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Medical Science vs Natural Childbirth 

I sat here to write the story of our first planned VBAC and realized as I scanned my other posts that I had to tell just a little more history to help explain the attitudes of the times.

During the mid 70’s early 80’s… our country was changing in many ways. In the medical world, Obstetrical medicine was becoming more specialized with the development of many subspecialties including  “Perinatology” and “Neonatology”.  Perinatology by definition is the study of the unborn fetus and recently born infant during the first several weeks of life. It was the changing concern of obstetricians from a sole focus on the mother’s health to one which is balanced between the mother’s health and the unborn or newborn. ACOG started to offer a specialty certification exam for perinatology  in 1974, and in 1977, the Society of Perinatal Obstetricians (now called the Society for Maternal-Fetal Medicine) was formed.  The term used to describe a Perinatologist today is a Maternal-Fetal Medicine Specialist.  This specialty is the management of high-risk pregnancies and the assessment and treatment of the fetus. Neonatology (established 1975 by the AAP) is the study of a highly specialized care of the newly born infant especially the ill or premature newborn infant usually hospital based in NICU’s.

Young women were becoming more and more interested in a natural approach to childbirth. People all over the country were driving maternity services to offer the availability of birth options for these moms. The ICEA [International Childbirth Education Association] came to our town in the late 70’s and a local chapter was born. “Freedom of choice based on knowledge of alternatives” in childbirth was a motto on their pamphlet information. There were some individuals in the community going for the new certification of childbirth educators. They were educating some new mom’s about birth options…… that we, the staff hadn’t learned about let alone developed as an option for our patients. Many on the staff scorned this movement. It seemed to me that these changes were all happening at the same time. We were learning about advances in observing and monitoring the well-being of both the laboring mother and her unborn fetus, preventing complications etc…. arising from the research studies done from the emerging sub-specialties. We had one fetal monitor and purchased another. As soon as the specialists found that continuous fetal monitoring was advantageous to picking up potential problems in advance, to possibly avoid or prepare for complications, there was a natural childbirth revolt against the constant recumbent positioning that EFM (electronic fetal monitoring) seemed to require. There were more examples as with IV fluids or access and other routine procedures. The nurses didn’t understand. They were just trying to do what science and our doctors were telling them…[though not always willingly as some were afraid of the newer technology.] To them, this group pushing a natural childbirth movement was the same population that had just wanted to be given drugs, put to sleep and “wake me when it’s over” crowd.  

I realize that although these advances in science and the movement of young people seeking natural childbirth options seemed to happen so close to the same time in my world, it probably didn’t happen this way for all of the country. Here, I really think it probably greatly contributed to the attitudes of nurses and doctors I worked with at the time. Those professionals who just couldn’t relinquish control. They were learning more about the science of birth, of monitoring and couldn’t quite allow or see how the “natural” component could fit in. Those individuals often were guilty of the abuse of professional power, the use of misinformation and the blindness and arrogance to maintain control of the birth process… taking it away from the mother.  Those professionals who should have known better.  They did not know of the rights of childbearing Women, or of general patient rights for that matter. Unfortunately– there are some who still have these control issues.

That’s another story….

15 Comments Post a comment
  1. This is really fascinating stuff. Thanks for sharing it.

    May 2, 2009
    • Birth_Lactation #

      Thanks for reading and commenting! I appreciate your interest!

      May 2, 2009
  2. It’s interesting you describe it in terms of women reacting to the implementation of medical technology. I always saw it as the other way around: the medical field trying to respond to the growing NCB movement, i.e. trying to keep women coming to the hospital.

    May 2, 2009
    • Birth_Lactation #

      Thanks Emily for your’re right..I think that I think of it really from both sides..I try to understand it that way. I am very very science minded and thrive on all the evidence based practice research. I also feel equally strong in support for women’s freedom of educated choice. I hope I’ll always look at it that way. I really appreciate your comment! 😉

      May 3, 2009
      • Birth_Lactation #

        I am reposting this comment here from a Twitter friend “TheFeministBreeder”. After I read her comment, I was inspired to tell a little more history.

        “I love reading these stories. Thank you. I’ve only cracked the surface on your posts because I keep running out of time to read all the blogs I’ve recently discovered, so I’m still trying to figure out – how did an L&D nurse, who saw all of this go on, turn out to be the advocate that you are? How did you not just become institutionalized like the rest of them?
        I honestly have seen so few L&D nurses who know a single thing about normal birth. They have all been drinking the kool-aid. So why are you different? (if your whole story is somewhere, just link me to that and I’ll be happy to read it.)”

