My first birth was a standard hospital delivery. It was attended by the on-call doctor, a man I'd never met until my baby was practically spilling out of me. While it wasn't abysmal, it certainly wasn't what I thought the birth of my first child would be like. I was forced to labor on my back, like a lot of women, which felt unnatural to me and made my labor far more difficult to bear, let alone to be an active participant in. I was given an unnecessary episiotomy, so quickly I couldn't protest. I was covered in uncomfortable monitors that dug into my contracting belly and had hands shoved inside me during back labor which was by far, the worst pain of my entire life.
Lastly, I didn't see my real doctor, the woman I'd been meeting with every few weeks for nine months, until days after my baby was born. She stopped by the room for no longer than 60 seconds to press on my belly and tell me I was "good as new" and in a flash, she was gone, off to press on a dozen more bellies and deliver just as many babies before noon- that I understood. But overall, it was a highly impersonal, slightly degrading experience and one I had no plans of repeating in the future.
Unfortunately, this is not unlike a lot of women's experiences with hospital birth and when I talk to other women about theirs, it seems that I was actually one of the lucky ones. The truth is, we live in a culture where it is not uncommon for women to suffer birth trauma because of how their rights in childbirth were violated or how their bodies were manipulated. Rates of unnecessary interventions are sky high, as are the rates of women reporting feeling largely dissatisfied with their level of care during birth. Some say they were seriously wronged during labor or perhaps that they didn't feel cared for or even safe. Some women are even taking legal action after the events surrounding the birth of their babies.
After working hard to educate myself after what happened during my first birth, when I became pregnant with my second child, I sought out a drastically different option- a home birth attended by midwives. At the time, home birth wasn't exactly legal in my home state of Maryland (though legislation has recently passed to change that), but I felt it was my best and safest option. The closest birth center was about an hour away and given this was my second birth, I figured it might move more quickly and I wasn't thrilled about the idea of laboring in a car. I knew without question that I didn't want to be back in a hospital, forced to labor in a way that my body objected to and be in a situation where I was at a huge risk of having major abdominal surgery (about 1 in 3 hospital births result in c-section, high above the recommended ranges).
After researching home birth success rates, I felt safe and informed in my decision. Still, I knew having my baby at home would give me some extra hoops to jump through, like having to fight to get my baby's birth certificate (after about 17 phone calls and two home visits from a social worker and we were good to go), not to mention the social stigma of having your baby at home and finding a pediatrician who didn't treat me like a negligent mother. But I was confident home birth was the right option for me. I'm glad to say that it turned out to be a wonderful experience and one I would do over in a heartbeat, mainly because the midwife care I received was so personal, nurturing and took my feelings about birth into consideration.
It goes without saying that my two birth experiences were drastically different and while I was thrilled with the outcome of my second birth, many women don't get to experience that kind of liberation with subsequent births. This is especially true for women who have had a cesarean and are hoping to have a vaginal birth with subsequent deliveries (VBAC). In many states, women seeking a VBAC currently have very few options. Some birth centers refuse them and many doctors will tell them they can "try", but do little to support their choice. I know many women who have sought out a home birth simply because they couldn't find a doctor or a practice that was supportive of helping them achieve a VBAC.
Every year, more women are choosing out of hospital birth because of the high rates of unnecessary surgery and interventions taking place in hospitals. In fact, even obstetricians themselves are choosing home birth, as is demonstrated in the documentary entitled Why Not Home? While I'm a huge advocate of birthing at home, I don't believe this is the right choice for every woman. Simply put, women need more options when it comes to how and where to birth their babies. Some women have high risk pregnancies and other women simply wouldn't feel safe giving birth outside of a hospital environment. It seems there needs to be a form of care that can support women who want a happy medium- care that is personal, evidence based and overseen by qualified professionals, whether that be a doctor, a midwife or both.
Fortunately, in some practices, this kind of care is now taking shape. In the new film, The Mama Sherpas, created by executive producers Ricki Lake and Abby Epstein (The Business of Being Born) and DC-based director, Brigid Maher, we are introduced to the idea of "collaborative care" which is where doctors and midwives work together to manage women's health during pregnancy and delivery. In a country where these two professionals are often on opposite ends of the spectrum in regard to practices and policies surrounding delivery, this idea is pretty empowering.
Women can now reap the benefits of what both professionals offer throughout pregnancy, labor and delivery. The result, as we see in the film, is care that is evidence-based with lower rates of interventions (such as cesareans) and maybe most importantly, women feeling respected and supported during such an important time in their lives. With women experiencing "traumatic births" or even suffering PTSD for years to come as a result of their delivery, I'd say it's about time for this model of care to come to the forefront of the birthing business.
The film looks at one practice in Washington DC, GW Midwifery, which is embracing this model of care and working hard to support VBAC women. The film opens with the delivery of the thousandth GW Midwifery baby (though that number has now doubled), a milestone which the practice is shown celebrating. You can quickly see the outpouring of emotions as one mother thanks the midwives "on behalf of VBAC mamas" and for giving her "a real shot" at having her baby the way she felt safest. With a 93% VBAC success rate, it's shocking more hospitals aren't already embracing this model of care, but hopefully, practices like this one will soon be an inspiration to many.
The flimmaker, Brigid Maher, also had a VBAC in a hospital with midwives when she gave birth to her daughter, Josie. Maher claims the experience of achieving the birth, a birth which so few women are given the opportunity, was so inspirational to her she says (in the film) "about ten minutes after her birth, I blurted out that I had to make a documentary about nurse midwives." Maher says she "couldn't imagine" trying to take care of a newborn and her older child during what she expected would be another rough recovery if she were to go under the knife again.
In many hospitals, women still feel that their care is limiting, impersonal and lacking evidence-based policies. While the risk for VBACs and the risk for having multiple cesareans is about the same, women are often railroaded into having multiple c-sections without cause. For lack of better options, as a culture, we've come to accept the care we've been given. With this form of collaborative care now in the works, hopefully, a new trend is on it's way in.
Midwives and doctors working together seems like a welcomed change that will greatly help to support families in pregnancy and birth. And on a personal note, as someone who experienced two very different models of care during my births, I got chills watching the doctors and midwives collaborate to give moms the best of both worlds. Collaborative care could be the future of childbirth and if so, it's a great future for mothers and babies.