Many women take a special class to prepare for childbirth since very few have ever seen a baby born before giving birth themselves. Some childbirth classes are geared toward teaching a woman how to achieve what is known as a "natural" birth--generally thought to be a birth free of pain-relieving medication. A much greater number of classes, however, are offered through hospitals and are more general in nature. These hospital-based childbirth education classes give a broad overview of what a woman can expect from a hospital birth, and a good deal of attention is given to what sorts of medical pain relief is available, as well as what sorts of complications might arise. Again, a woman's partner usually attends these classes with her.

Increasingly, pregnant women use what they learn in childbirth classes to draft what is known as a "birth plan": a written script of how they would like their birth to proceed. Often, the birth plan consists of a laundry list of common medical interventions--such as a routine IV or an episiotomy-- that the woman would like to avoid. When the woman takes her birth plan to one of her later prenatal visits in order to discuss it with her doctor, she is often told that the plan is acceptable, but that she needs to be "flexible" and understand that the doctor can't do his job properly if he is hampered excessively by a written plan. The doctor generally agrees to "try" to help the woman achieve the birth experience she envisions.

A great number of births in the United States today (some estimates put the number as high as seventy percent) are either induced or augmented with the use of medical practices--such as rupturing the membranes--or medications like pitocin. Many women check into their hospital birthing suite early in the morning and are hooked up to an IV with pitocin in order to get contractions started. This is especially true for women who go more than a day or two past their estimated due date. Hospital birthing rooms are often quite comfortable and homelike, and the woman's partner and mother or friends are able to wander in and out of the birthing room at will. Whichever nurses happen to be on duty monitor the woman's contractions and progress with the use of various technologies which include a fetal monitor strapped to a woman's belly or an internal monitor inserted into the birth canal and attached to the unborn baby's scalp.

Greater than fifty percent of American women (and as many as ninety percent in some hospitals) choose to have medicinal pain relief during childbirth. The most popular form of pain relief is an epidural, inserted into the woman's back by a highly-trained anesthesiologist. Epidurals frequently slow the progress of labor, so pitocin is often given to the woman at this point if she isn't receiving it already. The many wires and tubes attached to the laboring woman, as well as the fact that epidurals make walking impossible, mean that the mother is confined to her hospital bed, usually on her back or side.

When the baby begins to descend down the birth canal, the nurse on duty pages the woman's doctor, who arrives in the room in time to assist her with the actual delivery. The woman generally pushes while on her back with her legs supported with stirrups attached to the bed or by her partner and nurse or other birth helper. Nearly seventy percent of first time mothers in the United States receive an episiotomy when the baby crowns, making this one of the most common surgical procedures performed in the U.S.

After birth, the cord is cut quickly and the woman is often given another shot of pitocin in order to assist her in quickly expelling the placenta. Many women never see their placantas and the great majority of placentas are disposed of by hospitals as waste.

In the United States today, nearly one in four women experiences complications that prevent her from giving birth vaginally and cause her to require a Cesarian section. Approximately one in ten hospital-born babies requires a stay in the hospital's neonatal intensive care unit, making the NICU experience a fairly routine part of the American birthing culture.

Written with assistance from the booksThe American Way of Birth by Jessica Mitford (Plume, 1992) andA Good Birth, A Safe Birth by Diana Korte, Roberta Scaer (Harvard Common Press, 1992)

 

THE JU/'HOAN WOMEN OF SOUTHERN AFRICA

Among the Ju/'Hoan women of Botswana and Namibia, birth is seen as a transformative experience. A woman attains a much higher status when she has successfully completed the life passage of pregnancy and childbirth. Unlike most other cultures around the world, the Ju/'Hoan do not have traditional midwives in their communities. Instead, women and their partners place a very high value on the ability to give birth completely alone with no one at all present for the event.

Although solitary childbirth is the cultural ideal, a young woman may choose to have female relatives present for her first birth. However, even with others present, the woman herself is considered completely responsible for whatever happens during and immediately following her birth. An easy delivery and a healthy baby are said to reflect a woman's full acceptance of birth.

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