        May 3, 2009
      • In re: your interest in evidence-based practice research, in the OP you wrote, “As soon as the specialists found that continuous fetal monitoring was advantageous to picking up potential problems in advance, to possibly avoid or prepare for complications…”

        I assume you are speaking retrospectively? Because multiple studies have found no improved outcomes with the use of CFM, and instead, an increase in the c-section rate within the first few years of its implementation in a particular facility.

        May 3, 2009
  3. Birth_Lactation #

    Hi again Emily, YES I am indeed speaking retrospectively about a time some 30 to 35 years ago. I lived and practiced thru that time so I am trying to help others understand the mindset of many professionals back then. It WAS first reported to us that continuous EFM was advantageous to picking up potential problems early and I have NO doubt that there are studies showing how that was a factor in increasing the C/S rate. I am sure it did at my rural hospital. I am certainly not going to argue that one. Please remember that access to information in the late 70’s was a journal or an annual conference. We had no wealth of information or immediate access to new studies like today. I am attempting to describe the era, our thought processes and conflicts of that time. Do you have a reference that reflects your view ….”I always saw it as the other way around: the medical field trying to respond to the growing NCB movement, i.e. trying to keep women coming to the hospital.”…?
    I am not trying to be a historical reference… These stories are my understanding of how it all went down.
    I am very active now in implementing evidence-based practice. I always appreciate when I am afforded the opportunity to learn something may be able to be done better. I always attempt to achieve a balance with new technology, the science and the natural process of birth and breastfeeding. I”m happy for your input. Thank you 😉

    May 3, 2009
    • Oh yes, I know you are describing the mindset at the time. I find it particularly interesting to hear from women on both sides of the coin during that time. If I were to study for a doctorate, I might like to concentrate in either legal issues surrounding childbirth, or the history and development of the obstetric fields.

      I don’t have any specific reference about the medical field responding to the NCB movement, that was just my impression from the perspective of one looking back on history. I think it is interesting that you, as a health care provider, had a different perspective, especially considering you were actually there! It’s hard to judge motives and intentions by reading about it in books; it’s a whole other thing to hear it from one who was living it.

      I really have no ill will for the health care profession back in those days. As you said, access to information was limited, and of course, as all the technology was new, there were no real studies on the risks or benefits. I believe that doctors and nurses, for the most part, really believed they were doing their part to make childbirth healthier and happier for women, and were probably very confused why women wouldn’t want to avail themselves of all that lovely technology.

      Now, however, there is no excuse for ignorance. It seems to me that today, doctors are perpetuating a lot of the myths that were thought to be truths back in the day. I’m not sure if they do it on purpose to try to retain that sense of power and control, or if they ignore the latest evidence in favor of what the older generation considers to be “common knowledge,” or if they just can’t be bothered to learn the latest evidence.

      May 3, 2009
  4. Birth_Lactation #

    Emily I couldn’t agree more!! I think you have summed it up well in that last paragraph! 🙂 Unfortunately, I work with a lot of professionals with one or all of those ill attributes. As a matter of fact, I am thinking of eventually doing a story about how so many things are stuck in time even 35 yrs later…. Maybe someday. Go for that doctorate. You would do well on your dissertation!!

    May 3, 2009
  5. How did I miss this post?! I think this was when I was offline for a week and half.

    That last paragraph is a doozy. “Those professionals who just couldn’t relinquish control. They were learning more about the science of birth, of monitoring and couldn’t quite allow or see how the “natural” component could fit in.”

    That’s the schism that fascinates me and that is really the core reason for my blog and the side research I’m doing.

    May 28, 2009
    • Birth_Lactation #

      I do not KNOW how you missed it.. Aren’t you checking in daily?? Ha Ha– No- you were probably offline that week..don’t remember. I actually thought of you when I wrote it! The control issue is so sad isn’t it?? I continue to deal with it and will probably write more on it from time to time. I don’t remember if I thanked you for the the article find.. I got a question and found two ACOG committee statements that I posted in reply on the C/S 2nd twin post. May make a whole new post out of it actually. Thanks Jill- always a pleasure- Melissa

      May 29, 2009

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