The Environment of Birth in its Social Context - Essay Example

The Environment of Birth in its Social Context Introduction In 1993, the UK's Department of Health published a report that stated that birthing choices available to women should include that of labouring and/or giving birth under water. As a result of this initiative, more than three-quarters of NHS hospitals have installed birthing pools to provide this option for mother's-to-be. However, medical opinion continues to be divided over safety issues concerning the well-being of the infant. Advocators of this method claim that labouring, and/or giving birth under water, is of tremendous benefit to both baby and mother in both reducing pain and creating a more natural, less traumatic, environment for the child. Other professionals declare that water birth is not without its problems and, due to a lack of clear evidence, still believe that there are potential risks involved for the child. This paper will be critically analysing the environment of water birth in its social context, taking into account the physiology, psychology and spirituality of childbirth. By first considering its historical aspects, the essay will then reflect on recent research that indicate the benefits of water birth for both the mother and the child, the beliefs and opinions of those who fear this approach, recent research and media reports, and finally a brief look at both psychological and spiritual considerations. Historical Background "Treat a newborn infant as if it is aware of everything going on around it and being done to it. Because it is!" (Suzanne Arms, p. 152). Although it has only been relatively recent that the initiatives of using warm-water pools for labour and childbirth have been introduced into Western culture, there are records of women giving birth in shallow sea water in the South Pacific Islands, and also of Egyptian Pharaohs being born in the waters of the Nile. And, throughout the world today, there are many cultures that use water as a medium for birthing, due to the belief that it is a natural environment for child birth (Susanna Napierala pp. 67-74). In the 1960s, Igor Charkiosky, a Russian researcher, conducted extensive research into both the safety and benefits of water birth. During the same period the French obstetrician, Frederick Leboyer, developed the practice of placing new-born babies in warm water, due to the belief that it would help ease transition from the mother's womb to the foreignness of the outside world, and therefore reduce trauma for the new-born child (Frederick Leboyer, pp.52-68). On the basis of Leboyer's theory, another French obstetrician, Michel Odent, introduced the idea of using a warm-water pool to reduce the mother's pain, and as a way to give a more natural environment for the birthing process. The result of this was the refusal of many labouring women to leave the pool to give birth, due to the benefits that they felt while within water, which led to Odent researching safety aspects of water birth for the child - including potential risks that could possibly result from such an innovate procedure (Frederick Leboyer, pp. 32-39). By 1983 hundreds of women began to give birth under water as the practice spread across the world, and by 1987 approximately 3000 mothers had experienced water births. In London, at the Garden hospital, Dr. Yehudi Gordon ceased from using pethidine to help with pain relief, and instead introduced warm-water birthing pools. And today, more and more women are choosing the medium of water due to the claims of increased benefits for both mother and baby(Anestesiologia Mexicana en Internet, Online Article, 2007).. The Claimed Benefits of Water Birth I never felt anything so relaxing! I felt just like I had slipped into a hot bath during one of my rare alone moments with mommy. Within 15 minutes I was fully dilated and was waiting for the urge to push. I had never felt that sensation with my other two babies and couldn't believe the surging power going through my body. I held on to the side of the pool as my baby's tiny head emerged without any additional pushing from me (Childbirth.org. Online Article, 1999). Women who have experienced giving birth under water state that they never want to give birth again in any other way. Research has shown that warm water not only reduces the excretion of adrenaline, which is released through pain and fear, but also that it is more relaxing, helping to ease labour as it soothes and calms the mother-to-be. This leads to less lacerations and tears, due to the increased elasticity of the perineum, which is softened by the warm water (Verena Geissbhler, p.3). The labouring woman also experiences increased buoyancy in water, which allows her to change position easier, and there is also evidence of shorter, less painful births, with fewer women needing the help of analgesics. This buoyancy also produces a hormonal change in the body that gives the mother more oxytocin, which results in a labour that is more efficient (Freewebs.com, Online Article, 2007). Another factor that is important for the labouring woman is that birthing pools are large enough to include a supporting partner or midwife, which gives the