I’ve never considered myself a feminist in the stereotypical way, but having been involved in women centered care for several years has certainly made me more aware of women’s issues in a newly enlightened way. Much has been said about how the traditional feminist movement has by and large ignored birth issues. It has been wondered out loud that if the feminist movement ever really caught on and truly understood the disparity of care and the authoritarian manner that many women must endure during pregnancy and birth, the issue would have been settled long ago.
This past week I heard Judy Norsigian, Executive Director of Our Bodies Ourselves speak to a group of mostly women medical students. I’m assuming many of them may be planning on becoming obstetricians. The original book, a groundbreaking text for women, published in 1973, was a feminist statement concerning women having knowledge about and control over their own bodies. Our Bodies Ourselves has just this year published a book delving into the current state of affairs concerning pregnancy and birth. I have not yet purchased or read the book, so I can’t speak for everything included in the book, however I was very encouraged to hear Norsigian address the runaway cesarean rates nationwide, mentioning that in many places the rates are astronomical.
Norsigian also relayed to these up-and-coming medical students the results of Listening to Mothers II, published by Childbirth Connection. Childbirth Connection is a non-profit organization dedicated to improving maternity care and providing access to evidence-based information for women. Their Listening to Mothers landmark surveys provided the first real glimpse nationwide into the disparity between what has been reported to be women’s pregnancy and birth experiences and what is actually happening in hospitals across the country.
In the first survey it reported that:
- 94% of the women had electronic fetal monitoring (even though the official stance of the ACOG says intermittent monitoring is just as effective, and constant monitoring usually confines the woman to the bed and in one position)
- 83% had IVs (again it makes it difficult to remain mobile)
- 76% had epidurals (no more mobility with this one either, as well as a long list of possible side effects)
- 56% had bladder catheters (usually as result of the epidural, but puts them at risk for infection)
- 41% attempted induction (this has begun to be a big issue because of the number of iatrogenic premature births, it also contributes to the rising cesarean rates)
- 47% has their births augmented with pitocin (I have to believe that number is higher!)
- 47% had their bag of waters artificially ruptured
- 22% used narcotics
- 32% ended up with a surgical birth (cesarean, which has contributed to our unacceptable and rising maternal mortality rates)
- 25% had their vaginas cut in order to ‘assist’ the birth (studies show you are more likely to suffer a 3rd or 4th degree tear with an episiotomy)
- 28% were staff directed in their pushing
- 17% endured someone putting pressure on their belly for delivery
- only 63% roomed in with their babies
- only 39% of babies actually got to stay with their moms for that first golden hour
- 38% of babies who were supposed to only be breastfed were given formula or water (both detrimental to breastmilk supply and even one bottle of formula can start a negative autoimmune response)
- 44% of babies were given pacifiers (even though current recommendations by lactation consultants suggest this is detrimental to establishing good breastfeeding supply and latch)
Our Bodies Ourselves has issued a statement signed by physicians, midwives and women’s health advocates who support safe choices in childbirth as of November 2008. They are urging the following:
- That communities preserve the option of vaginal births after cesarean (called VBACs). There is substantial evidence that this is the absolute safest choice for most women, yet many hospitals are bowing to pressure from insurance companies and area standards of practice. This option has got to become available for women in every location.
- That options for hospital-based midwifey care (CNMs and CMs) be made available in all communities across the country. With a rising cesarean rate, less women are getting to take advantage of this alternative. For complicated reasons, many CNMs are having to choose to practice with very similar medical protocols and interventions as obstetricians, making them not much of a choice. But there are also some really good ones out there. Women need to be educated about their options and the interventions in pregnancy and childbirth in order to make a truly informed choice.
- That Certified Professional Midwives (CPMs) be licensed and regulated in order to make the option of homebirth as safe as possible. While I agree with the licensing aspect of this recommendation the ‘regulation’ part is flawed in many ways. While it is true that the CPM is a highly educated and trained individual and this is now considered the “gold standard” for certification for homebirth midwives, it ignores the rich history and excellent outcomes of other traditional midwives. The regulation aspect can also place undue burdens on midwives. Those burdens limit women’s choices. Some states place boundaries around the CPM in which she is not allowed to provide care for VBACs, twins, breeches and other variations of births. If more and more physicians and hospitals are requiring cesarean deliveries for these variations of normal, what other options does a woman have? Some states license the CPM but do not allow her to attend births and administer life-saving medications, which her training has instructed her to know how to use. Her hands are tied in an emergency situation. Other states place a burdensome provision requiring the midwife work in a supervised or collaborative relationship with a physician. This can be impossible to find, as many a cooperative physician have been pressured by their peers to drop the midwife or face persecution by their medical community. The Midwifery Model of Care is evidence-based, but it will never be a medical model of care and shouldn’t be. Otherwise, there is no discernable difference for women to truly have a choice between the way in which both approach the process of birth. Midwives will always see birth as a natural event and physicians will always see birth as a disease process they must ‘fix’.
The state of Tennessee (and I’m sure others) has a state midwifery board, much like most state’s medical boards, which oversees and supervises the midwives in that state. In cases of misconduct or malpractice, they have the authority to hold peer review and remove the right to practice. But this is a body of PEERS, all who have an understanding of what it is to practice authentic and skilled midwifery.
Placing midwives under the ‘regulation’ of the medical system is a bit like having a fox in the hen house. In other countries, midwives are seen as part of the team, not necessarily the competition. Midwives handle the majority of low risk mothers and births and physicians use their skills where it really matters; on the high risk pregnancies and babies. Their is a cooperative effort and collaborative effort, because the physicians see that as their role. But in this country, where an accident of history almost wiped out the influence of midwives in this country, we are not yet at that place.
To place midwives under the regulation of the medical system is to continue the status quo and that’s not a choice women should be happy about. To only legitimize the CPM and not the hundreds of other traditionally trained and skilled direct entry midwives is to also limit women’s choices. It’s something the feminists should think long and hard about.
Filed under: cesarean birth, Midwifery, normal birth, VBAC Tagged: | Childbirth Connection, CPM, feminism and birth, licensure of certified professional midwives, Listening to Mothers, regulation of midwives