Censored 2012 (75 page)

Sadly, US maternity care has come to prioritize ways of profiting from birth over concerns such as doing the best job possible of creating and maintaining a maternity care system that is woman-centered and produces good outcomes. Many Americans tend to forget that for-profit insurance companies are not in business to see that good health care is given. It is worth remembering that it was only when health insurance companies began to deny malpractice coverage to hospitals that allowed doctors to assist vaginal breech deliveries that obstetricians started applying C-sections to virtually all breech births, and medical schools stopped teaching breech delivery.

And the widespread practice of defensive medicine has become so serious that some physicians are beginning to write about their concerns of misplaced priorities in professional journals, a rather startling—and welcome—development. Dr. Annette E. Fineberg, for example, broke from the usual herd mentality in her poignantly titled article “An Obstetrician’s Lament,” published by
Obstetrics & Gynecology
(a highly influential trendsetter in US obstetrics, as well as in many other countries), in which she stated that choosing hospital birth usually means an obligatory cesarean section for women with breech babies, twins, or previous cesarean section, even in hospitals with good safety records for all of the above situations. She wrote, “Many obstetricians do not have the willingness, time, or skills to provide maternal choices.… Our contracting skill set as obstetric providers, as well as the prevailing risk-averse culture among physicians and hospitals, have given support to home birth.”
²⁴

Another editorial in the same issue of
Obstetrics & Gynecology
was just as newsworthy for the departure it represented from standard obstetric opinion over the last century. Its author, Dr. David Hayes, cited the unsatisfactory outcomes of US obstetrics in its present
condition and added this ringing declaration:

Self-respecting journalists and editors who are employed in the mainstream media should take a cue from Drs. Fineberg and Hayes, because these two obstetricians are pointing out how so many of their colleagues are limiting real choices for US women. It’s time for journalists to break out of the code of censorship that has so greatly added to the fear and confusion that characterize the way that most Americans view birth and maternity care. If the media stop their robotlike incantations of the scariness of birth and do enough homework to examine credible evidence, it’s possible that US women will someday have a chance to learn that their bodies are as well designed for birth as those of aardvarks, mice, moose, and elephants.

It is worth noting that at the present time, the only kind of birth footage allowed to air without digital “draping” at the moment of birth is the heavily edited cesarean section. When birth first began to be shown on US television during the nineties, decisions were made in
broadcasters’ boardrooms that it would be acceptable for people to see an incision made into a woman’s abdomen and uterus, and a baby’s head pushed through that incision, but not to clearly see a baby emerge from a woman’s capable body, from her vagina. This kind of censorship in the service of “modesty” has the effect of teaching the public that the cesarean section is safer and more socially acceptable for mother and baby than a vaginal birth. It also reinforces the notion that the woman’s body is something she should be ashamed of. While watching these cesarean “reality” shows, women are never shown how they would feel just after the epidural wears off, or what it would be like for them to be urged to get out of bed as soon as they are able to move (as is necessary to prevent a blood clot).

It has become clear that instead of creating safer births and healthier moms and babies, our overuse of technology has caused a host of problems. My friend Dr. Tadashi Yoshimura, a Japanese obstetrician, talks about how he suddenly became aware of how terrifying standard hospital routines can be to women in labor when he looked at a television monitor showing the face of a laboring woman who was hooked up to various devices and left alone. As he began to substitute routine use of technology with a caring and observant midwife for each woman, he got to see what he termed “the mystic beauty” of a laboring woman who is not frightened and is thus powerful in bringing forth life. I know exactly what he is talking about because I saw that on the face of the first woman I ever observed giving birth. He learned what I learned: that for the most part, nature gets it right in birth when women are healthy. Women’s bodies are not lemons. The creator is not a careless mechanic. The same process that has brought hundreds of thousands of years of human beings to earth can continue to do so today. The human species is no more unsuited to give birth than any other of the five thousand or so species of mammals on the planet. We are merely the most confused.

It’s high time that we gave common sense and compassion a try in maternity care for a change. If other female mammals were treated the way most US women are during labor, they wouldn’t have a very easy time of it either. No matter how much pressure our society may bring upon us to pretend otherwise, pregnancy, labor, and birth produce very powerful changes in women’s bodies, psyches, and lives, no matter by
which exit route—natural or surgical—babies are born. It follows then that the way birth care is organized and carried out will have a powerful effect on any human society. A society that places a low value on its mothers and the process of birth will suffer an array of negative repercussions for doing so. Even men and women with no interest in parenthood should understand that the right to a positive and safe birth is just as important as the right to choose whether or not to have a child.

It is critical that we examine how the mainstream media has shaped and often distorted our knowledge of our bodies and ourselves, especially in the realm of pregnancy and birth. Women and families should demand that the media report factual information, and that their representations of birth reflect the full scope of women’s experiences. This would include the mystic beauty I have witnessed again and again for nearly forty years as the director of the Farm Midwifery Center.

We need to train more midwives with respect for the natural process to provide care for pregnant and laboring women in every part of the US. It would take 150,000 new midwives to reach the midwives-to-physicians ratio that characterizes the industrialized countries that outdo us both in newborn and maternal mortality.

