UNIVERSIDAD Y EDUCACIÓN EN EMPRENDIMIENTO…

A great many damning things have been written lately about mechanization of birth, and with good reason. The transformation of what should be a supremely human moment into a celebration of medical technology is demeaning and, in many cases, self-defeating. Recent studies and statistical analyses leave no doubt about that. But to my mind, one of the most devastating criticisms of the way we deliver children now is Dr. Michelle Harrison’s stark account of a birth she witnessed one night as a house physician in a small, suburban New Jersey hospital.

That the delivery room happened to be in New Jersey is incidental. It could just easily have been in any other American hospital―or French, German, English, Canadian, or Italian one―and that’s what makes Dr Harrison’s account so compelling.

“in the delivery room” she wrote, “the patient...was doing well when arrived, mildly pushing, groaning, but not screaming . . . She had already successfully labored many hours alone and I thought she would enjoy the rest . . . I gowned, gloved, [then] checked her. She was fully dilated and would deliver quickly. I draped her . . . then, the anestheAst arrived―a young man, arrogant―and seated himself at her head. He placed a mask over her face and told her to breathe deeply. He reassured her it was almost over. She had only two or three contractions to go. I asked him what his giving to her. He ignored my question . . . minutes later he decided to answer, but I couldn’t hear what he mumbled. It didn’t matter, though, because at the moment the obstetrician arrived. The anesthetist deepened her sleep to await the scrubbing and gowning of the OB . . . The OB stepped in, ignoring my presence. He and anesthetist began speaking to another. The patient is now choking on the tubes in her throat. Her labor had stopped; the table had been tilted forward so the OB could look down at the spreading lips. Then, they spoke with contempt. The anesthetist was saying angrily that woman was gagging. The OB that she had stopped being any help to them―she wasn’t pushing, her uterus wasn’t contracting. Forceps were unwrapped, applied, and with deepened anesthesia the infant was lifted up and out of his mother’s womb by the iron clamps about his head. He was blue and listless, but soon recovered with oxygen and some slapping.

“The obstetricians and the anesthetist whet on talking while the patient was sewn up. They spoke of partners, of Puerto Rico, of vacations, weather, etc. The event of birth was lost to . . . standard male locker room talk.”

Obviously this is not a desirable way to bring a child into the world or to treat an adult woman. Modern obstetrics can and must do better. The revolution in prenatal psychology has put us within grasp of a new birthright for our children―one that can make an immense difference to them, to us their parents, and, ultimately, to society. We have the knowledge, we have the understanding.

We only need to apply them.

Since everything a women thinks, feels, says and hopes influences her unborn child, the kind of prenatal care she receives and the delivery alternatives she is offered should begin reflecting that fact. I am not suggesting that there is one best kind of birth; what works wonderfully for one woman may not work at all for another. But the various alternatives offered to an expectant mother should, without exception, be humane, effective, safe, meaningful, and appropriate. Birth is a celebration of life and hope, not a pathological disease state. Therefore, modern obstetricians must return to basics―to “baby catching”, not surgery; “to treating pregnant mothers as persons not “patients” it should allow a women and her family her voice in all decisions concerning labor and delivery. To ignore an expectant mother’s wishes and desires, as so often happens, is unconscionable. She has earned the emotional triumphs of pregnancy and she has every right to enjoy that vital, integral part of her womanhood. An obstetrician has no business denying it to her by playing God.

As Dr. Harrison’s story makes disturbingly clear, however, many obstetricians are unwilling to share the responsibility of childbirth with the mother. They were taught in medical school that birth is largely an engineering problem, and they seem determined―no matter what their patient’s wishes or what new research show―to continue treating it that way. Fortunately, there are some exceptions, and while still not large, their numbers and growing. So too are the number of new family centered approached and programs, which can help deepen and enrich the meaning of pregnancy and birth. However no technique―no matter what its adherents may say―is suitable for everyone. An obstetricians, friend and family can provide advice and guidance in choosing, but in the final analysis the decisions are the parents alone to make. Selecting among the various alternatives not only brings them peace of mind, but it can provide the kind of reassurance that benefits both them and their child.

This is not to say that their still won’t be occasional twinges of anxiety. Even the best prenatal program available will not silence all doubts; these are a normal part

of every pregnancy and a woman would not be human if she did not have a few.

But fears about stretch marks, figure or how she will stand up to the pain of labor can be allayed through discussion with an obstetricians, midwife, friends, or prenatal counselor. Knowing that a concern is universally shared brings a measured or relief in itself. So does familiarity: A labor room will not look nearly as intimidating or frightening if it has been visited beforehand, and neither will the doctors and nurses on the obstetrical floor if one has had the opportunity to meet them before the big day.

