Our broken birthing system
Allison Yarrow
Childbirth in the United States is broken. This is not merely an opinion, and the data keep adding up.
The U.S. maternal mortality rate, already the highest in the developed world, has more than doubled in two decades, according to the Journal of the American Medical Association. A recent Centers for Disease Control and Prevention report found that 1 in 5 women experienced mistreatment in their maternity care. Columbia University spent two decades protecting a predator who abused more than 245 people in his obstetrics practice. Up to 45% of people describe their birth experience as “traumatic.” In a country with 4 million births each year, that’s 1.8 million people traumatized while bringing life into the world.
ABORTION RIGHTS WON DURING TUESDAY’S ELECTIONS IN GLIMMER OF HOPE FOR BIDEN 2024
The “why” of this starts with the where. More than 98% of births occur in hospitals, where those giving birth are typically the only people seeking immediate care who aren’t sick or injured but are there for assistance with a natural bodily process. Yet they are treated like “patients,” with a condition to manage. And the managed care of birth often produces terrible outcomes.
Say you’re in labor or near your due date. When you arrive at hospital triage, a nurse will administer a pelvic exam to determine the extent to which your cervix is dilated. There is no agreed-upon standard of dilation, and there is no clinical evidence that dilation alone predicts when a baby will be born. But this is how hospital birth begins, with a stranger inserting their fingers into the vagina because of standard hospital procedure, not evidence-based medicine.
If you are “sufficiently dilated” and admitted to the hospital, you will most likely be administered a synthetic oxytocin called Pitocin to create or speed up contractions. Pitocin contractions are more painful than natural uterine contractions, and they typically compel a woman to receive an epidural steroid injection to tolerate the pain. Numbed from the waist down, you are strapped to an electronic fetal monitor to be surveilled remotely. Fetal monitoring is employed in most births “despite continually mounting evidence,” according to a 2017 paper, “which proves the procedure is nothing more than myth, illusion, and junk science that subjects mothers and babies alike to increased risks of morbidity and mortality.”
Next, you will probably spend hours withstanding additional and even more invasive pelvic exams before hospital staff permits you to push, which you will struggle to do because you are anesthetized. You’ll be coerced or forced into the lithotomy position, on your back, which helps doctors to see between her legs but also closes the pelvic outlet and causes perineal tears. If providers feel that you are pushing too long, they may decide, with or without your consent, to cut an episiotomy, a grisly 19th century procedure opposed by the American College of Nurse-Midwives but still very much in use. Hospitals don’t publicize their episiotomy rates, and rates vary, but the Leapfrog Group, a nonprofit healthcare watchdog, estimated that at some hospitals, the procedure is used over 40% of the time.
When these interventions fail, or if it’s nearing dinner time or their shift’s end, doctors may decide to operate. Cesarean sections are the most prevalent major surgery in the U.S., performed in roughly a third of all births, more than a million times per year. Major surgery entails major risks. With C-sections, these include hemorrhage, sepsis, and hypertensive disorders such as preeclampsia — leading causes of maternal mortality. C-sections are needed for serious conditions, such as when the placenta blocks the baby’s exit, and luckily this technology exists for such rare occurrences. But the bulk of C-sections are performed for two reasons: “failure to progress,” a nebulous term that means labor has stalled or hospital staffers are impatient, and the meaningless readings of electronic fetal monitors. In other words, surgery is ordered not to mitigate actual risk but when hospitals determine that labor is taking too long.
Why are hospitals so focused on controlled, quick births? Because labor and delivery wards are profit centers. “We make crazy money off of C-section, infection, and complicated birth,” said Kavita Patel, a former executive in one of the country’s largest hospital systems. “Even though patients and pregnant people would benefit, improvements for women lose money. …. Maternity is the best moneymaker.” It’s not only that technology and surgery are expensive but also that hospitals can earn additional fees due to the possibility of surgical birth. Even vaginal delivery can be billed at a premium because labor and delivery rooms convert into operating rooms, which Patel explained come with “a pre-negotiated facility fee.” A profit motive underpinning a process in the body, the birth of a baby, a forever event women never forget, is nonsensical and cruel.
The obstetrician Robert Bradley famously observed that birthing bodies require six things: darkness, controlled breathing, closed eyes, quiet, physical comfort, and relative solitude. Without these requirements, birth stalls or halts. Hospitals are designed to deny them all.
Cue “failure to progress” — after which needless risk is piled onto healthy people with normal pregnancies to keep the assembly line chugging, making the method by which new life is welcomed into the world perversely inhumane.
And then? Between 24 and 48 hours after delivery, most postpartum women and their newborns are sent home.
Infants will see a pediatrician within days. Most women won’t see a healthcare provider again for six weeks, the next visit insurance or Medicaid covers, far too late to identify and treat serious conditions. Some 95% of people have an unidentified risk or need after childbirth. More than half of maternal deaths, 52%, occur then, too, when pregnant people go from being painstakingly surveilled to totally ignored, practically overnight. As the obstetrician Alison Stuebe has said, “America treats new moms like candy wrappers: Once the candy is out of the wrapper, the wrapper is thrown away.”
Hospitals can be places filled with heroes, courage, and miracles. They excel at delivering lifesaving modern medicine. But most pregnancies aren’t medical crises. They’re physiological events that require little, if any, intervention — only the support from caring and knowledgeable providers, ideally midwives, according to studies.
If hospitals want to continue to be places where women go to labor and deliver their babies, they should adopt the midwives model of care, which considers the birther the expert in her body and supports her through the entire childbearing cycle. The midwifery model could improve care quality or “respectful care,” as the CDC calls it, which could help reduce maternal mortality, according to Debra Houry, CDC chief medical officer.
CLICK HERE TO READ MORE FROM THE WASHINGTON EXAMINER
The midwives model can occur anywhere, but it’s most often practiced during planned birth at home. One study found that the vast majority, 88%, of home births are uneventful. Around 12% of home births voluntarily transfer to hospitals, with just 3% of those requiring “urgent” care. A 2020 meta-analysis of 500,000 intended home births found that birthers were less likely to experience interventions, including C-sections, episiotomies, third- and fourth-degree perineal tears, maternal infection, postpartum hemorrhage, and “untoward birth outcomes.” And people who have given birth in both home and hospital settings overwhelmingly preferred doing it at home. Including me.
No matter where birth occurs, those doing it deserve to be centered in their own care, not coerced or forced into risky, unnecessary interventions, not mistreated and abused. Childbirth shouldn’t be an exercise in survival. It should be an experience based in respect, power, and transcendence for those doing humanity’s most awe-inspiring work.
Allison Yarrow is the author of Birth Control and 90s Bitch.