Most of all, we need to disabuse ourselves of the idea that high technology is always better than natural processes, while, at the same time, being fully thankful for those times that technology saves lives. I am eager to work with forward-looking obstetricians such as Drs. Fineberg and Hayes to build, for the first time in the US, the kind of maternity care system that US women and their babies need and deserve. I hope that our voices make it into the nightly news, along with the voices of women who have experienced the beauty and strength of their capable bodies.

Called the “midwife of modern midwifery” by
Salon
,
INA MAY GASKIN
has practiced for nearly forty years at the internationally lauded Farm Midwifery Center. She is the only midwife for whom an obstetric maneuver has been named (Gaskin maneuver). She is the author of
Spiritual Midwifery
(4th ed., 2000),
Ina May’s Guide to Childbirth
(2003),
Ina May’s Guide to Breastfeeding
(2009), and
Birth Matters: A Midwife’s Manifesta
(2011).

Thanks to
VERONICA LIU, CRYSTAL YAKACKI
, and
MEG HUFF
for additional editing and input on this chapter.

1
. Nathanael Johnson, “More Women Dying from Pregnancy Complications; State Holds on to Report,” California Watch, February 2, 2010,
http://californiawatch.org/health-and-welfare/more-women-dying-pregnancy-complications-state-holds-report
.

2
.
Trends in Maternal Mortality: 1990 to 2008
, report, World Health Organization, 2010,
http:/whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf
.

3
. Tiffany O’Callaghan, “Making Sense of the New Maternal Mortality Data,”
Time
, Healthland, April 16, 2010,
http://healthland.time.com/2010/04/16/making-sense-of-the-new-maternal-mortality-data/
.

4
. “Maternal Mortality—United States, 1982–1996,”
Morbidity and Mortality Weekly Report
47, no. 34 (1998), 705–07,
http://www.cdc.gov/mmwr/preview/mmwrhtml/00054602.htm
.

5
. Donna L. Hoyert, “Maternal Mortality and Related Concepts,” US Department of Health and Human Services,
Vital and Health Statistics
3, no. 33 (2007): 1–13.

6
. T. R. Reid,
The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
(New York: Penguin, 2010).

7
.
Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer, 2003–2005
(London: CEMACH Publications, 2007).

8
. “Christy Turlington Burns Hopeful for Change in US Maternal Health,” Canadian Press, May 13, 2011.

9
. The Maternal Health Accountability Act of 2011 is HR 894,
http://www.house.gov
. Its progress may be tracked here:
http://www.govtrack.us/congress/bill.xpd?bill=h112-894
.

10
. “Vaginal Birth after Previous Cesarean Delivery,”
ACOG Practice Bulletin
no. 2 (October 1998).

11
. “Planned Home Birth,” Committee Opinion #476, American College of Obstetricians and Gynecologists,
Obstetrics & Gynecology
(February 2011).

12
. Michael Lasalandra, “C-Sections on Demand Are Rising Fast,”
Boston Globe
, April 20, 2004.

13
. Greg Borzo, “Elective C-Sections Stir Up Controversy,”
Ob/Gyn News
, October 1, 2000,
http://findarticles.com/p/articles/mi_m0CYD/is_19_35/ai_66931827/
.

14
. M. E. Hannah et al., “The Term Breech Trial Collaborative Group: Planned Cesarean Section Versus Planned Vaginal Birth for Breech Presentation at Term: A Randomised Multicentre Trial,”
The Lancet
356 (2003): 1375–83.

15
. J. M. Schutte et al., “Maternal Deaths After Elective Cesarean Section for Breech Presentation in the Netherlands,”
Acta Obstetricia et Gynecologica
86 (2007): 240–43.

16
. Joseph R. Wax et al., “Maternal and Newborn Outcomes in Planned Home Birth Vs. Planned Hospital Births: A Metaanalysis,”
American Journal of Obstetrics and Gynecology
(2010), 203–07.

17
. Josh White and Susan Kinzie, “Midwife Pleads Guilty to Felonies in Death of Alexandria Newborn,” May 5, 2011,
Washington Post
,
http://www.washingtonpost.com/local/midwife-pleads-guilty-to-felonies-in-death-of-alexandria-newborn/2011/05/05/AFetRQ2F_story.html
.

18
. “Doctors Perform C-Section on Non-Pregnant Woman,” WTVD, Fayetteville, North Carolina, April 1, 2010. See also Steven G. Gabbe, Jennifer R. Niebyl, and Joe Leigh Simpson,
Obstetrics: Normal & Problem Pregnancies
, 4th ed. (New York: Churchill Livingstone, 2007).

19
. Marie McCullough, “Joined in Birth, Death,”
Philadelphia Inquirer
, May 10, 2007.

20
.
Charles Mahan, “Maternal Deaths in Florida a Grave Concern,” letter to the editor, June 15, 2007,
http://www.itsyourtimes.com
.

21
. Kenneth C. Johnson and Betty-Anne Daviss, “Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America,”
British Medical Journal
330, no. 7505 (June 2005): 1416–19.

22
. John Golden, “Postnatal Problem Ruled to Be Cause of Soldier’s Death,”
Watertown Daily Times
(March 8, 2005). See also
http://www.kpho.com/news/23995023/detail.html
.