12 December, 2008

another chance to ignore the evidence

tonight I wax cynical.

a cautious thumbs up to this bit of research stating it is perfectly normal for the active phase of first-stage labor to "stall". Often the stall is viewed as abnormal, a reason to hasten surgical delivery. I'd prefer the authors use the more positive term "plateau" in lieu of "stall". Semantics aside, defining a "stall" or "plateau" is predicated on the near-universal obstetric assumption that progress=cervical dilation.

there are different ways for this quite normal plateau phenomenon to play out. contractions may continue with full vigor and frequency, or they may space apart somewhat, or they could stop completely. in each of these scenarios, cervical dilation ceases for a while (our wondrous cervices can even reduce in dilation, per the brilliant Ina May Gaskin's Sphincter Law).

what else could be happening during the "stall"?
-baby is rotating into optimal alignment with mother's spine and pelvis
-an asynclitic (cocked to one side) head is centering
-the uterus is gathering its strength for the work ahead
-the baby is descending
-adrenaline and oxytocin are waging an inner battle for dominance
-the woman is craving/receiving some much-needed nutrition & hydration
-the woman and her partner, or mother, or sister are working through some emotional blockages

The study authors exclaim: "we found that just by being patient, one-third of...women could have avoided the more dangerous and costly surgical approach." So perhaps Friedman's curve mandating 1 cm dilation per hour can now be cast aside as a terribly outmoded and ridiculously machinistic view of human physiology. Perhaps.

But change is slow. practitioners often stick with the first approach they learned (old dogs/new tricks & all). being patient works fine in a low-volume setting where the staff and beds are plentiful. yes, surgical birth is costly--costly to women's postpartum quality-of-life and future obstetric choices. costly to insurance companies. but it sure is one heckuva money maker for hospitals and doctors.

Even if practitioners and hospitals consider change, what of the birthing women who hear story after story of disempowered birth, who do not trust the process, do not trust their bodies, who were brought forth from their own mothers by unnatural means and have no cellular memory of normal birth? What of these modern birthing women who are inculcated in a culture of birth fear? how to rouse our sisters' somnolent warriors?

I'd like to think the admonition to "be patient" could resonate within the heart of every compassionate birth attendant. I'd like to see a reversal of the alarming upswing of unnecessary cesarean births. Just not sure this particular drop in the bucket will quench my thirst.


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