Interventions and Birth: Understanding Our Physiologic Design

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By Rachelle Garcia Seliga, CPM
Banner photo credit to @knowingtracy

When I was 20 years old, I was in the northern part of Thailand, living and learning from the people there. The people I was staying with in Northern Thailand shared with me (with the help of a friend who was translating) how midwives had traditionally been trained in their villages. What they said was this:

For a woman to train to be a midwife in her community, her apprenticeship began with her watching the water buffalo birth during several seasons. The purpose of this was the following: If the water buffalo were birthing and having a straight-forward, easeful birth (the majority of the time), and the midwife apprentice tried to get close to the water buffalo or ‘help’ the water buffalo during its labor and birth, the water buffalo would KICK the apprentice. If a water buffalo was laboring/birthing and was having a difficult time which truly merited help (rarely), the water buffalo would ALLOW a human to come into its space.

Watching the water buffalo in this way therefore laid the foundation for Midwives in this community to know:
    – How to understand body language and how to read the birth field; 
    – How it was unnecessary to ‘get involved’ during labor and birth the majority of the time; and  
    – How one should only ‘get involved’ when there were clear signs that help was needed.

This aspect of the midwifery apprenticeship taught the INHERENT DANGER of over involvement during labor and birth.

In the case of sitting with the birthing water buffalo – the consequences of over involvement were dangerous to the Midwife apprentice herself. In the case of sitting with birthing HUMAN WOMEN – the consequences to over involvement are dangerous to MOTHER AND BABY.

‘Interventions’ have become commonplace during the childbearing continuum (pregnancy, labor, birth, postpartum), ACROSS THE WORLD. These interventions have become so common, they are thought to be ‘normal’ or a ‘routine’ part of ‘responsible’ tending to Mothers/babies; this has therefore NORMALIZED interventions.

Many modern Mothers and families have been led to believe that intervention ‘x, y or z’ during their labor and births is what ‘saved’ them and/or ‘saved’ their babies lives. However, it is often INTERVENTIONS themselves during labor and birth that CAUSE many complications to arise. Care providers then respond to the problem that has arisen because of the intervention/s, creating the illusion that it was the care provider (doctor or midwife) that ‘saved’ the Mother and baby.

When the word ‘INTERVENTION’ during labor and birth is heard, most people will think of very obvious, blatant ideas of what those ‘interventions’ are:
– Rupturing of a woman’s membranes (breaking open the amniotic sac);
– Cesarean sections;
– Pitocin (synthetic Oxytocin) being used to initiate or augment labor;
– Being hooked up to ‘external fetal monitors’, creating lack of mobility for Mother during labor and birth, etc.

And while these are MOST DEFINITELY interventions during labor and birth (which have been ‘normalized’), I want to draw attention to the interventions during labor and birth not even considered to be ‘interventions’ by the majority of birth professionals and families alike.

These ‘interventions’ are:

Anything that stimulates the Neo-Cortex during birth (the Neo-Cortex being the ‘rational’, ‘logical’ parts of our brains) interferes with our physiology and IS AN INTERVENTION.

photo by @elliana_allon

Some examples of how the Neo-Cortex is stimulated during labor and birth include:
– Bright lights
– Having people speak rationally and logically to you
– Being surrounded by people who behave like observers / feeling observed
– Restrictions (whether overt or covert) to a laboring woman’s movement, voice, bodily needs

Neo-cortex approaches to labor and birth by care providers (doctors or midwives) can cause an elevation in Adrenaline and Noradrenaline (our ‘fight and flight’ hormones), slowing labor, and re-routing blood from the uterus and baby to the muscles, heart and lungs in preparation for action. This spike of Adrenaline and Noradrenaline then decreases our body’s capacity to produce Oxytocin; Oxytocin being one of the primary hormones that facilitates a safe labor, birth, and postpartum period for Mother and baby.

All inhibitions come from the Neo-Cortex. When the Neo-Cortex is stimulated in birth, there tends to arise ‘complications’ at birth. These complications are often PRACTITIONER induced and manifest as:

– Fetal heart tones ‘DESCENDING’
– Blood pressure ‘RISING’
– Labor ‘STALLING’

‘Physiologic Birth’ is defined as: “Birth that is powered by the innate human capacity of the woman and fetus. This birth is more likely to be safe and healthy because there is no unnecessary intervention that disrupts normal physiologic processes. Supporting the normal physiologic processes of labor and birth – even in the presence of complications – has the potential to enhance best outcomes for Mother and infant.”

What we REQUIRE as humans to labor and birth in alignment with our physiologic design is:
– A FELT sense of SAFETY
– A FELT sense of PRIVACY
– A care provider (if so desired) who can WITNESS us, without making us feel we are being observed

In remembrance that: anything that stimulates the Neo-Cortex will interfere to some extent with the processes of labor and birth.

photo by @tribemidwifery

It is imperative we choose our care providers wisely. The hormones required for labor and birth are the same hormones produced when we are making love – and in both cases, we require safety, privacy, and not being observed. Would you want to make love within the setting where you previously labored and birth? Who do you feel safe with? Who do you want to witness you in your strength and glory and your struggle and initiation? Who are the maternity care providers around you who support these physiologic needs of birthing women?

In the animal kingdom – if there is any outside interference with labor/ birth/ or the early postpartum – a common consequence is that the Mother animal will REJECT her baby. This is because the interference disrupts the innate physiologic response that is REQUIRED for optimal laboring, birthing, bonding and attachment. Humans are mammals – in that we produce MILK to feed our young. When there is any INTERFERENCE (intervention) during our labor/ births/ postpartum period, there are consequences – be them large or small.

When a postpartum Mother is having “difficulty bonding with her baby” or is feeling “disconnected” or “apathetic”… When a postpartum Mother is feeling “depressed” or “anxious”, WE as birthing women and families, and WE as health care practitioners MUST TAKE INTO ACCOUNT HOW THE LABOR AND BIRTH EXPERIENCE WAS. And how the “birth experience was” means: Mother’s FELT experience of her labor and birth – combined with – understanding the way/s she was interfered with by means of interventions. In understanding these two elements, we have the capacity to REPAIR that which is needing HEALING. This healing is available and accessible no matter how long ago birth happened.

And of course – it is most optimal to NOT have to HEAL from a birth experience that was interfered with, but rather to create a birth experience that supports and honors women’s physiologic design.

Rachelle Garcia Seliga © 2018

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