All language subtitles for Sex.Explained.S01E05.WEBRip.x264-ION10

This is a stretch test,
which engineers use

to measure the strength and stretchiness
of materials, like rubber.

But here,
it's testing something different:

tissue from a human cervix.

The cervix is the gate
between a woman's uterus and her vagina.

It blocks anything,

like a penis, from going any further up.

And it stops important things
in the uterus,

like a growing fetus,
from coming down too early.

Think of the uterus like a balloon.

You blow up the balloon with air.

You have to keep the air in the uterus
or the baby inside the uterus,

and that cervix is the knot
that keeps the uterus closed.

As an engineer,
what's really struck me about the cervix

is that a pregnant specimen in the lab...

It just keeps stretching and stretching.
It never breaks.

Over nine months of pregnancy,
the cervix gets five times stretchier.

When it's soft like the skin on your lips,
it opens up.

And as you may know from experience

or from a common TV trope,

that's usually when...

Mindy, your water just broke.

Ah! My water just broke.

Oh! I'm sitting here in a puddle of water.

Uh... my water broke.

Oh, that's cool.
We got another one here in the fridge.

After the baby comes out,

this very compliant material
has to remodel and repair itself.

I don't know
of any other engineering material

that can soften
or remodel itself that quickly.

Put simply,

the cervix is an anatomical
and engineering miracle.

But that doesn't make childbirth itself
any less daunting.

I'm not really scared. I'm, like...
Yeah, I am nervous.

I'm completely nervous,
like, but it's only

because this is my first kid,
so I don't really know what to expect.

Around the world,
250 babies are born every minute.

In hospitals or at home

with midwives, doulas, and doctors.

Some women use drugs for the pain,

some have C-sections

or use other medical technology.

And others don't.

Sweetheart, show me what you got.
Ready? Nice deep breath in.

Breath. And push from your bottom.
You got this.

Two, three, four...

But childbirth still kills
more than 800 women every day

around the world.

And one global survey found that up

to 30% of women rate childbirth
as traumatic.

I just remember, like, closing my eyes
and going inside

into, like, the deepest part of myself

to just be like,
"I have to get through this."

I was, like, really traumatized
for a really long time.

So, what makes childbirth so hard?

And what can women do
to have the easiest and safest experience?

You got this.

The contractions
in true labor

always have a definite rhythm.

You may suddenly wonder

how the baby can possibly
get through that small opening.

Don't worry, you'll stretch enough.

It is not only pathological knowledge

which makes the great obstetrician.

It is vigilance.

One that does not let you forget you have
in your hands the lives of two people.

Most large primates give birth
in relatively similar fashion.

The female carries the fetus
in her womb for 30 to 40 weeks,

and then the baby emerges
from the birth canal,

usually headfirst, within hours.

But there's one key difference:

humans suffer a lot more.

It's not like a baby just falls out,

like some Monty Python sketch,
for non-human primates.

They do struggle, and still,

they have a seemingly
much more easy childbirth

than we have.

Humans labor around nine hours
the first time they give birth

and often go much longer,

while most chimps labor
for just two hours.

And there's one part
of the struggle of childbirth

that's harder to quantify... the pain.

It felt like the bottom half
of my body was gonna explode

and erupt goo
all over the four walls of the room.

Like you're
in some kind of pain blender,

where you're just being spun around,

and you don't know what's going on.
It feels like you're being ripped in two.

Everything painted red,

and there's, like, this alarm
that's like...

It looked like
I was experiencing an exorcism.

The question of why humans
have painful births comes down

to anatomy and evolution.

The theory goes like this:

Humans, unlike other primates,
evolved to walk on two legs,

which meant pelvises
became more complicated and narrow.

Our brains also evolved
to be bigger than other primates',

which means bigger newborn heads.

So chimps get to push out a small head
from wide hips,

while we're stuck squeezing out
a big baby through a narrow space.

But why did it stop there?

Why didn't we keep evolving our anatomy
to make childbirth less painful?

Well, why didn't we evolve

away from painful bowel movements?

