11.06.2007

Attempting Understanding

My personal understanding of a ‘schema’ and a ‘script’ are as follows:

A ‘schema’ is a set of beliefs or facts we have about any given thing we’ve encountered throughout our lives. It’s a sort of a psychological short cut that helps us to not have to relearn everything about something before we make a decision about it. In advertising, it helps us to categorize something being presented; think of it as a ‘one of these things is not like the other’ sorting process in the brain.

For instance, my schema for books includes: they are valuable, they are entertaining and informative, it is fun to read them, they are essential in education. Obviously I like books. Someone else’s schema might be: books are a waste of my time, they are hard work and no fun and they are heavy when you have to lug them home from school.

I’ve learned certain things about books that make them important to me. I have certain associations with books. Therefore I make certain assumptions about books and make decisions based on that knowledge base. Someone who has a hard time reading or who simply dislikes reading has different associations.

A ‘script’ is a set of actions based on a schema. Using the above example, say I’m given a book. I’m likely going to put it in a book case until I read it, take very good care of it while I am reading it, read it cover to cover and put it back in a book case if I plan to read it again. If I don’t think I will read it again, or if I think someone else would like it, I’ll donate it or pass it on to a friend I think would like it. If someone lends me a book, I’m very careful to keep track of it, take extra special care of it, and return it as quickly as possible.

Someone who has the latter schema may toss it in the back seat of their car, ride around with it for months, not caring if it get’s stepped on or dirty or banged up. They may or may not open it, but if they do, they may skip to the end to see if it’s worth their time or to see if there are any pictures, and if not, they’ll (gasp-it pains me to even write this) possibly throw it away. If someone has loaned it to them, they may or may not return it in a timely manner (if at all), and it may or may not be in the condition it was in when they got it.

These are the ways we act according to what we know, what we think we know, or what we have concluded through the lens of our experience. Often these ideas are so ingrained we may not even think about them, but they motivate us none-the-less. In marketing this is on reason why we buy a certain product over another.

Ok, now to apply this to the brand of BIRTH.

The prevailing schema for birth is it’s dangerous, it’s painful and it’s a medical event that requires doctors and hospitals. It is the most dangerous time in the life of mothers and babies. Birth is safer because it happens in the hospital, and that’s why we give birth there. Something could go wrong at any minute, everything doctors do is for the safety of mom and baby and there must be science backing every intervention, because they are doctors after all.

Based on this set of associations, the script of birth goes like this (starting in pregnancy where most birthing decisions actually begin): the pee stick turns blue, we call our OB, we have an ultrasound, we have a bunch of tests done at each visit, many of those tests necessitate further tests, we take a childbirth class at the hospital, we go to the hospital when we go into labor (or we go to be induced), we get an epidural or narcotic for pain, we have pitocin to speed up labor, we spend most of the labor flat on the back hooked up to monitors, we push like made while someone counts in our face, we have an episiotomy at the very least, with a vacuum extractor likely, or we have a cesarean section.

Now, every decision in the script makes perfect sense considering the schema. Any other decisions would seem downright crazy and irresponsible. The problem is that the schema has been manufactured for the purposes of marketing BIRTH. It isn’t real. Well, that isn’t fair; it’s real enough to the people who believe it, and therefore it becomes a self-fulfilling prophecy. It just isn’t based on facts. It’s based on beliefs that are then reinforced by the decisions that manifest the expected reality. And part of it is actually factual; for a lot of women and babies throughout history and currently the childbearing year is indeed the most dangerous time of their lives, but not because BIRTH is dangerous.

A multitude of factors make it a dangerous time, but none of them are specific to the state of pregnancy or the physical act of natural birth.

The leading cause of death in pregnancy in the US is murder.

Young women who are pregnant before their bodies are mature are more likely to die in pregnancy and during birth, but it’s because they are too young. Malnourished women, women living in poverty who cannot afford to eat or who are constantly pregnant without access to birth control are at increased risk. (Decent nutrition can prevent about 85% of pregnancy and birth complications, i.e. hemorrhage, pre-eclampsia/toxemia, etc. Brewer.) Women who live with poor sanitation, little education and no access to medical care that can prevent or treat illness and injury are at risk.

All of these are socio-economic (and cultural) issues relating to the very condition of being a WOMAN, and because women are the only ones who get pregnant and have babies, by extension, pregnancy and birth. That does NOT mean the childbearing year is dangerous. It means it’s dangerous to be a poor woman just about anywhere in the world at any time in history, including during pregnancy and birth. In places where women are fed, supported and educated in the childbearing year, birth is not considered a dangerous medical event, but is seen in more of a sociological context with physiological components.

