| Discussion Board |
| Topic |
| Survey |
| Dec/Jan Survey |
| Results |
America's Relationship with Birth
By Jennifer Maciejewski
But America continues to move further and further away from this low-intervention birthing model. In 2004, midwives attended a mere 11.1 percent of vaginal births, according to a 2006 National Vital Statistics Report, and of the 1 percent of out-of-the-hospital births, 65 percent were home births and 27 percent were in a freestanding birthing center. That same year, the rate of Cesarean delivery increased to 29.1 percent—the highest rate ever reported in the United States—and the rate of Vaginal Birth After Cesarean (VBAC) dropped to 9.2 percent—the lowest level reported since this information started being collected on birth certificates in 1989.
Based on results, America’s increasing reliance on surgical intervention during the birth process isn’t paying off. Although America’s infant mortality rate has dropped sharply over the past 40 years—from 26 deaths per 1,000 live births in 1960 to 6.8 deaths per 1,000 live births in 2003—the country lags far behind other developed nations, ranking 29th worldwide, according to the National Center for Health Statistics. And the mothers aren’t faring much better: the maternal mortality rate was 12.1 deaths per 100,000 live births in 2003, up from 9.9 in 1999, with the leading causes of death including postpartum bleeding, infection and eclampsia.
Since the status quo isn’t good enough, one can only question: How did we get here?
A Century of Change
In 1900, 95 percent of all births in America took place in the home. In the early 20th century, when the medical establishment became more organized and professionalized, the physicians launched a public relations campaign against midwives, relegating them as outdated relics of the old country, says Tina Cassidy, author of “Birth: The Surprising History of How We Are Born.”
Their tactics worked. “The medical establishment was quite successful in terms of convincing the public that midwives were unsafe, unclean and should be outlawed,” Cassidy adds, and “hospitals were offered as this gleaming, wonderful place where you could go and have a baby that would be cleaner and safer.” By 1938, only half of all births occurred in the home, and the downward spiral continued until it reached today’s paltry rate of less than 1 percent.
But despite their claims during the campaign and beyond, the new techniques, technologies and drugs offered at the hospital did not always make the birth process safer or cleaner for either the mothers or their newborns. In the early 1900s, the mother’s risk of infection rose since many physicians did not wash their hands between patients, and unlike midwives, many new physicians had never witnessed a live birth prior to going into practice.
For their own convenience, physicians in hospitals insisted that women labor in the lithotomy position, “the most physiologically dysfunctional position ever invented,” notes Robbie Davis-Floyd, a medical anthropologist and author of “Birth as an American Rite of Passage” and “Mainstreaming Midwives: The Politics of Change.” “Putting the mother flat on her back literally makes the pelvis smaller, makes it much more difficult for the woman to use her stomach muscles to push, and therefore makes it much more likely for an episiotomy to be cut or for forceps or the vacuum extractor to be used.”
Over the years, the physicians tried out an array of medical interventions during the pregnancy and childbirth process, many of which proved to cause more harm than good. Pelvic X-rays, routinely taken in the 1930s, caused cancer in babies. Administered from the 1940s-1960s, the drug scopolamine put mothers into a “twilight sleep,” which didn’t stop pain, but merely erased the memory of pain by attacking the brain functions responsible for self-awareness and self-control. The result? Thousands of new mothers experienced a form of psychosis followed by post-traumatic stress-like memories.
In the 1970s, physicians routinely prescribed the drug thalidomide to mothers with morning sickness, which they later discovered caused birth defects. In the 1990s, physicians used the drug cytotec to stimulate contractions in mothers who had undergone a previous Cesarean, an intervention that caused ruptured uteruses and high infant mortality.
America’s Relationship with Birth Today
Today’s drugs du jour include a one-two punch of medications: First, the mother receives an epidural, a lumbar injection that kills the pain below the waist. Since the epidural also retards natural contractions, physicians administer pitocin, which causes longer and stronger contractions, to speed things along. Though the goal is to achieve a shorter and less painful labor, the intervention can cause the opposite result, especially if it triggers a Cesarean because the labor fails to progress or the fetus becomes distressed.
