In the U.S., women learn about birth from television dramas and celebrity magazines and the medical system steps in to manage pregnancy and birth on computer screens, like any other disease. But, pregnancy is not a disease. Babies are not tumors to be removed. And, birth alternatives do exist for those persistent enough to find them.
In the U.S., women learn about birth from television dramas and celebrity magazines. Thousands of years of wisdom, passed from midwife, to mother, to daughter, have all but been lost. The medical system steps in to manage pregnancy and birth on computer screens, like any other disease. But, pregnancy is not a disease. Babies are not tumors to be removed. And, birth alternatives do exist for those persistent enough to find them.
Home, birth center, or hospital?
In Michigan, five percent of women experienced an intended home birth in 2015. One percent delivered at a birth center. The rest chose hospital birth. Those considering home birth often dismiss the option as being unsafe. However, a 2014 study
confirmed that, with an experienced midwife attending, home births are safe births.
Adela Nieves, a naturopathic health practitioner in Detroit, chose a homebirth when, at age 43, she gave birth to her first child, Nona. She had the help of two midwives, a doula, and her husband. “For me there was no other choice. I wanted it to be in the safety, peace, and calm of my own home,” she says. “Also in Caribbean Latin American cultures, we call giving birth “giving light.” For me, bringing light into the world was very sacred.”
Nieves notes that birthing at home made the transition to becoming a parent and nursing mother seamless. “I didn’t have to leave the house, re-acclimate, and bring a new child back into it,” she says. “We can trust the body to do what it has done forever. That can happen in many ways. Homebirth is a great option for one of those ways.”
Kelsey Hakeem’s first son, Cairo, was born by C-section in the hospital. She had wanted a homebirth but her insurance would not cover it. The C-section cost her much more than the homebirth would have. With her second son, Mosiah, she chose midwife Yolanda Visser of Birth Song Midwifery Services
, to attend her VBAC—vaginal birth after cesarean—at home. “That’s where I felt safest. I was confident that my body knew what to do,” she says. “It was so great. Very peaceful. It was so wonderful to be in my own bed, go to sleep and relax with the baby. It felt like a victory.”
Many mothers find giving birth at a home environment more calming than in hospitals.
Hakeem also appreciated her hour-long prenatal visits with Visser and Birth Song’s library. “She gave me so much more information to prepare myself for the birth. Cairo was posterior. Yolanda gave me information on how to turn the baby’s position before birth and how to handle it during labor,” she says. “My first picture of Cairo, he is alone on a table screaming. In Mosiah’s, he is swaddled in my arms.”
Visser has attended home births for more than 36 years and guided more than 3,000 babies into the world. “I choose to support women who want to give birth in the home setting. I provide education, dignity, and respect. I seek to empower women as they walk through this,” she says.
During prenatal visits, Visser spends forty-five minutes to an hour with clients, talking about diet, family, personal concerns, and fears. “We look at what the body is telling us, how the woman is feeling, and eating,” she says. “Depending on where the woman is in her pregnancy, we supplement with education, diet, and counseling.”
Visser believes birthing at home gives both mother and baby a “home-court” advantage that fosters mother-baby bonding. “Bonding is number one. You never want to separate the baby and mom at birth unless warranted. Baby goes right up to that mom’s chest,” Visser says. “Because the babies aren’t drugged up, they do all the primal cuing that they need to do.”
Another of Visser’s clients, Sarah Scott, delivered both of her daughters at home. “All of the women in my family had been born at home. Back in the day, that’s just what you did,” she says. “I know the smells of my home, where the bed is, the toilet and how it feels to sit on it. There were no transitions. Admitting. Paperwork. I wanted things to be comfy and familiar for the babies when they came out.”
Scott shares that being home helped her to stay calm and focused. “I can get pretty high strung,” she says. “Having those good birth experiences helped keep me calm and pass that on to my children. It’s not that I don’t think you can do that in a hospital, but for me, it was beneficial.”
She also appreciated the home remedies that Visser and her network of holistic practitioners shared. One, a lactation consultant, told her to put a cabbage leaf in her bra to relieve painful engorgement when her milk came in. It worked. “I’m still surprised when people are surprised to hear about home birth,” says Scott says. “Of course there’s a reason for hospitals and medicine. But, unless your house has a sink hole in it and is falling down, there’s no reason why it wouldn’t be safe.”
Birth center: The Birth House
A California native and midwife’s daughter, midwife Sara Badger, of Simply Born Midwifery Services
, was disappointed to find no birth centers in Grand Rapids when she moved here. After a first endeavor on Cherry Street was shut down due to zoning issues, she opened The Birth House
in October 2016, one of two birth centers now operating in Michigan. “Some people are not ready for a home birth. Others want to be closer to a hospital,” she says. “It’s like home. Postpartum, we’re not coming in every 15 minutes to wake you up. Everyone stays for 24 hours. We make sure they are stable.”
