Birth Plans

So after all the doctor visits, the lab tests, ultrasounds and hospital tours I’ve decided to switch healthcare providers and hospitals, and go with a midwife at the birthing center of St.Luke’s- Roosevelt rather than a traditional Ob. No easy feat at 28 weeks along (I called everyone in town and begged). Reason being we’re hoping and planning to have a natural child birth and the more I’ve researched birthing practices in this country the more appalled I became at the state of maternity care pre and post partum and how challenging it might be to actually have the child birth experience we’re hoping for without the right environment. It's not guaranteed that we'll get into the birth center as they are very restrictive on the patients they admit (you have to be very low risk) for fear of being shut down if they have bad outcomes. Any sign of a stalled labor and your shipped to the regular L&D floor in the hospital. But the move was instigated by the very high rate of unnecessary interventions in most hospitals, supposedly meant to improve outcomes for mother and child but often having the opposite effect. There is a stark comparison in the birth outcomes of the US to other industrialized countries such as Japan and western Europe where 70% of births are attended by midwives. The US infant mortality rate in childbirth is 5 in 1000 births, about the same as Latvia, Poland, Slovakia and Hungary. In Japan it’s only 1.8 per 1000 births. What is going on people?

Epidural rates are as high at 95% in some NYC hospitals. C sections rates in the city’s best hospitals between 30-50% (the World Health Organization recommends C-sections rates for industrialized nations should not exceed 15%, a safe range is determined as 10-15%. It is major surgery after all which although relatively safe is not without risks not to mention longer postpartum recovery times.) The c-section rate at Lenox Hill hospital where I was supposed to deliver was reported at 28% in 2005, although a doula I spoke to said a nurse there told her the unreported rate is closer to 50%, and pretty much everyone gets an epidural. Epidurals are knows to reduce fetal heart rates, increase the likelihood of needing a c-section, increase the likelihood of meconium, or even eliminating uterine contractions and stopping labor all together often requiring labor augmenting drugs such as pitocin to start it up again which in turn can cause overly long arduous contractions and fetal distress. Ummmm….. no thanks. It’s not to say that these drugs can’t be helpful, they can mean all the difference between a successful outcome (healthy mom and babe) and a not so successful one in the right situation. What needs to be questioned is the frequency of their use in otherwise normal labors.

An excellent documentary came out earlier this year on the subject titled the Business of Being Born that looks at the international comparison (we do have outrageously expensive health care in the US afterall – why are we pushing for more interventions instead of less?) but also the history of birthing practices in the US and all the unnecessary interventions that were later suspended as doctors realized they were doing more harm than good. Things like x-raying of women’s pelvises to determine if they were big enough to birth their babies until they realized the x-rays gave the babies cancer – no joke. Medications to deal with morning sickness that caused debilitating birth defects. Now there’s an ongoing debate on the effects of ultrasounds on babies (the norm is to have one at 12 weeks, 20 weeks and often at 32 weeks). It seems when it comes to pregnancy and childbirth women are the lab rats and doctors tend to do first and ask questions later. I can’t help but think that adequate prenatal care and birthing is a topic that’s been somehow left behind policy discussions on women’s rights. How much of the debate is being driven by insurance companies I wonder? The US after all has a lot to learn it seems from other countries with lower health care costs and better childbirth outcomes.