I can name thirteen friends, myself included, who have been pregnant over the past two years. Out of them I can count on a single hand those who have gone to a midwife for care. Actually I can count then with two fingers. One, myself, went to an out-of-hospital birth center and number two went to an in-hospital midwife.
Seven of the thirteen friends were induced.
Six were first time moms whose labors ended with cesareans.
Two labored without drugs. (This includes myself but I will disclose that my daughter was born surgically requiring me to get an epidural for the procedure)
A single mother completed the entire birth process without drugs.
What these numbers are telling me are that more then half of these women can not labor and birth without medical intervention.
Does that seem correct?
The World Health Organization (WHO) tells us that once the cesarean limit exceeds 10-15% the risks of the procedure outweighing its benefits . Our national average is at 31.8%. Colorado’s cesarean rate is 25.9% (click here for a list of ceserean rates by state)
So why is our rate so high? According to Childbirth Connection there are 7 reasons:
-Low priority of enhancing women's own abilities to give birth
-Side effects of common labor interventions
-Refusal to offer the informed choice of vaginal birth
-Casual attitudes about surgery and cesarean sections in particular
-Limited awareness of harms that are more likely with cesarean section
-Providers' fears of malpractice claims and lawsuits
-Incentives to practice in a manner that is efficient for providers. (emphasis mine)
All of these reasons coincide with OB /GYN care and are contrary to the midwife model of care. But I will get to this later..
Now I am digressing…
The point is not that the cesarean rate is rising to epidemic proportion; rather I am posing a question:
Why are women in our country choosing to use OBs over midwives?
I understand that it is engrained in our culture that you go to a hospital for birth and to OB /GYN for pre-natal care but I want to change that. My hope is that as midwifery becomes more mainstream people will conduct their own research and make an informed decision. I know too many people who go to a provider just because it is easy to go to someone who is in-network or close. Are these good reasons to choose the person overseeing one of the most emotional and important events in your life? Is the fact that something is easy a good reason to choose anything in life? Now, I am not saying that people who go to OB /GYNs are uneducated or making the wrong choice, but I do believe that sometimes people go to an OB /GYN because they are under-informed or misinformed. I often think that people forget that care providers are providing a service and that you can shop around until you find the one that best suites you. Sometime this will be a midwife other times it will be an OB. You wouldn’t just buy the first pair of jeans you tried on in a store would you? So why choose the first care provider you run into?
Fear also dictates choice. Couples choose OB /GYNs for the ‘just in case’ or ‘what if’ factor believing that a hospital is the safest place to birth. My response to this is look at the research. Women who planned homebirths overseen by midwifes experienced “significantly lower risk of obstetric interventions and adverse outcomes, including augmentation of labour, electronic fetal monitoring, epidural analgesia, assisted vaginal delivery, cesarean section, hemorrhage, and infection” when compared to a group of women who had in-hospital physician attended births according to a study in the Canadian Medical Association Journal.
Additionally women who birthed in out-of-hospital birth centers were half as likely to have a cesarean section and had a similar rate of death among babies after 20 weeks of pregnancy or in the first four weeks after birth. This information is from the website Childbirth Connection. Here is a link to a great article that compare physician attended births, in-hospital birth center births, out-of-hospital birth center births , and homebirths against each other.
In reality though the majority of the people I spoke with did not even consider a midwife because they didn’t know they had an option.
We do have options and our choices do influence. This is the great aspect of such a varied maternity care system- there truly is a care provider for every type of woman. For those who have a fear of hospitals and prefer a home like setting you can hire a certified home-birth midwife. For the person who wants the safety of a hospital relationship but wants to avoid the interventions that are common placed in hospitals there are free standing birth centers run by nurse midwives. For in hospital birth women have the options of hospital based nurse midwives who work under the OB /GYNs, Family Practitioners as well as an OB /GYN.
No comments:
Post a Comment