“This is a test of the emergency broadcast system. Had this been an actual emergency, you would have been instructed where to tune in your area for news and official information...This is only a test.”
Remember when you were a kid and your favorite show would suddenly, startlingly get interrupted by the highfrequency “beep”, followed by those unsettling words...? They always stopped me in my tracks, and despite their assurance that “this is only a test,” I still felt on alert, heart rate up a few notches, eyes glued to the set, bracing myself for that inevitable day when doom would surely strike...after all, why would the government spend years conditioning us to stop and pay attention if there were no real emergency on the horizon?
Our minds process information presented logically, but our bodies perceive safety, or danger, physically depending on the given situation. Reassuring words cannot halt our body’s physiological reaction to perceived danger. The resulting hormonal shifts and release of adrenaline and cortisol impact the health of our body systems and mental health, both short and long term.
For twenty five years, I have been a homebirth midwife. Of course, since the vast majority of people I meet aren’t familiar with the idea, I get a lot of questions. On countless occasions, I’ve repeated the same analogy, comparing laboring humans to laboring animals. Honestly, it never ceases to amaze me that EVERYONE knows that you can’t interrupt an animal giving birth, because, obviously, there will be irreparable harm, but NO ONE knows that humans require a safe, protected, uninterrupted environment to birth their babies. Once presented with the comparison, most people understand immediately. We all intuitively know that we need a calm, safe place to give birth, so that our hormonal system will function at an optimal level.
It’s not just about a mother’s experience of birth being more positive. Study after study has shown that giving birth while feeling protected and safe results in fewer complications and lower infant mortality. But I never really understood the physiological mechanism, the sequence of events that can impact the process, until I found out that MRI’s can increase back pain.
Hey, hold on a minute, I had herniated discs, I had an MRI, and I know I had pain before and after the procedure. How can an MRI make the pain worse? Well, it turns out that pain is created by our brains. The injury can be anywhere on our bodies, but our incredibly wise brains produce the pain as a signal to protect the injured area until it can heal. But if a patient is told that their MRI showed injury or damage, their brain decides that the area needs increased protection, and thus increases the pain level in the area. A study presented in the journal Spine (S pine: 1 5 August 2012 Volume 37 Issue 18 p 1617–1627) showed just that, and concluded that study subjects who had MRI’s for diagnostic purposes for low back pain had increased pain and disability after one year when compared with subjects who skipped the MRI. Herein lies the problem: most MRI’s in people over the age of twentyfive show wear and tear of life, with disc bulges and degeneration in varying degrees, but this does not necessarily correlate with resulting pain. There are thousands of people walking around painfree, who have no idea that their discs are bulging. But given the information, our brains will strive to protect the “injured area” and produce that protective pain, as it turns out, sometimes unnecessarily.
So what does all that have to do with moms, babies, and birthing? As I said before, the best possible environment in which to birth a human baby is in a peaceful, uninterrupted, protected space. Where that place happens to be is 100% up to the mother who is doing the birthing at the time. As a child, I attempted to ‘midwife’ my cats, creating what I thought was a nice, warm, quiet place for them to have their kittens, only to have them instead choose the clothes on my closet floor as the safest place to labor and birth. It simply has to be an individual choice. However, in the vast majority of birth settings in the US today, no effort is made to provide laboring moms with a safe, protected, uninterrupted, peaceful environment to bring their babies into the world.
This obvious oversight in maternity care is not without serious repercussions. The sad reality is that this lack of understanding of human physiology results in a much higher rate of complications, and accordingly, a higher infant mortality and morbidity rate. The US currently ranks an embarrassing 28th when compared with other developed nations when it comes to infant mortality.
The scenario repeats itself thousands of times each day in the United States...a laboring woman is admitted to the hospital, she is put in a hospital bed, set up with an IV, just in case, and is hooked up to a machine to monitor her baby’s heart rate and the strength of her contractions. The rooms are often chilly, brightly lit and industrial in decor. She is bombarded with questions about her health and personal information, and most of the time, she will have to endure a vaginal exam to determine her labor status. Aside from the fact that these rituals are of questionable evidence based value, the real harm lies in the inherent disregard of interrupting a laboring woman (mammal), compounded with the subtle, and not so subtle, anxiety producing atmosphere in which the hospital staff ‘prepares for the worst.’ The message created in such an environment, that birth is dangerous, is not lost on a laboring woman.
All of the normal hormonal processes are altered when, like the MRI patient, a woman’s brain is given so many reasons to believe that danger is inevitable, and her body responds by increasing her ‘protective’ pain level accordingly. The fear/pain cycle takes over, altering labor’s natural course, and many women choose, or are talked into, pain relieving drugs and epidurals as a result. These interventions also lead to an increased rate of complications in labor, and a much higher cesarean section rate than is physiologically necessary. Our bodies were designed to retreat to the safest, warmest possible place to give birth, and depriving laboring women of that opportunity disrupts the natural process.
Although I am a midwife who has mainly attended home births for many years, I am not suggesting that everyone should have their babies at home just because the atmosphere is naturally conducive to our instinctive inclinations. Generally speaking, moms who birth at home are aware of the need for retreating to a safe space. What I am advocating for is the idea that ALL laboring women, regardless of their chosen place of birth, be accorded the ‘luxury’ of creating the space that they require, as an individual, to feel safe, as uninterrupted as possible, and peaceful and protected during their labor and birth. I have always told potential clients that the safest place for them to give birth is where they f eel safe, whether that place is home, birthing center, or hospital. But the hospital model of birth has a responsibility to strive to meet the basic human needs of women in labor, and practice quiet, respectful, evidence based care.
No matter where or with whom a woman decides to birth her baby, her caregivers’ number one priority should be to help her to create the space she needs to birth in peace.
Ann Whitman, CPM, NHCM
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