And why didn't we evolve
out of painful breakups?

Natural selection doesn't care
about pain,

just survival. And even though it hurts...

...we keep making babies anyway.

What works, works.
And what's good enough is good enough.

It's a terribly tight fit.

It's a painful labor.
It's a long, protracted labor,

but it works. It's good enough.

So, to continue the survival
of our species,

women have always been stuck
with difficult childbirths.

- Almost there.
- How much more?

Not much more.
One push at a time.

The Old Testament says,

"With painful labor,
you will give birth to children,"

after Eve ate from the Tree of Knowledge.

And this scroll from 12th-century Japan
shows childbirth as so deadly

that it attracted evil spirits
who were drawn to near-fatal events.

That's why so many cultures
throughout history found ways

to protect and comfort women
during childbirth...

with rituals
and the support of friends and family.

Women also tried to numb their pain

with opium and hashish
in the Mediterranean,

or in ancient Greece, willow bark,
which is chemically similar to aspirin.

And scientists invented new tools
and technologies

to help if the baby got stuck.

Thanks to medical progress,
childbirth got less deadly over time.

And one of the biggest areas of progress

was the Caesarean section.

C-sections actually originated
thousands of years ago.

They're referenced
in almost every ancient culture,

and were performed to save the baby

when the mother had little
or no hope of surviving labor.

One of the first known C-sections
where the woman actually survived

happened in South Africa in 1826,

performed
by the British surgeon James Barry,

who was actually born a female,
Margaret Bulkley.

But that wasn't discovered
till after his death.

And around the same time,
a medical missionary

observed Ugandan doctors
performing C-sections.

He wrote about one operation
where the mother and baby both survived.

There was no anesthesia,

but the woman was liberally supplied
with banana wine.

In the 20th century,

C-sections started
to consistently save women's lives.

And then, birthing technology
really started to pick up.

Scientists started using pelvic X-rays

to chart the average length
and rate of labor.

And for women
who didn't progress fast enough,

they developed a new drug
to artificially speed it up,

called pitocin,
a synthetic form of oxytocin.

It's a naturally occurring hormone,

but it floods a woman's body
at three events in her life:

orgasm, breastfeeding, and labor.

Pitocin worked so well
that doctors and women

started scheduling inductions
if a woman went a week over her due date,

bringing some certainty
to an otherwise unpredictable event.

The history of medical intervention,
when it comes to childbirth,

has a lot to do with the emergence
of obstetrics as a medical profession.

For most of history,
doctors didn't deliver babies,

midwives did.

Women trained in the real world,
through experience and observation.

Then in the 1700s in Europe,
midwives opened up schools

with more official training programs.

And as waves of European immigrants

came over to America
in the following century,

they brought these skills with them
as they settled in the northern states.

While in the American South,
enslaved black women were forced

to attend to the deliveries
and care of white children

and were torn from their own families.

And they continued working
as skilled midwives

long after slavery ended.

They were often referred to
as "granny midwives."

They tended to be senior,
older members of their community

who had themselves already given birth

and were viewed with respect
among their community.

But in the 1900s,

doctors started to edge midwives out
of the delivery room,

and they made a convincing argument.

Birth might look simple.
It may have been going on for centuries.

But in fact, it was a pathological event
that requires medical intervention.

Like a procedure called the episiotomy.

During birth, it's common
for a woman to tear her vaginal opening.

Then in the 1920s,

doctors started proactively cutting
the opening instead.

I think the idea was that that would...
that would be easier to sew up.

And it turned out that giving people
an episiotomy

makes the tearing much worse.

And around that same time,

Western doctors also started offering
new pain drugs,

like one trend that emerged out of Germany
called twilight sleep.

It was a mixture of a heavy narcotics:

scopolamine and morphine.

Extremely controversial
'cause it was really dangerous.

Many of the women who were
behind twilight sleep

were involved in the suffrage movement.

And their argument was

that women should have the right to have
a painless childbirth.

But the drugs didn't actually
get rid of the pain,

just the memory of the pain.

