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Reconsidering "best birth" practices

An interview with Lisa Gould Rubin

By Sarah Werthan Buttenwieser

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Lisa Gould Rubin is a childbirth educator, who has been teaching and doing labor support and postpartum consultation for over twenty years in New York's Westchester County. She, along with Amen Ness and Jackie Frederick Berner, has co-authored The Birth That's Right for You: A Doctor and A Doula Help You Choose and Customize the Best Birth Option to Fit Your Needs (McGraw Hill, 2005).

Sarah Buttenwieser: You've been in the world of childbirth for a long time; tell me what you notice about how the world has changed or stayed the same.

Lisa Gould Rubin: Culturally, we seem to assign value judgments to birth, ascribing words like "normal" or "natural." In Utne Reader, there are a few articles about childbirth, including one called "Drugs, Knives, and Midwives" that looks at the current struggles midwifery faces, and the rise in infant mortality in this country as we head toward more interventions rather than fewer. But what's also striking to me is that through all different movements surrounding birth, we still come up with the same old dilemmas or issues that put a value upon birth as if there's a good or bad, right or wrong way to give birth.

SB: How does this tendency toward judgment affect women?

LGR: Lots of women feel crappy about their births. There was a big survey in 2005 -- Listening to Mothers II -- and it revealed that many women report feeling dissatisfied with their birth experiences. Some are guilty because they didn't have a "natural" birth; others wanted vaginal births and ended up with cesarean sections. To me, guilt shouldn't need to be part of their experience. Guilt is punitive.

SB: Is there a current version of "best" or "right" birth?

LGR: Don't you find that people judge epidurals to be as not as good as medication-free?

SB: Oddly, I know people who just scrunch up their noses at the idea I didn't opt for any medication. But others I know wanted no meds. For those women, taking meds represented some defeat, yes.

LGR: I really challenge the notion that there's a single "best" birth; that's why I wanted to write a book urging each woman to find the option that is best for her. I believe there's not nearly enough support out there right now for women to find their most comfortable choice and settle with that, as opposed to someone else's idea of what she should do. Lamaze, with its taglines, "A normal birth for every woman" and "Advancing normal birth," doesn't help. Again, like "best," who are we to determine what's "normal?" It'd be a little more truthful to say medicated and un-medicated. And, in the Lamaze world at least, there's a value still implicit in medicated and un-medicated.

SB: Lamaze is often the only game in town, depending upon your town.

LGR: I got certified as a Lamaze instructor because it was the method with the most credibility when I was starting out and it still has the most credibility. Some people think of a method like Bradley as a little more "out there." While Lamaze used to be wholly against medication, it has had to soften its stance for commercial reasons. So many women opt for medication that advocating success in terms of going without medication would fault or fail too many of its clients. Lamaze still has a strongly judgmental good/bad paradigm, though, from which I differ.

SB: While I'm not naive about the impact of litigation, it's interesting to me that in a time when so much information is available, the intervention rates in hospitals would rise again and midwives again find themselves fighting to keep a place in the hospital.

LGR: I loved the quote from the Utne Reader that "trying to have an intervention-free hospital birth is like trying to fit a square peg in a round hole." Hospitals and birth centers with midwives have lower intervention rates; with doctors, the intervention rates rise. Those are plain facts. The other thing, though, is that many doctors want the midwives' business and that interventions are expensive, and thus lucrative. Women coming in without insurance through an ER are probably not being induced nearly so fast as affluent women, because inductions are not cost effective, too many interventions tend to follow.

SB: Can you talk about why induction often leads to more interventions?

LGR: An induction with the drug pitocin often brings on very strong contractions. And you aren't as free to move around physically as you'd be without that IV attached, because you have to be more scrupulously monitored to make sure the baby is tolerating the drug induced labor. And because the contractions are so strong and mobility is so limited, it's not quite a given but nearly a given that women on pit will require medication, an epidural, to ease the pain and also to take the edge off of the fatigue that comes from handling those intense contractions. Without the ability to move around, labor -- even with the drugs --often stalls. At a certain point, if labor just won't progress, especially if there are signs of fetal distress, a section becomes the only option; looking back, you might see it as an inevitable outcome coming from that series of interventions.

SB: I definitely know plenty of women who have beaten themselves up over having birth experiences that seemed less than perfect or different from their expectations.

LGR: Part of what bothers me is that there are so many mixed messages. With so much information available -- you're supposed to look up every possible option or scenario on the internet -- women are blamed if they didn't do tons of research, although not every woman wants or needs to. And at the same time, it's very patronizing to judge women for things like their choices about medication, as if their own decisions aren't valid. So, at once we're placing culpability upon women and at the same time acting as if they can't make legitimate, responsible choices for themselves. And what's worse, women judge one another, so we can't miss out on support from one another. If we can't support each other, we're lost.

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is birth a journey?

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