College essay from 2017, please skip right past unless you want to know more about the current research into fallacies of birth practices in America today. P.S. My creative writing 101 professor disagreed with the thesis and consequently gave me a C.
Photograph of my actual visit to the natural history museum in the Bronx, New York City, NY.
An exhibit postulating that evolution has occurred such that babies are now too big for the birth canal and have to be helped through modern surgical methods to be born.
#1. Evolution doesn't work that way. If baby heads got bigger, mom's pelvis would too.
#2 What a load of crap.
Birth has transitioned historically from a
natural and organic process to a procedure that is typically accompanied by
medical intervention. This evolution of
birth, its rights, its freedoms and oppressions affect women and children
on a national scale. And whether good or
ill, medical intervention is a decision that should be purposeful, dictated by choice and medical necessity, not simply by physician efficacy and medical routine. Empowered women must seek valid studies and statistics to avoid becoming victims of out-dated birth practices that risk health and which have an oppressive effect on women's ability to make educated birth choices.
Birth practices prior to the twentieth
century utilized an organic approach to birth.
Birth occurred in homes and women were aided by other women. By the turn of the century, hospitals were
replacing homes, and by 1935 half of all women living in cities were giving
birth in medical facilities. By 1950,
only a quarter of births occurred outside hospitals. As birth moved from homes to hospitals,
infant deaths did not decrease, but in fact rose seventeen percent. Deaths in hospitals did not begin to decline
until the use of sulfa drugs became common and physicians finally agreed to improve
their sanitation procedures (Goer, Thinking, 202).
As mothers birthed during the first years
of the twentieth century, modifications on the natural process were rare. Medical interventions in labor and delivery
and pain relief were initiated by the surgical branch of specialized medicine
called obstetrics and women became the test subjects for medical
interventions. Today, birth without any medicinal
or physical intervention is rare and women and newborns continue to be on the
cutting edge for progressive advancement in labor and delivery protocols (Gaskin
p 3).
With the advent of medicine and science, the biological process of what was
once a natural occurrence has transitioned.
Today most of us join the proponents of medical advancements to
agree that medicine has improved many aspects of birth. From high-risk pregnancies, and the mortality
of premature babies to medical advancements that impact couples who suffer with
infertility, medical innovations have assisted those who suffer with
physiological birth challenges. In
addition, without the surgical specialization of the obstetric branch of
medicine, life-saving, emergency surgical interventions like caesarians would
be even more dangerous. Medical
intervention appears to be the wave of the future.
Yet, within the current birth practices, we need to ask which inventions and actions are the result of sound medical advancement and
which interventions can actually cause birth complications (Carroll). Could our ignorance of these issues be
contributing to an increase in the birth mortality rate of both mothers and
babies in America (CIA)? If any other medical suggested a procedure that doubled the risk of a major surgical intervention, that would be considered malpractice. Not so with labor induction that results in c-sections. https://www.reuters.com/article/us-induced-labor-c-section/induced-labor-may-double-the-odds-of-c-section-idUSTRE65K6DW20100621
As medicine and nature blend, it has
become increasingly difficult for consumers—parents-to-be, to make informed
decisions based on a full evaluation of labor and delivery options. These decisions must include risks and
benefits of birth interventions in these decisions because the method and
manner of birth can affect the growth and development of children throughout
life. However, individualized childbirth
decisions can be difficult to make because comprehensive studies on birth
practice are complex and nuanced and many times the studies seem too
complicated for a consumer to evaluate in the process of deciding the best
method for childbirth (Blanchette).
An evaluation of current birth strategies
and care giver alternatives are important in taking responsibility for one’s
one health choices. One of these is which professionals will attend the birth. 98% of births are now attended by obstetricians--physicians
whose training is in the medicine and surgical interventions of childbirth (Goer,
Thinking, 243). Family practitioners are
medical professionals trained in all aspects of family medicine and who are
typically birth attendants in rural areas who have minimal options available for
pain relief and surgical interventions.
The third labor class of delivery providers are certified nurse
midwives—specially trained and more frequently, state certified to attend birth
with minimal interventions.
