What Women Aren't Told About Childbirth

Home Births, 1978 and 1982

Learning to grandmother and to mentor my daughters' friends and my nieces has involved learning to hold my tongue about childbirth. I don't want to impose my experiences on theirs. I am not sure about the wisdom of my discretion as more and more young women, including my daughter, give birth by C-section. I practiced natural childbirth for all four daughters; I had the younger two girls at home. I was very fortunate to have medically uncomplicated births. I spent enormous amounts of time and energy researching my options and finding providers who shared my beliefs. Anne was delivered by an obstetrician; Michelle and Rose by nurse-midwives; Carolyn by a family practitioner. I also taught childbirth education and always discussed birth options as a La Leche Leader. I am puzzled why the most highly educated and professionally successful generation of women in history are not more skeptical about conventional obstetrical wisdom. We would never have to worry about world overpopulation if 30% of women required surgical births.

I urge you to read this excellent article--What Women Aren't Told About Childbirth. It is based on the survey, Listening to Mothers II (LM 2), released in 2006, which reports on U.S. women's childbearing experiences. Conducted for Childbirth Connection by Harris Interactive in partnership with Lamaze International and Boston University School of Public Health, the survey is representative of U.S. mothers 18 to 45 who gave birth to a single infant in a hospital, with 1,573 actual participants.

"The predominant picture that emerges from our data," the report states, "is of large segments of this population experiencing clearly inappropriate care." The majority of women ended up attached to IVs, catheters and fetal monitors. They had their membranes artificially ruptured and were given epidurals. Most of these women had little understanding of the side effects of these interventions, including cesarean and medical inductions. The report also shows that though women understood that they had the right to refuse medical interventions, few did, and many received interventions, such as episiotomies, without their consent. Among the more striking points are these:

• The United States is also one of the only wealthy countries where the maternal death rate is climbing. In 2004, the most recent year for which information was available, the maternal death rate in the United States jumped to 13 deaths per 100,000, according to the National Center for Health Statistics. This marks a significant increase from just four years earlier when it was 11 deaths per 100,000 births. Among developed countries, the World Health Organization reports, 29 have better infant mortality rates than the United States, including Slovenia and Cuba, and 41 have better maternal mortality rates.
• Childbirth educators often talk about the "cascade" of medical interventions: the likelihood that once you receive one intervention, like Pitocin, you are more likely to receive another intervention, like an epidural. The Food and Drug Administration (FDA) has never approved Pitocin for the use of augmenting labor and it has been suggested now that mismanagement of Pitocin is the leading cause of liability suits and damage awards.
• The World Health Organization recommends that the rate of cesarean births for any country not exceed 10 percent to 15 percent. The Centers for Disease Control and Prevention puts the U.S. rate at over twice that: 30.2 percent, and the LM 2 survey suggests this number is on the rise.
• Obstetricians are surgeons with an expertise in female reproductive pathology. They often provide routine gynecological care, but when it comes to childbirth, their training has primarily prepared them to actively manage a high-risk birth or to intervene medically and surgically when something goes wrong during a birth. Though they may have attended hundreds or even thousands of births, few obstetricians have much experience with unmedicated births. Even fewer have attended out-of-hospital births.
• Continuous electronic fetal heart monitoring is another seemingly innocuous medical intervention that is linked to adverse outcomes. Even though it requires women to be strapped to a machine and therefore limits their mobility -- movement in labor is listed as one of the recommended comfort measures by Lamaze International -- it may seem that constant feedback on a baby's heart rate would reduce unnecessary interventions and surgical procedures. Yet, some studies have shown CEFM to be an ineffective indicator of fetal distress and one of the causes of the increase in cesareans.
• Women without insurance are less likely to end up with cesareans, as are women with Medicaid, according to the HCUP study. Women with private insurance, the study says, have the highest cesarean rate.
• Most health insurance does not cover midwife-assisted home births or births in a birthing center, thereby forcing women into hospitals when they might prefer other options. Indeed, the American College of Obstetricians and Gynecologists (ACOG), last year went so far as to issue a wholesale condemnation of out-of-hospital birth. They cited a lack of evidence to support the safety of birth outside hospitals, despite its undisputed record of safety in many other countries.