Interventions

"The first intervention in natural childbirth is the one that a healthy woman does herself when she walks out the front door of her own home in labour" -Michael Rosenthal, Ob/Gyn.

This quote is an attention grabber and one that should set us all to thinking. We know about the "cascade of interventions" that sends most North American births down a tunnel of medical mishaps: strip membranes, pit/gel induction, fetal heart continuous monitoring, pain medications, distress in the infant, cesarean, post surgical infection, breastfeeding problems, post partum depression, etc. etc etc. Iatrogenic meddlesomeness at it's most blatant is easy to spot and condemn. We like to shake our heads, point our fingers and tut-tut-tut about this type of intervention.

What of the interventions that we don't see and are guilty of ourselves? The Oxford dictionary defines intervene: to interfere, modify course or result of events. Something that seems as small as turning on a light could be classified as "an intervention". Is it an intervention to wear perfume to a birth? To monitor the heartbeat of the baby every 1/2 hour? To leave a clock within the mother's view? To watch the mother? To speak to the mother? To ask her to take a walk outside? To tell her husband to get in the water tub with her? Do midwives take any time at all to ask themselves these questions?

What would "the course of events" be like if we weren't there? How could we possibly know? Recently I came into possession of an amazing video. This video is the raw home movie footage of the births that are shown in the unassisted birth film "A Clear Road to Birth". There is no attendant present at the births. The families have, for the most part, just put the video camera on a tripod and let it run and the result is an amazing view into a place that I have never been privileged to enter- ,a birth that is following the natural course of events. I found it difficult to watch because it is so very intimate, and I'm not sure that they wanted me to watch their beautiful, family private moments. It is a sacred film.

I come away from it with questions about how my presence at a birth affects the behavior of all the participants. The women on this film are not saying "How much longer will it be?" They are not saying "I can't do it anymore". There is no illusion or possibility of some other woman "saving" them, they are going to do it themselves and they seem to have an inner core of resolve about it. Their husbands and children mostly seem "surprised" that the baby is really there. This is unlike births where there is an "expert" present and the waiting and watching seems to go on forever.

This film of unattended births leads me to question "What about women who have unassisted prenatal care?" We are told that prenatal care is essential. We believe it is a cornerstone of good maternal/child health, but is this true? Are there interventions that take place in Prepared Childbirth classes that are subtle and affect the course of events? If we think of the spoken word as "an intervention", we must wonder if we are causing changes in the course of the birth long before the membranes release. I cringe at some of the "meddlesome midwifery messages" that women are given at prenatal checkups. Messages can be imparted both verbally and non-verbally. When I took prenatal classes 25 years ago, the nurse managed to impart the message that she didn't approve of breast-feeding with just the look on her face when she said, "How many of you are planning to breastfeed?" Her attitude changed the course of events for a lot of the women in my class. It was an intervention.

I have learned a lot about how to question my own interference in birth from listening to French obstetrician Michel Odent. His message is repeated over and over: "The most important thing is do not disturb the birthing mother". What does a nice midwife do that would disturb? I went to a birth as an assistant to the midwife several years ago. I was assigned to take a video of the birth and so I familiarized myself with the family's camera and began to do a little filming of the mother while she was in the watertub. I was getting some nice footage when, all of a sudden, the room went completely black and I couldn't get an image in the camera. I looked up to see what had happened... the brother-in-law of the birthing mother had closed the lights. I went over and turned them back on so I could get on with filming and, presently, the man came back and turned them out again! I was very annoyed and, in that moment, I realized that he was right! He was more in tune with what his sister-in-law needed than I was.

Birth seems to flow best for human beings in the same conditions as most other mammals. Darkness, familiar smells, privacy and quiet are the main ingredients for a smooth birth. Who in North America can give these simple things to a birthing mother? Are we willing to trade monitoring and charting for births that truly flow along smoothly? Are we willing to sit, out of view of the woman, completely still while she focuses inward and makes her own journey to meeting her child? Can we forego getting the acknowledgement and appreciation for all we "do" and be deeply satisfied with "being" unobtrusive?

I have been blessed with a midwifery partner, Mary Sullivan, who is always on alert for unnecessary intervention. At one birth, a quiet, religious woman pushed out a baby girl who did not pink up and cry quickly. The mother was holding the baby and, not wanting to suction, I urged her "Talk to your baby, tell your baby to breathe!" The mother spoke a few words to the baby, the baby pinked up and soon was nursing well. Later, when we drove home together Mary told me that she really disagreed with me intervening by telling the mother to "talk" to her baby. She pointed out that I am a real talker but that this mother was very quiet verbally- she had been talking to her baby through touch of the baby's skin, that was more her way. I had completely missed that communication because it wasn't my way. I learned to watch closer to the cues of the mammatoto and not be so fast to make it fit my pictures of what "should" be happening.

Another woman taught me a big lesson about timing and patience. This woman had a homebirth for her first baby who arrived at 36 weeks gestational age. The baby was only 6 pounds at birth, but the whole process seemed very painful for the mother. When she pushed out her placenta, it bulged at the introitus for what seemed like a long time. It was tempting to just give it a tug and complete the third stage but I just waited and finally the mother pushed it out into the bowl. Later, when I was helping her dry off after a shower she said "You know, Gloria, I can't understand how anyone could ever say birth is sexual! That hurt like hell and there was not one sexual thing about it. But.... that placenta, now that was sexual!" To this day, I have no idea what she experienced but I am so happy that she had that time to experience the birth of her placenta in a special way.

I believe that the 3 P's of obstetrics should be Patience, Patience, Patience and not Passage, Passenger and Powers. I am fond of the Buddhist words from the Tao of Leadership:

"Being a Midwife"

Remember that you are facilitating another person's process. It is not your process. Do not intrude. Do not control. Do not force your own needs and insights into the foreground.

If you do not trust a person's process, that person will not trust you.

Imagine that you are a midwife; you are assisting at someone else's birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge.

When the baby is born, the mother will rightly say: "We did it ourselves!"

From: The Tao of Leadership, John Heider

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