Unassisted Childbirth and VBACs, by Dr. J.E.

I read the article by “American Dad” titled “Prepping and Unassisted Childbirth”, and I must comment on some of his points.  As a “senior” practicing Physician, and an avid closet “Prepper” since the early 1980s, I have often considered the health consequences of a true SHTF scenario.  Only recently has my Family suddenly decided my preparations are not so “far out there” after all, but it has been a lonely quest these many years.  I long ago gave up trying to convince people to look past and through the media hype and actually “see” what is running the world view.  Either they do or they do not, but all you can really do is try to prepare for your Family, plan to join other like minded persons who may not be your Family, and bring along as many souls as you possibly can manage.  

You may also want to read www.shtfschool.com, where Selco (not his real name) will tell you in graphic detail of what happened to him in a year of SHTF in the Bosnia/Serbia arena concerning “basic” health related issues.  Selco is a Medical Professional, and he will explain how a “scratch” in that setting can kill you, leaving your children orphans.  I have corresponded with him, and what happened during that time left him a markedly “changed man”.  Nothing and I mean nothing can be taken for granted.

Having worked in third world countries, I have experienced first hand the effects of not having the best in medicines and medical expertise.  Certainly people do survive in these circumstances, some quite nicely, but that is often the result of “luck” more than it is anything else.  “Routine” maladies can and do quickly kill a human under these conditions.  It is horrifying and unnerving to witness these deaths and life threatening events knowing with simply the basic rudimentary elements of “modern medicine” available, most could have been prevented.  “Simple” pneumonias, small cuts and abrasions, minor fractures leading to disfigurement, the stench of gangrene, amputations (without decent anesthesia), and death become commonplace.  Remember this mental picture as I continue.

I am fortunate to have attended many hundreds of human births in my long career. Birthing is always a happy, joyous time…until it isn’t.   During my career my professional path has crossed the paths of Obstetricians, Family Practitioners, Mid-wives, Certified Nurse Practitioners, Obstetrical Nurses, Doulas, and “experienced” birthing Mothers.  I will state openly the following belief I hold dear:  It is every individual’s basic right to choose whatever type or degree of care they wish. It is also your obligation to assume the responsibilities associated with those choices.

American Dad laments, “The impersonal way hospital staff treated us; the overactive use of clinical equipment, terms, and technology; the fact that I had to keep briefing incoming personnel on our birth plan (since apparently they didn’t take the time to actually talk to read the copies I had provided, or talk to one another); the fact that they ordered my wife to lay on her back, which made the process excruciatingly slow and painful; the fact that the first thing my baby saw was a doctor dressed in a haz-mat suit; the way they whisked the baby away from mom as if the child were public property; the way they treated me like a useless observer and not the head, protector”

This interpretation of the birthing event in “modern” times is certainly different than anything I have experienced.  I shall refrain from lengthy comment concerning exactly “what” a newborn is capable of visually perceiving immediately at birth, but I do know most hospital settings allow one to practice anything the Mother desires as long as the modern techniques of frequent non-invasive fetal monitoring are allowed to proceed unencumbered.  Without a doubt, “fetal continuous monitoring” of the non-invasive variety has lead to a marked decrease in fetal morbidity during the birthing process in the last 20+ years.  Even with these data, most hospitals will forgo continuous fetal monitoring if the Parents insist.  They might, however, ask them to sign a liability waiver and an “against medical advice” waiver.  Those are very reasonable requests.

American Dad’s view of “Vaginal Birth After Caesarian Section” (VBAC) mirrors his obvious disdain of hospitals and their staff.  His comment, “The hospitals sure make a lot of money off of parents’ love for their babies, but they do treat all of the parties as ignorant, blundering, or unwelcome troublemaker” certainly is inflammatory, but neglects the simple fact most “Community Hospitals” are actively closing down their birthing centers.  The reasons are simple and straightforward:  they are losing money keeping them open, and the “liability” costs are too great.

Vaginal Birth After Caesarean (VBAC) deserves a special commentary.  The possible catastrophic events associated with VBAC, although correctly stated as “rare” by “American Dad”, are impossible to predict with certainty, and occur so suddenly, the mother and neonate can easily both be dead in a matter of ten (10) minutes or less.  This requires an entire Operating Team (Obstetrician, Anesthesiologist,OR Nurse, OR Technician, Assistant Surgery Member, and a Large amount of dedicated surgical supplies) be continuously present in the Labor Suite throughout the entire Labor Event of possibly many hours.  This is why VBAC is usually limited to large “University Training Centers” where all this is available.  They are costly and consume an inordinately large number of resources that most VBAC patients do not understand and cannot assume.  Just whom does “American Dad” expect to “cover” these costs?

