Safer Birth in a Barn? How Race Horses are Treated Better Than We Are

Our deeper understandings of birth may come to us from the most unexpected sources, and at the most unanticipated times. One of my most visceral midwife “light bulb” experiences came in the early 1990s when I was taking a break from midwifery and selling health insurance in New Mexico.

One day I drove several hours to meet with the general manager of an immense horse farm, hoping to sell a large policy to cover his many farm hands. I ended up wandering through some of the barns, searching for my appointment. One of the stalls I passed emanated energy that felt like so much like birth, I peeked in the large horse box. It was a familiar scene, but with a four-legged mama; a swollen mare was pacing restlessly in the afternoon quiet, deeply breathing and blowing.

We were in the middle of the insurance presentation about an hour later when an assistant breathlessly burst in, saying that “so and so” was foaling! The manager immediately stood and said, “Do you want to see a foal born?” He was startled when I asked if it was the mare I had glimpsed earlier. When I shared that I had trained as a midwife and it just “felt and smelled of birth,” he brightened and lost his taciturn ways, suddenly eager to talk about what he loved.

Until then I had not fully understood that I was in a very unusual place: a stud farm for some of the most valuable horses in the world. This particular unborn foal was already worth about three million dollars (in 1990 dollars!) and was expected to be of much greater value after birth because of the lineage it shared with two Triple Crown winners. As we hurried over, the horseman explained what I was about to see.

**He was adamant about his instructions, stressing the careful attention to detail that was needed to protect the well-being of this babe of breathtaking value.**

*“You’ll see that we’ve removed her halter and lead—you would never restrict the movement of a birthing mare; foals have been lost for less! She must be free to move any way she wants.”*

“The only person allowed near the mare is her familiar stable lad; even her vet is crouched as small as possible in the corner.” (And he was, hunched on his heels, silent and still, head and eyes downcast.)

“We keep the lights dimmed, because bright lights agitate and distract the laboring mare.”

“She’s been in this box stall (when not out to pasture) for weeks, because she must be in a familiar environment to birth smoothly.”

“There is her usual water and hay in the stall—never restrict their food in labor!”

“Don’t say a word. Any sound might disrupt the birth and a disruption puts the foal in danger.”

**With these admonishments ringing in my ears, I crouched in the dim, silent passageway outside the birthing box with several others.**

We watched the mare birth a huge colt with grace, barely pausing in her pacing as he slid with a heavy thump to the floor. All was quiet and still in the long minutes afterwards as the colt organized his breathing, gathered himself, and finally staggered up. He was so unusually large and long-legged that he stood on his ankles, his cartilage not yet firmed up enough to support his weight. Still, the horseman was elated with the outcome, passing off the odd and worrisome appearance with a “Give him time, he’ll work it out!”

Ironic, isn’t it? The protocols in the world of animal husbandry to protect an offspring at the time of birth —

No strangers
Dimmed lights
Freedom of movement
Familiar environment
Unlimited nourishment
Respectful quiet
No disruptions

— are done without hesitation because to do otherwise invites “unexplained distress” or sudden demise of the offspring. These thoughtful conditions are the norm, along with careful observation to determine when to use technological expertise in true emergencies. When there are veterinarians in my childbirth education classes, they always start to smile and nod when I tell this story. In fact, what are we all told if we find the cat birthing kittens in the back of the closet? “Shhhhhhh!” And why? Because she might stop giving birth, AND move the kittens! These are givens—instinctive givens even, for animals of all descriptions!

**Yet what are the “givens” for the human who births not in a barn, but in a “modern and advanced” hospital?**

In many cases, 100% the opposite!

Usually a laboring mother birthing medically is (often literally) exposed to a minimum of at least a dozen strangers in her first 12-hours in the hospital — the security officer at the hospital entrance, patient transporter, triage secretary, admission clerk, triage nurses, resident and/or doctor on call in triage, admitting nurse, first shift nurse, break nurse, additional nurse(s) at delivery, obstetrician or midwife plus possibly students at the birth, anesthesiologist, pediatrician, etc.

While laboring, she experiences unfamiliar sounds and smells as she is moved through brightly-lit halls to her room. Most parents have visited this corporate complex, which is primarily devoted to illness/trauma (not normal biological processes), only once briefly, if at all.

The bright lights in the triage and labor rooms are challenging to dim.

Mothers are tethered to monitors or IV poles, limiting their intuitive and spontaneous movement, which normally promotes efficient labor rhythms and progress.

Laboring mothers are expected to do their vigorous work, however long, on poor-quality nutrition ie.“clear liquids only.”

They are exposed to the voices of strangers beyond their own care, both from the hall or chatting by the attendants in their room during contractions or in the immediate post-partum period.

Endless disruptions may occur without sensitivity to the birthing or postpartum family, as the corporate health care model prioritizes business efficiency. In most case, it has not committed to providing institutional respect for the normal biological process and physiological work of birth.

**But then, do we ever find that we have the human offspring experience “unexplained distress?”**

Of course, and at frightening rates! Yet, oddly, many of these disruptions are still promoted as minor inconveniences or necessary to “protect” the baby.

Curiously, veterinarians commonly have to defend interventions in light of the additional costs, and the risks associated with interfering with nature. But providers caring for human mothers within the medical system are more commonly forced to defend why they did not intervene! Consider the high rates of

Inductions
Epidurals
Arrtificial rupture of membranes
Interventions timed shortly before shift changes
Immediate cord cutting
Cesarean surgical birth
And the vigorous defense necessary to fight for anything different
- Especially if time is involved, to
  - Go into labor
  - Progress in labor
  - Push longer than 1-2 hours
  - Allow the cord to deliver all of the baby’s own blood into its body before being cut
  - Get “done” bonding, so postpartum protocols may be completed.

I’ve frequently seen outstanding CNMs and Obstetricians sacrifice their own political reputations and suffer departmental reprimands for births that had perfect outcomes, just because they honored these sorts of wishes from mothers. These skillful and wise practitioners endured professional consequences when they opted during normal, healthy births to protect the mothers’ yearning for privacy with fewer vaginal checks, allow longer pushing time, or check baby’s heart tones during the pushing phase by hand, instead of (what the mother considered a massive intrusion), wearing the belted monitor. Interventions are considered to be the ultimate protection from litigation in human care, yet many of them greatly contribute to the high rates of medical distress in mothers and babies!

In animal husbandry, the first line of defense for protecting the unborn is to protect and nurture the nutritional needs and comfort of the birthing female.

In the case of institutionalized birth for humans, however, in spite of evidence to the contrary, the norm is to act as if the nutritional needs and the comfort of the birthing mothers are of concern to, at most, the marketing and public relations department! It’s an affront to common sense that as a society we are currently more accepting of the needs of foaling mares, whelping poodles, and high-producing cows than of our birthing humans. From the high rates of fetal distress, meconium staining, and breastfeeding problems, the consequences are clearly devastating to our infants, just as any decent horseman would predict. Mothers and babies are the most safe when their biological needs for privacy and minimal disruption are attentively and sensitively honored through every kind of birth, in every type of birth location, and by every sort of birth attendant.