In memory of my friend Tricia Anderson

Verena Schmid

Tricia was a passionate woman and midwife. We shared together this passion as well as the passion for teaching and empowering midwives, mothers, fathers and baby’s. We also shared our pain for the violence that women suffer during their most vulnerable and powerful time in life: during birth.

So, why do we need this passion today, why do we need a new way to deal with midwifery? Why does the world need midwives with a heart?

Actually the care of women who becomes mothers is medicalised. Obstetrics as well as midwifery are rational, linear, simplified, standardized, research based – that means “number based”- oriented on pathology. The focus in care is on the result: an appearingly healthy baby with an appearingly healthy woman in the shortest possible time. What happens later is not from great interest. The focus is also on risks. We have to search for signs of risks, to do diagnosis of risks and risk selection. Every woman has to be informed about omnipresent risks and she has to prove to be healthy. So we as midwives are educated always to look for something that’s wrong.

Medical care is focused on risks and so on diagnosis and therapy. Care is therefore professional centred. Woman can’t have true choices in this model of care, or only doctor friendly choices, choices of interventions. They are not aware, that many inappropriate interventions are violence on their body, but afterward they feel often depressed and frustrated, without understanding why. Birth becomes traumatic.

For healthy women, this approach is not appropriate. Risk thinking creates a lot of tension and fear that promotes dangers, not health.

Keeping birth in this medical model of care, dominated by male values, the very important tools that belonged traditionally to midwifery, tools of support and relationship, tools of empiric knowledge, intuition and observation, the knowledge about the laws of physiology have lost every value and recognition and are no more at the women’s disposal. They are even no more taught to young midwives. Physiology is no longer a guide and ground for our care. Even the manual capacities are lost. Midwives too, educated in the medical model of care, are in competition with doctors and use their same approach. So no true choice is available.

The results of medicalisation are very clear: rising caesarean sections all over the world, epidurals, inductions and a cascade of interventions, that let birth become a traumatic experience for the woman and the baby and weakens both. They become more vulnerable. All this confirms the idea that birth is a dangerous event.

So what could be a different, more female way to midwifery care?

We need to move away from the medical model and search for our own theoretical model, grounded on health, on physiology, on women’s knowledge, on a holistic approach to the person and the context and family.

When we ground our care on the science of physiology (when we understand how the body works), on salutogenesis or genesis of health, on the biological and psychosocial resources, on social and physiological adaptation, when we approach the woman in a holistic way, when we are able to create the right conditions, so that a woman can stay in contact with herself, her body and her child – that means relaxation, education, body experiences, prenatal bonding and so on, when we teach her partner to find his way to fatherhood and to support  the woman emotionally, with his body and his love, or giving her the space she needs, then the woman will be really at the centre of care and enabled to lead her experience of becoming and being a mother.

In the salutogenic model of care we search for signs of health instead of signs of risks and for resources. We will learn to observe the physiological systems, the pillars of health (autonomic nerve system, hormonal system, foetus-placenta system, mental-environment system) on three levels: in the body (clinical signs), in the woman’s behaviour and lifestyle and in her emotional expressions. So we will know the resources and can help an optimal adaptation. We will acquire non-medical tools of intervention on this different levels and systems to improve their functions. We will stimulate the biological resources to restore health if necessary and protect the women’s and baby’s integrity together with the wise laws of physiology.

Why is this so important?

We know today, that tension, fear, lack of knowledge and support, distress, chronic fatigue are very harmful for mothers and baby’s.

We also know, that pregnancy, birth and breastfeeding are big changes in the body and mind of a woman and an existential experience for the baby, giving him an imprinting for his whole life. So an active and good adaptation to this changes is the most important issue for midwives. We also know, that the adaptation systems and the laws of physiology provide very important mechanisms of protection that make birth safe. When we disturb them, birth becomes more dangerous. Trust can grow in the knowledge of this laws.

We know today, that high levels of cortisol during pregnancy lead to the most dangerous risks in obstetrics: diabetes, high blood pressure, placenta abruption, toxiemia, IUGR, as well as many problems with the baby after birth (hyperactivity, crying, vomiting, difficult relationship…).

So for example, in the centre of care during pregnancy we should put antistress treatments, relaxation, body experiences, prenatal bonding, meetings with couples, classes during early pregnancy.

