If you are thinking of getting pregnant, trying to get pregnant, or already pregnant, buy or borrow two excellent new books--Pushed by Jennifer Block and Born in the USA by Mardsen Wagner. Read them before your next OB appointment; they might substantially reduce your likelihood of having a C-section. As a long-time childbirth activist, I am appalled that so many American women face returning to work six weeks after major surgery.
Marsen Wagner is formerly the director of Women’s and Children’s Health at the World Health Organization (WHO). A whistleblower, he offers a scathing attack on obstetrical standards of care, suggesting they are abusive at worst, and based on nonscience that mainly serves doctors’ interests at best. Jennifer Block was an editor at Ms. magazine and a writer and editor of Our Bodies, Ourselves. Her book, extremely readable, covers much of the same ground Wagner’s does. Read the excellent, lengthy review in the Women's Review of Books:
Here are two central facts about American birth: first, the US spends more per capita than any other developed nation on maternity care. Second, the World Health Organization ranks the US thirtieth out of 33 developed countries in preventing maternal mortality, and 32nd in preventing neonatal mortality. Our country is not doing well by mothers and babies.
Both these books describe, in splendid detail, the myriad interventions of “active management”—the practices perpetrated upon even a healthy woman planning the most unremarkable of births. Although these practices may help in critical situations, they are more likely to cause harm than good in a normal birth. For example, active management includes the induction of labor in as many as forty percent of all American births, even though this leads to longer and more painful labors and “ups a woman’s chance of a [cesarean] section by two to three times,” according to Block. ...Active management also includes speeding up a woman’s labor with the use of Pitocin in perhaps a majority of American hospital births today. According to Block, “a recent American College of Obstetricians and Gynecologists (ACOG )survey found that in 43 percent of malpractice suits involving neurologically impaired babies, Pitocin was to blame.” And it includes routine electronic fetal monitoring, used in 93 percent of hospital births even though studies show that its only effect is to increase the c-section rate.The quintessential intervention is the cesarean section, which is how nearly thirty percent of American women delivered their babies last year. WHO says that when a population has a c-section rate of higher than fifteen percent, the risks to the mother and baby outweigh the benefits—and a WHO study found that “the main cause of maternal deaths in industrialized countries is complications from anesthesia and cesarean section,” Block reports. She cites another study published last year, of 100,000 births, which found that “the rate of ‘severe maternal morbidity and mortality’—infection requiring rehospitalization, hemorrhage, blood transfusion, hysterectomy, admission to intensive care, and death—rose in proportion to the rate of cesarean section.” As for the baby, other research has found that “preterm birth and infant death rose significantly when cesarean rates exceeded between 10 and 20 percent,” and that “low-risk babies born by cesarean were nearly three times more likely to die within the first month of life than those born vaginally.” Nonetheless, ACOG not only rejects the fifteen percent target, but even continues to support the idea of elective c-section.
What are your alternatives to an interventionist and/or C section birth?
As evidence is increasingly showing, the people who best enable normal births are midwives. Obstetricians, after all, are surgeons, and many never witness a natural, normal birth in their training. Midwives, in contrast, are women who know that one of the best answers to pain is sitting in a warm tub, who know how to manually palpate a woman’s belly to find the baby’s weight and position, and who know how to help a woman handle labor in ways that facilitate birth.But midwifery in the US is up against some powerful forces—mainly, again, obstetricians and American College of Obstetrics and Gynecology. Doctors throughout American history have worked to discredit midwives—labeling them dirty, uneducated, and unskilled—and to drive them out of business. Today certified nurse-midwives who practice in hospitals report having their hands tied by doctors and hospital protocol.
Is it possible for change to come from women themselves?
Block ends with a challenge to today’s organized feminists to bring birthing under the umbrella of “choice,” quoting childbirth educator Erica Lyon, who says, “I think this is the last leap for the feminist movement. This is the last issue for women in terms of actual ownership of our bodies. It will take a revolution."
These books deal only peripherally with one of the most problematic issues: what do you do when women freely choose, or think they freely choose, medical procedures that increase their risk and that of their children? If women believe their obstetricians are their best advocates, how do you convince them to think skeptically? Until women take birth into their own hands, until they realize that doctors are not necessarily women’s advocates, until they seek out the evidence, which is in these books but not in doctor’s offices, about the normalcy of birth and the dangers of interventions, they are going to continue to believe that birth is a crisis about which only one person – the obstetrician – knows best.
We fought this battle in the 1970s and early 1980s and thought we were winning. I had four children between 1973 to 1982; two were hospital births, two were home births. I employed one obstetrician, one family practioner, and two nurse-midwives. I was given pitocin against my will for my only OB-assisted birth; I received no other medications.