The Processes of Birth and Death -- a Comparison

In the year 2000, my mother was diagnosed with terminal lymphoma.  She was a strong believer.  After listening to the pros and cons of medical intervention -- which might extend her life by six months -- and of hospice care, she chose hospice.  This was my first experience with what hospice was about.

One thing they did was to give us a packet of information.  In that packet was an article on what happens as a person begins to die, until the moment of death.  This process can take several weeks, especially with death is due to dying.  By that, I mean that a seemingly healthy, but old, person, just starts to feel bad, slows down, looses his or her appetite, becomes weaker, goes to bed, and eventually dies.  The dying process is also seen in people with terminal illness, including Alzheimer's dementia.
I was so impressed with what I read, and then what I experienced with hospice care for my mother that I developed a presentation entitled "How to Support a Terminally Ill Christian Loved One" which I have used in women's ministry.

While I was reading the paper supplied by hospice for the first time, I was struck by similarities between labor and birth, and the "labor of dying" and death.  I could immediately see God's design in both.   I also could see that many of the interventions the health care system routinely implemented in both cases actually made each process more painful and more difficult.  Some interventions, thankfully, have been abandoned on a routine basis, but others have not.

Let's look at some of the parallels.

Food and Drink

During labor, women giving birth in most hospitals are not allowed to eat.  Some are allowed clear liquids, but are often discouraged from actually taking them ("You'll regret it later when you get sick and throw  up because you have this on your stomach!")   Instead, IV fluids are ordered.   These practices, on a routine basis, are not supported by the research.  Withholding food, and often, drink, is based on an outdated approach to the management of labor.  At one time, most women giving birth in the hospital were given medications which caused sedation and also decreased emotional control.  The benefit of these was that when the women woke up after their baby was born, they said "I slept through the whole thing!".  The truth was that many of these women cried out in pain and distress during labor.  Some had to be physically restrained in their beds.  If a Cesarean was needed, it was performed under general anesthesia.  In a few cases, the mother vomited during surgery (or during vaginal birth if "gas" was used).  In some of these mothers, stomach contents went into the lungs.  This is known as "aspiration".  In some of these cases, the mother developed aspiration pneumonia.  In some of these cases, the mother died.

In modern day obstetrics, most C-sections are done with epidural or with spinal anesthesia.  The mother is awake and thus the risk of aspiration approaches zero.  Only in rare circumstances is general anesthesia required.  In some of those, the C-section is planned, without the mother going into labor.  The typical "NPO after midnight" (no oral intake after midnight), can be implemented.  Still, in most of these scheduled C-sections, the mother remains awake for the surgery, and aspiration is of little concern.  

Statistically, a pregnant women if more likely to die in a car accident or from being struck by lightening than from aspiration syndrome.

In our lawsuit happy society, anesthesiologists still prefer to force women to fast during labor, no matter how long the labor, and no matter how uncomfortable and hungry it makes the mother.  Any honest anesthesiologist will tell you that fasting does NOT prevent aspiration in 100% of cases.  Any good anesthesiologist will tell you that they can manage anesthesia quite successfully in the patient who left a restaurant after a full meal and was involved in a car accident which resulted in injuries requiring immediate surgery.  However, by forced fasting, she experiences additional risks from the results of fasting, and from interventions used to address those problems which can arise.

Yet, for some reason, most women, except those giving birth at home, most birth centers, and a few hospitals, are required to fast during one of the most physiologically complicated and physically intense events of their lives.

IV fluids have no research to support their  routine use during labor.   First, it communicates to the woman that she is not a healthy woman giving birth, but a "patient" who is undergoing a medical procedure, which, hopefully, will go well.  Secondly, fluids over hydrate the mother and the baby.  This can lead to the unnecessary use of formula when a baby "looses to much weight", when in reality, the birth weight was skewed from the IV fluids received by the mother and passed to the baby.  Mothers can have trouble with breastfeeding because of breast and nipple edema which makes it difficult for the baby to latch correctly.  Also, if hormones which control labor are flowing through the mother's body, dilution of the blood stream by added fluid might cause labor to slow and contractions to be less effective.  Obviously, if a mom is dehydrated, or wants pain medications, or is considered high risk due to current complications, an IV is appropriate.


Fasting in labor not only makes most women uncomfortable, it can lead to problems with the birth process.  The contractions themselves may be more painful as the muscle known as the uterus is not getting the nutrition it needs to do its work properly.  Labor may last longer due to nutrient restriction.  Complications can accompany the use of Pitocin which is often administered to strengthen weak contractions.  Some women end up with a Cesarean.  And, in a few cases, some women die from complications of the surgery . . . including massive hemorrhage, infection, pulmonary embolus, and, once in a while, aspiration.

Women may have a decreased appetite during labor, but if labor is long, most women want to take in some nourishment. (My own mother told me that she wanted a steak just before it was time to push.  Since she gave birth at home, someone cooked one for her and she ate it!).   The energy supports the normal process.  There are fewer complications which require interventions which, too, carry risks.

A person who is dying will typically begin to loose his or her appetite.  This becomes more pronounced as the process continues.  At some point, they do not want to eat, or even drink.  Forcing foods and fluids can cause great G.I. discomfort in a digestive system which is shutting down.  This can make the dying process more painful and often longer than it would have been.  In such a terminal state, nutrition and fluid is not saving the person's life, but prolonging death in a way which is more uncomfortable for the patient.

I recently heard a relative state that another relative did not die from advanced Alzheimers, or heart failure, but from starvation after having received hospice care.  If food and drink was withheld from the patient, causing pain and distress, that would be starvation, but that is not the practice of hospice.  If the patient refused food and drink during those last days or weeks, then signs of starvation would likely show up on the autopsy, as it would if nutrition was intentionally withheld.  The difference is in WHY and HOW the starvation occurred.  When no appetite is present, then lack of nutrition does not cause the same discomfort that withholding food when appetite is present can cause.

