Is hospital birth a real disruptive innovation | Saraswathi Vedam | TEDxAmherstCollege

Many women choose to deliver at the hospital not realizing that they may set up for a choking and dehumanizing experience. Others who are choosing home birth are often criticized. In this talk, Saraswathi explains the importance of a friendly, familiar and safe environment during childbirth which event is known to have a big influence on the future of the baby and society as a whole. She calls all countries to facilitates high quality and safe humanized care in all settings and let the women choose. She shares with us the studies and testimonies of numerous women who have told her their experiences and their real needs, so that their voices be heard.

Senior Advisor for the MANA Division of Research, Saraswathi Vedam RM FACNM MSN Sci D (h.c.) is Associate Professor at the Division of Midwifery in the Faculty of Medicine, University of British Columbia, and founder of the UBC Midwifery Faculty Practice, Birth & Beyond. Over the last 30 years, she has cared for families in the USA, the Netherlands, India, and Canada in a variety of private and public health care settings. She is also a prolific writer and a fierce proponent of a woman’s right to choose where to give birth. For Saraswathi, home birth is as safe as or even safer than hospital birth.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Today, I'm going to talk to you,
as they said, about birth,

but I'm going to talk a little bit more
about what we know of ourselves as humans:

home birth.

Clay Christensen says
that disruptive innovation transforms

a practice or a product

that has commonly been traditionally

available only to the privileged few

and makes it mainstream.

It makes it so much more
affordable and accessible

that suddenly, everybody's doing it.

So in North America, we believe

that the disruptive innovation
was hospital birth.

Isn’t that what made birth safe
and accessible to all women?

A safe birth?

Well, it turns out
that some women don’t agree.

Some women want to stay
in their own homes.

We’ve exported this idea of hospital birth

being the way to get safe birth
to low-resource countries.

But even in low-resource countries,

women aren’t coming
in droves to the hospital.

Why is that? What's going on?

And is the disruptive innovation
hospital birth or is it home birth?

You’re all familiar
with this image, that’s DNA.

I’m going to talk to you
a little bit about the science,

the physiology of humans
and what we’ve come to understand.

You can see those components

that are joining from two
human beings' genetic information

to predict what the future will be
for this human being.

It turns out that’s the same
kind of linkage

that happens between the environment
and the physiology of birth.

We’ve learned a lot about it
from watching animals.

Animals in captivity,
for some strange reason,

when they’re outside
their familiar environment,

have a hard time getting pregnant,
a hard time staying pregnant,

a hard time staying healthy
while pregnant,

and a hard time releasing their babies
when they feel like they’re being watched,

when they feel like they cannot get
in what position they want,

they cannot access the comfort measures
or the food that they want,

they’re fearful, anxious or lonely.

This is Mei Xiang
and Lisa is the elephant.

They both successfully
delivered in captivity.

How did they do it?

They could get
in the position they wanted.

They were given environments
that were so familiar to them.

Maybe they were still in a zoo,

but something about it allowed them
to do what they had to do,

and part of that was that the zookeepers
and the veterinarians weren’t seen.

They were behind hidden video cameras.

So what does that tell us?

What if every time a young healthy man
wanted to run a marathon,

he was told, "It's okay.
We’re not sure you can do it

and you might have
a heart attack in the process.

So why don’t you come into the hospital?

You could run your marathon
around the hospital.

But don’t worry,
you can bring somebody with you

and your support or spouse can be there.

We will monitor you
to make sure that you're okay.

And just in case
you do have a heart attack,

the emergency personnel
will be standing right there.

Just in case you do have a heart attack,

you'd better not eat, and we probably
should restrict your fluids."

Does that make any sense to what you know
about the physiology of sports?

Do you think that if he didn't
believe he could do it,

he would be able to complete the marathon?

And what about making love?

What about making babies?

Suppose you told this young man

that he also could have a heart attack
when he had an orgasm,

some people do.

What if, we weren't so sure
about his ability.

We said, "No worries,
come to the hospital!

We'll give you a nice quiet room.
You can bring your spouse.

We'll just come in from time to time

check your heart blood pressure
and your heart rate

and make sure that everything is okay."

Do you think he'd have some sort
of performance anxiety?

(Laughter)

I think this is what he'd do:

He'd say, “I know what to do
and you guys leave me alone.”

So, what have we learned
about human physiology?

There're some very cool things
that have been discovered now,

things about when we control birth

and when babies
don't come out of the vagina.

Guess what? They don't get
the beneficial effects

of the good bacteria living in the vagina
that helps them for a long term health.

What about oxytocin, the hormone of love?
Why is it called the hormone of love?

Well, it's only released
in three times in our life,

three times which are absolutely
critical to bonding.

In fact, it does modulate
how attached do we feel.

It modulates social behavior.

Oxytocin is only released

when we make love -
when we have orgasm -

when we have contractions
to open up our uteruses

so that the baby can come out,

and when we let down our milk
so we can feed our babies,

so our babies can survive.

