Even before most women know they are pregnant, important developments are already taking place. In the week after conception, cell division has resulted in a zygote composed of 100 to 150 cells that are already differentiating and by two weeks the developing embryo has attached to the uterine wall. Phenomenal growth and development continues for nine months and culminates in the birth of a baby.
Out of hundreds of eggs and millions of sperm, one egg and one sperm unite at conception. This union, called fertilization, takes place in the woman's fallopian tube and the fertilized egg, also called a zygote, divides into approximately 12 to 16 cells on its journey through the fallopian tube to reach and implant in the uterus.
In the first four weeks from conception, fetal growth of the ovum begins with development of the spinal cord, nervous system, gastrointestinal system, heart and lungs. By eight weeks, in the embryonic stage, the face is forming, arms and legs move, the baby's heart begins beating and the brain and other organs form.
By 12 weeks, the baby, now called a fetus, grows to 3 inches long and weighs 1 ounce. She can move fingers and toes. Fingerprints are present. The baby smiles, frowns, sucks, swallows and urinates. The sex of the baby can be discerned by this time.
During the second three months of pregnancy, the baby kicks, can hear and has a strong grip. At 16 weeks a strong heartbeat is evident. The skin is transparent and fingernails and toenails form. The baby can roll over in the amniotic fluid. At 20 weeks, the heartbeat can be heard with a stethoscope. The baby has hair, eyelashes and eyebrows. He can suck his thumb and may have hiccups. By 24 weeks, the baby is 11 to 14 inches long and weighs 1 to 1 1/2 pounds. His skin is covered with a protective coating, his eyes are open and meconium, which will be his first bowel movement after birth, is collecting in his colon.
The baby is very active at 28 weeks and initial breathing movements begin. She is adding body fat. By 32 weeks, the baby experiences periods of sleep and wakefulness and responds to sounds. A six months supply of iron is accumulating in the liver. By 36 to 38 weeks she is 19 or more inches long and weighs 6 pounds or more. At this point she is less active and gains immunities from her mother.
Birth involves three stages. In the first stage, lasting 12 to 24 hours for first-time mothers, uterine contractions spaced 15 to 20 minutes apart in the beginning and lasting up to a minute stretch the woman's cervix and it begins to open. By the end of the first stage, contractions come every two to five minutes and dilate the cervix to an opening of about 4 inches, which allows the baby to move from the uterus to the birth canal.
The second stage of birth begins with the baby's head moving through the cervix and birth canal. By this time contractions come nearly every minute and last about a minute. The second stage ends when the baby emerges completely from the mother's body.
The third stage of birth is the afterbirth in which the placenta, umbilical cord and membranes detach and are expelled. This final stage lasts only minutes.
Lose Weight. Feel Great! Change your life with MyPlate by LIVESTRONG.COM
Obstetrician/gynecologist Lauren Plante has a remarkable essay in the International Journal of Feminist Approaches to Bioethics in which she condemns the rising cesarean rate and compares current U.S. childbirth practices to the industrial revolution.
Critical of the drive to standardize and medicalize obstetrics, a phenomenon that is reducing choices within hospital settings for childbearing women, she writes:
…despite the implied promise of safety if all the rules are followed — ID bracelets, intravenous lines, electronic fetal monitoring — labor may follow an unpredictable path. The definition of ‘normal’ becomes ever narrower, and toleration of deviance ever lower. The final stage of this philosophy takes the process of birth away from the woman entirely and turns it into a surgical procedure performed by the doctor. Childbirth becomes a manufactured experience, shorn of any real risk or real power, one in which the woman is so far alienated from the capabilities of her body that she is only a package on an operating table for a professional to open.
Plante notes that while the “choice” may be available to have a “maternal request” cesarean (something that does not appear to happen in demonstrably high numbers), this does not equate to increased real choice or autonomy for women.
In the US, we have heard arguments that women are entitled to autonomy in making their birth choices, and that therefore it is ethical to perform cesarean for no reason other than maternal request. Curiously, this vaunted autonomy stops at the door of the labor room. Women are implicitly allowed, or encouraged, to make only those choices which increase the power of the physician and which decrease their own.
Plante explores some possible reasons for the narrowing of women’s choices.
The drive toward fewer delivery options appears at first glance to be supported by upper-middle-class women, who have the least number of social and economic obstacles to autonomy. In fact, cynical staff at hospitals delivering large numbers of well-insured upper-middle- class women often refer to their institutions as baby factories: these are the places in which cesarean rates are highest. It is, after all, a paradox: women with higher incomes, higher levels of education, and commercial insurance have higher rates of cesarean delivery. If cesarean is a response to any perceived risk, why would women at statistically lower risk of a poor outcome have higher cesarean delivery rates? New Jersey has the highest cesarean rate among states, but no lower levels of maternal or perinatal mortality. What it does have, however, is the highest median household income.
Plante notes that a “new normal” has been created:
…seduced by the promise of pain-free, risk-free childbirth, women and their doctors are driving the cesarean rate ever higher. Rates approaching—or exceeding– fifty percent are now seen in some hospitals. This is the normalization of deviance. This is the new normal.
She describes what a full spectrum of childbirth choices entails:
Women can give birth at home unaided; at home with family or with trained assistance; in a birth center, either freestanding or hospital-based; in the hospital delivery room with trained assistance; or in the operating room where they are acted upon.
Then she remarks:
The American College of Obstetricians and Gynecologists calumniates not only women who want a home birth but anyone who advocates leaving that option open. Once in the hospital, women who might like to exercise their right to self-determination by choosing vaginal birth after cesarean, or vaginal breech delivery, will have a hard time of it. Is it not the opposite of autonomy to support only those choices which increase the woman’s reliance upon the physician?
Plante includes a sober look at the challenges we face as we try to restore choices in childbirth:
The paradox is this: women wish to be treated as individuals, and assert for themselves a wish to exert control, yet in the commodification and industrialization of childbirth they are so much more likely to be treated as units of production. I know of one large community hospital revamping their labor floor and planning for a 50% cesarean delivery rate: and just as we learned in the 1989 movie, Field of Dreams, if you build it, they will come. The staffing and scheduling patterns for a 50% cesarean rate, as well as administration plans for hospital length of stay, can’t be turned on a dime. Hospital administrations like predictability, in patient patterns, patient care pathways, and everything else. If we normalize this industrialized approach to childbirth, we are likely to be stuck in it for a very long time indeed—and we can’t look to the medical profession to correct it.
Her conclusion is shared by those of us at Our Bodies Ourselves:
We must clearly understand that real autonomy does not mean cesarean on request, but instead a spectrum of birth options that honor women’s authentic choices. Real autonomy also means, to borrow a sentiment from Gandhi, that women should bring forth the change they wish to see in the world.
The full article is available online (for a fee).
Plante, an ob/gyn at the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology at Thomas Jefferson University, has written a number of other articles supportive of choice in childbirth.
For more information on how to preserve women’s choices in childbirth, see the OBOS statement Choices in Childbirth, now signed by more than 400 clinicians and educators in the maternal and child health field.
Citation: Plante, L. Mommy, What Did You Do in the Industrial Revolution? Meditations on the Rising Cesarean Rate. The International Journal of Feminist Approaches to Bioethics. 2009 Spring;2(1):140-147.
CategoriesAbortion & Reproductive Rights, Pregnancy & Childbirth