Midwives routinely transport laboring women to a hospital whenever the mother’s or baby’s vitals fall outside of the normal range. None of the 53 women giving birth at The Birth House had to transport. If they had, Spectrum hospital is nine minutes away. Badger has a good relationship with doctors there and great respect for its obstetric nursing staff. During transports, she goes along to provide support throughout labor and birth.
Alternatives in hospital
A former Bradley Method childbirth educator and doula, Dr. Tami Michele, DO, sits on the State of Michigan American College of Obstetrics and Gynecology
(ACOG) Advisory Commission. She is the only OB-GYN appointed by the governor on the Michigan Board of Licensed Midwifery
and serves on the Alliance for Innovation on Maternal Health
for Michigan hospitals. She practices at Spectrum Health Gerber Memorial Hospital in Fremont, which runs its obstetrical unit more like a birth center (with surgical services when cesarean delivery is necessary). “Being a community hospital out in the country, we have to put a lot of emphasis on safety and obstetrical emergencies. We do a really good job with that,” she says.
“However, we follow more of a midwifery model of care. We individualize care to the needs of the woman. Every woman gets a birth plan. This gives the low-risk woman who wants no interventions an opportunity to have a natural birth, and the woman who desires pain management the opportunity to ask questions.”
The birth plan also helps women be aware of risks associated with interventions. For example, an epidural involves catheters inserted in the back and urethra, a blood pressure cuff on the arm, an oxygen monitor on the finger, and an IV. All these limit movement, which may slow labor. Also, the epidural itself may slow labor to the point that Pitocin may be required to stimulate contractions. Pitocin has its own subset of risk factors, including placental problems, ruptured uterus, or fetal distress that could result in cesarean section. "I like my patients to be fully informed and participate in decision-making," says Michele.
The Gerber staff supports women with holistic comfort measures such as movement, letting them eat and drink, using a birth ball
or rocking chairs, walking, position changes, aromatherapy, and water; each room has a jetted tub. “We approach pain control on a stepwise method, starting with [the] easiest things. We encourage comfort measures and use the birth plan to give women ideas so they can have an awareness,” Michele says. “We give them plenty of time for each stage of labor as long as mom and baby doing fine and there are no medical complications.”
Warm bath water and jetted tubs can help ease labor pains.
Gerber’s 11 percent Cesarean rate for first time mothers is drastically lower than the 32 percent U.S. rate for all births
(2015). “We do everything we can to avoid that first cesarean for women, unless medically indicated,” says Michele. “And, we got national recognition on our low episiotomy rate, 3.2 percent.”
Episiotomy, cutting the perineum to enlarge the birth canal, can damage pelvic floor muscles and result in incontinence and pain during intercourse. The episiotomy rate in the U.S. is 11.2 percent
(2015). In the 80s, US rates were above 60 percent. As women became aware of the procedure’s risks and began questioning its routine use, doctors listened and rates have come down.
Michele also counsels expectant mothers to eat a well-balanced diet that includes fresh fruits, vegetables, and 80 to 100 grams of protein every day. Gerber hospital childbirth educator, Samantha Kauffman, RN, facilitates group prenatal care in addition to individual prenatal appointments. Women and their partners meet for ten, two-hour small-group sessions for educational, social, and emotional support.
Because emotional support during labor is vital, Gerber welcomes doulas. “I’d like every woman to have a doula,” says Michele. “A doula can meet the psychological and emotional needs that many physicians or some partners cannot. When a doula attends a woman’s birth, C-section rates are lower and breastfeeding rates are higher.”
At the 2011 Home Birth Summit in Warrenton, Virginia, Michele helped write transfer guidelines now used nationally for home birth women with medical issues requiring them to finish their births in a hospital. She recently attended a meeting at Spectrum‘s Butterworth campus where those guidelines were being drafted into policy. “I love to create change in hospitals that benefits mothers and babies.”
A recent study
found that when a doula provides women continuous labor support, Pitocin use drops by 31 percent, C-sections by 28 percent, and pain medications by nine percent — and newborns are 14 percent less likely to go to a special care nursery.
In addition to attending the birth, doula Kelly O’Brien Pahman, St. Brigids Holistic Labor Support
, offers prenatal practice sessions, naturopathic and nutritional supports, and cranial sacral therapy. She likens birth to running a marathon. If the runner doesn’t prepare, someone else may have to carry them across the finish line. Her clients include homebirth moms who want no interventions and high-risk moms planning medicated hospital births. “Having a doula decreases interventions, epidurals and c-section, and shortens labor, on average, by four hours,” she says.