The decision of birth facility is critical
to birth outcome (Van Der Hulst). Birthing facilities must be
evaluated, ie., hospitals, birth centers within hospitals and births in a home
environment. An evaluation of the
financial benefits and risks to the medical and insurance industries may be
relevant in the birth decisions.
The primary focus of mothers, birth
professionals and this paper’s examination is a positive birth outcome—the
child. The birth process of a child has
been proven to affect the growth and development throughout childhood. As medicine and nature meld, women and
children’s health can benefit from solid, statistical information that focuses
on obtaining relevant education and evaluating diverse information related to
the physiology of birth. This knowledge is
what empowers a personal birth experience.
It seems that this is a simple evaluation
and that by making an effort to gain knowledge, women will become informed participants
rather than merely patients. But the truth is more complicated. Less than 2% of births in
America occur with no medical intervention (Gaskin, 5), and a review of the consequences
of this casual acceptance of the current medical practices of birth
intervention must be made to ascertain why.
As the medical facilitation of birth has
increased so have the risks to the mother and the baby. A woman in America has
a greater risk of dying from childbirth than do those in the 40 other
industrialized countries and that risk is increasing. The maternal mortality rate has doubled in
the last thirty years (Amnesty). These
numbers are so alarming to birth professionals that recently an industry-wide
call for the formation of a National Maternal Mortality Review Committee has
been made. The request, published in the
July 2017 issue of Obstetrics and Gynecology, makes the case that, “…these
numbers are four to five times higher than that of the best-performing
nations.” It goes on to state that, “In
fact, the United States has the highest maternal mortality rate of any
high-resource country” (Clark).
In
addition, the birth mortality of newborns in the United States has dropped
below seventeen of the high-resource countries in the world (Hamilton), and caesarian
rates have increased drastically in the last three decades (Osterman). One-third to half of all babies born today
(Goer, Thinking, p 202) are caesarian births. This is “in spite of the
fact,” states Dr. Louis Weinstein, chair of the obstetrics and gynecology
department at Thomas Jefferson University, “that a Caesarean is 6 to 20
times more dangerous than a vaginal delivery” (Donaldson). Nearly one in four American
women gives birth by cesarean section and “one-half to two-thirds of these
major abdominal operations were not needed.” (Goer, Myths, 17)
Birth is no different than any other consumer based
commodity. Supply and demand are
precursors for the wave of medical birth alternatives. Labor/delivery techniques have changed to
meet the demands of a free market economy that caters to the consumer and feeds
the need as it grows. Obstetricians are
aware of the prevailing trend and because their specialty is trained
specifically in the surgical aspect of birth, these physicians are positioning
themselves to be aptly suited to meet the market demands with labor and birth efficiency.
To get a jump on the prevailing trend, a preemptive
study on optional caesarian birth was conducted in Texas in 2006. It
investigated how much on-demand caesarians (c-sections) at 39 weeks could
benefit babies. This conclusion was
based on extrapolation of the number of injuries suffered by vaginal birth
babies multiplied by the estimated increase of babies that would be born
c-section if women were allowed to opt for an optional c-section at 39 weeks. The conclusion was that injuries to babies
that occur during vaginal birth would be greatly lessened with the optional
request for caesarian birth at 39 weeks, because the baby would not be
delivered vaginally (Hankins). This
study neglects to address the significantly increased dangers to the child of
c-sections. This study is used often to justify the continued overuse of this procedure. Fully thirty-three percent of births are c-section and statistics do not support the increase with improved mother/child risk.
In
response to trends, advocates for fewer caesarians have statistics that
counterbalance the positive effects of optional caesarians with studies of
their own. A 1992
Dutch study proved that over the course of one decade between 1982-1992, that
c-sections caused 700% more deaths than vaginal births, 28 per 10,000 (Goer,
Thinking, 23) Henci Goer, a birth
researcher and pregnancy and birth educator and the author of Obstetric Myths versus Research Realities: A Guide to the Medical Literature, challenges
studies like the optional c-section one and considers them to be spurious and
merely created to promote the intervention of major surgery without valid
statistics garnered from accepted birth study protocols (5). Ms. Goer, invites women to consider that,
“Cesarean section is the most common major surgery performed in this country…
despite the health risks, pain, recovery time and expense.” She also claims again in a subsequent book, The Thinking Woman’s Guide to a Better Birth
that, “The consensus of medical literature is that half of these operations
were not needed” (1).
