Saturday, July 12, 2008


Birth is important to me. It's been a part of my life as long as I can remember, with my mom teaching childbirth education classes, working as a nurse in obstetrician's offices and offering labor support (ie being a doula) to birthing mothers. Family friends include midwives and OBs and the result of all of this is that birth has never been far from my consciousness.

I'm no expert on birth, but I know more than a lot folks out there since I've been around it (and listened carefully) for so long. I decided that I would give birth to my children at home with a midwife, and I did.

A few weeks ago the American Medical Association released a "Resolution on Home Deliveries", in which they affirmed their commitment to "develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers."

Umm, not quite. Studies on homebirth show that for healthy moms with normal healthy pregnancies homebirth is every bit as safe as hospital birth. Gee, if I didn't know better I'd think the AMA was trying to restrict my individual rights and possibly jeopardize the my health and the health of my babies for their own profit! Oh wait, I do know better. Bunch o' asshats.

Jennifer Block wrote a great Op-ed piece for the LA Times on this very issue 3 days ago. If you or someone you know is thinking about ever having (more) children, I highly suggest that you read it. I'm not telling you to have your kids at home- that wouldn't be any different than telling me I had to have my kids in the hospital. But if you don't think birth is a business (and a big one), you're wrong. Most of us know better than to walk into a car mechanic or auto dealership and say, "Hi, I know absolutely nothing about cars and I don't intend to learn. Please sell me/fix whatever you like! I won't second guess you or get second opinion or even complain if I get a total lemon/you don't actually fix anything because YOU are the car dealer/mechanic and I'm sure you know what's best", yet many of us do something that looks an awful lot like that when it comes to birth. An educated consumer is a consumer who gets screwed over less often, and your health is rather more important than your car, right? Last year the Center for Disease Control and Prevention announced that the high rate of C-Sections in the US (approximately 1/3 of all births) has contributed to the rising maternal death rate. That's right folks- the maternal death rate in the US is rising. Nice work modern medicine! It wasn't bad enough that the US has the second highest infant death rate in the industrialized world (only Latvia ranks below us), now our maternal death rate (which already lagged behind most industrialized nations) is getting worse, and overuse of C-sections bear the blame for some of those rising numbers. According to medical studies, C-Sections should account for no more than 15% of a hospitals births. Anything over 15% indicates an overuse, which comes with increased risk of maternal and infant death.

There are of course many factors in the overuse of C-Sections in the US, but my personal pet peeve lies in induced labor. At this time a majority of babies born in the US have their labors induced for one reason or another, ranging from being "overdue" (40 weeks gestation is a midpoint, not an expiration date folks!) to "too big" (anecdotal evidence only here, but in my mom's 17 years in the field she never saw a baby that was too big to fit through its mother's birth canal/pelvis) to having too little amniotic fluid (this can usually be remedied by mom drinking more water since it is often associated with dehydration). As with C/S there are legitimate reasons to induce labor, but as with C/S induction is often misused. And when you try to induce labor on a baby who isn't ready (and it is the baby who starts the labor process)? Yep. Nothing happens. Or not much happens. Or it happns "too slowly", or the baby, unhappy with the forced contractions, goes into distress. And then? Welcome to major abdominal surgery and it's accompanying risks and recovery.

So to sum up: I want to continue to make my own health care choices, and (home or hospital!) I hope you do, too. Educated consumers, man. Educated consumers.


skyeball said...

Amen, sister!

Skye said...

I loved my hospital birth and my ob/gyn (who is appalled by elective c-sections), but I absolutely agree with you that women need to educate themselves so they can make the decision that's best for them.

I would also add that any responsible physician will encourage women to do so. If they don't, or they won't answer your questions, vote with your feet and your dollars and get the hell away from there.

Skye said...

OK, I didn't mean to say that I loved giving birth. I meant that I loved the fact that I was in a hospital.

Mary said...

On a more frivolous note, I just started working in a hospital in Atlanta. I get to walk by the Labor and Delivery unit every day if I want, and look at the brand new babies! And, whenever a baby is born they play "lullaby" throughout the hospital, (a nice non-invasive volume). So, i love people who have babies at the hospital because I get my baby fill!

Mary said...

But, i will say, I am all for our rights as people, and as women. First hand, dealing with the accreditation committees (Joint Commission, aka JCAHO, said "J-Coe"), the hospitals are terrified of having their accreditation taken away, and that is what typically guides their protocols and methods. I have worked there for a week and heard "JCAHO will be checking that, so make sure you do it correctly" at least 5 times already.

Rachel Main said...

Argh. Yet another part of my life that someone wants to regulate. Every bit of me - including my ovaries, my uterus, my mind, and my boobs are libertarian, man. I wish associations, accrediting bodies, task forces, and government committees would back the hell off and allow us some time and space to think.
Who's in charge of insisting that everyone think critically and ask questions?
Isn't that the most important safety protocol?

the main stitch upholstery said...

i have no opinion on where anyone should have a baby. all i know is that i was in labor with all 3 early and had to have the damn shots to keep them in me, then when we get the big ok and i am dying of contractions, they had to break my water with all 3 then insant baby. as long as there are long sticks to break water bags, i think it is all good no matter where you have it.

me said...

You are awesome. Naturally, I agree with all you have expressed here.
I am pleased that growing up you learned about birth. I think all children should.