mother far more physical contact and support, and more fully involves the father - something that is both more personal for the couple, more helpful to the mother, and which results in a completely different experience for both parents than that of a land birth (Childbirth.org. Online Article, 1999). Birth can also be an extremely traumatic and strenuous experience for babies too, and it is believed that water eases the transition for the child as it leaves the warm, familiar intra-uterine environment that has been its home for the past nine months. There has also been research that shows that this more natural manner of giving birth also reduces and softens both noise, light and colours (Frederick Leboyer, pp. 51). Many midwives and doctors have also reported a difference in the well-being of children born under water, stating that in comparison to babies born on land the infants cry less, seem more relaxed and peaceful, and were more eager to suckle at the breast and have eye contact with their mothers (Susanna Napierala pp 47-49). Concerns and Objections The safety regarding infection and neonatal outcomes are not addressed and large collaborative trials are needed to answer these critical issues..... the statistically significant reduction in maternal perception of pain and in the rate of epidural analgesia suggest that water immersion during the first stage of labour is beneficial for some women....... There is insufficient evidence about the use of water immersion during second stage of labour and therefore clear implications cannot be stated (Cluett E R, et al. Immersion in water in pregnancy, labour and birth, 2002). According to the many advocators of water birth, the majority of concerns from those opposing its employment are due to the fact that it is considered both unconventional and unorthodox. Nevertheless, it is recognised by all concerned parties that there is a risk that the baby could aspirate water if the infant is removed from the pool and then re-immersed. However this fact is clearly recognised by both midwives and obstetricians, who all place the child immediately at the mother's breast (Susanna Napierala p. 19). However, a recent BBC report described four incidents in New Zealand in which new born infants nearly drowned, and doctors stated that "better evidence that water births are safe is needed before the method is offered as a matter of routine" (BBC, Online Article, 2002). A baby's first breath is generated by the absence of water on the face, which triggers the mammalian diving reflex, together with the contact of air pressure on the trigeminal nerve area of the face. Therefore for a baby to take his first breath there is a switch from fetal circulation to newborn circulation, which occurs through the closing of the shunts in the heart that creates pulmonary circulation. This change in lung pressure pushes out the fluids that are already present, which allows for an exchange of oxygen and carbon dioxide. Until this transaction takes place, which occurs after a few minutes, the baby is still receiving oxygen through the umbilical cord. Advocates of water birthing, therefore, claim that there is no threat of the baby inhaling water until after there has been contact with air pressure (Verena Geissbhler, p. 9). However, according to several doctors; Potential adverse risks are a restriction of alternative analgesia, increased perineal trauma, lack of control of blood loss, increased risk of infection, decreased fetal monitoring, ineffective contractions and risk of water embolus. To the infant there is a potential risk of aspiration and hypoxia, increased infection, and delay in intervention in the setting of fetal distress (Pediatrics, Online Article, 2007). The same doctors also state that although it is claimed that primitive reflexes stop the baby from gasping until exposure to air, studies using animals have show that this is not always the case (Pediatrics, Online Article, 2007). Recent Research A considerable amount of research, over recent years, has been carried out into the safety and benefits of water birth. Dianne Garland, a British midwife, who has published a book called, Water birth: An Attitude to Care, compiled extensive research material through the National Health System, and Barbara Harper, an American childbirth educator and registered nurse, investigated the practice of water birth throughout the world. In her book, Gentle Birth Choices, she has recorded her findings, which include an historical view of giving birth using the medium of water (Barbara Harper, pp. 18-21). Both books strongly advocate water birth as the ideal medium for both mother and child. However, other medical studies and research are not so forthcoming. Although it has been recognised that the risk of perinatal mortality for babies delivered in water is similar to those women choosing land births, the degree of risk of hypoxia, infection, and water aspiration is "less well established" (Pediatrics, Online Article, 2007). In a recent study of 4032 water births, no deaths were believed to be due to delivery in water, 35 babies were admitted into special care within the first 48 hours, 15 had respiratory tract problems such as