In the small hospital where I first practiced, we had 400+ deliveries a year and I had babies born with unanticipated Down Syndrome and A-V canal heart defect (where there is a big hole in the middle of the heart where the walls of the atria and ventricles should have been to keep red and blue apart and send each to the right place); a baby with Potter syndrome (lack of kidney or lung development); a baby with congenital diaphragmatic hernia — bowel where lungs should be on one side; numerous babies born sick from Group B strep (a common germ that lives in most women’s vaginas); babies born with CMV or herpes infections – to women who didn’t know they had even been exposed; and more – but you get the idea.

Probably no more than 15-20 “bad babies” a year but the ones I mentioned would all have died without appropriate medical intervention. In the case of meconium, it requires suctioning the head on the perineum and as soon as the body emerges immediately intubating the baby to suck the poop out from the lungs. In the case of the Down syndrome baby, we had to urgently diagnose the condition (by examining the baby clinically, with EKG and ultrasound)to give lifesaving medicine until the baby could get to the medical college hospital for surgery. The baby would have survived a ten-minute ambulance ride just fine but would the home-delivered baby be taken to the hospital for the urgent care the baby needed when it still looked just fine? By the time a new baby looks bad, it is usually too late or almost too late.

The baby with Potter’s died but in a supportive setting with me taking care of the baby to be sure there was nothing else to help (and because Mom didn’t feel comfortable at first holding her baby when she knew it would die soon so she sat in a rocker at the baby’s bedside while I worked) and then the nurses and I facilitated having the family hold the baby until she died. The baby with the congenital hernia was immediately intubated (before one minute of age — it would have been before the first breath if we had known the baby had the condition)and flown to the big hospital two hours away. On the trip he extubated himself, suffered a cardiac arrest and sustained brain damage — but he would have died at home.

You name it — the baby with the rare blood condition that presented like septic shock and required the same resuscitation with major IV’s and all the rest. The one whose nose-to-stomach check (for patentcy using a small plastic tube) showed an abnormality of the stomach in a well-appearing baby — whose gut spontaneously ruptured in the arms of an experienced nurse caring for him; she had two good IV’s by the time I got there from a meeting downstairs and with excellent management the baby got to the operating table (thirty minutes north by helicopter) within two hours of the event. The baby had an excellent outcome and I followed him for years with no subsequent effects of his rough start.

Such a little time can make such a huge difference for a baby; they have maybe three or four minutes without oxygen but you don’t always know when the countdown started if it was in utero. No amount of prenatal study can substitute for experienced judgment and years of advanced training in treating newborns who present with sudden life-threatening events. We don’t let interns (new doctors) go it alone with these cases; I wouldn’t want a new post-partum mom thinking she could just call 911 and have a well (or even live) baby on the other end of the trip.

In any setting, childbirth is still a risky business for mother and child — because MOST will be fine – BUT just as we are lulled into a false sense of security, disaster occurs out of the blue. That’s when you DON’T want the body doing what it wants to do – because it’s trying to die. How many limp, blue babies have I worked on and prayed over – and nearly not breathed myself – until they did? And those were the kids I got straight from the OB – with a full staff, pretested equipment, oxygen mask adjusted and all the rest of the resources nearby.

The most helpless feeling of my medical student days was a bed birth because of a precipitous delivery while interns and residents were delivering all the others in the delivery rooms — and the baby was blue and I had nothing to work with, not even a suction bulb to clear the airway. All I could do was dry the baby and encourage it to breathe – and shout for the nursery nurse to bring me a resuscitation “kit” STAT. She did and it did — fortunately.

A very scarey day in my internship was the day I had successfully caught lots of babies and they were all doing great, so the supervising OB had gone down to the cafeteria for lunch. A women got ready and was pushing and I was trying to deliver a baby whose head barely made it through but whose body was stuck and I couldn’t get it out. It was too late in the delivery to push it back in and do a C-S. It was now or never. Fortunately that sixth sense had sent the senior doctor back to the floor and when I called for help, he was just coming up the hall.He performed a special maneuver that saved the baby. (That’s why he was the senior doc and I was the intern.)

Maybe I’m an old fraidy cat after all that scarey stuff. I can certainly understand a pregnant woman being frightened after a traumatic experience! Regardless, I agree that it is each person’s right to decide. My burden is that it be a truly INFORMED DECISION. If the person really understands the situation then they have to do what they think is best for them and their child. Once someone has the information, the choice is a value judgment. My dad was in his right mind when he chose no further treatment for his condition and he died well – in my arms. I myself could never have an abortion but if a woman believes it is in her and her baby’s best interest to do so, I would not forcibly prevent it. Try to talk her out of it, of course. Dictate her decision, never. To me it’s pretty much the same issue at either end of life. People get to and have to make their own decisions the best they can.

I hope you will think of searching out one of the good birth places — safe, homelike, noninvasive but instantly responsive in case of emergency. God bless you and I wish you well.

I did study neonatal resuscitation and newborn exams. I studied up on potential complications and how to treat them. I studied up on hemorrhaging and what it would look and feel like. I studied up on when to call for help. I spent my entire pregnancy learning how to be responsible for my own birth and my baby, and I would say the majority of UCers do the same.

Even so, some women may prefer to birth solo. Some women may prefer not to bother with learning all the medical stuff. Some women prefer to leave the outcome in the hands of intuition/God/fate/nature/whatever. That is their right! If a woman chooses that path, and accepts that something bad may happen, and believes that whatever happens was meant to be in any setting, who are we to say she is wrong for having that belief system?

It rather reminds me of the “right to die” debate, and the legal issues surrounding Christian Scientists and Jehovah’s Witnesses.

The truth is that childbirth in and of itself isn’t dangerous. Poverty and cultural beliefs and practices have made it so. Physician Michel Odent writes in his new book “The Functions of the Orgasms” that childbirth has been culturally controlled for thousands of years. This is why we cannot get a good picture of what TRUE unassisted childbirth looks like by looking at birth in third world coutries or birth a hundred years ago.

If 1 in 10 women did in fact die in childbirth it was most likely because they lived in poverty or were subjected to unsafe tribal practices. Babies were generally taken away from their mothers right after birth and given whale blubber and bread which their digestive systems couldn’t handle. This is because there has been a nearly universal belief that colostrum is evil. Even today it’s rare for a woman in a third world country to nurse her baby within an hour (or even a day) of birth. Preventing a baby from nursing also is dangerous for mothers. The World Health Organization says that we could reduce infant mortality by 22% simply by making sure that mothers breastfeed within an hour of birth. Taking a baby away from its mother is only one of the many unsafe practices that have caused high rates of maternal and infant mortality.

Odent claims that childbirth is still culturally controlled, and while he is supportive of non-interventive midwives, he says that “Everywhere in the world there has been a tendency to dramatically alter the original role of the birth attendant, to deny the birthing woman’s need for privacy and to socialize childbirth. More often than not, the midwife has become an agent of the cultural milieu, transmitting its specific beliefs and rituals.”

It would be wonderful if midwives or doctors simply stood by and only intervened when necessary, but in most cases they are required by law to “monitor,” “assist,” and essentially control the act of birth. It’s too hard to despel all the myths surrounding childbirth in a single comment, but there are valid reasons for choosing to give birth unassisted, and I encourage those who are truly interested to explore the books and web sites devoted to the subject.

There was a very interesting article in Scientific American a few years back about the evolution of assisted childbirth written by two female cultural anthropologists. There may be some good reasons why humans have sought assistance with birth from the beginning having to do with changes in the pelvis and position of the baby’s head from walking upright. We are not “cats in the closet” and no amount of wishing will make it so.