High levels of cortisol during birth and the first hours afterward lead to dystocia’s, malpositions, and trauma for the mother, and to a difficult adaptation and imprinting for the baby that can have lifelong consequences. We know today that the major illnesses in adults come from chronic distress in the perinatal period.

A baby goes into distress when:

–       he is extracted by an unexpected caesarean section or vacuum

–       his mother has an epidural and he has to do the birth work alone, without his mothers attention and protecting hormones, moreover, at the moment of birth he is drugged and helpless

–       when he is in a malposition and blocked in the birth channel

–       he is separated from his mother

–       he is not breastfed

–       he needs resuscitation (more often necessary in medicalised births)

Therefore the focus of care during labour should be on creating the right conditions, so that a woman can give birth with her own forces and that labour pain is reduced to its biological minimum (not stressed by medication and interventions).

The birth hormones from normal labour without any medication not only protect the baby from danger and help him to adapt during and after birth, but they prepare the whole process of bonding, love, happiness and ecstasy that forms the ground on which the child can grow. Moreover, they activate a protecting behaviour in the parents toward the child, and slow down aggressivity.

The mothers normal birth movements, guided by normal, rhythmic labour pain, enable the baby in using his own competencies and impress him, through the mirror neurons, “programs of action” that later in his life will be performed in motor and language patterns.

Under the high levels of endorphins and oxytocin he learns many things and in his brain the circuits of empathy and social capacities becomes activated. At the moment, when the awake and present mother meets for the first time her awake and present child, in the baby’s brain countless mirror neurons start to build up and work, in this way the child will be able later in life, to feel with others, to be empathic. This is an important part of his social intelligence.

Another very important hormone during labour is missed in the medical way of birth: prolactin. Prolactin reaches very high levels during labour and in the first period after birth. It protects the baby’s metabolism during birth and in the first time after and prepares his lungs for breathing.

But it has an other very important function: it activates in both parents a protective behaviour and a protective relationship toward the child and helps them to control their own “shadow parts”,, that in men is aggressivity and in women rejection and closure. Prolactin slows down aggressivity toward others and focuses it only on the defence of the child.  Prolactin stimulates the vagus and inhibits adrenalin from the sympathetic nerve system. So in prolactin we can find an important ally to prevent violence.

In normal birth hormones there is a big potential for the individual as well as for society. The biological channels are facilitators to the complicated processes of change and adaptation and they are directed toward social behaviour and relationship.

In conclusion I would say, that not only mothers, fathers and baby’s suffer under the lack of birth hormones and of an ecstatic birth experience, cut out with medicalisation and technology, but our whole society. The lack of prolactin, endorphines, oxytocin, oestrogenes creates more violence, aggressivity, frustration, depression, difficult relationships, learning disabilities and so on and leaves the children more exposed and vulnerable to the negative imputes from society and to abuse. When the bond with the mother is disturbed in the primal period, even the bond with mother earth is disturbed and the orientation in life will be more on problems, then on resources. Becoming a mother, a father can be much more joyful and easier with the normal birth hormones.

So women, baby’s, fathers as well as the whole world need tender, loving midwifery care. Our planet needs this nurturing loving female energy (from men and women) and a big heart to go forward to a positive future for the new generations, the new children that will come into this world.

Literature:

Antonowsky A. (1987): Unravelling the Mystery of Health – how People manage Stress and stay well, Jossey Bass Pub. San Francisco USA

Bauer J. (2005): Warum ich fuehle, was du fuehlst, Hoffmann und Campe Verlag, Hamburg

Davis Floyd R. (1992): Birth as an American Rite of Passage, University of California Press, Berkeley and Los Angeles

Gerhardt S. (2004): Why love matters – how affection shapes a baby’s brain, Routledge pub. London/New York

Goleman D. (2006): Social Intelligence – the new science of human relationship

Nathanielsz P. (1999): Life in the Womb – the Origin of Health and Disease, Promethean Press Ithaca, New York

Taylor S. (2002): The tending instinct, women, men and the biology ot our relationships, Times Books, Henry Holt & Comp., New York

Schmid V. (2007): Salute e Nascita, la salutogenesi in gravidanza, Apogeo ed. Milano

Schmid V. (2005): About physiology in pregnancy and childbirth