Women in delivery rooms thrashed violently
and screamed.

They were often hooded
or placed in cage-beds while they labored.

The birthing experience
differed enormously

based on where you lived,

your class background
and the color of your skin.

There is a theory that the more civilized
a race or a culture is,

the more difficulty the women
have experiencing childbirth.

And so, anesthesia was also required

to make sure they could get
through the process.

Working-class women, women of color,

immigrant women, no problem.

Babies could just pop out.

It was the over-civilized,
upper-middle-class women

that needed help.

That stereotype lives on today,

and it's one reason black women
in the UK

are five times more likely
to die in childbirth than white women.

And they're three times more likely
in the US,

where disparities exist even
at the same income level.

Biggest issue, they're not being heard.

When women have said, "I'm in pain,"

the understanding
or stereotype of women of color,

that they're not really in pain
the way they are.

So back in the 1950s,

while many black women
didn't get pain medication

even when they needed it,

white women started to speak out
about being over-medicated.

In 1958, The Ladies Home Journal
published an investigation,

"Cruelty in Maternity Wards,"

"They give you drugs
whether you want them or not

One woman wrote in,

"They give you drugs
whether you want them or not,

and strap you down like an animal."

Women start reacting
to what they believe to be

absolutely horrific birth experiences.

They get angry and think
they have missed out

on what should be
the most incredible moment of their lives.

And that somehow
that gets completely lost

in the process of medicalizing birth.

One of the most influential voices

in the grassroots movement

was Ina May Gaskin,
a midwife-turned-activist.

In her 1975 book, Spiritual Midwifery,

she said that when women are

"empowered to birth without drugs
or interventions,"

"birth is a spiritual experience
that each woman deserves

in a safe and comfortable setting."

There were a lot of hippie women involved
in the natural childbirth movement,

but there were
also middle-class suburban housewives.

There were people on all sides
of the political spectrum

that simply thought, "I don't need to be
knocked unconscious

in order to give birth.

I am capable of doing it."

And by that time,
there was a hot new drug in town:

epidurals.

Scientists discovered that
injecting anesthesia

into a certain spot in the spine
called the "epidural space"

stopped pain signals traveling
from the spine to the brain.

The entire lower half of a woman's body

would go numb within minutes,
while she remained fully alert.

It was great. It was very nice.

No regrets on the epidural.

I couldn't feel my body
from the waist down.

And I knew at that point,

it was one of the best decisions
I'd ever made in my life.

I... I was like...

The World Health Organization
says epidurals are perfectly safe

for healthy women in labor.

But of course,
half your body is numb so...

The pushing stage of labor tends
to be a bit longer,

maybe, on average,
about... about 20 minutes.

You have less control over your bladder,

and it may be less easy
to walk around afterwards.

Another medical intervention
that's been surging in popularity:

C-sections.

That's how one-fifth of babies
around the world are now delivered,

twice as many as in 2000.

In some countries, they account
for more than half of all births,

like Egypt, the Dominican Republic

and Brazil, where the overall rate is 55%.

But in private hospitals,
where doctors are being paid per service,

not per hours worked, it's 83%.

One study noted,

"Savings in time gained
by cutting labor short

may motivate obstetricians
to choose a cesarean delivery."

And while the maternal mortality rate
is lower

in countries that perform more C-sections,

that's only true up to a C-section rate
at 19%.

Above that, it doesn't make a difference,

suggesting a lot of C-sections
are medically unnecessary.

Women who have had a C-section
on one pregnancy are

at higher risk for complications
in later pregnancies,

including higher risks of miscarriage
and even stillbirth.

Natural birth advocates
say unnecessary C-sections

are a result of messing with a woman's
natural rhythm of labor,

a concept now known
as the "cascade of interventions."

I "consented" to this emergency C-section

due to, in my records, fetal distress
because of the heart rate monitor.

We'll see babies have
fetal heart rate changes,

particularly after getting an epidural.

And epidurals tend
to follow pitocin because...

As they started increasing my dosage,

I started having really,
really painful contractions.

