Academic anecdotes and ethical essays
Hospital or Home Birth, Bottle or Breastfeed?
May 18, 1977, five am. The delivery room of the Kitchener-Waterloo hospital. Thunder growled and lightning lit the sky. The walls of my mother’s uterus squeezed against my shoulders. She shouted in vain for the doctor.
“Where the hell is he?”
My father stood patiently by her side. A nurse tried to console her.
“He’ll be here soon.”
“I need to push!”
“Wait for Dr. Nurse.” Dr. Nurse was a black, six-foot-five, gentle and kindly Irishman.
“Not a chance!”
My mother was determined to birth on her own terms. Three months prior, she was struck with an abscessed tooth. Pus-producing bacteria gnawed between her cracked enamel and ate through the naked nerve. Imagine a screw being twisted into your gums by a very clumsy handyman who takes far too long to finish the job.
The dentist prescribed painkillers. My mother refused.
“I’m pregnant. I’m not taking anything.”
“The pain will be unbearable!”
“I’ll deal with it.”
And so she did. Epidurals were commonplace then (and now) but she declined. No epidural. No anaesthetic. No painkillers. Just all-natural oxytocin to get those contractions going. Pushed through the birth canal, I slid forth into the world and peed on the nurse (not to be confused with the doctor of the same surname, who arrived in the nick of time to catch me).
Now it’s my turn to scream. Thrust from the warm, silky membranes of the womb, I didn’t hide my displeasure. The nurses placed me in an aquarium, rubbed my skin until it hurt, and prodded me with cold instruments. I screamed even louder.
A sound floated across the room. The nurses and Dr. Nurse stopped what they were doing. The hustle and bustle of post-delivery protocol halted. Everyone listened.
My father was playing a tune for me on his bamboo flute. The soft, lilting sound silenced the room. To say the moment was magical is to say the sun is bright. Chaos became calm. For the first time, I stopped screaming.
Considering the decade of my birth, I was very lucky to have participated in this rare event: a vaginal birth without medical intervention. In the words of Alice Walker, “There is nothing more important than how we are born.” What better place to deliver than a hospital? A sterile environment with the latest equipment, nurses running to and fro, and a knowledgeable (albeit late) doctor at hand. It is hard to imagine a safer site to make your beginning.
But there are alternatives. Better alternatives. In fact, you do not have to look any further than your own house. Studies show that mothers and babies have healthier births with fewer complications when they deliver at home. Medical intervention rates—including cesarean section, forceps and induction—are drastically reduced during planned home births ( Johnson & Daviss, 2005) in comparison to planned hospital births. There is also a lower rate of infection ( Janssen et al., 2002).
Why do births at home usually have a happier result than those in the hospital? Two hormones provide the answer: oxytocin and epinephrine (or adrenaline). Oxytocin is a multifaceted hormone involved in arousal, temperature regulation, maternal behaviour, milk letdown, and contractions of the uterus during labour. Adrenaline is the “fight or flight” hormone. In stressful situations, our body floods our system with adrenaline, which in turn increases heart rate, blood flow and blood sugar levels. Oxytocin and adrenaline have a strong tendency to be antagonistic, or to oppose one another. In general, when there is more adrenaline in our system, there is less oxytocin.
What does this mean for birth? Adrenaline is released at times of stress. Oxytocin is released at times of comfort and calm. If a woman is in the hospital, surrounded by bright lights, bustling nurses, and busy doctors, this will stimulate the release of adrenaline. This inhibits the release of oxytocin. Less oxytocin means labour is prolonged, and the need for induction or other medical interventions are more probable.
In the peace and quiet of your own home—a safe, soothing environment—there is less need for adrenaline. Within this familiar setting only select loved ones are present, as well as a midwife whose sole duty is to guide you through your birthing experience. The lack of external stress is conducive to the release of oxytocin. Some endorphins are always released during childbirth. But less stress and stimulation ensures there is not an abundance of adrenaline in a woman’s bloodstream at a time when oxytocin is of utmost importance.
Not all births should be home births. High risk pregnancies can occur due to age, weight or pre-existing conditions such as p reeclampsia. Women in such scenarios may opt for a hospital birth, as the requirement for intervention is much more likely. Breech and twin births, and vaginal birth after caesarean (VBAC) can also carry additional risk. But the vast majority of pregnancies are low-risk. In the unlikely event of a serious complication, they can be transported to the hospital. If we want the best for our moms and our babies, more women should be giving birth at home. For this to happen, we have to get out of the fear mindset.
Pregnancy is not a disease. Gestation and labour are not defective conditions. But all too often this is how birth is treated. Instead of feeling empowered by their body’s ability to birth, mothers-to-be are filled with apprehension and doubt.