In
addition, epidurals continue to be the drug of choice for birth. Proponents minimize the risk to babies
suggesting that with the large numbers being performed, that epidurals have
been improved and are safe (Thorpe). The
average rate of epidurals in the US is 61% (Osterman) yet “an
epidural increases the odds of cesarean for lack of progress somewhere between
2- and 8-fold, especially in first-time moms and causes fetal distress in about
10% of babies,” (Goer,
Myth, 3).
In
addition, numerous studies on the effects of labor analgesia and infant brain
development have proved that epidural analgesia is connected to increased
duration of labor, medical interventions in instrumentation related to vaginal
delivery and in birth by cesarean (MacArthur; Eddleston; Thorpe).
Advocates for the medical industry
say they are just giving women what they want, and of course it’s up to the
consumer or insurance providers to ask, “At what cost?” A hospital makes significantly more on
surgeries and epidurals vs. natural birth.
Doctors also make significantly more and therefore the suggestion to
limit or eliminate birth intervention is going to come from that direction. Jenene Turley, a prenatal birth educator
felt compelled to publish a peer-review paper for the Journal of Prenatal
Education entitled, “How I Teach Evidence-Based
Epidural Information in a Hospital and Keep My Job” (Turley). It's obvious that there is no monetary value in a neutral advocacy group of obstetricians who would investigate safe, and non-surgical birth.
The two sides, medical
interventionists and natural birth advocates who are debating the issue ostensibly
join in empowering mothers, but each differ on what “birth empowerment,”
actually means. Medical professionals
argue that empowering women is accomplished through alleviating the discomforts
associated with birth, i.e., the inconvenience, pain through drug intervention
and the benefits of cutting edge technology.
Natural proponents offer a biological and organic alternative to
low-risk birth situations and insist that this empowers women through education
and involvement. Their model of care is not based on the obstetricians “normative
standards” of the progression of labor occurring on some prescribed schedule, but
instead on a pattern that is individual to each patient. Midwives follow the tenants of noted French
physician, Michael Odent. “One cannot
help an involuntary process. The point
is not to disturb it” (Goer, Thinking, 199).
More discussion on the impact of knowledge
on the empowerment of the personal birth experience is called for and insight
on what may happen when the patient takes an active interest and more
responsibility in health care could be the subject of subsequent research. What might be the result to the mortality of
babies in America and the mortality rates of mothers if education encouraged
them to transition from patients to proactive participants in evidence-based
labor education?
Evidence-based education must begin at the ground-level. For example, while strolling through the New
York City Natural History Museum, one may expect to see exhibits theorizing the
evolution of man. In the children’s area is an exhibit explaining human
birth with a scale model of a baby and the mother’s birth canal. The
exhibit descriptor explains that due to evolution, the human brain has evolved
such that the skull is so large that medical intervention has become necessary
to complete the birth process. Aside from the inherent inaccuracies
in the scientific theory of evolutionary process, (Darwin would say that if growth
over time has forced an increase in skull size, then that same impetus would
influence the evolution of the pelvis,) this exhibit in a prominent city museum
is an indicator of the nation’s general opinion of the need for intervention in
the natural process of birth as well as an indicator of the need for better
birth education.
Current methods of birth
practice may reflect scientific opinion, but medical practices fail to adapt
when the studies manifest negative results.
Surgical obstetrics is tradition based and has become so enmeshed in the
economy of health care that any modification of these practices—even those
evidence-based—does not motivate change.
The question is how can that be?
And a possible answer is offered by labor and delivery educator Henci
Goer, “Obstetric practice does not reflect the research evidence because
obstetricians actually base their practices on a set of predetermined
beliefs. If you start from this premise,
everything about obstetrics, including the inconsistencies between research and
practice, makes sense.” (Goer, Thinking
4).
