Ironically, modern maternity care in America runs very similar to a fast food restaurant. Only instead of giving your order and watching your food assembled and served to you, you are like the one being assembled and shuffled along on the conveyor belt. You arrive and give your name and what brings you to the hospital. Then you're shuttled off to a room to be hooked up to monitors and poked and prodded. Someone comes in and puts something in your I.V. (and tells you what it was only afterward). You're asked endless times if you're ready for pain relief. You're poked and prodded again. You're told things are moving along nicely or they're not and you'll need some assistance. Or you might be told that your body isn't working right, labor isn't moving along as it should be. You are assembled for labor and your baby, the product, is delivered.
Only no one tells you there is a better way.
The majority of women in the United States labor and deliver in a hospital. Over 4.2 million women in 2006. Hospitals need to keep you moving through the system; to increase output (your baby), make room for more laboring mothers and make more money.
Hospitals and obstetricians use interventions to keep you moving through the system. Many have been imagined. The following picture is a proposed machine meant to expel a baby using centrifugal force.
The machine, called "The Blonsky", was patented on November 9, 1965, by George and Charlotte Blonsky. The "ride" would generate a force of up to seven G's. Thankfully, this invention never made it past the patent stage! But a number of inventions created to induce, augment, monitor and control labor have become a reality. These interventions often become a cascade; one necessitating the next and the next. Here are just a few interventions you might run into if you deliver in the hospital:
- IV- intravenous fluid
- EFM- electronic fetal monitoring
- AROM- artificial rupture of membranes
- Pitocin- used to induce or augment labor
- Intravenous Analgesics- pain medicine
- Epidural Anesthesia- pain medicine
- Forceps or Vacuum- used to manually extract your baby
- Cesarean Section- baby is delivered through an abdominal surgical incision
All of these inventions carry risks to the natural, physiological process of childbirth. The IV is the most seemingly benign. Yet it is the one that allows obstetricians the ability to deny your most basic rights: food and drink during labor. Electronic fetal monitoring (EFM) may give you peace of mind that your baby is okay during labor or you may think it will help you prepare for that next contraction, but since the introduction of EFM, cesareans have risen dramatically and its effectiveness at preventing the deaths of babies during labor remain unproven. The IV and EFM also render the mother immobile and may lead to fetal malpositioning and distress. EFM, if internal, increases the risk of infection for moms and babies as well. AROM also increases infection risks. AROM is when the obstetrician or nurse uses a gloved finger(s) to tear the amniotic sac prematurely. This intervention can cement the baby in a bad position for vaginal delivery. Pitocin is one of many ways that doctors like to induce (start artificially) labor or augment (speed up) labor. The contractions that pitocin causes are described as unbearable by most women, necessitating the next intervention: the epidural. The epidural carries more risks than most people are aware of. It can slow or stop labor. It can cause a sudden drop in blood pressure for the mother and oxygen for the baby. It can cause headaches and increases your chance of a c-section to 50%!
The Ultimate Intervention: Cesarean Section
Cesarean section carries its own risks: to your baby now, to your fertility, to you, and to your future babies. It is not something to take lightly if presented this option without a true medical necessity. Jennifer Block quoted Public Citizen writing that "cesarean section, while at times a life-saving intervention for both mother and child, can be a cause of significant harm to mothers and provides no additional benefits to infants when performed outside certain well-defined medical situations." There is a higher risk of:
- hemorrhage
- infection
- hysterectomy
- surgical mistakes
- re-hospitalization
- dangerous placental abnormalities in future pregnancies
- unexplained stillbirth in future pregnancies
And with every c-section, these risks increase even more. Babies born by cesarean have a greater likelihood of being admitted to the NICU (neonatal intensive care unit). They have a higher risk of:
- low birth weight
- prematurity
- respiratory problems
- lacerations
There is also the fallacy that cesareans aren't as painful as labor. Imagine that every time, for several weeks (not hours), you move, sit up, walk, lift your baby or change your baby it feels as if your insides are going to fall out from the still healing wound that stretches nearly hip to hip. Labor pain is gone after the baby is born. The physical pain from a cesarean can last weeks, months, or even years.
The 2007 U.S. Cesarean Section Rate was 32%
The World Health Organization (WHO) recommends that the c-section rate not exceed 10-15%. The U.S. rate exceeds the maximum by 17%. The high rates are often blamed on maternal request and increasing maternal age but the biggest increase is among women under 25, up 57% since 2000.