Growing up in our media-infused society, I took many misconceptions about pregnancy as truth. From newspapers, movies, and television I learned that birth takes place in a hospital overseen by a doctor (usually male), the woman should always lie on her back, epidurals are a prerequisite, and the whole process is extremely painful and disgusting. In addition to these erroneous notions, the rewarding aspects of birth were always downplayed, if not completely ignored.
To get the straight facts on birth, one needs to talk to a midwife. The leading practitioner in inspiring confidence in mothers-to-be is Ina 
May Gaskin. Often referred to as the world’s most renowned midwife, she has been a midwife at the The Farm Midwifery Center in Tennessee for over thirty years. Of the 2028 pregnancies (between 1970 and 2000) followed on The Farm, the neonatal mortality rate was 0.39%. This statistic is nothing short of extraordinary. In both the Americas and Europe, the neonatal mortality rate is more than five times greater ( WHO, 2003).
Her most recent book, Ina May’s Guide to Childbirth, is a bible for birth. The first 127 pages are filled with stories written by women who birthed at The Farm. These vivid tales are full of truth, wisdom and compassion. If I could offer only one piece of advice to prospective mothers (and fathers) to be: replace fear with empowerment and read this book!
The choice between bottle and breast is straightforward: in every sense, breastfeeding is best. No respectable person in the health field would suggest otherwise. I was breastfed for nine months. Quite the feat in 1977. Back then there was no maternity leave, so my mother came home every workday during lunch breaks to feed me rather than herself. She was scolded and ridiculed—by two different family doctors!—for breastfeeding longer than six months. Nowadays, the American Academy of Pediatrics strongly supports breastfeeding for at least a year, while the World Health Organization and the Canadian Pediatric Society both recommend breastfeeding for two years or more. I owe a huge 
debt of gratitude for my mother’s insight, and the trust she has in her own body.
Both mother and baby benefit from the breast. For the baby, fewer ear infections and allergies, as well as reduced respiratory illness, diarrhea and serious infections such as meningitis. There is also evidence that babies breastfed longer have a higher IQ (Anderson et al, 1999). However, a recent study suggests otherwise ( Der et al, 2006). For the mother, benefits include quicker postpartum weight loss, less cost compared to buying formula, and better emotional health. Furthermore, breastfeeding lessens osteoporosis and reduces the risk of breast, ovarian and uterine cancer. One can argue that the most important aspect of breastfeeding is the bond formed between mother and child, upon which no price can be placed.
In the words of childbirth educator Judith Lothian, “The medicalization of birth has robbed women of choice, of confidence, and of the exquisite pleasure of working hard in labor and being rewarded for that sacred work.” The birthing experience is one that has the potential to be very safe, exciting and profound—for both mothers and fathers. Based on the science and the statistics, birthing at home is an option far too few consider. For those who are pregnant, I have three recommendations. Grab yourself a copy of Ina May’s Guide to Childbirth, get in touch with a midwife, and be sure to birth in the place you are most comfortable. Oxytocin required, flute optional.
Lee Beavington
September 22, 2007
References:
American Academy of Pediatrics: Breastfeeding and the Use of Human Milk. Pediatrics. Vol. 100, No. 6, December 1997, pp. 1035-39.
http://aappolicy.aappublications.org/cgi/content/full/
pediatrics%3b100/6/1035#B75
Anderson, J. W, Johnstone, B. M, Remley, D. T. Breast-feeding and cognitive development: a meta-analysis. American Journal of Clinical Nutrition. Vol. 70, No. 4, 525-535, October 1999.
http://www.ajcn.org/cgi/content/abstract/70/4/525
Der G, Batty D, Deary I. J. Effect of breastfeeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis. British Medical Journal, 4 October 2006.
http://www.bmj.com/cgi/content/abstract/bmj.38978.699583.55v1?hrss=1
Janssen P. A, Shoo K. L, Ryan E. M, Etches D. J, Farquharson D. F, Peacock D. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. Canadian Medical Association Journal. 2002;166(3):315–323. et al.
http://www.cmaj.ca/cgi/content/full/166/3/315
Johnson K. C, Daviss B. A. Outcomes of planned home births with certified professional midwives: Large prospective study in North America. British Medical Journal. 2005;330:1416–1419.
http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom
Lothian J.A. Home Birth: The Wave of the Future? Journal of Perinatal Education. 2006 Summer; 15(3): 43–46. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1595304
World Health Organization. Health Status Statistics, Mortality: Under-five and infant mortality rates. 2003.
http://www.who.int/healthinfo/statistics/indneonatalmortality/en/