Every year, 350,000 women die
while pregnant or giving birth.

2 million newborns die
within the first 24 hours of life.

This is true.

Is this why we don't recommend
home birth to everybody?

Is it home birth?

You know, most of these women
live in 58 countries.

They’re low resource countries.

In these countries, women do not have
access to lifesaving techniques.

They don't have the medications
to stop bleeding.

If they could access it,
they can't get there.

They don't have somebody
checking their blood pressure.

Sometimes they're exposed to conditions
which are dangerous for themselves.

They don't have methods
to resuscitate a baby

that maybe just needs a little help.

Is that why everybody
should deliver in the hospital?

What does the research say?

For a long time we had a hard time
understanding what it really says.

Just like what Carzy said this morning,

you've to ask the right questions
in the right way. Guess what?

We weren't asking the right
questions in the right way.

We were mixing up planned home birth
with unplanned home birth.

When we looked at the difference
between home and hospital birth

we had a lot of cases in there

where the woman delivered
en route to the hospital

without an attendant, accidentally,

even in high resource countries
where all those things are available.

And that doesn't tell us the story.

If we don't know who's attending her,
what their skill set is,

if we don't know if she can change
the plan when she is in trouble,

we don't know what's really
dependent on place of birth

and what is instead dependent
on the type of care that she gets.

What we do know now?

The good news is that we have
15 or 16 really high quality studies.

We'll never have
a randomized control trial,

because women will not agree
to be randomized to home or hospital.

They have opinions
about where they want to deliver.

And they've tried!

There was one trial that they tried
to run for about 15 years.

They got 11 women to agree.

Not big enough to say something.

So, what we know is that
for an essentially healthy woman

who has attendants with skills,

and those skilled attendants
bring basic equipment and medications

and they have seamless access
to specialized care

when a complication arrives,

we actually get healthy mothers and babies

and they experience less interventions.

So what's the problem?

Why don't we all agree that that's
the system that we should set up?

I study attitudes

and what leads to attitudes
among maternity care providers.

I did this in Canada,
a big large national study.

You can see that midwives, obstetricians
and family physicians don't agree.

Why does that matter?

Provider’s attitudes matter,
because they influence what women choose.

Women want to do
what's best for their bodies.

They want to be able
to believe their providers.

We know that providers
who know more about breastfeeding

and have education about it,

their patients will be
more successful at breastfeeding.

We know that women
who choose cesarean on demand,

their providers are more likely
to have chosen that for themselves.

There's something else going on there.

If we ask the right questions
to the right people,

we might ask the women,

what happens when they listen
to their providers,

try to access safe care,

leave their homes and familiar
environments, and come in?

Well, this is what they say,

“I was told to be quiet and lie down."

"I was put in a room
with women I didn't know.”

“I didn't know that man.

He came in and he said to me,

'Spread your legs like you did
when you got pregnant.'”

“I had to undress in front of strange men.

They watched me while I got up
on the table to have my baby.”

Women in the Philippines will say...

Actually a lot of places in the world
where women by droves are coming in now,

- because there're institutional
post-policies for institutional birth -

are overloaded by normal cases

and don't have enough resources

to look after the women
who really need their care.

This is a labor ward, and a postpartum
ward, and a newborn ward.

Is that where you would like to be?
Does that feel safe to you?

This woman is an indigenous woman.

She came in because she believed

she was going to have
a safer birth in the hospital.

When she got there,
they didn't understand her language.

They didn't believe her
that she was really in active labor

because she had walked from her village.

So they made her leave.

Shortly thereafter, she delivered
on the grass in front of the hospital.

Is that safer care?

If you think this is just happening
in low resource countries,

it's happening all over the world!

This is North America:

strangers around,
women being told to push.

One woman said,

“I was hooked up and trussed.
I couldn't move six inches.

I knew I had to get up to have my baby,
but they told me to lie still

because they couldn't hear
my baby's heartbeat.

I was worried.

I listened to them,
but they didn't listen to me.

So I closed my eyes
and I hid in my music

while they stood around and watched me.”

So what is this issue about relocation?

How are we defining safety?
And who gets to define what safety is?

We know when all
of these silly things happen,

when mammals are not
in their familiar environment,

when they're disturbed,
have a loss of privacy and dignity,

it can affect their ability
to care for their own babies.

Women tell us.

Tiye, who is some of the women
I looked after, told me

she had a good job in the hospital.

She was a lab tech.

She said, "Everybody knows everybody's
business ; I don't want them to know mine.

The white women I work with
don't understand me.

I don't want to be undressed
in front of them.”

We looked after a woman
when I was at Yale on faculty.

Her husband would not tell us
what his name was.

He said his name was Fred.
Nobody believed him.

They said, “Maybe he is undocumented,
that's why he doesn't want to tell us."

It was 2001, October.

His name was Osama.

He was afraid if he's told
the hospital staff his name,

that they would not treat his wife well.

