This letter was printed in the National Post on February 22, 2006.

"DON'T KNOCK MIDWIVES" by Shawn Gallagher

In his Feb.20 column, "Natural childbirth? No thanks," Jonathan Kay expressed skepticism toward any birthing option other than a doctor-supervised delivery in a hospital, complete with epidural analgesia.
I'm sure Mr. Kay and his expectant wife thoroughly researched their physician of choice. But they should realize that he or she is unlikely to attend their child's birth (doctors rotate their on-call schedules).
A question for Mr. Kay: Did you know that most obstetricians attend only the last minutes of the birth? Labour and delivery nurses do about 95% of the medical monitoring.
Readers should know that Registered Midwives in Ontario receive a four-year Baccalaureate in midwifery (the highest standard internationally). Mr. Kay's comments lumping midwives in with untrained mystics - "in Guatemalan hats" or otherwise - reflect an uninformed attitude.
Most importantly, however, Mr. Kay's column displayed a common misunderstanding of natural childbirth. The human body is designed to create its own natural anaesthetic - but only in an environment of reduced fear. Endorphins (naturally produced morphine) are safe, certainly far better for women and their babies than artificial pain-killers.
Mr Kay's unwavering faith in the medical practice of childbirth is not surprising. Medicine has dominated human birth for almost a century in North America.
But doctors and the "life-saving machines" Mr. Kay praises are no guarantee of a safe birth. Over 90% of American births are physician-attended, yet the United States ranks worst (24th) among industrialized nations in infant mortality and low birth weight. Research clearly shows that hopital-induced infections and mishaps cause hundreds of thousands of deaths annually in North America due to preventable medical errors.
Medical interventions fall into three categories: the use of diagnostic equipment, drugs and scalpels. Routine episiotomies (surgical incision to the perineum) in childbirth started in the 1920s because one obstetrician thought babies delivered in this way would be less likely to become criminals. Such absurd views are long gone, of course. But the scary thing is that it wasn't until the 1980s that episiotomies were finally tested in randomized control trials. And guess what? Routing episiotomies were found to create more damage, not less. Sixty years of a painful and harmful procedure was inflicted unnecessarily on millions of women - and it continues even today.
As for all those wonderful "life-saving machines," consider this: Electronic fetal montitors (EFM) are used in 75% of Canadian births, resulting in an increased incidence in caesarian, forceps and vacuum deliveries, but no decrease in fetal mortality or morbidity. And to the best of my knowledge, continuous EFM has never been tested for safety on the mother's body. How many women are told that EFM is a form of radiation? What is the effect of countless hours of ultrasound on ovaries and uterus later in life? No one knows.
An epidural may assuage the fear of pain experienced by many parents. But it should not be approached lightly, as the risks of epidural use, while slight, can have devastating consequences.
Given that the epidural rate for first time mothers is 70% to 95% in Toronto hospitals, I would say that Mr Kay's piece is preaching to the already converted, at least in Canada's biggest city. Most women are deeply frightened of birth. So many plan natural birth, but are unsuccessful because they don't get the help they need in the months before their delivery.
Believe it or not, with proper support and training, childbirth can actually be manageable without chemoanaesthesia. Hypnosis, for example, halves the length of labour and significantly reduces surgical and medication use.
Whatever medical decisions expectant parents choose is a personal matter. Both my babies were delivered at home. I wasn't aiming to have a "spiritual event" - to quote Mr. Kay - just the safest option for my babies and myself. While I provide hypnosis training to couples preparing for childbirth, I don't promote some choices over others. I leave decision-making to the parents: Home, hospital, epidural, natural - it is their choice.
It's wonderful that Mr. Kay is comfortable with his family's choice. But articles such as his can mislead readers into thinking that his medical choices should be theirs.

info@midwiferyconsulting.com
Shawn Gallagher is a retired midwife, and a Certified Hypnotherapist with advanced training in Emergency Hypnosis and Pain Management. She is an associate with the Ontario Hypnosis Centre, a teaching and clinical facility in Toronto.