Neither extensive studies
nor grass-roots advocacy has had an effect on obstetric labor and delivery techniques,
yet maternal mortality and infant mortality rates continue to stymie medical
interventionists. Kathleen Harper, an
obstetrician practicing in Nevada wrote a paper calling for more obstetricians
to be trained—blaming the increase in the maternal mortality rate in Nevada on
the lack of obstetricians (Harper). The author of the paper failed to clarify
what is causing the mother and infant mortality and is perhaps unaware of what is
adding to the death statistics. Hemorrhage
is the #1 reason for delivery-related deaths—and obstetricians rely on surgical
intervention to treat this problem. Most
hospitals, although mandated to provide operating facilities, are not prepared
to facilitate emergency surgeries (Goer, Thinking, 206), and delivering mothers
bleed out before they ever get to the surgery.
A significant majority of the deaths--African
American women—are a 3-4 times greater risk (Bond). Substandard social structures is one
contributor to the problem. Training
more obstetricians will not solve the issue of social inequality—nor can their
methods become part of the answer. The
obstetrician’s traditional birth practice of vaginal delivery involves
releasing the mother from the hospital within 12-24 hours and not seeing the mother
again for a week. This practice
exacerbates the risk to those in difficult social circumstances.
The Maryland study of
maternal mortality identified drug use as the other major source of the mortality
issue. (MDOHP) This problem can be addressed with the same answer, improved home
health care professionals, trained and required to attend a pregnant mother in prenatal
and postnatal visits in the home. A
professional, like a midwife, identifies interventions for problems related to
social inequality. Only midwives are
required by law to make extensive before and after-care visits and only those
visits can reveal on-going health situations that could be resolved through existing
social programs. Until we begin to
utilize the birth practitioner who is trained to address these failures, we can
continue throwing doctors at the problem without ever experiencing a
solution.
There is cautious optimism
about the evolution to healthier birth practices. Smart consumers—made even wiser through clearer
information and better education will grow to understand their responsibility
in this issue and demand changes via the economics of supply and demand. Just last month a newscast was finally shown
by CBS TV news, which quoted an Associated Press article from December of the
previous year. It recommended to
laboring mothers that they require that their doctors allow the umbilical cord
to completely deliver all of the cord blood to the baby rather than clamping
and cutting the cord immediately upon birth. This small change had been proven
to positively affect the well-being of children as far-reaching as four years later
(Andersson.) The newscast went on to say that although the new policy would cut
into the hospital economics (which has a lucrative business in selling
umbilical stem cell blood for research,) the long-term health of a child would
benefit. But, that study was published back
in 2015.
It’s
easy to get lost in the mortality numbers and caught up in the birth
statistics, but there is more at risk than our national standing in the World
Health Organization’s mortality standards.
Women are laboring and delivering babies along the cutting edge of
technological advancement and consumers must become educated in the true facts
of these medical options. Birth cannot always
be managed, scheduled and manufactured with the precision of an assembly line;
humans are not machines. Caregivers must
take their focus off expediency, tradition and consideration of normative
procedures and refocus on the individual’s simplistic progression through the
birth processes. If even one child or
mother is at greater risk because of the expediency of medical interventions,
then consumers must respond more judiciously and advocate for safer
alternatives. Safer birth demands
it.
Works Cited
Amnesty
International. “The Maternal Health Care
Crisis in the United States,” March 2011, https://www.amnestyusa.org/reports/deadly-delivery-the-maternal-health-care-crisis-in-the-usa/
Associated
Press, December 1, 2016, Web: https://www.cbsnews.com/news/dont-cut-umbilical-cord-too-fast-doctors-say-pause-benefits-newborns/
Andersson,
Ola, MD., PhD., et. al., Effect of Delayed Cord Clamping on Neurodevelopment at
4 Years of Age, A Randomized Clinical Trial. Jama Pediatr. 2015;169(7):631-638.
Doi: 10.1001/jamapediatrics.2015.0358 July 2015,
Web https://jamanetwork.com/journals/jamapediatrics/fullarticle/2296145
Donaldson,
Susan. “Trying to Take Back Childbirth.” ABC News, July 28, 2008, http://abcnews.go.com/Health/ Reproductive
Health/story?id=5462833&page=1
Blanchette,
H. “Comparison of obstetric outcome of a primary-care access clinic staffed by
certified midwives and private practice obstetricians.” Am J
Obstet Gynecol. 1993; 168(5);1407-1413.