suspected aspiration, pneumonia, and tachynea of the newborn (Pediatrics, Online Article, 2007). Another study that was carried out in Switzerland, included 2014 water births, 1108 deliveries using the Maia birthing-stool, 2362 births on a wide bed - in a half-sitting position, and 467 deliveries using other methods, such as the rope, on hands and knees, using the Roma wheel or birthing bag. Results showed that no child suffered any respiratory problems due to water aspiration; that water births showed less tearing - with a high number of water births having no tearing at all; there was lesser blood loss and use of analgesics, and minimum Meconium-stained amniotic fluid compared to other birthing methods (Verena Geissbhler, Online PDF Report, 2000). Holistic and Spiritual Approaches ".....as human beings we function simultaneously on physical, emotional, mental and spiritual levels and that meeting these needs define our health, happiness, success, meaningfulness and place in life"(Holistic Parenting Program, Online Article, 2007). The world of medicine has over recent years laid an emphasis on a holistic and spiritual approach to health practice in general, and also within that of childbirth. Scientific research indicates an important connection between both reproductive and hormonal responses, emotions and thoughts, and the need to take into account the three essential elements of man - body, mind and spirit - is now receiving far greater acceptance throughout the Western world (Pam Armstrong, pp. 89-102). Childbirth, pregnancy and breastfeeding have all, at one time or another, been treated by the medical profession as if a woman was suffering from a health complaint, rather than that of a joyous occasion that just might need medical attention. This has led to an increasing emphasis on the part of midwives, doctors, and other health professionals to address the need of a more natural approach to labouring and delivery (True Blue: Midwifery Care Links, Online Article, 2007). Midwifery is rooted in a more natural method in caring for future mothers, and considers pregnancy and child birth to be a fundamentally healthy process that can have many normal variations. It is only when any complications arise which need the intervention of doctors that a woman is transferred either to obstetric care or hospital (TorontoHolisticDirectory, Online Article, 2007). Water births, along with many other holistic and alternative methods, are seen as a more natural approach to childbirth, which needs to be more fully integrated within the NHS system. Conclusion The four water birth cases that resulted in respiratory problems due to water aspiration in New Zealand were isolated incidents which, according to Dr Ruth Gilbert, of the Institute of Child Health in London, "could occur if the water birth was poorly managed" (BBC, Online Article, 2002). And, although it is clear that further study and research into both the benefits and safety aspects of water birth needs to be undertaken, it is apparent that there is little real evidence that points towards any valid threat in this method of birthing for either the child, or the mother, as long as the guidelines that have been laid down by members of the medical profession are plainly followed. References Anestesiologia Mexicana en Internet, Online Article, Water Birth History, 2007. Page downloaded 19/03/2007. BBC, Online Article, Water birth drowning risk, 2002. Page downloaded 22/03/2007. Barbara Harper, Gentle Birth Choices, Healing Arts Press; 3 Pap/DVD edition (August 20, 2005). ISBN-13: 978-1594770678 Childbirth.org. Online Article, Water Birth, 1999. Page downloaded 22/03/2007. Cluett E R, Nikodem VC, McCandlish RE, Burns EE. Immersion in water in pregnancy, labour and birth. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD000111. DOI: 10.1002/14651858.CD000111.pub2. Frederick Leboyer, Birth Without Violence, 1975, pp.52-68. Inner Traditions; Reprint edition (September 1995). ISBN-13: 978-0892815456 Freewebs.com, Online Article, Women's Options in Maternity Care & Birth, 2007. Page downloaded 22/03/2007. Holistic Parenting Program, Online Article, 2007. Page downloaded 20/03/07. < http://holisticparentingprogram.com/welcome.html> Pam England, Birthing From Within: An Extra-Ordinary Guide to Inner Childbirth Preparation, Partera Press (July 1998). ISBN-13: 978-0965987301 Pediatrics, Online Article, Water Birth, A near drowning experience, 2007. Page downloaded 24/03/2007. Ina May Gaskin, Spiritual Midwifery, Book Publishing Company (TN); 4th edition (March 2002). ISBN-13: 978-1570671043 Susanna Napierala, Water Birth: A Midwife's Perspective, pp. 67-74. Bergin & Garvey Trade (September 30, 1994). ISBN-13: 978-0897892858 Suzanne Arms, Immaculate Deception II: Myth, Magic & Brith, Revised Edition, p. 152, 1996, ISBN13: 9780890876336 The Centre for Creative Parenting, Online Article, Holistic Approach, 2007. Page downloaded 24/03/2007. TorontoHolisticDirectory, Online Article, 2007. Page downloaded 23/03/2007. True Blue: Midwifery Care Links, Online Article, Empowered Births, Parents and Families. 2007. Page downloaded 23/03/07. Verena Geissbhler, Online PDF Report, Waterbirths: A comparative study, A sudy Read More