A sense of perspecAve also helps―particularly when it comes to pregnancy’s effect on the body. As a mother of four, English prenatal counselor and anthropologist Sheila Kitzinger knows something about this subject first hand. Even so, she is continually amazed by the results each time she ask her prenatal pupils to draw pictures of themselves pregnant. Even the happiest, most exuberant expectant mothers see and draw themselves as dumpy, unattractive creatures. (the fact the most pregnant women realize their situation is temporary distinguishes them from the high-risk mother, who believes she is going to be rendered permanently unattractive. I will expand on the subject below.) As Dr. Kitzinger rightly points out, this is a view few males there. The allure of the pregnant woman’s body, with its full, flowing lines, gives many men a sense a real sexual pleasure, and women should be aware of that.

Sometimes things you normally wouldn’t think of―such as living space―can also create anxiety. One study showed that cramped quarters significantly soured feelings toward pregnancy; the more room a husband wife had, the happier they felt about the pregnancy. Couples in homes felt better than couples in apartments and so on. Obviously one way of dealing with this is by making present living quarters more spacious. Another is by moving. The best time to make a move is before becoming pregnant, but if that is not possible, trying to find a home or large apartment in the same general area is a wise course. As we have seen, moving in pregnancy poses some peril, but there is evidence that what upsets women is not the move itself, but the move to an entirely new locality.

Work also effects a woman’s perception of pregnancy. I have found that women who are their family’s sole means of financial support often make the poorest adjustment to pregnancy. In the study conducted by Dr. Helmut Lukesch, these women frequently the most angry and resentful, which is understandable, in general, though, working at home, working in an office, or not working is, in a sense, beside the point. What matters is the sense of accomplishment and worth a woman gains from the works, because the way she feels about herself is going to affect the way she feels about her unborn child.

In the final analysis, the normal, well-adjusted woman who feels good about her pregnancy will make the transition to motherhood smoothly as she makes every other critical transition in her life. The women (and children) in danger are those who enter pregnancy already in emotional turmoil, and unfortunately many of them go unnoticed and un aided. Psychological screening is still not a routine part of prenatal care in most places. Nor are many obstetricians, midwives or prenatal counselors sensitive to psychosomatics effect of pregnancy, an expectant mothers’

nutrition, weight, heartbeat, and blood pressure are minutely monitored, but almost never her psyche. Unless a woman’s distress is so obvious that those around her cannot ignore it, she unlikely to be referred for psychological help.

Inevitably, that means a large number of women who could benefit significantly from counseling never get it. The effects of this shortcoming are there to see- in the studies on stress, and in the studies on pregnancy and birth complications. To be fair, though, many mothers who are emotionally at risk do seem perfectly normal;

and in fact many of them were normal until pregnancy ignited some dormant psychic conflict that had been establish long before. A woman comes to pregnancy with a given history, a formed ego and practiced coping style. If and when her ego becomes threatened in some unforeseen way or her coping style collapses under the emotional pressures of pregnancy, then danger arises―and then, for her sake, even more, for her child’s she should seek help.

The emotionally high-risk woman tends to fall into one of three categories. The first and probably most common, is the woman caught in an unsatisfying relationship. Pregnancy has way of delineating the parameters of a marriage with intimidating clarity. All the title cracks and fissures that could help be ignored before suddenly begin looking imposing. Doubts, long buried, spring up: what kind of mother will she make? Is he reliable? Do I want to be a father? Couples find themselves asking new questions of themselves and of each other and, if the answers they get are not satisfying, their relationship can deteriorate precipitously-with enormous consequence for their unborn child. The best time to ask such questions is before pregnancy, but if they arise during it, a couple should immediately seek some form of marriage counseling.

One other significant relationship in a woman’s life that may also affect her pregnancy in a woman’s life that may also affect her pregnancy and delivery is the one she had with her mother. A child learns her first lesson about mothering from her own mother. She is her daughter’s initial and most influential role model. If she is a strong, supportive mother, it is likely her daughters will become one as well. If she not, if she uncomfortable or anxious in the role, or feels in adequate, her child runs a greater risk of feeling the same way when she becomes pregnant, and that

can lead to serious physical as well as emotional problems. One recent Swedish study found that what I will call “unhappy daughters” had a noticeably higher rate of birth and pregnancy complications than happy daughters.

Of course many women who related poorly to their mothers have normal pregnancies and grow into happy, confident mothers themselves. What such history does do, however, is raise the risk of incurring obstetrical complications; for that reason, such women should try to work out their conflict before becoming pregnant.

Finally, there is a woman beset by fears and anxieties that are unusually intense and morbidly specifics. Her concern are not random and they are easily laid to rest.

In study after study, she is the one who exhibits the deepest degree of fear and dependence. She is at the mercy of her husband, her obstetricians, her mother, her friends. There seems to be no decision, however small, she can make alone. Her fears are often wildly irrational. First and foremost, she is concerned about what pregnancy is doing to her look. This is not a casual or passing concern, but near obsession: each stretch mark becomes harbinger of doom; she will never be slim or attractive again; pregnancy has maimed her beauty forever. Her other obsession is the health of their child: without any medical evidence, she is somehow sure he will be born deformed or irretrievably injured.

