Book Review: "Gentle Birth Choices" by Barbara Harper

"Gentle Birth Choices"
Barbara Harper
1994, 268 pages

"Human birth is the most miraculous, transformational, and mysterious event of our lives.... A gentle birth begins by focusing on the mother's experience and by bringing together a woman's emotional dimensions and her physical and spiritual needs. A gentle birth respects the mother's pivotal role, acknowledging that she knows how to birth her child in her own time and in her own way, trusting her instincts and intuition." (Harper 1994: 7)

This book has a new edition, released in 2005. I would love to have read that edition, but my library only had the 1994 edition - still great!

This book is truly the classic among classics in the alternative childbirth arena. It will give you top-notch information that is meticulously well-documented and is a must-read for all prospective parents. I highly recommend this book. I'm actually surprised that it took me this long to get around to reading it, as it is such a timeless classic.

Barbara Harper does such a great job with this book that it is hard to know where to begin. Let's start with a basic overview.

The forward to this book is written by Robbie Davis-Floyd, an eminent anthropologist and specialist in birthing anthropology and politics (I am reading one of her books right now, "Mainstreaming Midwives," and it is already an all-time favorite). I learned a ton through her short forward! I never realized how important birth practices are from an anthropological point of view, and how important the study of anthropology is to a true understanding of the meaning behind cultural birth practices. Here's a great quote from Davis-Floyd:

"We in the United States live in a technocracy - a society organized around an ideology of technological progress. The core values of the technocracy center around science and technology and the institutions that control and disseminate them. In every society, core cultural beliefs and values are most highly visible in the rituals that accompany important life transitions like birth, puberty, marriage, initiation into a religious or occupational group, parenthood and death. Rituals at the most basic level are enactments of these core cultural values and beliefs. Thus it is not surprising that the core values of our technocratic society would be most visible in the rituals with which we surround the birth process.

"Basic to initiation rites across cultures is the removal of the initiate from normal social life. Once so removed, initiates are stripped of their individuality - their heads are often shaved or their hair clipped short; their clothes and adornments are taken away and they are dressed in identical gowns or robes. They are then subjected to hazing processes designed to break down their normal ways of thinking. Once this cognitive breakdown is well underway, the initiate is bombarded with messages about the core values of the culture. These messages are conveyed through powerful symbols.... These symbolic messages serve to rebuild the belief system of the initiates in accordance with the dominant beliefs and values of the group of society into which they are being initiated.

"It is not difficult to see striking parallels between this cross-cultural initiation process and hospital birth. Birthing women are removed from their social setting and taken into the hospital - a powerful institution organized around our culture's supervaluation of science and technology. Their clothes are taken away, they are dressed in hospital gowns, and their pubic hair is shaved or clipped, symbolically desexualizing the lower half of their body and marking it as institutional property. Labor itself is a natural hazing process - the pain of contractions leaves women disoriented and wide open to internalize the symbolic messages they are sent. The powerful cultural symbols that convey these messages are the intravenous (IV) line, the electronic fetal monitor, the Pitocin drip, and all other myriad technological procedures through which most birthing women in the United States must undergo during their rite of passages into motherhood. What messages do such procedures convey into the bodies and emotions of birthing women?"
(David-Floyd, "Gentle Birth Practices, xi-xii)

Wow! How interesting! And, I believe, how often accurate.

Harper begins her book with a list of "ingredients for gentle birth" - a list including preparation through education, a reassuring environment, freedom to move, quiet, low lighting, gentle first breaths and caresses and early breastfeeding and bonding - an excellent list with all ingredients well-explained.

Harper then goes on to give a history of childbirth, including a great explanation of how the United States got into the current mess with childbirth that we are currently still experiencing. She covers the witch hunt for midwives, the move of childbirth into the hospital, and the take-over of technology over the normal physiological process of birth.

Harper then has a great chapter in which she unpacks and dispels common medical myths, citing evidence proving these myths unfounded and showing how the opposite is actually true:

The hospital is the safest place to have a baby
Maternity care should be managed only by a physician
The electronic fetal monitor will save babies
Once a cesarean, always a cesarean
Birth needs to be sterile
Drugs for pain relief won't hurt the baby
An episiotomy heals better than a tear
It's better not to eat or drink during labor
Family and friends interfere during birth
The baby needs to be observed in a newborn nursery
If you are over thirty-five, your birth will be difficult

Here are some great quotes from that section:

"The results from this particular study (Mehl, 1976) show that the mortality statistics for hospital birth and homebirth were identical. Aside from mortality rates.. this study also dramatically revealed that complications and interventions during birth were far greater in births that took place in the hospital than in births that took place at home. Five percent of home-birth mothers received some form of pain medication, whereas 75 percent of hospitalized mothers received medication. There were three times as many cesarean sections in hospital births as there were in the planned homebirths with subsequent transfer to hospital. Hospital-born babies suffered more fetal distress, newborn infections, and birth injuries than home-birth babies. The episiotomy rate was ten times higher for mothers in the hospital, and they suffered twice as many severe perineal lacerations. The increased episiotomy rate and severity of perineal lacerations was most likely the result of the use of forceps and the lithotomy position for birth." (Harper 1994: 54)

Numbers which have remained constant in the years since this book was written. Wow.

