Michel Odent Interview

Can someone with HPV, but no warts, have a homebirth?
Human papillomavirus (HPV) infection is extremely common. It does not influence the way women give birth.

What are the risks associated with a vaginal birth after an abdominal myomectomy? I am in my first pregnancy and my doctor is suggesting a c-section as the safest method. Is it possible to attempt a vaginal birth and how significant are the risks?
It is difficult to answer your questions because there are many types of myomectomies (surgical removal of fibroids) according to the location of the fibroid(s). If the docotr is suggesting a c-section to prevent a possible uterine rupture, it is probably because the fibroid was 'intramural' (inside the wall of the utereus). If the fibroid was 'subserous' (outside the wall of the utereus) or 'pedunculated' (connected to the utereus by a stalk), you should not hesitate to try to give birth vaginally. You need a detailed report of the operation.

I would love to have a waterbirth, but there are not many people in our area who do them. Do you have any advice on how to pick a good midwife for a waterbirth? I am 28, healthy, and in great shape. Is there anything I need to do to prepare for our little arrival's waterbirth?
Your midwife does not need any special training. She does not need any previous experience of the use of birthing pools. She just needs to be aware of a small number of recommendations. All these recommendations are based on the fact that immersion in water at the temperature of the body tends to make the contractions more effective during a limited length of time, which is in the region of an hour or two. The first practical recommendation is to give a great importance to the time when the laboring woman enters the pool. If she is patient enough to wait until the middle of the dilation, if she does not feel observed or guided, and if the room is dark enough, there is a high probability that she will reach complete dilation in an hour or two, even for a first baby.

The second recommendation is to avoid planning a birth under water. In general it is better when a pregnant woman has no precise pre-conceived script of what the birth of her baby will be. When a woman has planned a birth under water she may be the prisoner of her project; she is tempted to stay in the bath while the contractions are getting weaker, with the risk of a long second stage followed by difficulties for the delivery of the placenta. There are no such risks when a birth under water follows a short series of irresistible contractions before the mother feels the need to get out of the bath. A birth under water can happen. It should not be the primary objective. The primary objective is to reduce the need for drugs.

Of course you need a deep enough birthing pool, so that your body can be completely immersed. Today it is easy to rent such birthing pools. You also need a way to check that the temperature of the water is never above the temperature of the body (37 degrees Celsius). A too hot bath is dangerous for the baby. It is better if your husband, or partner, has to prepare the bath while you are already in hard labor. Remember that a century ago the secret for an easy home birth was to make the husband busy: he was spending hours and hours boiling water. Are we rediscovering the value of old rituals?

Dr. Odent, it is an honor. I am in the USA, studying to become a midwife and noticed a peculiar quote in my Anatomy & Physiology textbook. It states that "The pain of human childbirth, compared to the relative ease with which other mammals give birth, is an evolutionary product of two factors: the unusually large brain and head of the human infant, and the narrowing of the pelvic outlet, which adapted hominids to bipedal locomotion." (Kenneth S. Saladin, Third Edition). Do you agree with this statement, or is this merely an assumption made due to the high levels of intervention and passivity of the woman during childbirth? Thank you for your time; I truly respect all that you havedone.
We cannot deny that human beings must overcome several handicaps in the period surrounding birth. The main handicap is not mentioned in your textbooks. It is the huge development in our species of that part of the brain called the neocortex. The neocortex is not basically different from what we might call the brain of the intellect. The point is that during the birth process (and during any sort of sexual experience), if there are inhibitions, they come from the powerful neocortex.

Nature found a solution to overcome this human handicap. The maternal neocortex is supposed to be at rest, so that primitive brain structures supporting our survival instincts can more easily release the necessary hormones. That is why women who give birth by themselves, with their own hormones, tend to cut themselves off from our world, to forget what they read or what they have been taught; they dare to do what a civilized woman would never dare to do in her daily social life (daring to scream, to swear, to be impolite, etc.); they can find themselves in the most unexpected, bizarre, primitive, often quadrupedal postures; I heard women saying afterwards: 'I was on another planet'. When a labouring woman is 'on another planet', this means that the activity of her neocortex is reduced. This reduction of the activity of the neocortex is an essential aspect of birth physiology among humans.