Pitocin can help when a woman's cervix

isn't opening up fast enough.

And so they upped my pitocin,

which I needed
because I hit my due date

and I still hadn't gone into labor.

You know, the minute I had to be induced,
it was up to technology.

But there's one problem
with the cascade of interventions theory.

In a large, randomized trial,
researchers found...

Women who are induced

are actually not more likely
to have a C-section.

We probably do induce more frequently
than we need to,

but there aren't any
hugely obvious downsides.

But last-minute changes
at the hospital

can impact a woman's mental health.

One study found that women
who had unplanned C-sections

were more likely to experience
post-traumatic distress and depression.

In her 2004 bestselling book,
Ina May Gaskin wrote

that more drawn-out labors could be
"because of a lack of privacy or fear."

She called it the "sphincter law,"

saying the cervix was
like a sphincter muscle

and that "sphincters do not respond well
to commands."

Let's say you're in a public bathroom,
and you're trying to take a crap,

and someone opens the door...

or a loud noise, something happens.

Your sphincter will freeze.

Think about trying to push a baby out
of your vagina.

You're trying to be relaxed, breathe...

Fear is going to have a major impact

on your ability to do so.

The idea that fear made
childbirth harder was also preached

by the French obstetrician Fernand Lamaze
in the 1950s.

He popularized
the psycho-prophylactic method,

now just known as the Lamaze method,

a set of techniques for a pain-free,
fear-free, drug-free birth.

It involved breathing techniques,
different laboring positions, and massage.

In his book, Lamaze wrote

that we should not try to
"cure the pain of childbirth

by the use of drugs"

and instead,
just stop fearing the pain itself.

But women's reasons for choosing
or rejecting pain relief

have always been complex.

In Japan, just 6% of women get epidurals,

because there's a cultural expectation
that suffering is a part of childbirth.

And while more than 70%
of American women choose epidurals,

that means almost 30% decide
to go without.

My family, when I told them
that I wanted to do a natural childbirth,

they were like, "You can't do it.
You won't make it."

And I was just like,
"Oh, no, now I have to do it,

'cause you can't tell me
that I can't do it."

I just had this weird fascination
with what it would feel like,

and I just wanted to know
what it would feel like.

Now that I look back, I'm like,
"Why didn't I, like, want an epidural?"

I have no idea
why I didn't want an epidural.

Today, some scientific research
suggests that being relaxed

could have real physical impacts on labor,

just as natural childbirth advocates
have argued for decades.

The top of the cervix actually
has a lot of muscle that does contract,

so that's what made us start to think,
"Okay, well maybe this is a sphincter."

And so, that actually completely changes
the map that we're working with

to understand what goes on in pregnancy,

because in women who deliver early,

that cervix starts to open prematurely,

and it might actually be a sphincter
that's relaxing too soon.

But why that happens
in one patient over another,

we don't fully understand.

Mechanics obviously play
a really important role in pregnancy.

I do need an engineer to help me
understand how strong is the tissue.

We can run "what if" scenarios.

So,
what if the patient has a short cervix?

Will her cervix open if the baby kicks
or if there's a small contraction?

Can that cervix mechanically withstand,
you know, the loads of pregnancy?

We should know those answers.
You know, we're curing cancer.

We should be able
to understand pregnancy a lot better.

That's why there's still
so much conflicting information out there

on the best way to give birth.

And a lot of it is very insistent.

These baby boards are probably
where the seed was planted for me.

Things like an epidural were cheating,

and that the best way forward

would actually be give birth

without any medical intervention
whatsoever.

I think sometimes the voices there
in the movement

can push themselves
into a particular set of choices.

And rather than saying,

"Let's empower people
to make whatever choices they want,"

say, "Let's empower them
to make these particular set of choices."

Well, when I found out that my daughter

was going to need to be delivered
via C-section,

I felt like a failure.

I felt like I had failed to do
what I set out to do.

Natural childbirth advocates
may be criticized by some

for exaggerating the negative impact
of medical interventions,

but their advocacy
has also dramatically improved

the way many women give birth.

