Nutan Pandit visits Dr Odent’s maternity clinic in France to report on the doctor’s experiments

The Centre Hospitalier de Pithivers is a public hospital situated in the little town of Pithivers about 60 kilometers south of Paris. From outside, the hospital appears to be like any other ordinary hospital. However, what goes on in the maternity unit there is rather remarkable.

In an age when man is becoming increasingly dependent on technology, this little unit uses no foetal monitors or drugs to control contractions, thus adding no risk to the mother or baby.

The man behind this is Dr. Michel Odent, who has practiced in Europe and Africa. Women from all over Europe travel to have their babies in the maternity unit here. It is said that a third of midwives from Stockholm and Sweden have been here to observe.

Starting his career as a surgeon, Dr. Odent was called on to handle difficult maternity cases. In Africa, he noticed a constant battle between African women and European doctors.

The women wanted to sit up to deliver their babies, while the doctots insisted they lie on their backs. Dr. Odent also noticed that if left to themselves , these women would find a quiet dark corner to be in, and as labour progressed, they moved restlessly, constantly changing positions, often adopting rocking motions of the pelvis.

When he came back to France, as surgeon at the hospital at Pithivers, and had to do the ‘difficult’ births, he began to question the basic procedures followed at a delivery, in the light of his African experience.

Indeed there is evidence that lying flat on the back makes natural childbearing difficult. Apart from the African women, who have been sitting up to deliver for centuries, women working in fields also deliver squatting. A lot of primitive and ancient sculpture who suggests that women give birth squatting.

Lying on the back to give birth became fashionable when King Louis XIV of France wanted to watch his mistress give birth. She therefore was made to lie on her back instead of using the traditional birthing stool. It soon became fashionable to do so, and when forceps came to be used, it perpetuated the position. Some birth was ‘taken over’ by hospital doctors who found it convenient to handle a woman lying passively on her back half groggy with drugs.

Today it has been 19 years since Dr. Odent and his team of midwives, who together manage the maternity unit, have put their ideas into practice with encouraging results. Today the prenatal maternity mortality rate has dropped from 15 per 1000, the average French figure, to 10 per 1000.

On entering the maternity wing at Pithivers, one might chance upon a woman in labour taking a walk in the corridors. The walls of the corridor are lined with pictures of mothers of different cultures ranging from Indian Women to African, holding their babies.

As inflated, plastic child’s padding pool is one of the rooms comes as a surprise. Also, a ‘meeting room’, when couples come for get-together. They have sing-song evenings, yoga classes, meetings with pediatricians.

Occasionally a woman in labour walks in with her husband for a while, or a newly delivered couple comes to show off their baby. These ‘meetings’ are also joined by midwives when they are free, as women like to have familiar attendants at birth.

The emphasis is to help women forget what their culture has told them about birth and to listen to what their bodies are telling them to do. When in labour they are encouraged to find naturally comfortable position.

Most women walk in the first stage of labour, and as they reach the second stage, just before birth, they often kneel, go on all fours or go into the plastic pool.

For delivery, a woman can choose between the conventional delivery room and the unconventional delivery room, which is more like a living room decorated in orange and soft browns, with a large platform.

The conventional delivery room is complete with a high table, stirrups, lights and surgical equipment. It is used for operative deliveries. Analgesia and anesthesia are used only for these operative deliveries.

What goes on in the unconventional delivery room is very interesting. Here women deliver in a supported-squat-position, which is quite like the position one adopts in the Indian toilet, except that the woman is supported from behind her husband or doctor, who give her support by holding her under her arm.

Research has shown that the area of the birth canal increases by as much as 30 per cent when a woman moves from lying on her back to squatting. Also, gravity can be used to advantage more by a woman who is upright, than one who is lying down.

In 1968 it was calculated that the weight of a full term baby was enough to supply much of the force needed to expel it, provided the mother was upright. Also, an upright position puts less pressure on the blood vessels like the vena cava, so that the blood supply to the mother and baby is more efficient, hence reducing the chances of distress.

“According to Dr. Odent, the supported-squat position is “imperative” in certain emergency situations, like when the baby is being born feet first, in the breach position. “We know”, he says, “that in a breach delivery what is dangerous in the delay between the delivery of the abdomen and the baby’s head. This delay is artificially created or made worse by the dorsal position. When the mother is in the supported squatting position, as soon as the breach is delivered, the whole body comes”.

Women are encouraged to do as their bodies guide them to do, so that as labour progresses, they receive a more primitive level of consciousness and the brain releases powerful natural pain killers called endorphins. However, any drug given to a woman in labour can disturb the system of endorphins. It is this reason that labour is allowed to progress without recourse to any drugs. Drugs are also avoided because they immediately pass to the baby through the placenta. On reaching the baby, they act as nervous depressants, and retard the baby’s natural nervous depressants like sucking and breathing. For women who find it difficult to release the warm water of the pool and the semi-darkness reduce a degree of relaxation that can be reached to women without any preparation or classes.

Immersion makes the contractions more efficient and less painful, so that labour is quick. Many women do not want to leave the comfort of these and sometimes deliver there.

Although this is not the aim, it has happened at 38 times. Dr. Odent says the baby is not at risk it transfers from one watery medium to the other – from the amniotic fluid in the uterus to water. “It is not the process of birth but the comfort with the atmosphere and the sudden drop in temperature that causes the baby to draw breath.

What is striking is the relaxed atmosphere, the supportive and gentle air, the quiet. After delivery the mother usually sits on the sheet on the floor cuddling her baby while it is still attached to be tied to the cord. This gives the baby extra blood supply from the cord.

No syntrometrine hormone is injected into the mother to help detach the placenta from the uterus. Instead, hormonal stimulation is caused as the baby sucks at the mothers’ breast. The placenta is generally delivered by itself without any trouble.

The baby is placed in a tub of warm water after being suckled, and then dressed. The tub is placed on the floor between the mother’s legs. There is routine cleaning of the baby’s air passages with tube.

If ever a Ceasarean section, an episiotomy or a vacuum extraction (substitute for forceps), becomes necessary, it is done with a great deal of calmness. However, many women who have had Ceasarean sections, deliver normally the next time.

Only 7 per cent of women have an episiotomy, women tear, but according to Dr. Odent there is no evidence that tears are more painful, heal more slowly or create more long term problems than episiotomies.

According to a report by the International Childbirth Education Association in the U.S., “Lying down increases the need for episiotomy because of the increased tension on the pelvic and the stretching of the perineal tissue”.

This does not mean that science is something that is scoffed at. For women who are suffering from diabetes or have a Rh negative blood group or some other complication, science is saving fat. But, a healthy woman and a normally grown foetus generally manage beautifully without any intervention.

May be we need to trust nature a little more in realm of birth. Nature is more to be trusted as cheaper to adopt in the bargain! What better one could one want, specially in a poor country like India?