I doubt “American Dad” would agree to the “costs” of providing all this service on a “just in case” basis at a Community Hospital.  My guess is “American Dad” assumes the “worst case scenario” would never happen to his wife, and if it did, then he would consent to the C-section (“Worst case, we’d have to get another C-section.  Fine.”)  The problem is, in anything other than the scene described above, it is quite probable he would be facing a considerable risk of morbidity and mortality for both his Spouse and his unborn child.  It is doubtful the Surgical Team could be assembled in less than 30 minutes in a Community Hospital.  In “American Dad’s” case add to that time the trip from his home to the hospital.  “American Dad” is, however, willing to assume that risk, which is his and his wife’s choice.  Let us be clear, these are serious considerations.

American Dad agrees an “unassisted childbirth” (UC) would take some “serious training”.  Actually he is over-stating this.  Face it; for many thousands of years, Mothers have given birth quite “naturally” over 90% of the time without much assistance at all.  Simply brace them against a tree in the squatting position, give them a green twig to gnaw on for the pain, stand back, and let “nature” take its course.  It’s that pesky 10% that quickly made it clear “things” could be vastly improved by knowledgeable persons helping with the process.  After all, each new life is a priceless asset to the group, and the magnitude of the loss of a working Mother cannot be quantified in simple terms.

For those of you fellow Preppers kind enough to have stayed the course of this, here are my observations and simple steps to follow in a SHTF situation.

  1. Find the best of what you can find to suit the situation you are in concerning Birthing.  If you are in a position and are fortunate enough to have the availability of a trained Obstetric Physician, by all means, use that person.  If not, then find the best “Family” Physician (GP in the old parlance).  Next would be a Nurse Midwife or an Obstetrical Nurse.  Finally, an experienced Mother who has survived several successful births would be better than going it alone.
  2. Without the availability of #1, EXPECT SERIOUS LOSSES and morbidity.
  3. Do what you can to have a person with “advanced medical training” and experience in your group, or at least have access to that person.
  4. In a SHTF scenario, pregnancy cannot be considered “lightly”. Know the risks.
  5. Since order is usually eventually restored, plan your pregnancy wisely.

Events happen suddenly and swiftly in the birthing arena.  I seriously doubt “American Dad” or any lay person with no experience could act decisively and quickly enough with most of the common complications.  As “American Dad” correctly states, “Again, this isn’t rocket science.  The techniques aren’t mystical or complicated”, but it isn’t calming and relaxing either.  These situations are tense, messy (blood, amniotic fluid, bodily fluids), and emotionally charged.  It is a “pressure cooker” situation and “time is of the essence”.  You had best know exactly what you are doing.  A mistake here will be costly and unforgettable.

Each year we attend to people in our large western city who have a Home Birthing experience complication.  The people have similar qualities:  They are usually quite intelligent like “American Dad”.  They are well read.  Many are “professionals”, frequently Nurses.  Their “hearts” are in the right “place”.  Common to all I have seen and attended is the fact none thought anything would go wrong, or that they were really at risk of death.  By the time they present to us, their condition is frequently quite critical, costing several days in the hospital. 

As adults, each of these individuals has the capacity to make these choices to take these increased risks.  Shall we even broach the capacity of the unborn child to make the decision to not take these increased risks that are unnecessary without a SHTF event?  When we elect to “go it alone” when going it alone is not necessary, is that a fair choice to make for the unborn child.  It becomes far more serious with these thoughts considered.

“American Dad” has much useful information in his article, but the cavalier attitude he takes toward this subject will not well serve his readers.  There are reasons for how and why Professional Medical Practitioners do the things they do.  It’s not always a remuneration issue.  Frequently it is about common sense and giving you the best available chance to make it through a potentially very dangerous event alive and well.

JWR Replies: Home birth is gaining popularity (United States Home Births Increased 20 Percent from 2004 to 2008), but it is still a relatively low 0.67 percent of United States births. The statistics for planned home births show a very high success rate with “No significant differences were found between planned home and planned hospital birth.” But it is important to note that that this data is skewed, because expectant mothers who show any sign of pre-natal difficulties almost always opt for a planned hospital births. Thus, hospitals get all of tough cases, and it is mostly those that expect a “low risk” easy delivery opt for home birth.

One key metric is the transfer rate–the rate at which planned home births transition to emergency hospital births. These are usually precipitated by any signs of fetal distress, such as bleeding, umbilical cord issues, extended labor, or stained waters. (Meconium in the amniotic fluid.) Early transfer is a wise course of action. In the U.S., the transfer rate averages around 16%. In Sweden, the transfer rate is only between 6 and 12%. In some First World countries, midwives are required by law to order a transfer if labor goes beyond a set number of hours. But it is noteworthy that some of these transfers are not due to fetal distress, but simply because a midwife was called too early and becomes exhausted. (Midwives often work alone, and they cannot be expected to function well after 12 hours at a delivery home.)

For what it’s worth, three of our children were born at home, with plenty of prior planning.

I do recommend home birth for most moms. If nothing else, this experience provides crucial knowledge and experience for the potentially dark days ahead, when home birth might be their only option.