Review: Babies Are Not Pizzas, They Are Born Not Delivered - Evidence Based Birth
Trigger Warning *Trauma, Sexual Assault, PTSD*
Over Thanksgiving I had the opportunity to dive into this amazing book "Babies Are Not Pizzas, They Are Born Not Delivered," by Dr. Rebecca Dekker Evidence Based Birth. Check out her website or podcast for more info! Reading birth non-fiction is a small obsession, this resource was not a let down! (No pun intended).
"What happens in birth stays with you the rest of your life. Those feelings never leave."(p.13) So many women carry with them the wounds of birth trauma, and never receive the validation or gain awareness that this is a possibility. "Birth trauma is defined as a birth event with actual or threatened serious injury or death or when the person giving birth feels they have been stripped of their dignity or treated inhumanely."(p.13) It is estimated to occur in 33%-45% of all U.S. and Australian births. This is significant. Harm can occur in a variety of ways, forced compliance being one in particular. Another is invalidation, this procedure/intervention/exam etc. is necessary to "keep your baby safe" is a common tactic. These subtle threats gaslight a birthing because of course no one is intentionally hoping to harm one's newborn. Of course you would do whatever is necessary, however slowing down, informed consent, and exercising your preferences are always condition available to you in birth. It isn't an either or situation.
Rebecca goes on to describe how survivors of sexual assault are at an especially high risk for PTSD after birth trauma. The goal here as a Doula, is to find coping skills that allow the survivor to feel empowered in her birth. This could mean visualization, guided meditation, gentle touch therapy, opting for less vaginal exams, opting for a less clinical environment if that is an additional trigger or vice versa, working with a trauma counselor to establish goals and reframing, providing a support system and many more strategies. It is important to note that in a review of 137 studies on birth satisfaction, researchers found that the factors that most influence birth satisfaction include:
1. Whether of not your expectations were met
2.Whether or not you felt involved in the decision-making
3.How you were treated by your care providers
I find this hugely comforting. Especially because a Doula can offer a significant boost in all of these aspects. It can be easy to dismiss this, after all a hospital brimming with residents, attendings, students, nurses, must have all the available latest knowledge at their disposal? Except it's important to remember that hospitals are institutions. Institutions keep the lights on through funding, insurance, and maintaining efficiency. These methods while ideally keep the patient's best care in mind, I hate to break it to you, just don't. There is risk, lawsuits, and of course shift change. So many variables going on behind the scenes. Doulas are immune from these external pressures. We operate in stealth mode, as independent keepers and guardians of the birthing person's autonomy. We don't make decisions for the birthing person, but we can be the gentle voice that humanizes the mother asking for an alternative, or requesting a comfort measure (like moving positions in labor), or simply ensuring the mother feels supported in her choices. Doulas are invaluable to the birthing person's experience because our success is her success.
After her own traumatic birth experience, Rebecca founded the initial seeds that would grow into the Evidence Based Birth network. Evidence based care is defined as using research to help inform medical decision-making, considering the health care worker's expertise and the patient's values, goals and preferences. It is a three-legged stool, made up of:
1. Research evidence
2.A provider who is trained in how to help you interpret evidence, and
3. Care that is tailored to your own values, goals and preferences (p.19)
This sounds great right? Most people probably assume this is the "standard of care" they will receive in a birth setting. The reality is, the majority of care is still based on long-standing tradition, doctor's opinion, as well as financial incentives/disincentives and fears of liability. Research is more of an afterthought rather than a foundation for current medical practice. Researchers have found that it takes on average, `5 to 20 years after something is proven in medical research before it becomes used routinely in hospitals. This time lapse is referred to as, the evidence-practice gap. (p.20). Rebecca breaks down specific examples such as eating and drinking while in labor and other practices. Another favorite of mine is the gestational diabetes test and pregnancy diet recommended to women, that's another topic for another book review! (stay tuned). Back on track, another example is the term "failure to progress". (p.47)
Data collected during the era of Twilight Sleep was used to set a standard called "Friedman's Curve" for how fast women should dilate during labor, leading countless women to have Cesareans for diagnosis of this faulty timeline. We now know that Dr. Friedman's Curve, introduced in the 1950s when women were sedated or unconscious during labor, cannot be applied to women of the 21st century. But, the diagnosis of "Failure to Progress" is still one of the MOST common reasons for preventable Cesareans today and it has been noted in medical textbooks as recently as 2010. (p.47) But it isn't just this outdated measurement of labor progression that haunts laboring women to this day...but a more pervasive cultural power hierarchy. The lack of consent.
Rebecca goes on to describe how Twilight Sleep, a very mechanical procedure where medical staff would just do things. Women were viewed as passive, dehumanized objects, and their role in the birth process was non-essential. The physician possesses absolute control over the patient, and one author, Dr. Judith Leavitt, referred to is as being, "the boss" in the delivery room. (p.47) This is troubling at the least, and a dangerous attitude considering the risk to the birthing person. If we are ever to elevate birth from a risk that must be mitigated, to something to control and dominate, into a joy that can be experienced and felt for the natural and transformative power it holds, how are we to do that with such power hierarchies to contend with? Medical birth trauma is a very real concern affecting birthing people and birth workers. I hope that by shedding some light on the subject, through Dr. Dekker's writings, that this will help others find a sense of validation and worthiness on their journey to achieve their most ideal birth experience.