St. Brigids also offers placental encapsulation, i.e., drying the placenta for use as a capsulized nutritional supplement. “It improves mood and helps balance hormones,” says Pahman.
Teach your parents well
No matter where a woman decides to give birth, becoming an active, informed participant can improve outcomes. The roots of today’s U.S. obstetrical practices are based in a male-centered paradigm developed in 18th century England when male-midwives began to replace traditional female midwives, according to the Journal of the Royal Society of Medicine, "General practitioners and obstetrics: a brief history."
The nomenclature was replaced by the term “obstetrician” in the early 19th century, though most births remained in the home until the early 20th.
For their own convenience, these fellows had women lay still on their backs during birth, even though this position slowed labor, reduced oxygen to baby, and increased labor pain. To deal with the pain, a number of medications were introduced. Early medications knocked the woman out completely, hence the increase of C-section and forceps deliveries. By the mid-twentieth century, most U.S. women had ceased giving birth while men, for the most part, delivered the babies – usually with a swift slap on the butt to induce the drugged infant to breathe.
As decades advanced, so have obstetrical practices. However, many women have yet to reclaim their power in this natural function of the female body. “Birth in this country has become a fear-based event. Women used to be raised culturally in communities with birth being a communal, social event. Women helped each other have babies as part of everyday life. Now, your mom lives out of state, So, you have to learn about birth outside of your upbringing,” says Visser. “Childbirth classes can provide women with the tools to be an active participant. Hypnobirthing offers a diversity of tools for birth because everyone has to walk through it differently.”
Hospitals offer a variety of helpful childbirth classes. Some of these are based in the LaMaze method, which provides women tools to distract themselves from labor rather than tune into and work with it, like Bradley Method and HypnoBirthing. While these provide good information and support, taking classes independently from the hospital, watching YouTube homebirth or natural birth videos, and reading a books on childbirth from outside the mainstream can provide a broader perspective.
A program of five, two-and-a-half hour classes, HypnoBirthing®
teaches breathing, relaxation, visualization, meditation, nutrition, and positive body toning, enabling women to dismiss the fear-based misinformation that is propagated by media and childbirth horror stories. This fear causes tension that interferes with the natural birth process, resulting in longer, more painful labors and unnecessary interventions.
Raquel Knack, AAHCC
, a Bradley Method childbirth educator, explains. “Normally, when we experience pain that means something bad has happened to our bodies, a broken bone, a sprained muscle. In birth, that pain is part of the natural process. If you don’t know exactly what’s happening, it creates fear and stress,” she says. “Education gives us confidence that what we are going through is normal. In addition, it equips us and our partner to deal with that discomfort in a natural way without medications.”
Developed by Dr. Robert Bradley in 1947, Bradley Method Childbirth
classes encompass twelve weeks of instruction covering nutrition, breathing and relaxation techniques, exercise, positive communication, and coaching. Knack used the method during all three of her pregnancies. Her children are 21, 18, and four years of age. “I’m striving for my couples to have a positive, natural birth,” she says. “Women are being traumatized. I’m equipping them to handle birth naturally and explain the risks and benefits of procedures being offered.”
For example, inducing labor raises risks for epidurals and pain medications, which in turn raises risks for C-sections or sleepy newborns who may be reluctant to breathe on their own or latch onto their mother’s breast. Electronic monitors and IVs may hinder a woman from moving, walking, and changing positions, measures that can speed labor and reduce pain. Artificially rupturing the amniotic sack to speed labor takes away the fluid cushion between the baby’s hard head and mother’s pelvis, creating more intense pain, a need for pain medication, and increased risk of fetal distress.
Knack explains how partners can apply pressure to help ease the pressure of hip expansion during birth.
Knack sees birth as a natural process akin to swimming. If a person jumps into the middle of a lake without ever having a swim lesson, they will most likely panic and perhaps even drown. When the culture quit looking to mothers and grandmothers for childbirth wisdom, birthing women began to feel that same panic. Childbirth education fills the void so that women can tune into their bodies as they give birth as nature intended. “If we have consistent lessons every week where we are learning exactly what to do with our bodies, we will be able to swim the whole distance and feel confident.”
Swim on, powerful mamas, swim on.
This article is part of Michigan Nightlight, a series of stories about the programs and people that positively impact the lives of Michigan kids. It is made possible with funding from the W.K. Kellogg Foundation. Read more in the series here.
A working writer since 1992, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She also writes poetry and has a book in the works. She taught Bradley Method Childbirth Classes from 1984 through 1992. Stelle has five children, four sons born in hospital and, at age 40, a daughter born at home. She has written a zine about pregnancy and birth, “Build a Better Baby.” You can contact Stelle at firstname.lastname@example.org or via her website, www.constellations.biz.
Photography by Kristina Bird, Bird + Bird Studio.