I’ve got a small garden and a black thumb. Since last year I killed most of my plants by not watering them enough, I was determined this year not to neglect them. So I’ve been watering them frequently. The plants didn’t seem to be making the transition very well, so I thought I wasn’t watering them enough — it didn’t rain very much, about a month ago (but I now think the dew was abundant). So I was watering them more… but it seemed to help them less. So, I contemplated that maybe I was watering them too much, so determined to cut back on watering. And then we went into a rainy spell. Which drowned my plants. Sigh…
But that got me to thinking about birth — when there are interventions that can be used, is it too much, or not enough? I’m a natural birth advocate, so when I read some studies about when interventions are used, I read them with a jaundiced eye. My first thought typically is, “Ok, so what this study is saying is that this intervention is better than that intervention — but what about no interventions at all?” For instance, Henci Goer writes a critique of a study that concluded that early epidural doesn’t increase the C-section rate compared to late epidural. You can read the full critique because there are several points of interest; however, the most important point is that this study doesn’t really compare early epidurals to late epidurals, plus there is no true control group of women who did not get an epidural at all. Our current national C-section rate is about 30%. About 10% of women who planned to birth at home end up transferring to the hospital for all reasons (inducing or augmenting labor, pain relief, nonreassuring fetal heart-rate, etc.); not all of these women get C-sections. Home-birthing women are a self-selected group, and they are by definition low-risk, so this would account for some of the difference; but two out-of-hospital studies had a 4% C-section rate. Most women who participate in studies such as the above epidural study are low-risk (the typical study will be limited to full-term first-time moms pregnant with only one baby), although many women who choose to give birth at home have had previous vaginal births.
So, what I would like to see are well-designed studies that compare an intervention to no intervention — a truly natural birth compared to a medically-managed birth. The only problem is, most hospital births can’t be called “natural” in just about any way. Women do not “naturally” lie in bed on their backs with EFM belts across their bellies in labor. “Natural” is movement. Many women in hospitals are not allowed to eat or drink anything, but are forced to rely on IV fluids for hydration and sustenance. Although not all women want to eat or drink in labor (I didn’t in my first labor, but did in my second labor), it is not “natural” to deny them food or water if they want it. Have there been any studies that compared C-section rates of women who were allowed freedom of movement in the hospital versus those who were required to stay in bed? Or studies comparing women allowed to eat freely versus those who were restricted?
These two factors may seem insignificant, but they are not. Hunger is your body’s natural signal that you need nourishment, not just sugar-water. When I’m hungry, I get irritable and can’t think as well and don’t deal with things as well — many negatives are augmented. When I was in labor with my first baby, the midwife had me lie on my back once or twice in order to check my cervical dilation. Those contractions were the worst. At that point, “epidural” crossed my mind, but I blocked it out and replaced that thought with, “Now I know why women in hospitals get epidurals.” I could deal with the contractions when I was upright or on my side, but they were just that much worse when I was on my back. If I had to have contraction after contraction while lying on my back, I would have requested an epidural, too, and I was not yet to 4 cm dilated when she checked me. Yet the thought of requesting an epidural or any other pain relief (except counter-pressure on my back during a contraction) never went through my mind again. It’s a completely different experience.
So while a hospital may find that the majority of women require or benefit from this intervention or that intervention, I always wonder if they would have truly been helpful or necessary had they been at home. Just as I over-watered my plants when I should have decreased the water, I wonder if some doctors over-intervene when they would have better results had they used fewer interventions.