This aspect of human birth physiology implies that laboring women need to be protected against any sort of neocortical stimulation. This helps us to understand the importance of quiet (since language is a powerful stimulant of the neocortex) and of a dim light. It explains also the importance of privacy (when we feel observed our neocortex is stimulated) and the need to feel secure (when we perceive a possible danger we must be attentive and alert). Because the most important aspect of birth physiology is not understood in our cultures, there is no reference in your textbooks to the handicap related to a highly developed neocortex.

It is commonplace, on the other hand, to focus on the mechanical difficulties of the birth of Homo Sapiens. In fact, these difficulties are also related to brain development. Today Homo Sapiens is classified as a chimpanzee with an enormous brain. At term, the smaller diameter of the baby's head (which is not exactly a sphere) is roughly the same as the larger diameter of the mother's pelvis (which is not exactly a cone). The evolutionary process adopted a combination of solutions in order to reach the limits of what is possible.

The first solution was to make pregnancy as short as possible, so that, in a sense, the human baby is born prematurely. Furthermore we have realized recently that the pregnant mother can, to a certain extent, adapt the size of the fetus to her own size by modulating the blood flow and the availability of nutrients to the fetus. That is why small surrogate mothers carrying donor embryos from much larger genetic parents give birth to smaller babies than might have been anticipated. From a mechanical point of view, the baby's head must be as flexed as possible, so that the smaller diameter is presenting itself before spiralling down to get out of the maternal pelvis.

The birth of humans is a complex asymmetrical phenomenon, the maternal pelvis being widest transversally at the entrance and widest longitudinally at the exit. A process of 'moulding' can slightly reshape the baby's skull if necessary. When mentioning the mechanical particularities of human birth, one cannot help referring to and comparing ourselves with our close relatives the chimpanzees. The head of a baby chimpanzee at term occupies a significantly smaller space in the maternal pelvis, and the vulva of the mother is perfectly centered, so that the descent of the baby's head is as symmetrical and as direct as possible. It seems that since we separated from the other chimpanzees, and all along the evolution of the hominid species, there has been a conflict between moving upright on two feet and, at the same time, a tendency towards a larger and larger brain.

The brain of the modern Homo is four times bigger than the brain of our famous ancestor Lucy. There is a conflict in our species because the pelvis adapted to the upright posture must be narrow to allow the legs to be close together under the spine, which facilitates transfer of forces from legs to spine when running. An upright posture is the prerequisite for brain development. We can carry heavy weights on our head when we are upright. Mammals walking on all fours cannot do the same. That is apparently why the process of evolution found other solutions than an enlarged female pelvis in order to make the birth of the 'big-brained ape' possible: the faster our ancestors could run, the more likely they were to survive.

Nature found several other solutions to overcome the mechanical difficulties. One of them is that when the neocortical control is reduced, the laboring woman can spontaneously—instinctively—find postures that are usually complex, asymmetrical, and adapted to the different phases of the process of rotation. Another solution is the capacity human mothers have to give birth thanks to a powerful 'fetus ejection reflex', that is to say a series of irresistible contractions without any room for voluntary movements... on the condition that the neocortex is at rest.

We must add that Nature found solutions to compensate the physiological pain of labour. One of them is an appropriate release of natural morphines. Another one is the reduced activity of the new brain, so that the painful stimuli are not processed and imprinted in the upper parts of the nervous system, and so that the memory is depressed. We cannot deny the human handicaps in the period surrounding birth. The point is to understand the many solutions the evolutionary process found to overcome a great diversity of difficulties. Understanding these solutions is the prerequisite to rediscover the basic needs of laboring women. It is a difficult task after thousands of years of culturally controlled childbirth and a recent proliferation of theories that have mislead most schools of "natural childbirth." What a responsibility for the generation of midwives you belong to!

