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The President's Pen
by Mary Ann Shah, CNM, MS, FACNM
Originally published in Quickening July/August 2002

Now that the 47th Annual ACNM Meeting is over, it would be nice to bask in the successes of our May 24th-30th Atlanta gathering. However, I will simply pay special tribute to the following: Yvonne Green and Tim Johnson whose opening remarks energized us for the action-packed days that followed; the recipients of the 'Hattie' (Sister Jeanne Meurer), the 'Kitty' (Lynette Ament), and the new Dorothea Lang Pioneer (Johanna Borsellega and Myriam Castro de Castaneda) Awards as well as the Regional Awardees of Excellence (Region I's Joyce Poirier, Region II's Vivian Lowenstein Goldenberg, Region III's Mary O'Meara, Region IV's Kate Schwob, Region V's Pamela Glenn, and Region VI's Kate Pelosi); the induction of 12 new esteemed ACNM Fellows (Ginger Breedlove, Grace Allman Burke, Nancy Clark, Barbara Graves, Lisa Kane Low, Joanne Leck, Jane Mashburn, Jean Tease, Frances Thacher, Deborah Walker, and Linda Walsh); Sister Angela's inspiring Terese Dondero Lecture; the passing of the leadership torch from the outgoing members of the Board of Directors to the new officers (Vice President Teresa Marchese to Gwen Spears, Region I Representative Ruth Keen to Amy Levi Rousseau, and Region VI Representative Barbara Douglass to Susan Jacoby); the impressive array of student reporters, representatives, Varney Participants, and scholarship recipients; the multitude of speakers and exhibitors who replenished our grasp of the art and science of midwifery; the pioneers who shared their historic recollections with us; the committees and divisions whose activities furthered the work of the College; the members-at-large who contributed their insights during the daily business sessions; the transition of Chairs (the Division of Standards & Practice from Jan Kriebs to Cathy Collins-Fulea and the Division of Education from Maureen Kelley to Peter Johnson); the reunions that abounded among friends and colleagues; the spirited Breakouts for Debates; the generous donations of Blankets for Babies; the ACNM Foundation's fun-filled Southern Discomfort; and the display of camaraderie and friendship at the 'Hats Off to Midwifery' Closing Party. I salute all who have been honored for their outstanding contributions to our College and sincerely thank those who quietly serve us day in and day out without public recognition.

As tempting as it might be to continue in this celebratory mode, publicly saluting and thanking all who serve our College day in and day out, I cannot forget the 15 contemporary realities which I identified as challenges facing our profession in my 2002 presidential address (an unabridged version is available on ACNM's website www.acnm.org). One, in my opinion, looms as an overarching issue. Specifically, are women being disempowered by technologies that ensure 'childbirth without pain' and now 'childbirth without labor'? As astutely observed by Nancy Lowe, CNM, PhD (See 'The nature of labor pain,' Am J Obstet Gynecol 186(5):S23, May 2002 Supplement), the epidural epidemic and the growing popularity of optional cesarean sections 'seem paradoxic in a society that celebrates individuals who endure great pain and distress in the pursuit of mountain peaks or completion of a marathon race.' This leads me to ask: Would Mount Everest climbers feel the same sense of exhilaration upon reaching the top if helicopters were available to lift them from difficult peaks along the trail? Similarly, would anyone bother to participate in marathons if volunteers lined up along the way and pulled exhausted runners to the finish lines in 'American Flyer' red wagons? Or, to take the analogy just one step further, would a serious composer consider 'giving birth' to a flawless composition that had been computer-generated? I contend that the mountaineer, the marathonist, the musician, and the laboring women all experience a tremendous sense of self-fulfillment fulfillment and awe when they are able to laboriously - and sometimes even painfully - overcome the challenges - and yes wonders - of nature and their own innate talents.

Remember the 'Twilight Sleep' era of over four decades ago when the joy of birth all but disappeared? Injections of labor 'cocktails' (scopolamine, Phenergan, and Demerol) rendered women out of control as oxytoxics, forceps, episiotomies, and general anesthetics expedited the escape of babies from their mothers' wombs? Those of us who bore witness to such practices can attest to the deleterious effects they had on childbearing families. Human dignity was lost as frightened women labored without the support of their loved ones, were shaved and given enemas, vomited from the effects of narcotics and often had to be catheterized, became agitated and uncooperative, and frequently had to be physically restrained. In addition, worried expectant fathers and grandparents were exiled to waiting rooms; babies were born sluggish, frequently requiring resuscitation; and early parent/child bonding was compromised as newborns were whisked off to nurseries where they remained isolated - except for scheduled feeding times when they were wheeled to their mothers -  bedsides to be fed bottles of formula. The 'drug ?em up / drag 'em out' abuses probably persisted because women' were unaware of the price they had to pay for such 'sedation' while their conscious memories of the horrific events that ensued were obliterated by pharmacologically-induced amnesia.

While I certainly do not equate epidurals ('consciousness without sensation') with twilight sleep ('sensation without consciousness'), nor do I think that chemical analgesia, anesthesia, and surgical interventions are not legitimate obstetric interventions when used appropriately, I am concerned that we could be on a slippery slope. It is particularly worrisome that more and more women are demanding painless labors - or no labor at all - even before experiencing their first contraction. It is also disconcerting that fewer and fewer women are seeking childbirth education as they surrender control from themselves to technology. And, above all, science has yet to prove that optimal integrity of the newborn is not best preserved by the least technologically-manipulated labors.

I believe that our task is threefold: 1) we must gather and disseminate evidence about any maternal/infant risks associated with elective epidurals and cesarean sections; 2) we must help women to explore their goals for birth more fully and assure that informed consent has been adequately provided them; and 3) we must educate the women of the world about how powerful they and their bodies really are - that with the proper education and labor support, most can deliver their babies with little or no intervention - and that birth is a natural and sacred event that is an empowering life experience.

I offer the above for your summertime reflections. I wish you all a safe and contemplative summer with the hope that we can come up with an agenda that will help turn the tide of the new birth culture that is emerging across this country.