Monday, July 09, 2007

L'Arbre et Le Fruit

Here's a little excerpt from an article by Dr. Michel Odent, noted French obstetrician.

"According to traditional wisdom in rural France, a baby in the womb should be compared to fruit on the tree. Not all the fruit on the same tree is ripe at the same time. A fruit that has been picked before it is ripe will never be fit to eat and will quickly go bad. It is the same with a baby. In other words, we must accept that some babies need a much longer time than others before they are ready to be born. If you have some apple trees in your garden, you will listen to your common sense and choose an individualized and selective approach: you will not pick all the apples on the same day."

A recent client was concerned that she would be induced, as she had been in her first pregnancy. I had the confidence to tell her that her physician would not induce labour, even if she reached 42 weeks, as long as she and the baby were well. I could say that with confidence because I have been working closely with this particular group of family doctors for almost 20 years. This gave her peace, and she was able to relax. Soon after, she went into labour on her own, well after the typical "10 day limit" imposed in most North American hospitals. All was well. She could hardly believe the wonderful difference from her previous, induced, labour.

I live in a bubble, working as I do with midwives and family doctors who respect the current research, dare to challenge hospital protocols, and fully respect their clients' rights. I am fortunate to work in collaboration with caregivers who dare to wait, who only induce women if it is truly medically indicated (even if it causes a fuss with other staff!) In reality, this means I rarely see a woman face induction.

I am glad that I only work with caregivers who follow the best care practices. We work in concert with each woman and her body. Labours start on their own, women dance and move freely, women are continuously supported, women do not face regular interventions, women give birth standing, kneeling, or wherever they choose, and the women reach to pull the babies to their breasts. (Left brain dominant? Click here.)

In birth, we are not the keepers of the power, each woman's body is. Yes, we have to do our homework and ensure that everything we do is supported by the best evidence. But, after a while, the 21st century knowledge is only a backdrop to the ancient truth of birth.

So, if a woman's body is the tree, then the apple will fall, as it should, whenever it is ready, and will rest on soft safe ground. And the orchard keepers will be sitting, as they should, with their hands beneath them, in the shade of the tree. - Jacquie Munro, Vancouver Doula


Sandi said...

I still wonder about my induction. I wonder if I should have agreed to the extra tests and monitoring so that I could have waited a bit longer. I feel so lucky that my induction went so quickly and smoothly.

My only regrets about the birth are agreeing to the induction without talking to my OB about waiting a few days longer, getting the epidural and not asking for a mirror. That said I guess I can't complain, I got two beautiful children that day.

Andrea said...

If a woman must have a C-section and cannot go through a natural delivery, when is the right time to schedule that? (Note: I'm conservative on C-sections and had natural delivery with first child, but it just isn't possible at all this time, given risks.) Doctors seem to say 38 weeks, but why 38 and not 39? Any thoughts?

Jacquie Munro said...

It's interesting... while trying to compose an answer to your question, I have been unable to find "one answer" that fits. There are so many variables to the situation - who's the caregiver, how far are you to the hospital, why is the cesarean birth required, are you sure of your dates, etc.

For example, a transverse lie would result in a different answer than, say, placenta previa...

And if, perhaps, you lived in Yellowknife, NWT, and your OB was Andrew Kotaska, I'd say to go and have a discussion with Andrew about your thoughts on the timing of the cesarean and then make your own decision based on the combined evidence at hand and your gut.

With him, depending on the circumstances, you might choose to wait until the first signs of labour before beginning the surgery...or choose 40 weeks, or whatever.

There is no right answer...just the answer that works for you and your baby in a particular place on the planet, at a particular place in time...that sits well with you.

But...arbitrarily at 38 weeks? Hmmm... Personally, if it was me needing the cesarean...boy, I'd call Ina May, Andrew Kotaska, Murray Enkin, and all my own midwife mentors from around the world...and then sit quietly, listen to my heart, and make my own decision.