Conventional pregnancy magazines are full of ads and articles on banking cord blood. Is this just a profit-driven trend or is there value to it?
Women who are supposed to give birth to the baby and to deliver the placenta without any drug should be reluctant to bank cord blood. When the physiological processes are not disturbed, human mothers have the capacity to reach a very high peak of the hormone oxytocin soon after the birth. This peak of oxytocin is vital, first because it is necessary for a safe delivery of the placenta without any blood loss, and also because oxytocin is undoubtedly the main hormone of love. This release of oxytocin is possible (in a warm place) if the mother, who is still 'on another planet', is not distracted at all and has nothing else to do than to feel the contact with the baby's skin, to look at the baby's eyes, and to smell the baby. Imagine a mother who has just given birth and who has forgotten the rest of the world while discovering her newborn baby. Then a practitioner arrives with clamps and scissors to collect a sufficient amount of blood from the cord. What a dangerous distraction! The risk is a difficult and bloody delivery of the placenta. Furthermore the baby will be deprived of a certain amount of precious blood.

Well-informed women would not take such risks, while the odds that the average baby without risk factors will ever use his banked cord blood are negligible. It is another matter in the case of medicalized births (cesarean-section, drip of pitocin, or drugs injected routinely to deliver the placenta). In such cases, the cord is clamped anyway soon after the birth of the baby. Then the risks are mostly financial. The point is that until now there has been little experience with transplanting self-donated cells (stem cells from bone marrow are currently given by relatives or strangers). Some experts have hypothesized that an ill baby who receives his or her own stem cells during a transplant would be at risk of repeating the same disease. Long-term studies are needed. Meanwhile we must be cautious.

My planned natural birth turned out to be very traumatic. I had severe abruptio placente. I was 24, I don't smoke or have any of the risk factors for it, I was very healthy, I ate right and was not overweight. It happened while in the early stages of labor at home and things didn't seem right to me. My husband rushed me to the hospital. I was in severe pain and only 4 cm dilated, my baby's heart rate was at 70, I was hemorrhaging. They rushed me to perform an emergency c-section. My daughters had to be intubated for a short time and spent a few days in the NICU. I thought I could never be thankful for such medical intervention, but I am for it saved our lives. My daughter is two now and we are thinking about having another child. I have not found much information on what happened to me. Is it because they aren't sure why it happens? Is it likely to happen again? Should I still try for a natural birth? How can I find out more information on it?
Abruptio placentae means that the placenta separated from the uterus before the birth of the baby. It can happen before the labor starts or during labor. The separation may be complete or partial. In your case it was probably a quasi-complete separation. Your daughter was rescued thanks to an emergency c-section. Abruptio placentae is an important chapter of the program of 'first aid in obstetrics' we include in our information sessions for doulas. We understand why your doctors could not give you much information on what happened to you. More often than not it is impossible to find a cause for such an accident. It is noticeable that a previous abruption placentae is not usually mentioned as a significant risk factor for the advent of a similar accident at the end of the following pregnancies.

The conclusion is that when you give birth to your second baby, you'll be in the usual situation of a mother trying to give birth vaginally after a previous c-section. This means first that labor induction will be an absolute contraindication. Because you cannot extinguish in your memory the dramatic complication you previously had, you'll probably prefer to labor in a hospital. The point is to find a hospital where they accept your project of a trial of labor and at the same time where they understand the meaning of the word privacy.

Can artificially rupturing the membranes contribute to fetal distress? I know that it can speed up labour, and that shorter labors can be less distressing, but my daughter's heartbeat dropped considerably not long after my doctor broke my water.
We cannot be sure that, in your particular case, there was a cause and effect relationship between the artificial rupture of the membranes during labor and the changes in your daughter's heartbeat. However it is well understood that, after a rupture of the membranes and therefore after an acceleration of labor at a time chosen by the doctor (or the midwife!), the baby's head is suddenly subject to greater pressure during contractions and the cord is more likely to become compressed. The baby must protect herself by releasing in particular the hormone ?noradrenaline?, which tends to slow down the heartbeat. The best way to prevent the common temptation of breaking the bag of water is to avoid assessing the progress of labor with vaginal exams. This is easier when the laboring woman has complete privacy and does not feel guided. In this case an experienced birth attendant can more often than not follow the progress of labor thanks to the noise the mother-to-be is doing, the way she is breathing, and the complex postures her body can find spontaneously.