Bond, S. “Maternal mortality rates
increase in the United States with risk of death 3-4 times higher in African
American women.” J Midwifery Womens
Health. 2011
Jul-Aug;56(4):404-5. https://www.ncbi.nlm.nih.gov/pubmed/21861303
Carroll, JC et al. “The influence of the high-risk
care environment on the practice of low-risk obstetrics.” Fam Med
1991; 23(3): 184-188.
CIA Central Intelligence Agency (US). https://www.cia.gov/library/publications/the-world-factbook/fields/2091.html. October 2017
Clark, SL. et.al., “The
Case for a National Maternal Mortality Review Committee.” Obstet Gynecol. 2017 Jul;130(1): 198-202
CDC Home Birth Statistics. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6103a6.htm
Eddleston, JM, et.al. Comparison of the
maternal and fetal effects associated with intermittent or continuous infusion
of extradural analgesia. Br J Anesth 1992 Aug;69(2): 154-8
Gaskin, Ina Mae, Guide to Childbirth, Bantam Dell, Random House,
Inc., NY, NY Mar. 2003
Goer, Henci. The Thinking Woman’s Guide to a Better
Birth, Peregee Books, 1999
Goer, Henci. Obstetric Myths
versus Research Realities: A Guide to
the Medical Literature, Peregee Books, 1995,
http://www.hencigoer.com/obmyth/
Hankins, GD, et.al. Cesarean section on
request at 39 weeks: impact on shoulder
dystocia, fetal trauma, neonatal encephalopathy, and intrauterine fetal demise.
Semin Perinatol. 2006 Oct;30(5):276-87.
Hamilton, Brady, et.al. Center
for Disease Control, National Vital Statistics Report, Vol 64, Number 6, June
17, 2015 Web. Retrieved 10-15-2017 http://www.cdc.gov/nchs /data/nvsr/nvsr64/nvsr64_06.pdf
Harper, Jenene, “Response
to Nevada’s Incidence of Maternal Mortality with more Obstetricians,” Am. Jrnl
Obstetrics and Gyn., May 2015
MacArthur, C, Lewis M, and
Knox, EG. Investigation of long term problems after obstetric epidural
anesthesia. BMJ 1992;304:1279-1282
MDOH Maryland Department of
Health. State Maternal Mortality Review
(MMR) Program Retrieved Oct. 2017 https://phpa.health.maryland.gov/mch/Pages/mmr.aspx
MDOHP Maryland Department of
Health Poster for media release. https://www.acog.org/-/media/Sections/MD/Public/MarylandMMRposter2017.pdf?dmc=1&ts=20170927T1731113112
Osterman, M.J.K, Joyce A. Martin, MPH, Epidural and
Spinal Anesthesia Use During Labor: 27-state Reporting Area, National Vital
Statistics, Health and Human Service Department: 2008 Retrieved: https://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf
Shapiro, Samantha M. “Ina May Gaskin and the Battle for at-Home Births,” May 23, 2012 Web http://www.nytimes.com/2012/05/27/magazine/ina-may-gaskin-and-the-battle-for-at-home-births.html
Thorp,
JA, Breedlove
G. “Epidural
analgesia in labor: an evaluation of risks and benefits.” Birth. 1996
Jun:23(2):63-83
Tumblin,
Ann, CD(DONA), LCCE, FACCE. “How I Teach Evidence-Based Epidural Information in
a Hospital and Keep My Job,” J Perinat Educ. 2007 Fall;16(4): 69-69
Van Der Hulst LA, et al.
“Does a pregnant woman’s intended place of birth influence her attitudes toward
and occurrence of obstetric intervention?” Birth. 2004 Mar;
31(1):28-33.
dec 6 2017
