What Women Aren't Told about Childbirth

I just read this article online, and I hope you will read it, too. Many of you may find the information shocking; I've heard it all before and I'm still shocked when I hear about the things that go on in hospitals surrounding childbirth. Anyway, I recommend that all women - even if you won't be bearing any more children and especially if you will - become more informed about childbirth in this country. The more we know, the better choices we can make (and the more informed we can help others to be). [Everything in italics is my emphasis.]

Here are some highlights from the article:

The survey Listening to Mothers II (LM 2) was released in 2006 and reports on U.S. women's childbearing experiences.... "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.

Informed consent is one of the very basic principles of health care ethics. (A side note on episiotomies: while tearing may occur during birth, natural tears are likely to be smaller and heal faster than a cut in the perineum made by a doctor/nurse. Except in rare situations, there is no evidence that having an episiotomy is helpful in any way. See here for more info.)

A large percentage of women -- 76 percent of all women in the LM 2 survey -- wind up getting an epidural for pain during labor. Many doctors consider epidurals to be the standard of care for treating the pain of labor.

Despite the fact that half of the interviewed women felt that birth should not be interfered with unless medically necessary, the vast majority received medical interventions. Many women reported experiencing pressure to have their labors induced, to accept an epidural and even to have a cesarean. A full 73 percent who had an episiotomy were not given a choice in this decision.

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. The United States is also one of the only wealthy countries where the maternal death rate is climbing.... 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.

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.... Indeed, their professional association, the American College of Obstetricians and Gynecologists (ACOG), last year went so far as to issue a wholesale condemnation of out-of-hospital birth.

(For being trained as medical doctors, it's scary what Ob/Gyns DON'T understand or know how to do, according to the reading I've done.)

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. Many women never question these interventions, though they frequently are linked to babies being born by cesarean section. "In an unmedicated labor," Doyle says, "the body releases its own oxytocin, which stimulates contractions. The brain responds to the pain of these contractions by releasing endorphins. When synthesized oxytocin [aka Pitocin] is administered through an IV, contractions can come on quite suddenly, and these contractions are often longer, more intense and more consistent than the body's natural endorphins can keep up with."

And really scary:

The Food and Drug Administration (FDA) has never approved Pitocin for the use of augmenting labor...

For most women, the fact that hospitals have virtually cornered the market on childbirth and maternity care means that birth itself can assume the form of a medical problem rather than a normal human process. And, since most mothers are giving birth in a hospital room surrounded by highly trained doctors and sophisticated medical instruments, a low-risk, unmedicated labor can rapidly convert into a complex surgical case.

With all the pro-choice rhetoric in this country, it seems obvious to me that women should be given more information so that they are able to make the right choice, especially when it comes to giving birth!