut the cord.
I was there to finally experience my own healing. After the disappointments, the frustration, the anger, the heartache, the pain, the stress, and fear of another pregnancy/childbirth, I couldn’t help but feel elated, relieved, and healed by Mrs. BWF’s accomplishment.
And to this day, it was the best day of my life.
What Do You Mean Your Own Healing? You’re a Guy!
Watching your wife literally go through hell three different times doesn’t exactly render a sense of peace and comfort about birth from the male perspective. Having three bad experiences in the hospital and four bad experiences with a midwife doesn’t give me a sense of confidence in any birth provider whatsoever. Trusting birth, after my trust in it was profoundly shaken, is not an easy thing to do. Even now.
Despite our amazing experience with our fourth baby, I still have fear. But not of birth. It is a fear of what will happen to Mrs. BWF. It is the sense that if something happens to her, I can’t do anything about it. It is a very helpless feeling, and I don’t like to feel helpless.
Sure, our fourth experience was an unassisted pregnancy and homebirth, but the only thing that alleviated the fears I had was witnessing the absolute faith and confidence Mrs. BWF had in her body to birth that baby after two c-sections and an intervention-riddled VBA2C. The result was truly amazing to behold.
I’m sure most of you know Mrs. BWF is pregnant for a fifth time, and again, I still have my fears, despite the healing we went through with baby #4. But I don’t focus on them. Instead I focus on the faith and confidence I have in Mrs. BWF.
Watching Mrs. BWF become a beacon of hope to other women with similar experiences, and solidifying her own faith and confidence in her body to, once again, birth this fifth baby reminds me how good an experience birth can be.
That is what pushes me past my fears.
Posted @ 18:27:16 on 09 February 2012 back to top
I have been missing in action for a few days as I have been with woman. I have to have the absolutely best job in the world, it doesn't seem right to call it a job to be honest. It is such an honour to be present when a new life enters the world. It is emotional and thought provoking to say the least.
Posted @ 19:12:09 on 25 January 2012 back to top
When I first started doulaing, being on call was all consuming. I couldn't sleep, waiting for the phone to ring to tell me that I would be needed. I would spend my days sitting at home just in case I was called and my mobile phone became an actual part of my hand!
Posted @ 18:50:01 on 20 January 2012 back to top