These feelings can produce a wide range of potentially dangerous problems.

One researcher, for instance, found that such women often difficult bonding with infant after birth. A recent report from the University of North Carolina shows they also run a materially higher risk of incurring birth complications. Women in this study who had the longest labors, the most forceps –attended deliveries, and bore babies with the lowest Apgar scores* also scored highest in testing on dependency, fears for self and fears for baby.

As I mentioned earlier, the keyword with regard to these anxieties is intensity. It is one thing to be consumed by such fears―and a therapist can help deal with that―and another to be legitimately concerned about one’s self and one’ child. A sensitive, understanding physician can help a woman deal with these worries. Next to your husband, he is the most critical figure in your pregnancy. Remember that delivery room scene Dr. Harrison described at the beginning of this chapter? It was not chance that brought the young mother’s labor to a screening halt. Strapped to the delivery table, in the middle of painful labor, she was at her most vulnerable when her obstetrician walked on, had his attitude been more humane, the rest of

*The Apgar score is based on five tests performed one to five minutes after birth. It measures the newborn’s pulse, breathing, muscle tone, reflex irritability and color (blue to pink). A score of seven or above is considered is good, four to six only fair, and below three so poor that resuscitation is necessary.

the birth would have proceed as smoothly as Dr. Harrison had expected earlier in the evening.

Who delivers and how the woman feels about him or her makes that much difference. It is a difference that should be explored carefully beforehand. The first step in making a choice is deciding who is most suitable, a family physician, an obstetrician, or a midwife. For the physically high-risk mother, that decision has already been made. Her illness or her child’s will dictate the use of an obstetrician.

A woman who feels uncomfortable without a physician or equates a delivery without one with second rate care is also better off with a doctor. The peace of mind his or her presence will provide could be important to her later during pregnancy and delivery.

The best way to find a compatible doctor is through friends who have recently given birth. They will be able to provide the small but important details about personality and philosophy that are not included in the recommendations hospitals and county medical societies make. The next step is a personal interview, and it is the best to interview several doctors before settling on a final choice. Be direct, and don’t let yourself intimidated by the white-coated figure on the outside of the desk remember, you are―or should be―the one who makes the final decisions.

Ask about treatment philosophy. Is the physician going to be delivering the baby or are you? He or she is the most comfortable doing―will the doctor assist at the neutral birth or only at a medicated one? And what about his or her (and the hospital’s) rule on fetal monitoring, ultrasound, anesthetics, episiotomies, shaving and the use of enemas? Will your husband permitted in the delivery room; will your baby allowed to remain with you after birth? And if your child is born premature or ill, will you be able to visit him in the hospital pediatric intensive care unit? The way these questions are answered is just as important as the answer themselves. You should be comfortable with your doctors doesn’t elicit a sense of trust in you, doesn’t use him as your baby assistant.

This also applies to midwives, although they have a long and venerable history, only since the late 1960s have they re-entered the medical mainstream in significant numbers. That very newness may make some women uneasy. But think a midwife some important advantages. For one thing, her view point toward birth is likely to be more sympathetic and humanistic. Unlike a physician, whose disease orientation trains him or her to see birth as a potentially state, the midwives’

training teaches her to view it as a normal biological event.

She is a specialist too, but in natural births, and the methods she employs reflect that fact. Episiotomies, fetal monitoring, prepping, all the normal paraphernalia of a medical birth are usually absent at midwife-assisted deliveries. Her orientation

makes her receptive to innovations. Usually, she is just as comfortable with, say, the Bradley method as she is with Lamaze, and as comfortable assisting in a birthing room. Another of her advantages is accessibility. She has more time to answer questions and is usually really interested in supporting her patients emotionally. A young woman i will cal Marsha can attest to that. Her first child was delivered by obstetrician, her second by midwife. The midwife, said Marsha, made a difference. “Toward the end of my labor, while I was pushing, she leaned over and said, ‘help push your baby out.’ She used the word ‘baby’ and she kept using it.

The doctor had just say ‘Push, keep pushing’ He made it sound mechanical. The word ‘baby’ made it real. It reminded me that I wasn’t there pushing as an abstract exercise. There was a real baby trying to come out.”

A midwife brings more than sensitivity to her task, and that is particularly true of a nurse-midwife. Just to qualify for nurse-midwife training. A woman first must be registered nurse and have at least one year’s experience in public health as well as one year of in-patient hospital service. Usually the training itself takes anywhere from eighteen months to two years; during that time the midwife will normally participate in over one hundred births. Added to the deliveries she attends once she has graduated, that often gives her as much or more experience in managing a normal pregnancy than a busy obstetrician.

One of the other important choices a women faces early in pregnancy is how

One of the other important choices a women faces early in pregnancy is how