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We cannot live in a world that is not our own, in a world that is interpreted for us by others. An interpreted world is not a home. Part of the terror is to take back our own listening, to use our own voice, to see our own light. Hildegard von Bingen
We cannot live in a world that is not our own, in a world that is interpreted for us by others. An interpreted world is not a home. Part of the terror is to take back our own listening, to use our own voice, to see our own light.
Hildegard von Bingen
At the turn of the year and the beginning of a new astrological age, I find myself once again thinking about the future of life, humanity and of course, the future of birth. So today, to pick up where we left off near the end of 2020, I thought I would share my thoughts about the future of birth. So here we go to contemplate about the future and the choices that will take us there.
As we sit at the beginning of 2021 and it feels a bit like the year of 2020 never happened, all the stuff happened that we will always associate with 2020, new habits we have formed, new views on life and health, new perspectives about things we won't take for granted like toilet paper and parties, but there is also this feeling that we missed a year and I think some of that is because so much felt out of our control, so much of our lives in 2020 became about being told what was allowed and not allowed, while the focus was less on education and understanding and more about fear and compliance.
In fact, it became so interesting as a birth professional to see how much the events of 2020 paralleled the world of birth in the system, where much of the "recommendations" and "precautions" are less about the individual wellbeing, but more about what we think we know about public health and safety based on a limited amount of information.
Now I don't want to spend time here on the covid virus because that is not my area of expertise and what I understand is based on my general understanding of the immune system and some undergrad coursework I did at the University of Washington when I thought I would go on to study public health and epidemiology, but it turns out that field is much too political for my interest. But, I do know that we don't know very much about this virus still after only 12 months, the research is still in the baby phases as far as research goes, we still don't know the whole picture of how this virus works or how to treat it for a large majority of those who experience symptoms.
I think it's important to keep that in mind because often we hear politicians and government agencies making decisions and policies based on science and research, but we don't actually know if the decisions they are making on our behalf are accurate, because the research and science are just too little and too soon and I expect that years from now, we will know so much more - we will know where we were right and where we were wrong. They say hindsight is 2020, and that phrase is going to only have so much more meaning when we're not in 2020 anymore. Just one more oddity of the year.
So back to birth, because that's really why we're all here! Now the reason I brought up covid is, well for a couple reasons, as I mentioned already, the whole time this has been going on, I have been really curious about how much it parallels what we see in the realm of birth. And also, I have been thinking about the future of everything, as I am sure you have too, especially if you have kids or about to become a parent for the first time, and on the cusp of the year changing, as I am recording this in the final weeks of 2020.
The reason I see the events of 2020 paralleling the realm of birth is that inside the birth system, and I am not only talking about only within hospitals here, this can be equally present in birth centers and even among homebirth midwives in many areas today - birth inside the system is based on very little research, because research in pregnancy and birth is often not ethical, and it's complicated because there are just so many factors and unknowns in birth and so often there are many other people and influences over a woman's birth, plus it's not a medical event and, there is very little money in research around birth. If we research certain interventions and find they are not supportive or improving outcomes, which has been done in several areas by the way, but the research is largely ignored, because no one makes money off of doing less interventions in birth. For example, we know that continuous fetal heart monitoring does not improve outcomes for babies or moms, but we still do it so much both in hospitals and now even in birth centers as wireless, continuous fetal monitoring is being offered as an option in more and more birth centers.
And while it has never proven to improve birth outcomes, we know that continuous fetal heart monitoring does lead to a greater risk of high profile interventions like vacuum delivery and c-sections. This is because the research is small scale and mostly based on observation, the numbers clearly indicate that outcomes haven't changed despite the use of continuous monitoring for decades, and yet it is still in use in over 60% of birth, and now that may even rise since many birth centers are using it today.
So this is where I feel that we have to be careful relying on science to make decisions, because the practice of using fetal heart monitors is based on a scientific idea that if we can monitor a fetal heart, we can prevent a negative outcome, but the science hasn't supported the outcome, and yet the practice is still in use and families are still told that using this technology is the best chance of having a safe birth, which is not actually true. Even if we apply the supposed gold standard of evidence based medicine, and if you don't know how I feel about that, you can read this article where I talk about research and evidence based medicine and how it applies to birth, but even if we apply this method, it doesn't fit the model. Remember true evidence based medicine is based on 3 aspects: the public health information that has been gathered from the broad population, your care provider's clinical experience, and your choice to accept or decline the intervention.
