Why Fewer Interventions Make for Safer Births
by Elon Bartlett, D.C.
As a prenatal chiropractor, my professional, and personal, experiences validate my belief that our bodies know how to birth babies, and that fewer interventions lead to safer births.
I was born at home in San Francisco in 1970. My mother had had a previous birth in a hospital and let’s just say, she didn’t enjoy it. It ended up being a power struggle between her and her doctor and left her feeling traumatized.
She had a sense that the experience of birth could be something more, could be not only empowering for her, but could also bring our family together. So my mom decided to give birth at home, in the family bed, with the lights turned down low and my father there to catch me. I’ve seen the film footage of this remarkable moment and my mom appears to be completely calm and trusting throughout the entire process.
Growing up with that vision of how birth occurs, I had the impression that birth was intense but not unbearable, and something that occurs naturally without assistance. When I learned that our culture is filled with images of hospital births, they stood out to me as different, as aberrant from what I considered “natural” or “normal.” The high energy, bright lights, screaming by the mom and AT the mom all seemed like foreign concepts to me. Why does it have to be that way?
Well, it doesn’t. It turns out there is a scientific explanation for why birth works best when done in a peaceful environment, as opposed to one with fear, drama, or even the slightest amount of perceived danger.
When I attended chiropractic school, one of the main focuses of study was the nervous system, which controls and regulates all the other functions of your body. All the automatic functions, like digesting your breakfast, breathing in air, or your heart pumping blood throughout your body, are regulated by your autonomic nervous system. This part of you has two modes, the famous “Fight or Flight” mode which is called the Sympathetic Nervous System (SNS), in which your heart rate increases, your pupils dilate, and blood goes to your arms and legs for fighting and running. The other mode is the Para-Sympathetic Nervous System (PNS), which is known as the “Rest and Digest” mode. In this state, your heart rate slows, you feel calm, and blood goes to your internal organs in order to do their jobs.
It turns out that everything about birth, just like everything about digestion, needs the PNS to be dominant. To really have an easy time relating to this, let’s first consider digestion. When it comes to eating a meal, which would feel better? Eating in a dimly lit room, with soft music playing, and a sense of connection and intimacy with those at the table, -OR- being in a brightly lit room such as a cafeteria, with loud and unfamiliar sounds, and feeling adversarial to those at the table with you?
The other part of digestion is elimination, where the same mode, the Para-Sympathetic mode, needs to be dominant. Under which set of circumstances would it be easier to go to the bathroom? You’re in a dimly lit room, with soft music playing, and a sense of privacy, -OR- in a brightly lit room, with loud and sudden sounds, and the feeling of being watched, or worse yet, the feeling of being rushed?
Now let’s look at reproduction. Not surprisingly, conception is a Para-Sympathetic dominant phenomenon. When people set up a romantic scenario, which do they prefer? A room with dim lighting, soft music, and a sense of intimacy with their partner –OR- a brightly lit room with jarring sounds and the sense of being frequently interrupted?
Finally, the other end of conception is birth, and by now, I’m sure you’re seeing where this is going. In order for our biology to function properly, what mammals need is a Para-Sympathetic state. This is assisted by dim light, soft, slow sounds, and a sense of intimacy with all involved. Birth is biologically hampered when anything triggers, even a little bit, a Sympathetic state. This occurs when bright lights are used, when there are loud or unfamiliar noises, and when any amount of fear is present.
Given that having some fear about birth is a cultural norm, how do we empower pregnant women to have the best births possible? For starters, we have to recognize that the person who should be in control, the person who gets to make the decisions about what does and does not happen, is the laboring woman. When this control is given to anyone else, whether it be her partner, her doctor, hospital administrators, or the government, she enters into a dependant state and is at the mercy of someone else’s decisions. From here, her fear all too often increases and her body’s normal processes shut down. At this point, I would say that her body is doing exactly what it’s designed to do when threatened: stop having a baby!
But our culture likes to “stay on schedule.” Our culture feels more comfortable when it controls nature rather than when it has to wait for nature to take its course. So the stories I hear time and again from my patients go something like this: they go to the hospital because they fear what would happen if they didn’t, and then they are treated in a way that stimulates their Sympathetic state so things might begin to shut down, at which point, the hospital suggests an intervention that will hurry birth along.
But how necessary is it to “hurry birth along”? What would happen if we simply told the laboring woman that everything was fine, that she needs some time to rest, and things will pick back up in a little bit? What interventions are going to do a better job than the woman’s own nervous system being in control and leading the way?
What routine interventions are being recommended? Prenatal ultrasounds, induction of labor, epidural, episiotomy, artificial rupture of membranes, continuous fetal monitoring, vaginal exams, restricting the woman’s movement, withholding food, and telling her that things aren’t progressing “appropriately.” And as each intervention is added, it tends to increase the likelihood of the next one.
These interventions may have their place in certain emergency situations, but none of them improve outcomes when performed routinely. In fact, there exists lots of research showing how the routine use of medical interventions leads to worse outcomes for moms and babies.
((Goer, H. (1995). Obstetric Myths Versus Research Realities: A Guide to the Medical Literature. Westpoint, CT: Bergin & Garvey.))
((Wagner, M. (1994). Pursuing the Birth Machine: The Search for Appropriate Birth Technology. Sydney & London ACE Graphics.))
((Wagner, M. (spring 1999). Misoprostol (Cytotec) for labor induction: A cautionary tale. Midwifery Today;49: 31–33.))
If using expensive technology on a daily basis isn’t the route to better birth, what is? I say, everything that works well, works by promoting a Para-Sympathetic state. The best way to eliminate fear is with understanding. Fear lives in the dark, and is driven out by knowledge. We have to start by educating women that their bodies already know how to birth a baby, and in most cases, no interference is needed. Anything “extra” runs the risk of being disruptive. If we cut our finger, our bodies know how to heal the cut without any “extra” instructions. When we get pregnant, similarly, our bodies know how to birth the baby, no instructions needed.
Another good way to eliminate fear is to know your options “just in case.” I think most women choose not to have a home birth because they imagine that it prevents them from having access to life-saving medical treatments, if needed. Well, homebirth midwives are experts at detecting when birth is happening naturally, or when a transport to the hospital is truly needed. In other words, beginning labor at home doesn’t preclude a trip to the hospital, but a trip to the hospital does preclude having your baby at home.
As I’ve mentioned earlier, simple steps anyone can take, in any setting, to promote a Para-Sympathetic state include: dimming the lights, playing familiar music, having the people around you speak softly and slowly, surrounding yourself with familiar images or pictures of loved ones, and having a strong sense of intimacy and trust with those around you. Adding a doula to the birth team provides continuous support from someone that the laboring woman has come to know and trust ahead of time.
The human mind is capable of incredible feats, and our ability to think ahead about the consequences of things is one of our best features, but when we use our mind to worry or to be afraid, we are going to impede birth. Therefore, one of the most powerful steps we can take to improve birth is to reassure pregnant and laboring women. Taking the time to speak to her in an empowering way, telling her that she CAN do this, that her body knows just what to do, has an immensely powerful effect and reinforces the woman’s trust in her own body’s ability to give birth.
I support anything that tells pregnant women that they are in charge, and that their bodies know what to do.
Elon Bartlett, D.C. is a prenatal chiropractor in Oakland, CA and is the founder of Acorn Wellness Center ((www.acornwellness.com)). AWC provides a variety of services and classes that empower all members of the growing family to make choices for their improved health.