An international perspective on natural childbirth

At first glance, there is nothing remarkable about the picture above. It’s a group of African women with their children. But it is a remarkable photo because not many years before, these women were rejected by their husbands, families and neighbors after sustaining obstetric fistulas. Each of these women is holding a child she conceived after her fistula was repaired.

These happy results reflect the efforts of Dr. Mary Lake Polan, who led a group of American OB-GYNs to Eritrea to repair vaginal fistulas.

Below is a guest post from a frequent reader of this blog who wanted to share a different persepctive on natural childbirth.

There are two phenomena that span the various cultures in the Balkans; first, like a dream from a Joseph Campbell book, we live by myths, legends, and sayings. The second is that to us, nature is not something one leaves home to see over the weekend, it is home.

I grew up in a Bulgarian village in the picturesque Rhodope mountains twenty kilometers from the Greek border. While growing up, I heard many stories, for what else is there to do but tell stories when there’s limited hours of black and white TV due to communist austerity measures.

One particular story stood out in my mind; that in the old days, when their time for delivery neared, women from the area went back to their families of origin in the case they died in childbirth, ensuring they could be buried near their ancestors. Indeed, women from my culture in general and my family in particular feared birth not because we were “conditioned” by the Establishment or bullied by the conveyor belt of the centralized medical care system. We feared birth because for generations the birth of a child has been a dreary experience. For one, despite Ina May Gaskin’s claims to the contrary, I was one of those footling breech babies that did not “just slide out.” My own agonizing birth left me with memories to last for the rest of my life; four scars from the corrective surgery to repair my dislocated hips and a very traumatized mom who almost lost her life to give life to me.

Because of my operative interventions, I was lead to believe that I could only deliver children via c-section, a belief I never questioned until I walked in the door of Foxhall OBGYN practice in Washington DC pregnant with my first daughter. I read in blogs and forums that in America the medical system is designed to protect doctors at the expense of mamas and babies. If this was truly the case, I would have been the perfect victim of a scheduled c-section. In fact, I argued with my provider that my hip surgery preclude me from pushing–he begged to differ. Some six years later, three children born vaginally on two continents, and some twenty countries visited, I have solidified my belief in the extraordinary value of Western obstetrics and have realized that the fear of birth is not insular to my culture of origin but is rather universal, independent of any commercial or western influence.

My most memorable birth encounters were in the country of Eritrea where I lived for two years. There, I had the privilege of meeting Dr. Mary Lake Polan, the former head of the Stanford University School of Medicine’s Department of Obstetrics and Gynecology. The reason that the likes of you and I have not heard of her is because her name does not usually appear in forums and blogs that tell us to “trust birth” but people who attend conferences on obstetrics and gynecology worldwide have heard of her plenty. That is because Dr. Polan dedicated much of her life to developing the very same life saving techniques and procedures that natural birth advocates tell us so boldly to reject in emergency situations. Her desire to extend her knowledge internationally to treating entire populations lead her to pursue a degree in public health, on top of numerous other degrees and recognitions she obtained from some of the world’s top universities. While pursuing her public health education, she visited the newly independent country of Eritrea where she led a group of American OB-GYNs in the complex surgical repair of vaginal fistulas.

In America, vaginal fistulas are unheard of today because women are generally not left to labor for days, sometimes for weeks, without a medically trained attendant, waiting for nature to take its course, as is still the case in the greater part of the Horn of Africa. Historically however, fistulas were so common here that the first fistula hospital in the world opened in New York City in 1855: Woman’s Hospital where J. Marion Sims, MD treated endless number of patients.

Fistulas occur as a result of prolonged labor. If the mother survives (the baby never does) she is left with a gaping hole in her vaginal wall through which both urine and fecal matter may come through. The smell from the incontinence is so unbearable that the women are abandoned and shunned by their own families and live as recluses and beggars for the rest of their lives. For over a decade since her first visit to Eritrea, Dr. Polan and a team of dedicated American OBGYNs have helped hundreds of women in need of fistula repair regain their dignity and in many cases become mothers to healthy babies. The youngest fistula patients have been in their teens, the oldest, in their sixties, having lived with their abhorrent condition for decades.

When in Eritrea, I was always eager to find out the general attitude among women toward labor and delivery because the country is completely isolated from western influences and epidurals and elective cesareans are simply not an option. My curiosity was always met with descriptions such as: labor is painful; we fear it; it can kill you. That is despite the fact that Eritrean women are some of the emotionally strongest and most resilient people I have ever encountered, who have delivered and borne babies in trenches during the 30 -year-war for the country’s independence.

I met Dehab in her sister’s home in the capital city of Asmara. She had just been released from the hospital where she delivered her tenth child, a baby daughter. Dehab could neither read nor write in any language and lives in a village without running water or inside sanitation. Although city life is foreign to her, she nevertheless traveled two hours on a dilapidated bus during the last stage of her pregnancy to deliver at a hospital to ensure her and her baby’s survival. Homebirth with a traditional attendant was not something that she could not easily opt for–it was something that she did not want.

I also met Helen, a woman in her thirties and a mother of two daughters. During her first birth, the hospital made her go home in the midst of active labor, where she delivered a daughter who was not breathing. Fortunately, Helen’s neighbor was a clinical nurse and helped revive the newborn. For her second birth, Helen had made up her mind, once in the hospital, to refuse to move, regardless whether she was told to go home or not. I asked her why she went back to such an unfriendly situation and whether she would have preferred to deliver at home, if her neighbor, the nurse, could help her again. She said that although being home was comfortable and familiar, she preferred to be at a place where, if it needed, her child could be resuscitated.

During my extensive travels, I have been privy to many birth experiences, the kinds that one cannot find online but can shake us to the very core. The latest one came from a fellow American expatriate family living in New Delhi, India. The wife of the family’s driver lost a child at birth. Seeing the devastation such unfortunate event brought to the family, my friend paid for all the prenatal care of the lady’s subsequent pregnancy at a western-style obstetrics clinic where the woman delivered a healthy baby via a c-section due to complications related to gestational diabetes.

I wonder, while holding her nine pound baby boy Keven-Sam, what this new mother thought she had had an”unnecessarian,” or whether she was bothered that at the facility where she gave birth her culture was not respected; no doubt that someone there nonchalantly mentioned that the likes of her, people who run errands for other people, do not give birth there,.

I know that this information is hard to digest because it is distant to the majority of people who have only experienced the United States as their home. As a mom, I know that if I told my four-year-old to eat her lunch because there are children in Africa who are starving this will get me nowhere, even though she grew up in Africa. But while a child cannot comprehend the experience of another and is concentrated on his or her immediate needs and wants, an adult is capable of learning vicariously, enabling her to act reasonably and responsibly when such high stakes as someone’s life are at risk. Although birth is a topic laden with emotion and controversy, I chose to share this in the hopes of providing a broader perspective, one that leads to better outcomes for mothers and children.