The C-section is now the most common procedure performed in the United States. A third of American children are born through the belly instead of vaginally. Every year for the last decade, the States has set a new record for the number of C-sections.
Now that I have your attention, there is an increasing gap between the traditional Western medical community and that of midwife-delivered, woman-based care. A couple of recent articles, in Time and in the LA Times, explore this gap.
Here we are, discussing health care reform, and at the top of that discussion should be the way we bring babies into this world. One Oregonian midwife, Melissa Cheyney, has begun to examine the differences in care.
The U.S. has a limited idea of what it means to have a positive outcome at the end of a delivery. Basically it just means that everyone’s alive.
You’ve heard it, and I know I’ve said it, “You got the prize in the end!” Sure, you have the baby, but did you receive the care that was appropriate to your circumstances?
But when you don’t have a lot of medical intervention, you also tend to have more breast-feeding and reduced rates of postpartum depression.
Sounds great, right? Everyone’s happier, healthier, and the avoidance of interventions costs less: for insurance companies, Medicaid, and our own wallets. The LA Times reports:
As the No. 1 cause of hospital admissions, childbirth is a huge part of the nation’s $2.4-trillion annual healthcare expenditure, accounting in hospital charges alone for more than $79 billion.
Pregnancy is the most expensive condition for both private insurers and Medicaid, according to a 2008 report by the Childbirth Connection, a New York think tank.
The financial toll of maternity care on private [insurers]/employers and Medicaid/taxpayers is especially large. Maternity care thus plays a considerable role in escalating healthcare costs, which increasingly threaten the financial stability of families, employers, and federal and state budgets.
No wonder the American Medical Association isn’t too keen on changing care.
They should be, though. The U.S. isn’t the picture of health in many cases, and with childbirth, we’re lacking. According to the Time article:
About 99% of all births in the U.S. take place in hospitals, yet we rank 29th in the world in infant mortality — below Hungary and tied with Slovakia and Poland — with 6.71 deaths per 1,000 live births. That compares to a rate of about 3.5 deaths per 1,000 live births in Far Eastern and Scandinavian countries such as Singapore, Japan, Norway and Sweden.
Or how about this recent study, from the Netherlands? It showed that for low-risk women, giving birth at home or in the hospital gave an even rate of infant mortality. Not too shabby.
So what can we possibly do for these women and their families?
- Treat low-risk women as just that. If a woman (such as myself) is young, healthy, and has no previous labor complications, she should be considered low-risk and empowered to labor in a peaceful setting without continual monitoring.
- Pregnancy Education. I was lucky to have an awesome birth class for my first son, where the instructor not only gave women the low-down on what to expect during labor, she also walked us through the possible interventions and the side-effects of jumping on the drug bandwagon. This kind of education should be a part of every family’s pregnancy experience.
- Pain Management. Give women reasonable alternatives to drugs to remedy the labor pains (when appropriate), such as massage, birthing pools, walks, and different positions. Those who have used epidurals for their labors may believe I’m crazy (I’ve heard as much), but contractions are the most intense pain you’ll ever forget…and quickly at that!
- Bridge the Gap. I’m not entirely against doctor care, folks. I know there are many, many PhDs who believe that women can give birth naturally. As a community, midwives should work to show the public all the awesome outcomes of natural birthing. And they are. Now the AMA needs to listen!
- Normalize Home Births. Many American women are low-risk, but the laws vary from state to state as to midwife care at home. I’m not asking for a federal law regarding home births, but I believe that if it were not regarded as an “out there” practice, we would be able to birth many babies in the peaceful environs of their own home.
- Legacy. This is a big one to me. I was always told that “Pregnancy and childbirth are not medical problems.” Most women and their partners have been given a legacy of fear regarding birth. But anyone who has given birth naturally will tell you that it was a wonderful, empowering experience. After both of my sons’ births, I could have run marathons, if it weren’t for that pesky bleeding and the obligation to—you know—nurture and breastfeed the chil’ens. So Stop. Telling. Pregnant. Women. Your. Horrific. Birth. Stories. Period. They are not a receptacle for your baggage!
This summer, Cheyney and a colleague will draft new guidelines to help midwives and doctors work together better. She hopes it will be “a model for collaborative care that will be the first of its kind in the United States.” That’s a great first step.
The next step? Bringing down those high costs and the predilection to reach for the epidural at the first sign of pain.
As a gender, we’ve been doing this birthing thing for a looong time. I’d say we should probably work on getting it right.
Image: davhor on Flickr under a Creative Commons License.