Inherent in a birth center’s business model is a deep support for the natural and normal birth process. Every decision that’s made, every intervention that’s suggested, is based on that question: is it natural and normal, and if not, why not?
Our midwives never hesitate to suggest a medical intervention when it is clearly needed for an individual client. We know that sometimes natural and low-risk can turn borderline or even move into the realm of high-risk, and our first priority is the health and safety of our moms and babies.
As a rule, what we don’t do is routinely recommend the same medical intervention for all clients. For us to do so, the evidence has to be pretty compelling. When it comes to third stage labor – the time between baby’s birth and the delivery of the placenta – the evidence for offering routine medicine to every client has become pretty compelling.
Earlier this year, new statistics were released that show a steady and significant increase between 1993 and 2013 in the incidence of postpartum bleeding. Obstetric hemorrhage is the leading cause of maternal mortality in the United States, yet with just a single injection of Pitocin – a synthetic form of the hormone Oxytocin – in the first few minutes after birth, it can prevent one of the most serious complications of labor and birth. (See Cochrane Review of Studies.)
This is why Breath of Life now recommends an injection of Pitocin immediately postpartum for all of its clients. Most women who experience excessive blood loss after their baby is born do so for one reason: their uterus is tired and doesn’t contract as strongly as is needed to clamp down the blood vessels in the uterus where the placenta once lived. There’s no predicting with 100% accuracy who will have excessive postpartum bleeding, so to reduce the risk for all new mothers, the solution is a small dose of Pitocin immediately after birth. There are few or no side effects to mom, no harm to the already-born baby, and the Pitocin is completely out of mom’s system in less than four hours.
We know that offering a routine medication, especially one that has a bad “rap” in the natural birth community, does not fit in with the true definition of natural or normal, but neither does excessive bleeding, postpartum hemorrhage, and an unexpected transfer to the ER. Our job is to ride the fine line between natural and safe, and sometimes a compromise is needed. The evidence shows that this is one of those times.