"In addition to the medical competency of midwives, an important aspect to consider is the psychological support that midwives provide... Pregnant women are also less likely to be overly dependent on a midwife, who generally assists women in becoming educated about the birth process and encourages them to trust thier instincts. In comparison, it is common for pregnant women to see their doctors as authority figures and for doctors to readily assume that role. Even the language that most midwives use differentiates their views of childbirth from those of physicians. Physicians have patients but midwives have clients. A physician "delivers the baby," which implies control, while a midwife helps the woman "birth her baby."

I have noticed all of the above big-time in my interaction with the birth world, and it is extremely important. As a client of my midwife, I feel all the equality that the word implies. For my next pregnancy (assumed) I will also be under the care of an OB for help with hyperemesis, and am considered a "patient." After repeating the phrase a couple of times, I have rejected the terminology and the subservience it implies and now call myself a client of my OB - much better!

This is an AMAZING quote by Dr. Edward H. Hon, inventor of the electronic fetal monitor:

"Dr. Edward H. Hon, inventor of the EFM, asked his colleagues to consider the causes of the rising cesarean rate in the United States. He stated that he never intended the EFM to be used in routine obstetric management. 'If you mess around with a process [birth] that works well 98 percent of the time, there is a potential for much harm... The cesarean section is considered as a rescue mission of the baby by the white knight, but actually you've assaulted the mother.'"

A little-known fact about EFM is that the widespread introduction of EFM into normal labors has done absolutely NOTHING to reduce fetal mortality or morbidity - the rates have remained the same. What has changed is the c-section rate, which has skyrocketed. The EFM gives ridiculously high rates of both false positives and false negatives in terms of detecting fetal distress, causing physicians to perform vast numbers of unnecessary sections - and giving unethical physicians the opportunity to perform sections for personal convenience or simply to avoid lawsuits.

The process for many modern labors is described below (described verbatim by many of my friends):

"A typical hospital scenario during a slow labor [personal note: or oftentimes, a prematurely induced labor] is to administer the drug Pitocin, a synthetic version of oxytocin, which a laboring woman's body produces naturally. Pitocin is given in order to speed up and intensify contractions. Thus, when women are given Pitocin, they are often offered a painkiller as well. While the Pitocin works to quicken the labor, the drugs for pain relief have the opposite effect. In addition, the administration of Pitocin effectively restricts the movements of the laboring woman because she is required to have an intravenous (IV) line and an internal fetal monitor w. These restrictions can slow labor even further. If the Pitocin does not work within a certain time limit, a laboring woman will often hear statements like, 'We've tried everything' do you want to do this for another twelve hours?' or 'You just weren't meant to have this baby vaginally.'" (pp. 66-67)

I'd love to say that this was a thing of the past, but too many of my friends are coming home from the hospital with the exact same story.

Harper then gives great chapters on guidelines for gentle birth, including birth preparation techniques and a wonderful chapter on waterbirth, as well as chapter on the mind-body connection, homebirth and the creation of gentle birth. Here's one quote from a physician well-versed in waterbirth, which applies to all facets of gentle birth:

"'Waterbirth is a reasonable thing to do, and there is only one way it's going to happen. It will not come from universities; it will not come from doctors; it will come from consumers, that is, mothers and fathers who demand it. As more birthing places offer water birth as an option, women will walk away from doctors who say no. The establishment will be forced to change because the consumer demands it.'" (p. 146)

This is true of all gentle birth practices. Change only comes by consumer demand.

Rosenthal also notes that moving waterbirth into the hospital does not erase all of the problems of modern hospital birth.

"The beautiful new Jacuzzi tubs installed in the Santa Monica Hospital maternity unit in 1991 are a case in point. Women are 'not allowed' to enter the bath if their water has not broken and the baby's head has not descended into the pelvic cavity. They are also 'not allowed to enter the bath after their water has broken. Rosenthal does not think American hospitals will widely adopt water birth as an option: 'The problem is removing obstetricians from normal birth. The problem remains of educating doctors on how to surrender into this normal process. How can a doctor, traditionally trained, even conceive of any other way to give birth if he has only seen a thousand women on their backs, hooked to fetal monitors, with legs up in stirrups?'" (p. 165)

Along the same lines, here's a great quote from Marsden Wagner:

"'Change won't come easy. We have an incredibly obstinate obstetrical profession. It's all about territory. It's all about power. It's all about control. And at the end of the day, it's about money.'" (p. 215)

Personal note: Again, there are lots of great OBs out there who work toward gentle, respectful birth practices. This does not apply to you!!

Harper concludes her book with a great section of additional resources and questions to ask prospectives physicians and midwives.

I loved this book! It's a definite keeper and will be going in my library soon. I recommend it to all pregnant mamas and daddies and natural-childbirth aficionados. There is a wealth of knowledge contained in this book and I can't say enough about it!