Women's Bodies, Women's Wisdom (102 page)

Unfortunately, the American public in general (physicians included) may have a false sense of security about the safety of giving birth today because the statistics on maternal death in the United States are mis leading. Unlike most other developed countries, the United States counts in its pregnancy-related death statistics only women who die within a six-week period after a pregnancy ends. Other developed countries include deaths that occur up to one year afterward. According to the Centers for Disease Control, the number of maternal deaths in the United States is probably up to three times as high as the number reported in our national statistics because not all maternal deaths are classified as pregnancy-related on the death certificate.
⁴²
I highly recommend the short video
Reducing Infant Mortality and Improving
the Health of Babies
by Debby Takikawa, which you can view for free at
www.reducinginfantmortality.com
. The video shows how using midwives and other means of labor support can help transform the perspective of birth-as-emergency so that laboring mothers and their newborns will not merely survive but truly thrive. Also, please consult the Birth Survey (
www.thebirthsurvey.com
) for feedback and ratings on the doctors, hospitals, and birth resources in your area.

I
NA
M
AY’S
S
AFE
M
OTHERHOOD
Q
UILT
P
ROJECT

In the early 1990s, midwifery pioneer Ina May Gaskin began to research maternal death rates in the United States. She was concerned that with escalating hospital birth interventions, such as induced labors and planned C-sections, the rate of maternal deaths would rise dramatically despite the profound medical advances enjoyed by those who live in the United States. Her research shows that forty-one countries have lower maternal death rates than the United States.

The maternal death rate in any given population is known to be a very good indicator of the overall health status of that population. So it was especially shocking when Ina May found that the maternal death rate in the United States has actually
doubled
in the last twenty-five years. In 1982, the rate was 7.5 per 100,000 live births. By 1999, the rate had risen to 13.2, and by 2005, it was up to 15.1. In some New York City hospitals, it’s even higher. Moreover, Hispanic and African American women continue to have much higher maternal death rates—perhaps four times as high or higher.

“When I first became curious about the maternal death rate in the U.S., I wondered why it was so difficult to unearth in the medical library,” Ina May recalls. “This was in the early 1990s. I noticed a sharp contrast between how maternal deaths are counted here in the U.S. and the U.K.’s system of confidential enquiries, where four countries cooperate to achieve 100 percent ascertainment of maternal deaths that are directly related to pregnancy and birth. (They claim 97 percent accuracy.) According to the CDC, the actual number may be 1.6 to 3 times the figure that is published annually. I find this shocking, especially since we know that the maternal death rate has been rising in recent years—something that isn’t happening in other countries.”

To humanize and emphasize this often-hidden problem, Ina May began collecting the names of women who have died from pregnancy-related causes since 1982 (the year when the maternal death rate was the lowest). In 1999, inspired by the AIDS Memorial Quilt, she started the Safe Motherhood Quilt Project. “The purpose is to bring awareness to the rising maternal death rate in the United States and to the substantial degree of underreporting of such deaths,” she explains. “Reduction of the maternal death rate depends upon complete ascertainment so that it is possible to learn from past mistakes.” To date, Ina May has collected 230 names, and quilt pieces for 163 women have been completed, with the rest in progress.

I was in San Diego when Ina May unveiled the quilt at the annual meeting for the Association for Pre-and Perinatal Psychology and Health in November 2005. The quilt honors every mother who has died in childbirth or in the postpartum period. As she tells each of their stories, you quickly realize how truly tragic and utterly preventable most of these deaths have been. It raises consciousness because you realize that these women aren’t just faceless, nameless statistics. They were mothers, wives, sisters, and lovers—all of whom have left behind motherless families, a mark that will affect their children and families for generations.

For more information about the Safe Motherhood Quilt Project, see
www.rememberthemothers.net
.

When it comes to infant mortality, the figures are even more shocking than those for maternal death rates. The National Center for Health Statistics, a division of the Centers for Disease Control and Prevention, reports that the U.S. infant mortality rate began to plateau in the year 2000—the first time the rate had not declined over a sustained period since the 1950s. Currently, the United States has 6.86 infant deaths per 1,000 live births, a rate higher than that of most other developed nations. Although the United States had the twelfth-lowest infant mortality rate in the world in 1960, its ranking slipped to twenty-ninth in 2004.
⁴³
(Singapore has the lowest infant mortality rate— 2.28 deaths per 1,000 live births.) As with the maternal death rate, infant mortality is a very important measure of public health because it reflects factors such as the quality of prenatal care, maternal health, socioeconomic status, and health insurance coverage. So much for the benefits of high-tech birth.

6.
There are many choices for how to have your baby. In fact, there are more childbirth choices now than ever before—everything from high-tech hospital birth to water birth at home. To choose the safest and most mother-friendly option, you must be informed. I recommend that you visit the website of the Coalition for Improving Maternity Services (CIMS), a group of individuals and more than fifty organizations whose mission is to promote a wellness model of childbirth. (For more information, read “Having a Baby? Ten Questions to Ask,” on CIMS’s website,
www.motherfriendly.org
.)

OUR CULTURAL INHERITANCE: LABOR AND DELIVERY

Labor and delivery most often go very well. Yet as a society, we continue to treat the normal process of birth with hysteria. The high anxiety about pregnancy and birth in this country is partially the result of our collective unresolved birth trauma—nearly every one of us has unfin ished business about her or his own birth that we keep projecting onto pregnant women. Most baby boomers, after all, were born drugged and were then whisked away from their mothers to the glaring lights and sterility of the hospital nursery. The World War II generation was born at home. Then birth became medicalized and moved into the hospital. Though the maternal mortality rate fell, we lost a great deal of birthing wisdom with this shift.

