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Natural Birth Ideally childbirth should be one of life's most precious moments; a time when instincts can take their course, when intense bonding with the newborn occurs, or so we think. The reality for most women is rather different: birth has become a medical event in need of effective management by the professionals of obstetrics. Women are made to lie passively on a table - the physiologically most difficult position in which to give birth - whilst the experts decide which medical inter-ventions are needed. These can include every-thing from sed-atives, intra-venous drips delivering syn-thetic hormones, epidurals and other anaes-thetics, right up to caesareans. According to childbirth expert Sheila Kitzinger the 'active manage-ment' of hi-tech births means taking drugs which will tranquillise, stupefy, disorient, cause hallucinations, produce amnesia, change the woman's body chemistry, and also deprive the the foetus of oxygen, turning the newborn baby into a limp, sleepy little bundle with a headache, instead of a wide-eyed, searching, learning creature. This leads to a 'snowball effect': interfering in one way makes it necessary= to interfere in others too; an epidural anaesthetic, for instance, makes it likely that forceps will have to be used in the delivery. In U.S. hospitals this has meant that up to 65% of mothers face the trauma of forceps delivery and risk the injury to the baby which it occasionally results in. The typical delivery room in a modern hospital is full of bright lights as well as the noise and bustle of the obstetrician and a team of assistants. Electronic monitoring machines and hospital antiseptic add to the oppressive atmosphere - little wonder t hat many women find hospital birth depressing. Obstetricians have by and large excluded mothers from their central role in childbirth, and at the same time drained the experience of its sexuality. All this is done in the misplaced hope that it will achiev e a painless effortless managed birth, at a convenient time; fitted in with the obstetrician's game of golf according to many critics!=20 The Birth of Obstetrics Historical studies tell a different story: vertical positions for giving birth have been prevalent across the globe for thousands of years. Aristotle was the first known advocate of a recumbent - and passive - position. It was much later in 17th century France where male doctors first assumed the midwives' role and required their aristocratic women clients to lie on their backs so that the recently-invented forceps could be used more easily. The fate of women was sealed when Louis XIV had his mistress en dure this position so that he could see the birth better from his hiding place behind a curtain on the other side of the room. Later Queen Victoria was the first woman in England to use a chloroform anaesthetic - which further en-trenched the lying down p osition in defiance of the force of gravity. The practices of confining a woman to bed for much of her labour and then the rise of the obstetric table for deliveries soon followed and spread throughout the Western world. Looking at the current situation in her latest book, "The American Way of Birth", Jessica Mitford found that a powerful alliance of medical societies, including the American Medical Association (A.M.A.), and insurers had succeeded in making midwives into outlaws in many U.S. states. She has even come across recent examples of midwives being arrested at gunpoint and taken away handcuffed! The hospital births favoured by the A.M.A. cost a minimum of ten times as much as home birth with a midwife and can ea sily add up to far more.=20 Alternatives The trend has not all been one way: since 1962 the in-hospital maternity unit at Pithiviers in France has been a notable centre of experimentation. As he gradually gained the courage to return control over childbirth to women, its chief obstetrician Miche l Odent found that women themselves would instinctively choose the upright position for birth, and would also choose to move around during labour. The delivery room there was small and quiet with subdued lights. Machines and drugs were kept only for the few real emergencies and forceps banished. The midwife, and the husband too, were able to play a greater role - such as in helping to support the mo ther in the squatting position which is commonly chosen for birth. Odent began to realise, against the common wisdom, that women during childbirth act most 'rationally' when they 'forget' themselves and follow their instincts - deliveries became faster and easier. Both he and Sheila Kitzinger agree that The right enviro nment for birth is exactly the sam= e as the environment in which to make love. Most labours should be uncomplicated and do not need special equipment. They need not be seen as a kind of illness needing treatment in an intensive care setting. As the Pithiviers staff became more sure in trusting women's own instincts they broke more and more of the accepted conventions of obstetrics: they stopped wearing rubber gloves, they stopped speeding up delivery by breaking waters which surround the unbo rn, they stopped prescribing bedrest for the mother during pregnancy and after, and they allowed the newborn to be with the mother from the moment of birth. Odent brought in a warm pool where women could relax during the painful contractions of labour and, to everyone's surprise, found that many seemed to develop an affinity with the water and some would remain immersed to give birth, which is perfectly safe.=20 Some women who had previously claimed to dislike water even moved over into the pool to give birth. As far as the clinical results are concerned (mortality rates etc.), those at Pithiviers compare favourably with the best in the world. The caesarean rate of 6-7% is far better than the 25% in the U.S. ( a 400% increase in 20 years); postpartum depression is also rare at Pithiviers. Those who come to Pithiviers to give birth live mostly in the surrounding area and are not pre-screened in order to avoid difficulties. Others who come from further afield - even from other countries - have often had difficul t births or caesareans beforehand and come in order to secure the best chance of having a rewarding vaginal birth. Hammersmith hospital recently claimed credit for discovering that close contact with both parents may be the best thing for a premature baby, rather than an incubator. Instead of crossing the Channel to reach Pithiviers, where this had long been common kn owledge, a research project was carried out in Colombia to make these findings! Wishing for a similar return of control over birth to the mothers, the 'Active Birth Movement= ' was founded in Britain in April 1982 after one London hospital which had initially encouraged upright positions changed its mind and banned them. A small Birth rights Rally, planned as a 'squat-in' of the hospital= foyer, ended up as a rally of 6000 on Hampstead Heath; speakers including Kitzinger and Odent helped reverse the decision. Odent has long questioned his own role as a male obstetrician: The revolution so many of us are seeking, he writes, will not be triggered by the professionals of obstetrics, or even by the medical profession overall. He has since left Pithiviers and n ow works in London with mothers giving birth at home which he currently believes is the only place... where a woman has the degree of privacy needed to allow maximal efficiency of the physiological and hormonal responses. The strikingly good results at Pithiviers have led to other maternity units being established along similar lines around the world and other hospitals too have gradually been adjusting to women'= s demands to choose whatever position they find most comfortable throughout labour and deliv ery: to change from passive patients to active birth-givers.=20 Adapted from: Birth Reborn - What Birth Can and Should Be, Michel Odent (London: Souvenir Press, 1984); New Active Birth: A Concise Guide to Natural Childbirth by Janet Balaskas (Thorsons, 1991) who is co-founder of The International Active Birth Centre, 55 Dartmouth Park Road, London, NW 5 1SL Tel. 071 267 5368; also relevant: The Continuum Concept, Jean Liedlof (Arkana, 2nd. ed, 1987); The American Way of Birth, Jessica Mitford, (Gollancz, 1992)