The empowerment of birth.

The image of a woman reaching down to bring her baby onto her breast at the moment of birth is a powerful one. She birthed her baby, and every cell in her body knows and shows her strength. At the end of hours of pain and emotions felt more intensely than at any other time in life, she is exultant. To know the exhilaration, euphoria, and power that comes with the exhaustion and pain of giving birth is truly empowering. After giving birth, a woman knows she can do anything, accomplish any goal. Even women who need interventions for the safety of themselves or their babies are given the gift of empowerment, for they know they did the best they could.

Birth has long been thought of as the ultimate rite of passage. Cultures close to nature have devised methods of initiation, testing young men to show that they are adults, ready to take on the responsibilities of adulthood. Women have not needed such tests, for they have birth. A woman may have doubts about her body: are her breasts too small, or too large; her hips too narrow or too broad? Even in these days of women's liberation, it is not unusual for a woman to have questions about the "rightness" of her body. However, "after giving birth, a woman knows her body works beautifully.

Another facet of the empowerment of birth is the complete bonding that happens when the baby is brought immediately on to the mother's breast and allowed to stay there until the mother is ready to have the baby checked and weighed. This, of course, is assuming the baby has no problems. As empowering as birth is, some women in our culture have become afraid of birth, afraid of the pain, and afraid they cannot do it. Today, inductions, c-sections, and epidurals are done so frequently that practitioners have become quite skillful in their management and have significantly reduced the risks associated with these procedures. However, when not medically indicated, such interventions do increase the risks involved in the birthing process. They also remove a woman from the experience of giving birth. While there are many women who choose to try to birth naturally, most women in the United States today are choosing the latest obstetrical model, which is one of controlling the process.

"Mrs. Smith, how would you like to have your baby next week? You will be close to your due date, and this baby is mature and big enough to be born. You can check into the hospital, we'll start some pitocin, and get you an epidural so that you'll be comfortable for the entire process. You'll have your baby by the end of the day."

Sounds tempting. No wondering if you are really in labor, if you'll make it to the hospital, if you will have help at home, or if you should have taken those birthing classes. For the care provider, there is no rescheduling of the office, fewer middle of the night calls and conflicts with vacations or meetings. This is known as nine-to-five obstetrics. Another trend is to offer a scheduled cesarean section as a choice even before a woman is at the end of her pregnancy. Ostensibly, this is to preserve the perineal floor, although there are no well-designed studies that show cesarean section prevents urinary incontinence or prolapse of the uterus.

With the current c-section rate around 25%, we tend to forget that a section is still major abdominal surgery with all the risks of hemorrhage, infection, and postoperative pain. Epidurals offer good pain relief in most cases, but they are not without risks. When they do not work well, a general anesthesia must be given for surgery, which may add yet another risk factor.

While we are all grateful that inductions, epidurals, and c-sections are available when needed, they often work to rob a woman of the experience of childbirth and the empowerment that comes with going through that experience as much as she can on her own strength.

Interventions are often needed to safeguard the health of the woman and the baby, especially if she is a smoker, does not have good nutrition, or has any of a number of other risk factors such as diabetes or hypertension. However, intervention for medical reasons should happen only in a small percentage of pregnant women.

The great majority of women are capable of giving birth naturally, especially if they have support from their obstetrician or midwife and their partner and family. To not support a woman in this most definitive of feminine acts is to rob her of her birthright to empowerment, to leave her devoid of the deep resource of power that birth can give.

Jan Verhaeghe is the mother of five children and has been a midwife for over 21 years. She is Director of Midwifery at New Dawn Midwifery in Asheville, NC.