In 2000, I first built the Birthing Naturally website. I wanted to provide an internet source of natural childbirth information. I included a list of my birth philosophies on that website and every version since. Here is the a statement from my philosophy:
The female body was designed to give birth. A healthy woman should have only about a 5% chance of a complication during the childbirth process.
Have I changed my philosophy?
My thinking about this statement has changed because I have a more nuanced understanding of “healthy” and “complication”.
When I first began teaching childbirth classes I had a very strict definition of healthy and complication. A woman was either healthy or she was not healthy. She either had a complication or she did not. There was no in-between. In my head, risk did not exist because you treated a problem when it happened. If the problem was not apparent, you didn’t need to do anything.
Fast forward to today, and I no longer define health as the absence of illness. Today I would define health and wellness as a continuum. I also understand the importance of understanding risk so I can identify women who are more likely to have a problem; and the women who are least likely to have a problem.
There is probably more I should say about this, but I don’t know how to put 18 years of learning into one blog post. Eighteen years is no exaggeration, this topic is the crux of the work I have done for the past eight years. My research involves learning to identify women who will need assistance early to prevent problems. But my research also involves the other side of the issue, identifying women who are not likely to have problems so they can remain in their community to give birth. I used to be afraid of identifying risk because I thought it meant forcing women to have interventions they don’t need. Now I want to improve our risk identification because I understand how important it is to demonstrate the safety of birth in community hospitals and health centers for most women. If we cannot learn to tell who is and is not likely to need help, we are likely to lose maternal healthcare in our rural areas. Indeed, between 2004-2014 9% of rural counties lost their obstetric services — this increases the distance the women must travel for care and increases her risks for a pregnancy or labor problem without altering her health or wellness. Like I said, it is more nuanced.
I also have learned to use early identification of risk to help women prevent problems. I still understand risk is not the presence of a problem, but I understand that by helping women move closer to the healthy and well end of the continuum she can reduce the chances she will have a complication. It turns out I’ve always been a fan of prevention, I just never understood that prevention exists within the measurement of “risk”.
To be fair, I cannot remember where I found the 5% number. It is probably a number I heard mentioned at a conference or in a book and accepted it without considering how it was calculated. I would never do that anymore – accuracy with statistics is part of the job of a researcher.
My, how I’ve changed
When I started this project to look back at what I wrote, I expected to have a small amount of change in each statement. I assumed that when you added together all the small changes it would be a big change in the way I think about birth. Instead I’m finding that nearly all the changes in my philosophy about birth have been in this statement. What about you, how has your understanding of pregnancy and childbirth changed over time?