This is a guest article by Silvio Aladjem MD – Simon Barrett

In continuing my blogs with issues related to High Risk Pregnancies, I would like to discuss the interrelation between what we call “High Risk Pregnancy” and the patient’s desire for a “Birthing Experience”.

In previous blogs, I explained why a “Normal Pregnancy” is a retrospective diagnosis. One can never know in advance if a pregnancy and its labor and delivery, are going to be “normal”, while acknowledging that the vast majority of pregnancies are normal.

Some time ago, I read a blog where a mother was complaining that, because of unexpected complications during labor and delivery, which led to a cesarean section delivery, she was deprived of having a “birthing experience”. What surprised me was that at no time did she mention her healthy child. I do not know the medical history of this particular lady, and therefore I can’t comment on it. But it seems to me that, in this lady, having a “birthing experience” seemed to have taken precedence over having had a healthy child. Well-meaning people, are brainwashing our pregnant women about what pregnancy and labor and delivery are all about. Pregnancies are about having a healthy mother and a healthy baby. It is time for the public at large to understand that.

High Risk Pregnancies are not incompatible with the desire of having a Birthing Experience. There is no need to “miss” that experience because some women have certain complications. The problem is that the “birthing experience”, as most people understand it, has to be really “natural”. Nobody has defined “natural”, however. As someone commented once, “death is natural, and I don’t look forward to it”. Theoretically, if one wants a “natural birth” we would have to look at underdeveloped countries where labor is really “natural”. The woman takes care of herself in a hut away from the village. I don’t think anybody really wants that. I firmly believe that the answer to what is “natural” is having “a healthy mother and a healthy baby”. I challenge anybody to tell me otherwise.

How can we, therefore, reach a middle of the road where everyone is happy: the mother has a “natural” birth and a “birthing experience” and the physician or midwife can take care of the mother to assure that we reach our goal of a “healthy mother and healthy baby”?

Let’s us first talk about the normal pregnancy, without any complications or concerns during labor and delivery. Most women would like to be able to walk during labor until delivery becomes imminent, rather than lie flat on a hospital bed. There is no reason not to allow the mother to do that. In fact, there are studies that showed, beyond doubt, that labors are better tolerate, contractions do not hurt that much, and labor duration is shorter, when the laboring woman walks around. In return, the mother has to lie down every 15 minutes or so, to allow for the fetal heart rate to be listened to and make sure there are no problems, and, when needed, to allow for a vaginal examination.

A few years ago, a French physician, Leboyer, devised a delivery environment with low lights, mood music, soft speaking, never pulling the baby’s head, and encouraging early maternal-baby=bonding. It was called Leboyer method. It had its followers. There was nothing wrong with what he was doing.

There were, and still are, supporters of delivering in a hot tub. I am sure that it soothes the contracted muscles and the warm body environment makes labor contractions more tolerable. I have no experience, but those that used the method, were happy.

Of course, the prime condition for Leboyer, or hot tub deliveries, or anything else for that matter, should be that pregnancies and labors be absolutely normal. When they were not, nobody ever suggested it was a good idea.

In High Risk Pregnancies, one has to differentiate between uncomplicated High Risk Pregnancies” (there is such a thing) and complicated High Risk Pregnancies. An example of uncomplicated High Risk Pregnancies would be well controlled diabetics, with normal size infants. At the other end of the spectrum, we have “complicated High Risk Pregnancies which are those where either the mother’s or the baby’s wellbeing are threatened. In such cases all bets are off. The “birthing experience” in such extreme circumstances should be being alive and having a healthy baby.

Is this all so difficult to understand? I doubt it, or someone would have to explain to me where my thinking is skewed.

The public has been overwhelmed with information coming from groups that have a mission: promoting the thinking that physicians are mandating to a pregnant woman what to do thus transforming a “normal” event into a disease. That’s both foolish and disingenuous. I strongly believe that these are people with an agenda. Economics are not far behind. Why would anyone want to deliver in a “Birthing Center” because of their “home environment”? Is the home environment more important than the life of the baby or mother? If something goes wrong, “we’ll transfer you to a hospital” they advertise. Excuse me? Like in a prolapse cord where you have minutes to deliver the baby? Or a massive abruption, where the placenta detaches from the uterus before the infant is born, and where minutes feel like hours? It is not my intention to deny the pleasantness of a home environment, as long as that home environment is next to an operating room and neonatal services. If you think I am trying to exaggerate or using scare tactics, , may I remind you of the unnecessary death of a child in Lansing MI about a year and half ago, which made headlines, where an ongoing birth in a “Birthing Center” went sour, and the infant died shortly after being “transferred” to a Hospital. I am sure there are other occurrences like that, but they not always reach the news.

The bottom line is really, why would anyone want to risk a situation where the mother’s and baby’s life may be on the line? I know it only rarely happens. But if it happens to you, it’s not rarely, it’s a 100%. Think about it when you are told that it is very rare.

I remember a physician friend of mine was once asked what is the difference between a minor and a major surgery. Smartly, he answered: “It’s minor if it’s done on you, it’s major if it’s done on me”
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SILVIO ALADJE MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website, www.drsilvio.com

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