The Hmong women
I looked after in California

were used to having
all of their elders around,

but the hospital had a rule

that only one person
could come with these women.

This lesbian couple knew

that if they went to the hospital
with their known and beloved donor,

that it was very likely

that the hospital staff
would hand the baby first to him

and not to the primary parent.

Women tell us that when they're home,

they can get in what position they want,
they can use gravity

and they can still be assured

that someone will be checking them
and their baby's heartbeat.

So what about babies
who are fascinated with technology?

What about what women say
about technology?

It turns out that they actually don't want

to reject technology or modern medicine.

They want access
to all those lifesaving techniques.

They just want to be told the truth.

All of the things I was telling you about
were based on studies

that we've done where women
have told us what they want

and what's most important to them:
comfort, convenience, empowerment.

This study has just come out.

About 2000 women
answered a very long survey

about what they thought
about their maternity care.

These were all women
who planned hospital births.

Guess what?
They say the same thing.

They believe they're in charge.

They believe they're choosing
the best options for their baby.

They just want to be told the truth.

They want to be told,
how does this risk relate to me?

What if I live in a place
that does have those resources?

What will it be like
when I go into the hospital?

And they also tell us

that some interventions lead to things
that they wouldn't choose

unless they were very sure
that it would save them or their babies.

40% of women are induced
in the United States today.

We have over 30% C-section rates.

Do you think the species
would have survived

if that was the needed rate?

In fact, most countries
that have much better outcomes

than we do in North America,
have much lower rates of these things.

So what about risk?

Who gets to choose?

This is a one-in-a-thousand risk.

When you have skilled attendants at birth

and access to equipment and personnel
when you need it, this is the risk.

About one per two to three thousands
is what loss will look like,

- not fetal loss, I’m talking
about neonatal loss.

And 50% of stillbirths are unexplained,

so we don't really know
what's going on there.

So one-in-a-thousand.

That's about the same risk than that man
who wanted to run a marathon,

would experience of having a heart attack.

Is that an acceptable risk?

And what about the risk
of loss of dignity, of abuse,

of disrespectful care?

How do you define safety?
Who should decide?

Who is most invested and most responsible?

How much risk is too much

and whose agenda and whose destiny
are you talking about?

You know what women say?
What would your mother say?

Do you think she was more concerned
about you than the doctor?

Yes, that's what women say:

''We care about our baby’s health.

We are offended when people suggest

that we are choosing home birth
or choosing respectful care,

just for our own convenience
or for comfort,

like it was some sort of cosmetic option.

We know that if we are not well,

if we're not treated well,
if we're abused,

if we feel like we had
an unnecessary intervention

or if we're in an environment
where we don't feel safe,

that can affect how we feel
about our babies, our future.

We're concerned
about our baby’s health also.

What about the use antibiotics?

What about with C-sections
or any of these things?

Absolutely! Give me a C-section
if that’s what I really need.

I want my baby to be healthy.

I value the advances that modern medicine
have brought to high resource countries.''

That's what they tell us.

But is anybody listening to women?

Paula Freire said, “Washing
one's hands of the conflict

between the powerful and the powerless

means to side with the powerful,
not to be neutral.”

Isn't it time we took a stand?

Which is the disruptive
innovation we await?

Is it home birth?
Is it hospital birth?

Or is it humanized birth?

What if all countries took steps

to facilitate high quality care
in all settings?

And all women were told
how to access that care

wherever they felt safe?

If the focus was access
to safe humanized birth in all settings,

then we'd prioritize the availability
of lifesaving measures and skills

everywhere and carry them to the places
where a woman feels respect, autonomy,

and the ability to listen
to her own body and baby.

I wrote that down
because I wanted to say it all.

I wanted to be sure
I didn't forget to tell you

that it is about
all of those things together.

We can carry those things to her.

They might be packaged a bit differently.

We know most people won't need IVs

if they're cared for
and start out healthy,

- we're talking about
term pregnancies here.

We could be ready standing by
with resuscitation equipment for her baby.

It doesn’t look like the hospital
but it’s got all the same stuff.

Meanwhile, the woman could get
in whatever position she wanted.

And we could remember
that whether or not we're there,

whether or not
the interventions are there,

a woman will deliver undisturbed

and will receive her baby
and care for her baby,

because that's what humans do.

They would receive their babies with joy

and with the people that they love,
with gentleness.

If we attended them
in that respectful way,

perhaps they would invite us
back into their homes

to help them learn
how to care for their babies.

And their babies
would come out alert and healthy,

ready to receive
the wisdom of their grandparents.

This is what one of my favorite
photojournalists said.

This has been around for a long time.

I graduated here in 1978

and I read this book shortly thereafter.

Suzanne Arme said, “If we hope
to create a non-violent world

where respect and kindness
replace fear and hatred,

we must begin with how we treat
each other at the beginning of life,

for that is where our deepest
patterns are set.

From these roots grow
fear and alienation or love and trust.”

Thank you.

(Applause)