United States ranked 41st in maternal mortality
This was one of the lowest rankings of all industrialized nations. In 2005, 1 in 4800 women died from pregnancy related complications. The following statistics from the United States National Center for Health Statistics shows an enormous disparity in the maternal mortality rates based on ethnicity.
The information is based on women that die due to pregnancy or labor related complications within 42 days of delivery. The risk is greatest for Non-Hispanic Blacks at 39.2 deaths per 100,000 live births and lowest for Hispanics at 9.6 deaths per 100,000 live births.
Control and the Violation of Basic Rights
The control of labor and its process has gotten out of hand. In a 2004 CBS News article, Debate Revived on Mothers' Rights, David Caruso reported that several mothers had been, or were attempted to be forced to undergo cesareans. One mother of six, Amber Marlowe, was told that her baby could only be delivered via cesarean section because ultrasound had revealed that her baby was too large to deliver vaginally. She left the hospital and delivered elsewhere without incident. She only found out later, from a reporter, that the first hospital had obtained guardianship over her unborn child giving the hospital the ability to force her into surgery. Another mother, battling cancer, was forced to undergo a cesarean against her wishes at only 26 weeks pregnant. She and her baby died within two days of the surgery. Women should clearly have autonomy over their own body to make these life and death decisions.
The Assembly Line
The assembly line process applied to childbirth offers a semblance of control over when and how a woman delivers. In the book Pushed, Block noted data from The Centers for Disease Control and Prevention (CDC) regarding the "weekend birth deficit". The 2004 report showed that most births occur Monday through Friday. Weekend births decrease by 4000 deliveries per day. This "weekend birth deficit" is due to obstetricians' control over deliveries by inducing labor or extracting the infant via cesarean section.
The assembly line process in maternity care puts the laboring mother "on the clock" so to speak. One nurse at Florida Hospital noticed a change in the nine-to-five birth phenomena when Hurricane Charley hit. She told Jennifer Block that women that were supposed to be induced, went into labor on their own and did better than if they had been induced. Many interventions are done only because a woman's labor is not progressing as quickly as the staff or obstetrician expects or would like, not necessarily because the baby or woman are in distress.
Another Way
In Improving Maternity Services, Dennis Walsh writes about his observations of a free standing birth center and their lack of assembly line processes. When reflecting on hospital birth he writes that the number of women in labor at a given time makes it nearly impossible to provide one-on-one care that has been proven more effective. Hospitals provide care for pregnant women from low to high risk, which makes it more difficult to implement.
The obstetric protocols for interventions during labor, violation of maternal autonomous rights, maternal mortality statistics and the United States' international maternal mortality ranking all call for a serious look at the maternity care system as a whole. Being shuffled through labor, as though on an assembly line in a factory, is harming mothers and babies. The only way to avoid active labor management and overhaul the current maternity care system is to integrate free-standing birth centers and home birth for low risk mothers. We need to allow obstetricians to focus on high risk pregnancies and save mothers and babies that need saving. It is imperative that obstetricians collaborate with midwives in order to improve our severely crippled maternity care system so that optimal care of all mothers and babies will prevail.
Block, Jennifer. Pushed: The Painful Truth about Childbirth and Modern Maternity Care. Cambridge, MA: Da Capo Press, 2007. Print.
Caruso, David B. "Debate Revived on Mother's Rights." CBS.com. The Associated Press, 19 May 2004. Web. 10 May 2010.
Cesarean Rate Jumps to Record High- up 53% since 1996. International Cesarean Awareness Network, 23 March 2010. Web. 29 April 2010.
Walsh, Dennis. "Taking Labor off the Assembly Line." Improving Maternity Services. Oxon, OX. UK:2007. Pag. 52-67. Radcliffe-Oxford.com. Web. 9 May 2010.
World Health Organization, UNFPA, UNICEF, Averting Maternal Death and Disability. Monitoring Emergency Obstetric Care: A Handbook. France. World Health Organization, 2009. Print.
United States. U.S. Department of Health and Human Services. National Vital Statistics Reports. Trends and Characteristics of Home and other Out-of-Hospital Births in the United States. By Marian F. MacDorman, Ph.D., et al. 3 March 2010. Web. 27 May 2010.
United States. U.S. Department of Health and Human Services. Health Resources and Services Administration, Maternal and Child Health Bureau. Women's Health USA 2008. Rockville, Maryland: U.S. Department of Health and Human Services, 2008. Web. 31 May 2010.
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