I have seen cemeteries in New England strewn with the headstones of women who died young, surrounded by the graves of their dead chil dren. Most of these deaths and traumas resulted from poor nutrition, overwork, and lack of maternal support,
not
necessarily from lack of sophisticated medical intervention.
⁴⁴
Data show, for instance, that women who are unsupported in labor are at greater risk for prolonged labor and poor outcome. Several excellent studies have also shown that the presence of a supportive woman called a
doula
who “mothers the mother” during her labor decreased the average length of labor from admission to delivery from 19.3 hours to 8.8 hours. The presence of a doula also resulted in the mother being more awake after delivery so that she was more likely to stroke her baby, smile, and talk to her or him.
⁴⁵

In so-called primitive hunter-gatherer societies, pregnancies are often spaced two to four years apart by unrestricted breast-feeding, which keeps prolactin levels high and acts as a natural contracep tive. In the course of her lifetime, a woman from one of these so cieties might have twenty periods, as compared with five hundred for Western women.
⁴⁶
In these societies, provisions are also made to support a pregnant woman and her labor. The birth is celebrated as a community event. Though I don’t mean to imply that childbirth is always a completely risk-free, glorious process, even in societies in which women have been well nourished and well supported, we could learn a lot from combining the collective women’s wisdom of native, nature-centered people with our current medical technology.

Women Labor as They Live

Having participated in hundreds of cesarean-section deliveries and other forms of medicalized birth over the years, I’ve learned that our current dilemmas over birthing start long before a woman ends up on the labor and delivery floor. In fact, they originate years before she even gets pregnant. Each of us carries the seeds within ourselves, and we must look at the ways in which we daily participate in less-than-optimal treatment.

A woman’s attitudes about pregnancy arrive with her on the labor and delivery floor. One professional woman I know wanted to labor without feeling a thing. She said, “Knock me out—I’m not an Indian.” This is the statement of a woman who doesn’t understand the power of labor and delivery. It implies that only “primitives” go through labor and that sophisticated intellectuals get babies via technology, keeping their hands clean, their brows uncreased, and their makeup intact.

Too many women approach labor with the wish, stated or unstated, “Take care of this inconvenience, please. I don’t want to feel a thing—just hand me the baby when it’s over!” Though what women need most in labor is encouragement and loving support for their abilities to birth normally, too often they don’t get this because doctors and nurses hold the same attitudes about labor as they do about a crisis or inconvenience—cure it as soon as possible.

I’ve learned that a woman’s entire life leads up to what will happen in labor. Studies have shown that women with prolonged labors have certain personality characteristics. They have inner conflicts about reproduction and motherhood and are unable at the time of the labor to com municate and admit their anxieties. (In our culture, where mothers typically receive so little support, who wouldn’t have conflicts?) These psychological factors may result in inefficient uterine action and subsequent prolonged labor.
⁴⁷
It is also a fact of our culture that violence is common in many women’s lives, especially during pregnancy, when the woman’s pregnant belly is often the target of abuse. This can certainly increase your chances for pregnancy complications of all kinds. Ask yourself the following questions: Within the last year, or since you have been pregnant, have you been hit, slapped, kicked, or otherwise physically hurt by someone? Are you in a relationship with a person who threatens or physically hurts you? Has anyone forced you to have sexual activity that made you uncomfortable? If you answered yes to any of these questions, you’re being abused. To get help, call the National Domestic Violence Hotline at 800-799-SAFE (7233) or your local women’s shelter or domestic violence hotline.
⁴⁸

Women who have experienced incest or other abuse are prime candidates for dysfunctional labors and subsequent cesarean sections unless they work through this—which is certainly possible. Many of these women have learned at a deep level how to be victims. This plays out in childbirth—a time when, instead of being victims of their bod ies, they need to be at one with the process. One of my patients realized that she had gotten stuck in labor because at some unconscious level she was afraid of giving birth to her father’s child. Another sexual abuse victim came to realize that she had learned the victim role so well that she could not push her baby out. Like most people living out of a feeling of powerlessness, she simply turned the experience over to the hospital and the staff. On some level she expected them to birth the baby for her. I’ve worked with countless women who have learned this attitude.

Other survivors of abuse, however, use control as a survival mechanism. During pregnancy these women often come into a doctor’s office with a long list of demands: no IVs, no monitor, no medical students, a limit to exams, and no shaving or enemas (despite the fact that shaving and enemas haven’t been done for years). Many obstetricians sense that those women who need to control the birth process the most are often the ones who end up with the most interventions. Any birth attendant will tell you that the longer the “laundry list,” the greater the chance of an unplanned intervention, such as a C-section. The reason is that the list is often a symptom of the woman’s illusion of intellectual control, her attempt to manage a situation about which she feels completely terrorized and out of control. By trying to control all the variables associated with the birthing process, she thinks she can somehow avoid the terror that she associates with her body, with feeling her body in general, and with the birth process. The more a woman operates from this illusion of control, the less likely she will be to surrender to her body’s process and the more likely that an intervention will be necessary. And the medical system plays into this seamlessly.

Labor also reveals the bare bones of a woman’s relationship with her husband or other labor support people. Sometimes women sud denly, when nine centimeters dilated, lash out at their husbands vi ciously, simply because they are in transition. I was taught that this just “happens,” but it never made sense to me. I’ve since learned that it doesn’t just “happen.” Any hostility that emerges between people during labor was already there long before labor began. But because of the essential, primitive nature of the process, all pretense at socially accept able politeness gets dropped, and reality shines through. My father once told me that if I wanted to learn who someone really was, I should go on a camping trip with them. You could say the same thing for the labor and delivery process.