I recently read an article titled “Birth Simulator Reduces the Chance of Emergency C-sections“.   With the c-section rate in the US at an all-time high, I’m always excited about ways to reduce the number of unnecessary cesareans.  As I read further, however, I was disappointed to discover that the simulator is not designed to reduce c-sections overall, but rather to turn “emergency” c-sections into “planned” c-sections.

Here’s how it works: the pregnant woman’s pelvis is scanned using an MRI.  Then a team creates a 3-D model of the woman’s pelvis, and projects 72 trajectories which simulate how the baby could pass through the pelvis.  Through this process, the team predicts the likelihood that a woman will be able to give birth normally, or that the baby will get “stuck” in the pelvis or need forceps/vacuum to assist the delivery.  Based on the information gained from the simulator, the obstetrician can then suggest to the woman that she elect to have a planned c-section, avoiding hours and hours of labor which end in an “emergency” c-section.

What is wrong with this scenario?  If the simulator is able to predict which women will end up needing c-sections as consistently as researchers claim, wouldn’t this be a good thing?

I vote no.  There are important variables that the MRI and the simulator cannot measure.  They cannot measure the power of the birth process itself.  Birth is more than just measuring the baby’s head and the width of the pelvic opening from multiple angles, and deciding it won’t fit.

Birth is also about the passion and heart of the laboring mother.  I have been privileged to witness many laboring women give birth; women who had previously been told they would never be able to birth vaginally.  Patience, trust in her body to be able to birth, working with the sensations of labor rather than deadening them–all of these factors can help a woman to give birth normally.

Birth is about the efforts of the baby to help itself be born.   As any midwife who has assisted at the birth of a stillborn infant can attest, a living baby does much to help itself be born.  The baby moves not just its body, but its head, in order to find the best fit.  I have seen babies at crowning, still moving their heads to wiggle their way out.

Birth is about the power of the female body to give birth when allowed to do so.  An arbitrary time limit of two hours for pushing may not be enough for many babies’ little heads to mold adequately to fit through the pelvis.  The longest second stage of labor I have ever assisted with lasted seven hours.  The woman was determined to birth her baby normally.  Her spirits and courage were high throughout the process.  She listened to her body, resting for intervals, and then resuming pushing when she felt the urge.  Gradually, oh so gradually, the baby’s head molded and inched its way through the pelvis.  I kept careful watch on both mother and baby’s vital signs.  Both were perfect throughout the seven hour second stage, and she continued to slowly make progress.  Imagine this woman’s feeling of triumph as she finally pushed her baby into the world.  Can a simulator capture that?

Birth is, finally, about the process.  So many of the interventions we have created to “help” birth move along actually hinder it.  Breaking the water artificially may create additional pressure on the baby’s head, leading to fetal distress and and “emergency” c-section to remedy the disaster we created.  Keeping women immobile so we can monitor them continually may lead to a multitude of problems from decreased blood flow to the baby and increased pain for the mother, to an epidural and vacuum delivery because the immobilized woman cannot push the baby out as quickly as we would like.  Constantly intruding on the woman’s privacy during labor in order to monitor her, ask questions for the electronic chart, check her blood pressure, and a myriad of other interruptions, can affect the ability of birth to progress normally.  This then leads to further interventions, such as pitocin, to stimulate the labor that we stalled by intruding on it.  A simulator cannot project the effect that a gentle, respectful, and non-intrusive caregiver can have on keeping the birth process normal, and optimizing the conditions for the baby to be born.

It is indisputable that some births can take place more safely by cesarean delivery.  For that option, I am grateful.  I would not want to be a midwife in the bygone days when there was no recourse but to watch a woman or baby die before your eyes.  We must remember, though, that those instances are truly rare.  For example, the Farm has achieved stellar out-of-hospital birth statistics with a cesarean rate hovering around 2%.  Yet their babies and mothers have better outcomes than the national averages for babies and mothers born in the hospital.   The cesarean births that have occurred with the Farm clients have mostly been for indisputable emergencies, such as a prolapsed cord, or a complete placenta previa.  For the rest of the difficult births, patience and supportive midwifery care have resulted in enviable outcomes.  I wonder how many of the women who have birthed at the Farm would have had a planned c-section recommended to them had they utilized the birth simulator?

Birth is a mystery.  There are many aspects to the process that we still cannot define or know.  Science can only take us so far in predicting outcomes, and the variables it cannot measure or define, are, I suspect, the most critical in determining the birth outcome.

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