But drugs aren’t the only factor contributing to America’s skyrocketing Cesarean rates. When several studies in recent years showed an increase in uterine rupture rates, especially when the women have undergone an induction or a failed trial of natural labor, obstetricians stopped offering the procedure due to their increased liability. In 2006 alone, 37.1 percent of obstetricians reported that they increased the number of Cesarean deliveries, and 32.7 percent indicated that they stopped performing or offering VBACs, according to an American College of Obstetricians and Gynecologists study.
“The birth activist movement held our Cesarean rates at under 25 percent from 1980 to 2003,” Davis-Floyd says. “Then we lost VBAC, and they started to rise, now up to 30.2 percent nationally. As the Listening to Mothers Surveys I and II clearly show (see childbirthconnection.org), the rise is not a result of consumer demand—women are not choosing to schedule their C-sections; in most cases, doctors are convincing them to do so.”
“Given the trends in much of the rest of the world toward ever higher Cesarean rates, it seems likely that the rate in the U.S. will continue to rise for some time to come, in spite of studies showing that maternal and perinatal mortality and morbidity increase as the Cesarean rate increases,” Davis-Floyd continues. “Below 5 percent, women and babies die from lack of access to Cesareans. Above 15 percent, women and babies are injured and die from excess Cesareans—mothers primarily from infections, babies primarily from prematurity (many Cesareans are scheduled too early).”
Whether the birth occurs in a home or a hospital, several studies show a positive outcome when a midwife assists with the delivery: The Cesarean rate for hospitals with nurse-midwifery services was about 13 percent lower than the average Cesarean rate for all hospitals, according to the Washington-based Public Citizen’s health research group.
Plus, negative outcomes are consistently higher in hospital births than in home births, according to a report by Lewis Mehl-Madrona, M.D., Ph.D., coordinator of Integrative Psychiatry and Systems Medicine at the University of Arizona College of Medicine Program in Integrative Medicine, which compared 1,046 home births to 1,046 hospital births. The fetal distress rate was six times higher, babies required resuscitation 3.7 times more often, and the maternal postpartum hemorrhage rate was three times higher in the hospital than in the home. In addition, 30 birth injuries occurred in the hospital, as compared with none in the home.
Starting the Conversation for Change
Despite the proven benefits of midwife-assisted hospital as well as home births, the medical establishment in many countries, including America, continues to push midwives out. In order to get the conversation started about the vital role midwives play in the birth process and challenge Americans to re-evaluate their own relationship with birth, actress Ricki Lake, herself a doula—a woman who assists another woman during labor—decided to executive produce “The Business of Being Born,” a documentary that examines and questions the way American women give birth.
“Before, I had thought that childbirth was a purely medical experience and that the goal was to escape as much pain as possible,” says Abby Epstein, director of “The Business of Being Born,” which will be available for rent via Netflix in March 2008. “The most empowering thing would be to get your epidural as early as you could. That’s what I thought, and that’s probably what I would have done had I not become pregnant while making this film. Seeing so many births and seeing the way birth can be was such an eye opener. I had never imagined that birth could be that purely intimate, simple and uncomplicated. Once I actually witnessed birth with my own eyes, all of the levels of fear about this experience that I’d built up over my whole life lifted.”
In addition to featuring a wide cross-section of natural birth experiences from women across the country, the documentary includes footage of Lake’s home birth of her second child, which was shot before she’d even conceived of the idea of making this film, as well as Epstein’s home birth experience and subsequent hospital transfer.
“I filmed [my son’s] birth for me, but in the end, I’m glad we used it because it’s a beautiful moment,” Lake says. “I don’t necessarily look my most beautiful, but it’s a powerful image. Birth is such a miracle. It’s a privilege to be able to have a baby grow inside of you, and it’s a very empowering experience to have the baby come out on your terms.”
Even though Epstein’s home birth didn’t go as planned and she ultimately required a Cesarean, both Epstein and Lake felt that it was important to keep her story in the documentary. “I think that’s what made it more balanced,” Lake says. “It’s about empowering and educating women to make the best decision for them, whether that’s having an elective C-section or a home birth. We’re not anti-hospital or anti-doctor at all. We all need to work together and let everybody do what they do best. It’s about choice.”
©2006 Today's Chiropractic