Medicine: Natural Birthdays
In Alabama 100 years ago, midwives wrapped a laboring woman in her husband’s shirt and cap, so his energy could help her with the birth. In Guatemala, birthing mothers are given beer in which a purple onion has been boiled—more agreeable, perhaps, than the custom in Bihar, India, where labor is helped along by drinking water in which the mother-in-law’s big toe has been dipped. In the Central African Republic, laboring women chant EI-OH mama ti mbi, ti mbi aso mbi! (Ei-Oh mother of mine, my belly hurts me!) to a response of Kanda be ti MO! (Tie up your heart! Meaning, tough it out). In Mexico, traditional midwives step between the woman’s legs at the moment of birth to prevent curses entering.
Named by obstetrician Grantly Dick-Read in his 1930s book of that title, this middle way has gained vast popularity in the developed world. Many hospitals, the Hadassah–Hebrew University Medical Center in Jerusalem among them, do all they can to accommodate support systems in the delivery room—from partners, mothers and doulas to breathing regimens, focal objects, massage, washcloths and crushed ice.
Two years ago, however, Hadassah took a giant step beyond simply accommodating natural childbirth. It opened a Natural Birthing Center dedicated to helping women give birth in the way they want.
Comprising two custom-designed rooms along the corridor from the main delivery suites, the protocols practiced here may seem as improbable to the women of India, Mexico, Guatemala and the Central African Republic as theirs do to us. There is, for example, a ladder on the wall by the bed for the woman to hold if she wants to deliver her baby standing. Or she may choose to sit astride a physiotherapy ball, lean against a birthing stool, sway on all fours on the exercise mat or relax in a Jacuzzi. Lights are on dimmer switches, and the hand-wash basin, sterilizer, rubber gloves and medical supplies are behind a curtain of sea-greens and blues.
Within Hadassah’s high-tech medical environment, this is a midwife-led center, calm and unstressed. New York-born, Hadassah-trained Nancy Novik is its director. She has delivered thousands of babies during the past 30 years, has been a robust advocate of natural birthing for at least that long and has delivered each of her own three children this way.
“Managing labor and delivery with minimal medical intervention is an empowering process for the mothers and very professionally rewarding for myself and the dozen other senior midwives on staff,” says Novik. “While we do all we can to support laboring mothers in
Hadassah’s eight delivery rooms, every midwife takes care of at least two women at a time, and more than 500 babies arrive every month. So you can’t compare what we’re able to do in a dedicated center: Here we have time and space to support the laboring woman one-on-one and use experience, skill and intuition, rather than medication, to control pain and advance birth. We know we succeed when we hear, time after time, from mothers in the center, ‘I couldn’t have done this without you!’”
More than half of mothers in Hadassah’s delivery rooms will ask for an epidural, either at the beginning of labor or as it progresses. In the birthing center, such a request is rare.
Over 100 women have given birth in the center since it opened in July 2009—a substantial number, according to Novik, since it has never been advertised. A donation from Hadassah member (and mother of a midwife) Dorothy Shaker will be used later this year to inform people about the service.
Those who have heard of the center and given birth there, says Novik, “are women with high awareness of what they want and expect from the birth, and to whom it’s important to have intimacy with their health care provider. There have been a number of Anglos among them, a lot of native Israelis and a handful of Arab and ultra-Orthodox women.”
This demographic is not, however, a fair reflection of the market. “Unfortunately, the service is not free,” explains Novik. “It runs about $1,000 per woman, and so for many it is beyond their financial means.
“Though, it must be said, while this sum is perhaps high for an individual,” she adds, “in terms of income to the medical center it is very low indeed, and we are grateful to Hadassah’s administration for supporting our efforts.”
The women who deliver at Hadassah’s birthing center must meet medical as well as financial criteria.
“We wait until the 35th week of pregnancy and then register only pregnancies that are low risk,” says Novik. “That excludes a range of conditions—among them, chronic diseases; gestational diabetes; high blood pressure; very small or very large babies; severe anemia; and a seventh or later child, when a birthing woman has an increased tendency to bleed. All our women go into labor with a closed saline lock (preparation for intravenous administration) in place on the arm. The medical staff insists on this and we agree. A cordless monitor in each of our two rooms allows us to hear fetal heart tones so we know how the baby is feeling wherever the mother is in the room—in bed, in the bath or walking around.”
Each of the senior midwives has her own emphases and ideas, but all give the mothers in their care focused attention. “I think that is among the most important contributions we make,” says center midwife Polly Hyams Sherman. “Add to that our very long experience. I can look at a woman in labor and think: Right, time to get her moving—to encourage her to walk, gyrate, dance, whatever suits her. Or, let us get her in the bath to relax for 20 minutes or so, but no longer because that will slow her labor. Maybe a bit of guided imagery: I will have her imagine her pelvis as a lotus flower, opening its petals. Or, I will sit her on the birthing stool to lean against her partner—right now, she needs his support, physical and emotional.”
The advantages of natural childbirth are well documented. A woman given labor support is likely to feel positive about her birth experience, asserts Sherman. Babies, less exposed to the narcotics and drugs that augment labor, are more likely to be born alert and can thus be placed right away on their mother’s skin.
While many women want a natural childbirth, there is sometimes a gap between what they want and what they can manage. “For that reason, we always prepare a birth plan with our mothers before they go into labor,” says Novik. “A written plan helps ease the stress of making decisions during labor.
“Handling pain is in every birth plan. If, for example, we know that pain intervention is a last resort, we won’t distress the woman by offering it. Or we may have a pre-decided ‘code word’ that the laboring mother will use to alert us that she truly wants pain medication.”
Medication is never pushed as long as the labor remains low risk. Should anything happen to alter that, however, the center has the safety net of an advanced medical presence—obstetricians and anesthesiologists—as well as the option of immediate transfer to its delivery and operating rooms for epidural, vacuum extraction or C-section.
“Essentially, we provide the comfort of a home birth with the security of expert medicine close at hand,” says Novik. “We enable an empowering birth experience.”
The women who give birth in the center agree. “After a truly dreadful labor with my third [in a regular delivery room], I couldn’t imagine ever having another baby,” says one mother.
“But there I was pregnant with number four, and dreading the birth. I heard about the Hadassah center from a friend who raved about it, so I registered.
“And this time, the birth was amazing, for my husband as well as for me. And now we cannot wait to have our next baby!”