If the schema is all wrong, then the script must by necessity be also. Starting out with erroneous beliefs means that all decisions based on those beliefs must also be flawed. Is there any way to test this? Absolutely!

There are several books that have compiled all the scientific evidence and broken it down into understandable language for the average person. Obstetric Myths vs. Research Realities takes each intervention in the BIRTH script from pregnancy through birth, finds the evidence in the scientific journals, includes the abstracts from those studies, and then translates the findings into real language. Anything by Goer is heavily researched. A Guide to Effective Care in Pregnancy and Childbirth, uses the most comprehensive database for maternity care, the Cochrane Database of Systematic Reviews, to evaluate the effectiveness and risk of each intervention and then gives a recommendation on implementing those findings. Finally, Marsden Wagner’s book Born in the USA, uses available data on pregnancy and birth from around the world, compares US outcomes and provides solutions for our abysmal statistics, Faith Gibson’s website, and the new Business of Being Born (links to trailer) also have ideas for improving outcomes. I won’t even try to reinvent the wheel here. Anyone who attempts to be an informed consumer and seeks for information outside the 'birth machine' as Dr. Wagner calls it, will see they are heavily cited by objective sources and suggest that the script of BIRTH (the brand) is all wrong for women who want a safe, gentle and dignified birth. I could literally cite dozens and dozens of studies that refute this routine care, but they already have, so I won’t waste my time. I will however list one study per step of the script that refutes that particular step for the first few steps.

Keep in mind that we need doctors and hospitals for the sick and injured. When we are sick or injured, we make sacrifices; we weigh the risks and the benefits. It’s the healthy mothers and babies who are making sacrifices for NOTHING and taking risks without any benefit that need to rethink their schemata.

So, let’s dissect a bit of the script and see how the facts match the schema:

Frequent visits for low risk women-not supported

Villar J, Ba'aqeel H, Piaggio G, et al, for the WHO Antenatal Care Trial Research Group(2001). WHO Antenatal Care Randomised [sic] Trial for the Evaluation of a New Model of Routine Antenatal Care Lancet. Lancet.

Surgical specialists as caregivers for healthy women-not supported

Janssen, P., Ryan, E., Etches, D., Klein, M., Reime, B., (2007). Outcomes of Planned Hospital Birth Attended by Midwives Compared with Physicians in British Columbia. Birth 34 (2), 140–147

Routine internal exams in pregnancy-not supported

Wildner, K., (2002). Terbutaline or not Terbutaline…that is the question. Midwifery Today, Autumn. (Yes, I used my own previous article; I've done all the research I care to do for tonight and didn't see the point in doing research I've already done...)

Frequent, routine ultrasound-not supported

Beech, B., (1999). Ultrasound: Weighing the propaganda against the facts. Midwifery Today. Autumn.

No one has to believe me. No one has to believe the science that's already been done and compiled into books for your convenience. I had a great birth and have no regrets. I live by the motto: "Examine all you've been told; reject what insults your soul" (Walt Whitman) and no one should do anything based on anyone else's opinion or collected facts. No one can know the specifics of your situation. I just wish more women could experience the wonder and ecstasy of birth instead of the accepting needless suffering.

So, if you don't believe birth can be this way based on facts, would you believe it if you saw it? Painless birth; orgasmic birth; what would it take to change your schema?

Birth As We Know It

If you think how you birth doesn’t matter, think again:

What Babies Want

I wish that Born in the U.S.A. had a clip on You Tube, but they don't. However, there are plenty of organizations that don't have a vested interest who want women to have options for birthing.

Here's one that doctors who want to create change can join: Physicain’s for Midwifery

Access to information is easier than ever before. We don't have to be victims of our faulty beliefs. Our mother didn't have a choice; we do.

2 comments:

toshia said...

I love this look at what we "think" we know about birth and how we may have accepted birth to be something that in may in fact only be a product of our beliefs.


I have seen birth be beautiful, peaceful and painless as I attend women who are clear in thier purpose of gently birthing. It is my intention to offer this possibilty to every pregnant woman that has an interest in gentle birthing.

It is time for women to embrace their power and use that power on behalf of thier children. We can all take a step toward gentle birthing by standing in our own power of light and love.

Kim Wildner said...

Thanks for commenting, Toshia!
Once you've seen an empowered, or even ecstatic mom (or as in our case as HypnoBirthing instructors, many!) gently and peacefully birth an alert, aware baby, isn't it sad to then know that so many women are robbed of that?
I know how tirelessly you work for mothers in south/central Wisconsin, so I hope you don't mind if I provide your contact information so people can find you. :-)
Toshia Parker, CHt, HBCE, Doula
hypnobirth2000@yahoo.com
608-393-9921
www.wellnessfromwithin.org