Birth Stories, Birth Advocates, and Evidence for Promoting Normal Birth

Abstract

The editor of The Journal of Perinatal Education describes the content of this issue, which offers a broad range of resources, research, and inspiration for childbirth educators.

Sharron S. Humenick Editor

Instead of presenting one individual's personal birth story, the “Celebrate Birth!” article in this issue illustrates how normal-birth stories can bond a group of women over the years and influence future generations. Thus, we follow how normal birth becomes part of the culture of group members and their families.

This issue's guest editorial is by Penny Simkin, a well-known author and normal-birth advocate. She reflects on years of advocacy work in the face of a society with increasing technological births. Simkin asks questions many of our readers may have asked themselves. Read her guest editorial to learn what keeps her motivated. Then, after being inspired to keep going, check out Molly Gordon's thoughts about how to earn a living wage as a childbirth educator.

As a group, the articles in this issue take the reader beyond a focus on pregnant adult women with singleton births. Two articles focus on the needs of fathers, and one of these presents a model used in Australia to better meet the needs of expectant fathers. A third article serves as a continuing education module and begins Part 1 of a two-part series on childbirth education for multiple pregnancies. Thus, collectively, this issue's group of articles encourages childbirth educators to consider the needs of a broad range of clients.

In this issue's “Tools for Teaching” column, the reader will find charts that illustrate how Lamaze International's efforts to promote normal birth fit the goals of other alliances, including those of Healthy People 2010 and the Coalition for Improving Maternity Services. Additionally, the article finds a comparison of selected labor interventions that are not supported by research summaries in the Cochrane database and yet have been shown to be commonly used with laboring women in the United States. Armed with a foundation from which to promote normal birth, read Judy Lothian's “Navigating the Maze” column about how this is accomplished within a childbirth education course.

We welcome Amy Romano of the Lamaze Institute for Normal Birth who reports on selected recent research articles. Her “Research Summaries for Normal Birth” column will become a regular feature in this journal. Teri Shilling continues as the journal's “Media Reviews” coordinator and, as usual, Deb Gauldin gives us a last laugh. After the reader is encouraged to take himself or herself seriously with our research reviews and advocacy roles, it always seems good to me to end by having a good laugh at ourselves. A healthy laugh helps us with our “keeping on” outlook, as discussed by Penny Simkin.

LETTERS TO THE EDITOR

Changing the Culture of Birth

Unfortunately, I find that I cannot agree with Dr. Lalonde in his December 8, 2004, letter to the editor [The Journal of Perinatal Education, 14(1), 2–3] that the American College of Obstetricians and Gynecologists (ACOG) promotes “natural childbirth” as the first choice for pregnant women in the United States. Although there are certainly individual physicians who promote normal birth, the ACOG as a whole has issued several statements in recent years that contradict this view. By promoting elective cesarean and, in many hospitals, elective induction and epidural analgesia for most first-time mothers, many obstetricians are not promoting normal birth.

In 2001, I was invited to the conference “The Nature and Management of Labor Pain,” an evidence-based symposium jointly sponsored by the Maternity Center Association and the New York Academy of Medicine. National leaders from many groups providing care for birthing women participated. Interestingly, the obstetricians and anesthesiologists seemed to be grouped on one side of the room, while the midwives, doulas, and childbirth educators were on the opposite side of the room. There were definitely different views about pain management in labor. At least one national leader stated that we in the United States can afford to pay for universal access to epidural analgesia or for nonpharmacologic pain management strategies such as one-to-one care and birthing tubs, but not for both.

The truth is that most women in the United States are not fully informed about the potential benefits of normal birth, and if they choose to “try” to birth normally, they have to fight for options that will increase their chances of achieving normal birth such as freedom of movement, access to tubs and showers, intermittent monitoring, one-to-one support, and light food and fluids.

I certainly agree with Dr. Lalonde that complex factors are at play here. I am not asking that obstetricians promote natural birth, but I am asking that all caregivers provide full information to pregnant women. And for those women who would like to experience normal birth, that they be supported with evidence-based strategies such as one-to-one support, freedom of movement, access to tubs and showers, and fluids (if not food!) during labor.

For myself, I will continue to work with the other committed and dedicated members of Lamaze International to change the culture of birth so that normal birth as defined by the World Health Organization and Lamaze International becomes the norm, rather than the exception, in this country. So that women will want normal birth. So that both mothers and babies are alert and primed with the hormones that nature intended (and that many medications interfere with) at the moment of birth. So that families get the best possible start.

Sincerely,

Debby Amis, RN, BSN, LCCE, FACCE

Education Council Chair

Lamaze International

Taking a Stand for Normal Birth

I just finished reading the article “Tools for Teaching: Toward More Evidence-Based Practice” in The Journal of Perinatal Education [Winter 2005, Vol. 14, No. 1, pp. 46–49]. Barbara Hotelling gave excellent advice by promoting the use of Lamaze International's six care-practice papers in childbirth education classes. As an LCCE educator, I fully endorse these papers and strongly urge parents to read them, and I also use them for reference during discussion.

Unfortunately, I was told by my hospital that I could no longer hand out, refer to, or even refer parents to the Lamaze Institute for Normal Birth website to read those papers. I was also told I could not refer to A Guide to Effective Care in Pregnancy and Childbirth by Enkin and colleagues, or refer parents to the online version of it at www.maternitywise.org. I was told the reason behind not being able to advocate those papers or that publication was, “It sets parents' expectations too high; and when they realize our hospital does things differently, it disappoints the parents.”

Because of these directives, I chose to resign my position as a childbirth educator at that facility. I felt it was unethical to withhold some of the best information around because it might make parents want and ask for the medical care concerning the birth of their child to be of a higher standard based on evidence-based research. I realize that many LCCE educators face this same problem.

I appreciate JPE's publishing of Barbara Hotelling's excellent article advocating the teaching of normal birth and evidence-based care.

Anna Marie Garcia, RMT, CD, LCCE