In the 1970s, episiotomy rates
in the UK were over 50%,

sometimes performed
without the permission of the patient.

But then, there was a backlash
against so-called "birth cuts."

A survey was organized by British midwife
and activist Sheila Kitzinger.

And she found episiotomies
caused more lasting pain

than any other procedure in childbirth

and that a natural tear
generally caused much less pain

than a cut.

A study was launched,
and three years later, it concluded

that there was "no evidence to support
the supposed benefits of episiotomy."

More research confirmed these findings,

and by 2012, episiotomies in the UK
were down to 15%.

And the natural childbirth movement

brought back one of the most ancient types
of labor support...

having a doula present.

Doulas aren't doctors or midwives.

They're trained birth coaches,

there to support the laboring woman
and help make sure her wishes

are being respected
by the medical provider.

You're so strong. Look at you.

A number of studies
have confirmed the presence of a doula

"reduces the need for interventions,"

finding a 51% decrease in C-sections.

I think it's partly just that it's nice
to have somebody in the room

to say, "Yeah, this is... this is normal."
Like, "This is okay."

Like, "Everything is going fine."

I think that that part of labor is quite...
can be quite scary.

We almost there, sweetheart.

We are almost there.

And the natural childbirth movement's

underlying message
continues to resonate around the world...

that women should
make their own choices

based on what's best for them.

I decided to have a natural childbirth

because you go to a hospital,

black women
are kind of disproportionately, like,

ignored, I guess, in hospitals.

The only birth I ever had witnessed before
was a friend who gave birth

without any medicine or interventions,
but it was in a hospital,

and I thought that was the best
of both worlds.

My birth plan was go to the hospital,

listen to everything the doctors say,
and then come back with a healthy baby.

That was 100% of my plan.

There's no way yet to predict
how any one birth will go

or what interventions are necessary
for each person

because every woman is different.

And then also, like,
every baby is totally different.

The baby was, um, sunny-side up,

the kind of labor pain that's, like,
way worse than regular labor pain.

I turned blue.
There was blood everywhere.

They ended up giving me pitocin
without any epidural,

and then I had an episiotomy,

and all of it was like a total shock.

I had no idea that any
of this would be so hard.

I was really nervous.
I know how much the tissue stretches,

but I trusted my physicians,
and I was in good care.

With my first kid, the experience
was more overwhelming.

The birth experience with my second kid

was, like,
sort of a very idyllic experience.

I mean, also, with a lot of blood.

I'm not gonna lie.
I am angry and resentful,

and I have a lot to process,
five years later.

And yet, at the same time,
it was amazing and wonderful.

I still consider my C-section
to be natural childbirth.

I don't consider anything humans do
to be unnatural or supernatural.

And so natural is the only other option.

I was afraid of pain,
and I had a full epidural.

I thought, "This is so silly.

I'm missing out on something.
I could have done this."

I was angry at myself
and kind of ashamed that I just caved.

They have nothing to be ashamed of
because they're still doing a big work,

- which is bringing life into the world.
- ...two, three...

Growing a human
and bringing that human into the world

regardless of the route of delivery...

Nine and ten. Beautiful.
Deep breath, deep breath!

...is still a big feat.

Right back at it. Ready?
And push on your bottom!

Come on, baby, you got it.
That's it. You got it.

- Come on, give me another one.
- Ready? This is it.

Here we go. That's it.

- Let's go.
- Ready?

Most important push of your life.
Ready? One, two, three. Right back at it!

You got it. Yes, Daysha. Hold her down.

Open your eyes! Open your eyes!
Open your eyes!

- Look at your baby.
- Open your eyes.

Oh, my God!

- Oh, my God!
- Okay.

- Oh, my God!
- Congratulations, Mommy!

You never worked on anything so hard
in your life.

- I know he's worth it, right?
- My grandbaby.

- My grandson.
- Mm-hmm.

Oh, look at him! He's so little!

All right. Come on, bud.

There you go. There you go. There you go.

Welcome to the world, sweetie!

Daysha, Daysha, you did it!