Regarding waterbirth, I have two questions: 1. Is there a point at which it is too early to get in the pool? 2. Is it really possible to get so relaxed that labour can stop? I wouldn't say I was relaxed - just removed from the present and in a deep state of concentration.
1. Entering the bath too early is the most common misuse of the birthing pool. Originally we introduced the concept of birthing pool in a French hospital in order to replace drugs when the first stage is long, difficult, very painful, and when the dilation of the cervix is already well advanced. It is essential to understand that immersion in water at body temperature makes the contractions more effective during a limited period of time, which is in the region of an hour and a half. Helping the laboring women to be patient and to avoid entering the bath too early is a new aspect of the art of midwifery. However, in some cases, a bath can be useful to stop the contractions of a painful pre-labor, and therefore to make the difference between labor and pre-labor.

2. When a woman is so relaxed that apparently labor stops, it means that it was not labor, but pre-labor. In general the release of adrenaline (which induces the opposite of a state of relaxation) inhibits the release of oxytocin (the hormone necessary for effective uterine contractions).

How would you define "normal" birth?
The term 'normal' is useless when applied to birth. In 'normal' there is a cultural connotation. A birth can be considered normal in Rome, but not in Santa Fe. It is only in retrospect that a birth can be qualified 'normal' (the same about 'natural'). What we need today is to qualify an attitude. That is why I suggested the concept of 'biodynamic attitude in childbirth'. A biodynamic attitude (in farming, in childbirth, etc.) is based on a good understanding of the physiological processes. In other words it means: working with the laws of Nature.

What are the risks associated with routine ultrasound for low-risk pregnancies?
In general the most authoritative studies of the long term effects of being exposed to ultrasound during fetal life are reassuring. A Swedish study, for example, involved 19 prenatal care clinics and more than 4000 children.(1) After randomization (after drawing lots) only the pregnant women belonging to the 'screening group' were offered a scan at 15 weeks. After follow-up of the children, no statistically significant differences in body weight or height at 1, 4, 7 years of age between exposed and unexposed children were found. There were no differences either in terms of impaired vision or hearing during childhood.

However there are studies suggesting that exposure to ultrasound during fetal life is not completely neutral. This is the case of a large Australian study. It appeared, after analyzing thousands of cases, that frequent exposure to ultrasound tends to restrict fetal growth.(2) Such results confirmed the results of studies with pregnant monkeys scanned with doses used in human medicine.(3) This is also the case of several Scandinavian studies showing that exposure to ultrasound tends to slightly modify the proportion of right-handed and 'non right-handed' children.(4,5)  Since exposure to ultrasound during fetal life is not completely neutral, the selective use of scans should be preferred to routine scans. There are reasons to be cautious but, in the scientific context of 2003, one cannot refer to documented real complications.

-1- Kieler H, et al. Routine ultrasound screening in pregnancy and the children's subsequent growth, vision and hearing. British Journal of obstetrics and gynaecology. 1997; 104: 1267-72.
-2- Newnham JP, et al. Effects of frequent ultrasound during pregnancy: a randomised controlled trial. Lancet 1993; 342: 887-91.
-3- Tarantal AF, Hendrickx AG. Evaluation of the bioeffects of prenatal ultrasound exposure in the cynomolgus macaque. Teratology 1989; 39 (2): 137-47.
-4- Savelsen KA, et al. Routine ultrasound in utero and subsequent handedness and neurological development. BMJ 1993; 307: 159-64.
-5- Kieler H. Routine ultrasound screening in pregnancy and the children's subsequent handedness. Early Human Development 1998; 50: 233-45.
Source: http://www.waysofthewisewoman.com/dr-michel-odent-notes-obgyn-studies.html