So if we look at the first aspect, the public health data, we haven't improved outcomes for moms or babies with continuous fetal heart rate monitoring, so it fails. Your caregiver may feel strongly that they have seen continuous monitoring save a baby's life, and if they've attended enough births, it may be true that they have seen a birth where the fetal heart rate monitoring was the clue to a problem, but most often there are signs before this point if you're paying attention and at this time, even the American College of Obstetrics and Gynecology (ACOG) acknowledges that continuous fetal heart monitoring has increased rates of unnecessary interventions like vacuum deliveries and c-sections without improving overall outcomes. And this kind of situation is where it's clear that relying on external information impacts pregnancy and birth and mothers and newborns.
In part, this reliance is a problem because when it comes to this type of technology the error rate is very high for many reasons, for instance one simple, and often overlooked reason is because babies move, they descend deeper and deeper into the pelvis and the monitor loses track of the baby, and even worse, it can pick up the elevated heart rate of a laboring mom, which sounds like a deceleration of the baby's heart rate, and this starts the fear and intervention cascade. Now most of the moms I work with aren't in an environment where they use monitoring like this, so they don't see this type of scenario, but I do teach them the basics of monitoring just in case they find themselves needing a transfer and having to advocate for themselves in a hospital environment where this can spiral very quickly. So I think it's important to have an understanding of the technology out there. Also, because the third aspect of evidence based medicine is if you even want this intervention at the outset, of course as I covered in the earlier article, this aspect of evidence based medicine is rarely discussed in practice for every intervention, especially if your caregiver sees an intervention not as an intervention but as a routine procedure, remember the cognitive bias I wrote about way back from February 2020, when I covered communication.
So that's the past and the present, now let's get to thinking about the future of birth, where are we going? Right now, we are so programmed to think that science and research and medicine know what is right and wrong for us, so they can tell us what is allowed or not allowed in birth, and this will be the experience so often for families choosing to birth in the system where there are policies and regulation in place. Because this is normal and it's accepted as routine today, it can be hard to imagine how to give birth any other way. So what does this mean for the future of birth? Can we as a species forget how to have a natural birth without direction from an expert?
As a species we have become dependent upon external help to give birth, upon someone else directing us, and that relationship really begins during prenatal care, actually, it probably begins when we start going to the doctor or the pediatrician in the first place for routine visits, essentially, we are trained for this, when our provider tells us what we need to do, what we need to know, what we need to be tested and screened for to tell us whether our pregnancy is healthy and to tell us if we are capable of giving birth in the paradigm that has been created for us.
Now I do believe that medicine is an important part of life, and doctors are needed for their expertise when we are actually ill to a level that we choose to seek help. But the dynamic we have set up for ourselves, the way we disconnected from our own knowing and have become so dependent on external information and validation, this is where I feel the need to raise a concern.
Because what kind of future does that set up if you are dependent upon what someone outside of yourself tells you about your own body or your own pregnancy or what you are allowed to do with your body?
This is a conversation that has come up with my cohort of birth professionals because we are seeing as we move forward in time, more of the women giving birth will themselves have been born via induction or by c-section in a time when these interventions were on the rise, and we wonder what kind of imprint that leaves on a woman's body, does experiencing a managed birth or a surgical birth affect the inborn knowledge of natural birth of that generation?
If a woman's first experience of birth, meaning her own birth, was birth by force, what does that tell her nervous system about normal birth? If her mother birthed her in a state of pain and fear, what did that tell her newborn nervous system about the safety of birth?
The system we are living in right now is one of dependency and one that is changing the definition of normal birth in exchange for perceived safety, much like 2020 really, and we don't actually know if the efforts we are undertaking, all the interventions and management in birth now, are these approaches really making birth safer?
One could shout that yes, of course, fetal mortality has dropped significantly in the last 100 years since we have brought birth into hospitals, since we introduced physician managed care of birth, since we started directed pushing, created the technology to monitor every second of birth, since we started using antibiotics.