A woman in labor will eat and drink as she desires.  This makes her labor more comfortable.  A dying person will eat and drink as he or she desires.  This make the dying process more comfortable.

Activity

Women in labor typically find that moving around and changing positions to those which bring comfort help them cope with pain.  These also help facilitate labor.  When movement is restricted, women experience more pain and longer labor.

Again, some of the reasons for restricting the mother's movement is not based on the research evidence.  For decades, women giving birth in the hospital were forced to remain in bed so they could be continuously hooked up to the electronic fetal heart monitor -- which, in  itself, was an unproven, experimental intervention.   Epidurals became common because most women could not tolerate the added discomfort bed restriction caused.  With both limited mobility and the use of epidurals (not to mention limited understanding of what those monitor tracings meant), it is no wonder the C-section rate skyrocketed from around 5% to close to 40%, and even higher in some hospitals.  More recently, it has been around 33% on average, but varies according to place of birth and whether the birth is high risk or not.  Thankfully, a better understanding of why those C-section rates escalated has occurred and new guidelines regarding monitoring the baby's heart rate, allowing the mother more time to reach active labor, and others, should result in a reduction of C-sections.

The person who has begun the dying process slows down physically.  While there is merit in suggesting (like food and drink) some light activity, it is better to let the dying person take the lead.  Of course, a bed ridden person benefits from being turned every two hours to minimize pressure sores, but at some point, near the end of life, this can become very uncomfortable to many patients. 

A few years ago, my neighbor, a wonderful Southern gentleman in his early 90's, was dying from COPD.  He had just arrived home from yet another hospitalization because he chose to die at home. He was in the bedroom with his nurses aid, and his two daughters were waiting to come in.  As he sat in his favorite recliner, he told the aid that he just could not move right then.  She responded "You don't want your daughters to see you without your pajama top on, do you?".  As a gentleman, he forced himself to put on the pajama top, gasping for breath even though on oxygen, and collapsed back into the recliner -- and died.  Poor man! 

When my own mother was in a hospice facility, very close to death, I had noticed that it had been about 8 hours since she was turned.  I asked the nurses about this.  They said that they had been discussing turning her, but believed that, if they did so, it would lead to her immediate death.  They were right.  When they did finally turn her, she took her last breaths and died.  Thankfully, in this case, my mother was deep into the death coma, and did not suffer, like my neighbor did.

When a person is dying, especially when he or she is quite close to death, the desire for movement or no movement should be respected.  Is it really worth forcing movement which causes pain just because "this is what we are supposed to do (in healthier patients)" or because of social propriety?

Women in labor should be allowed to move and to assume the positions most comfortable for them.  People who are near the end of the dying process should be assessed to determine how much movement they can tolerate, and the indicators of how well they tolerate the movement and positioning (grimacing, crying out in pain, etc.) should be considered.

Focus, Zones and Euphoria

God's design for natural birth includes "pain medication" in the form of endorphins.  The hormone oxytocin facilitates normal contractions and also an increasing trance-like state in late first stage labor.  Both of these help the mother rest between contractions and helps her to better cope with the contractions.  As labor advances, the mother "withdraws" from everyday life to becomes birth focused.  All attention is on dealing with each contraction, and, near the end of the first stage, just before complete dilation, on resting between them.

Likewise, as the dying person nears the end of life, they leave everyday life and are engulfed in the "valley of the shadow of death".  

For the woman in labor, giving Pitocin, a synthetic form of oxytocin, disrupts the path toward the "natural pain relief" provided by her body.  While Pitocin causes contractions, they are often harder and have a different form from natural contractions.  We have already discussed the effects of forced fasting.

The epidural, too, interferes with the natural flow of these hormones.  Thankfully, most women in this country have access to epidurals if they want one.  My personal position is that all women have the right to make an informed decision on every intervention or restriction ordered or suggested in labor and birth.  Like all options available, the epidural has benefits and risks.  Women who have an epidural will miss out on the special mental and emotional status provided by endorphins and oxytocin.  They will miss out on an intense "high" experienced by most women who have had a totally natural childbirth.  As one of my clients loudly exclaimed after giving birth without pain medications last year, and holding her newborn daughter skin to skin at hear breast, "I am SO HAPPY!".  That was the hormones talking.

Forcing the basic things which sustain life can interfere with the floating, trance like, "far away" state the dying person enters into.   Giving oxygen, when the dying person is not experiencing air hunger, interferes with the euphoria which can occur when carbon dioxide builds up in the body.  Again, forcing fluids and food can disrupt the "fading away" and the "floating" and the more euphoric state which God has integrated into His design for the dying process.  Oxygen is a comfort measure to the person who is exhibiting signs of air hunger, but not for those who do not.

The process of labor itself, correctly understood and supported, provides for some natural pain relief and for positive emotional and mental states. The process of dying, correctly understood and supported, also provides for some natural pain relief and positive emotional and mental states.  In both cases, additional pain relief is, and should be, available for use as needed.

There are other parallels, but these are the most important, in my opinion.  Whether a woman is giving birth, or someone we know is dying, even though we live in a fallen, imperfect world which prevents both the natural process of birth and of death from being universally experienced, the basic principles are still in place.  If we trust these designs as a gift from a God who loves His creatures, even those in rebellion to Him,  we can experience His blessing whether giving birth, or leaving this world.

For more information on the evidence for the labor and birth procedures noted above, go to www.EvidenceBasedBirth.com.