[wvns] US Hospitals Violate Birthing Women
Midwives Decry Fearful Trend in Birthing Practice
By Melinda Tuhus
WeNews correspondent
http://www.awakenedwoman.com/wenews_csection.htm
[NOTE: Epesiotomy is also a huge abuse of women in American hospitals
and is nearly a universal practise. Cutting the birth opening during
labor adds three weeks of pain while healing from the stitches after
childbirth where it hurts to sit, compared to a natural birth which,
while admittedly painful during the labor, results in a woman's being
able to sit comfortably within hours after delivery. In the US the
only way to avoid epesiotomy is to hire a midwife for a home birth.]
(WOMENSENEWS)--At 30 percent of all deliveries, the current national
Caesarean-section rate in the United States is twice the 15 percent
maximum rate recommended by the World Health Organization and three
times the preferred rate cited by many researchers.
All of which Dr. Bruce Flamm, an obstetrician with Kaiser Permanente
in Riverside, Calif., says is remarkable. But he isn't sure if it's
remarkably good or remarkably bad. Flamm says that notwithstanding the
WHO recommendation -- which followed the same official U.S. health
recommendations in the Healthy People 2000 initiative -- there isn't
enough data to say what the appropriate C-section rate should be.
"Some of my colleagues think it should be higher," Flamm says. "I have
heard some doctors say that all women should have babies by C-section,
that vaginal births are archaic. Some docs have a C-section rate of 50
percent because they believe in their hearts it's the best thing for
their patients." Flamm does not include himself in the group of
doctors who think vaginal births are archaic, but he does agree with
the October 2006 recommendation by the American College of
Obstetricians and Gynecologists -- to which he belongs -- issued
against out-of-hospital births.
Even though the chance of something going wrong is very small, Flamm
thinks it's safer to have all necessary equipment and personnel
immediately available in case of an unforeseen emergency, which can
happen even in low-risk pregnancies. The physician organization's
recommendation -- combined with the rising rate of C-sections -- is a
hot topic among midwives.
Nurse-Midwife Protest Letter
The American College of Nurse-Midwives sent a letter in late November
2006 to the physician's organization taking issue with the idea that
safety could only be provided in a hospital.
"The safety of birth in any setting is of utmost priority," the letter
read. "The implication that there is insufficient evidence to support
the safety of planned out-of-hospital birth is unsubstantiated . . .
Furthermore, we are not aware of evidence supporting the assertion
that the hospital is the safest setting for labor, birth and the
immediate post-partum period for low-risk women."
The letter went on to say that by discouraging support for
out-of-hospital birth providers the organization's position could harm
the culture of safety around birth, for patients and providers. It
appealed for collaboration to ensure women's safety.
Stacy Brooks, a spokeswoman for the physicians' organization, says the
decision to recommend only hospital births was not based on data
showing home births are dangerous, but just to minimize any possible
complication. The midwives' organization, on the other hand, lists
multiple studies on its Web site supporting the safety of home births.
One large study, published in June 2005 by the British Medical
Journal, concluded that the safety of "planned home birth for low-risk
women" in North America involving certified midwives "was associated
with lower rates of medical intervention but similar mortality to that
of similar hospital births." Many midwives also say that the growing
preference for hospital settings automatically leads to unnecessary
and often uncomfortable interventions. A prime example is the fetal
monitor, which Flamm says he thinks is used on virtually all women who
labor in hospitals.
Fetal Monitors Studied
Meredith Goff, a practicing midwife on the faculty of the Yale School
of Nursing, is writing a paper about the reliability of fetal monitors
versus the old-fashioned fetoscope. The former is an electronic
device, usually attached to the outside of a woman's belly and less
often attached through the vagina to the baby's head. The latter is a
hand-held instrument a medical provider moves over the women's belly
to periodically check the baby's heartbeat.
"There is absolutely no evidence to support continuous fetal
monitoring since it came about in the late 1960s," Goff says, "yet in
2002, it was used on 85 percent of women in labor in the U.S. It's the
most commonly performed obstetrical procedure. And every professional
organization agrees there is no evidence of its usefulness." In fact,
she says, the procedure has a very high false positive rate, meaning
that in most cases when the monitor indicates fetal distress, the baby
is fine. "So we're doing all these C-sections for no reason because we
can't divorce ourselves from this technology," Goff adds.
One of the trends that many midwives find particularly troubling is
the decline in vaginal births after Cesareans. They point to a June
2006 study by researchers at the University of Utah of more than
30,000 women. Published in Obstetrics and Gynecology, the study found
several serious complications, including hysterectomy and the need for
a major blood transfusion, increased significantly with each C-section.
Dr. Robert Silver, chief of high-risk obstetrics at the University of
Utah, is the primary author of the study. Only 9 percent of babies
born to a woman who has had a C-section are delivered vaginally now,
down from 30 percent a decade ago. "Vaginal deliveries after a
C-section are pretty safe, the risk is quite low," Silver says, "but I
think people have gotten scared off."
Downsides to Both Options
Silver says there are downsides to both options. Vaginal deliveries
can damage the pelvic floor, possibly leading to urinary and fecal
incontinence and pro-lapse (in which the pelvic organs descend,
causing discomfort). C-section births lead to more maternal morbidity,
increased recovery time, less bonding and more difficulty with
breastfeeding.
Paula Cate, a midwife who's delivered more than 4,000 babies in 28
years, says a factor in the rocketing rise of C-sections is the
economic incentives of highly skilled medical specialists favoring a
high-tech birth, like the rise in the participation of
anesthesiologists in even routine births. "There are now lots of
places where there are anesthesiologists on the labor and delivery
floor, but when I started in 1978 that wasn't true; you had to call
them to come," says Cate.
Midwife Deborah Cibelli argues that C-sections are being driven by a
fear of lawsuits. "It's a rare provider who gets sued for doing a
C-section," she says, "but if there's any outcome that's less than
perfect, you can get sued for not doing a C-section." With the cost of
malpractice insurance for both midwives and physicians skyrocketing,
many providers find it more prudent to do C-sections if there's any
hint -- however remote or even mistaken -- of complications.
Midwives say current popular culture does little to subdue the sense
of danger and complication surrounding childbirth. Cibelli, for
instance, says "The Baby Story," a program on the Learning Channel
that shows labor and birth experiences, recorded several of her
patients delivering their babies in the hospital, but none of them was
shown.
"The filmmakers told us that mine were just too normal. What really
sells is drama. They love the rushing down the hallway to save the
baby's life to do a C-section. Mine were quiet, with dimmed lights.
The people filming thought they were wonderful, but they knew they
were not going to sell because they were not sensational."
Melinda Tuhus writes about women's issues from New Haven, Connecticut.
Women's eNews welcomes your comments. E-mail us at
editors@womensenews.org .
For more information:
"Don't Blame Mothers for C-Section Vogue": -
http://womensenews.org/article.cfm/dyn/aid/2710/
American College of Obstetricians and Gynecologists: -
http://www.acog.org/
American College of Nurse Midwives: - http://www.acnm.org/ -
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