Chin Music Press - Adventures in Publishing - The war on midwives (part 4)

The war on midwives (part 4)

Life in Japan | Life in the US | Midwifery

What we know about pregnancy and childbirth today were largely shaped by the medicalization of birth, following the anti-midwife campaign. Pregnant women, the physicians insisted, were best served by the professional care of obstetricians because childbirth is fraught with risks and dangers that require intervention. Only a very small minority of women were able to give birth naturally and trouble-free, they said. Well, the public ate that up hook, line and sinker. By the late 1960s, midwife-assisted births dropped to an all-time low of under 1%.

When I was born at a Manila hospital in 1965, my mother was so drugged out she could barely recall what had happened. Years later she told me that the only thing she remembered before the painkillers kicked in was how much she had wanted to squat. Her instincts were correct; squatting, which yields to gravity, is one of the most natural birthing positions. But she was overruled in what must have been a common situation back then. You could say ours was a generation practically born to drugged-out mothers in hospitals across the country. I was extracted with forceps; perhaps you were too.

For years, that was how I pictured my own childbirth � at a hospital with drugs. How else was I supposed to give birth? Towards the end of the birth class I attended with my husband, the childbirth educator Elena de Karplus told us that if we should have to literally run into a birth center with the baby's head emerging between our legs or if we ended up giving birth in the car on the way to the hospital, then we should consider ourselves very lucky. "That should be your goal," she said triumphantly. We all thought she was crazy.

It turned out that she was right. And the good news is, the midwifery model of care has been making a small but steady comeback since the 1970s thanks to the hard work of a few dedicated midwives, supportive obstetricians and innovative natural-birth techniques imported from Europe, notably Lamaze. Hospital births still account for 99% of all US births, but today 10% are assisted by midwives. Homebirths account for about 1% of midwife-assisted births.

Also, the rate of episiotomies has been dropping, more babies are being breastfed for longer periods, and the medical establishment is beginning to acknowledge the benefits of midwife-assisted births. These small but significant accomplishments are still dwarfed by the enormous amount of work that requires immediate attention.

The US has the world's highest C-section rate, with nearly one out of four women undergoing the major abdominal surgery. The World Health Organization has indicated that C-section rates should not exceed 15%; anything beyond that was dangerous. Women who have undergone C-sections face greater risk of infection or surgical complications. The US also ranks among the highest in infant mortality in the industrialized world. The top three countries with the lowest mortality rates are Japan, Sweden and Iceland.

The culprit for this situation is no longer only the obstetrician. The medical liability crisis has created an environment that forces obstetricians to practice defensively. That means treating normal, healthy pregnancies like high-risk cases. And if anything goes wrong, the distraught parents fault the physicians. But can anyone really blame the desperate parents for doing so? A woman who has agreed to the medical model of care has in essence deferred most decisions surrounding her childbirth to the obstetrician, so in her mind, she has nobody else to blame but the doctor.

Also, one intervention leads to another. It usually begins with the use of pitocin to induce or strengthen labor contractions. Pitocin-induced contractions are often stronger and faster, thereby harder to deal with. Many women request an epidural analgesia shortly after the pitocin takes effect to help cope with the seemingly endless and fierce contractions. At this point, the fetus is under continuous electronic fetal monitoring because pitocin-use is often associated with fetal stress. Studies have linked the use of electronic fetal monitoring to a higher incidence of C-sections.

That's just a rough sketch. I know a few mothers who have experienced the medical model of childbirth and have had smooth births. I also know many mothers who have had homebirths or midwife-assisted births without a hitch. The goal should always be a safe delivery for mother and child. To get there, we must know all our options and their potential consequences.

But, for most of us born in a hospital and raised with great faith in Western medicine, trusting in our own bodies during childbirth is a giant leap of faith. That's where the Setsuko Yamadas and Debra O'Conners of the world play a significant role. They encourage us to educate ourselves about our choices, listen to our own bodies and succumb to their amazing power to do the right thing. If we stop making informed decisions concerning our own body, pretty soon we won't know how to. Worse yet, we could end up losing that right.

That's why it's a relief to know that the little birth center in Setagaya has something to celebrate.

Yuko >> February 23, 2005

Comments

I don't see the name of the author of this article but apparently she was my client at childbirth education classes. It is always gratifying to see that after all thse years, something that I said struck a chord with someone and perhaps made a difference in the way she views her body and her birthing experience. I would really appreciate to know the name of the author of this article which I am sure will make a big difference in somebody's life as well.
With love,
Elena

Elena de Karplus at March 27, 2005 04:48 AM

elena, it is great to reconnect with you, although you may not remember me. who'd have thought a couple of sessions with you would forever change the way i perceive the world. i've also sent you a personal email and hope to hear from you.

yuko at March 27, 2005 09:23 PM