But, just like with infectious disease, we cannot say the improvements are strictly because of hospital interventions. Much of the improvements to health come from infrastructure improvements - homes having indoor plumbing and running water, clean energy for heat, understanding cleanliness, refrigerators so food does not spoil so easily. Yes, medicine is part of our overall advancement, antibiotics have a time and place, even surgical birth has a role in saving human life, but we cannot say that improvements to birth come from within the managed system most of the time, and I wonder at what point we will question if we've gone too far or if there's a point we can no longer give birth naturally or without the aid of medicine, and maybe birth will become a true medical event.
And maybe there will be a reason and a truth for that, maybe the evolution of humans is dictating that we will be born via c-section for a reason. I can't say I feel that to be true right now, but we evolve and things change, so maybe that is the path at some point in our future, our far off future.
So the future of birth, where is it really going? As much as I see the system becoming more about creating dependency, I am also seeing more women questioning the system because of that dynamic, and I am especially curious about the women who are questioning the midwifery care they are receiving. Questioning whether their birth is really under their own power when they are met with so many restrictions around if they will qualify to give birth with their midwife, and now with more and more interventions being offered in birth centers and homebirths, women are asking why their midwives are losing faith in birth, why they feel so much need to manage and control birth, and why the care is presented one way, but delivered in another...why the incongruency in words and actions.
But some women see through it and are looking for other options, and I see you out there, I hear you questioning and I see you searching for something different, something that you know is still alive in our birth culture, and I want you to know that you can find it if you look for the wise women who hold the space for a new future of birth, a future that puts birth back where it belongs, in your hands, in your heart, in your body, in your control. A future that sees women and babies as strong, as powerful, that sees how important it is that powerful women are born out of the birth process, that sees that the voices of these powerful women is needed to heal the entire world right now.
Every birth is really two births, the birth of a new life and the reincarnation of a powerful woman, a mother, and we need that power and those voices today in every aspect of life. I see this as how we change the trajectory of the path we are on today for not only birth, but even to maintain civilization, to bring harmony to the world that has become very tilted toward the male oriented, high speed, loud and proud, yang dominant energy, and we need the gentle, but firm, the contemplative and just, the yin energetic to balance the harmonics of the world we are in right now.
By taking away women's voices in birth, the most transformative time in a woman's life, when we are silenced under the authority of the expert in the room, under the external knowledge that stifles the inner intuitive knowing, this has been the major disruption to the birth process. When we are afraid to go to the inner depths of birth, to those higher levels of consciousness where instinct and intuition can support the birth process, when instead we want to be here in this everyday realm, that means a woman has to be present with the pain, to be present with every contraction, every centimeter of dilation, with the stretch of every joint and bone, and this creates dependency.
Instead, I hear more women looking for the way back to a more instinctual and intuitive birth, waking that inner knowing that knows how to birth, but the instinct and intuition are untrained for so many women today. That means we as a society, as women, we need to re-educate ourselves about the normalcy of birth and our bodies and our energies, about our physiology, about the physiology of birth, and reawaken and train our intuition so it's there to guide your birth experience.
This will take time, but if we start now and we teach our daughters, and they teach their daughters, birth can belong to women and the voices of powerful yin energy will rise to balance the harmonics of the world again.
Yes the world is changing, yes technology will be more and more incorporated into our lives as we continue into the future, and few of us would give it up, after all, this blog wouldn't exist if it weren't for computers and iPhones and internet, but we can use technology with reason, we can use it to inform us when needed, we can use it to responsibly save lives, and we can balance it with our inner knowing. We can and should unplug regularly and check in with our inner selves, to find our intuition before we forget how. This could be the future of birth, and this could just be the future, if we choose to accept the work of our re-education as a society.
If this resonates with you I would love to meet you and continue this conversation! Send me an email at info @ naturalbirthcompass.com or find me on social media @naturalbirthcompass. I look forward to continuing this conversation with you and creating a beautiful vision for our future. Until then I am wishing you a peaceful new year, a beautiful and fulfilling outlook on the future, and a wonderful journey to birth.
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