Current mood:

angry

Rant: childbirth choices in the US
You should see the movie "The Business of Being Born." Put it on your Netflix queue, if you have one.

Why? This is why.

It's a statement from the American College of Obstetricians and Gynecologists against homebirth. What you're seeing here, between this statement and the movie, is a conflict over the cultural framing of childbirth: should it be treated as a normal event, with occasional complications that require medical attention, or should it be treated as a medical procedure even when nothing goes wrong?



If you've never looked into the possibility of homebirth, it might sound frightening. It's true that childbirth can go wrong, and quickly -- who wouldn't want to be as close to medical facilities as possible, just in case? But according to the limited studies done so far, normal (i.e. low-risk) homebirth is just as safe as a comparable hospital birth. England and the Netherlands have no problem with it. Another thing we know is that homebirths have far fewer medical interventions, most of which are unpleasant and not entirely necessary! I'd guess that there's also shorter recovery time, less chance of a multiple-resistant infection, better bonding between newborn and family, and less stress overall. Less cost to the insurance system, too, though nobody talks about that much.

Least of all the ACOG. They imply that homebirth is "fashionable" and a "cause célèbre" (no doubt referring to "The Business of Being Born"), and that mothers who choose to give birth at home "place the process of giving birth over the goal of a healthy baby." Oh, please!

A few years ago, I had the honor of attending my friend's homebirth. The baby was born quietly in a sunny living room, without any noisy machines, IVs, monitors, hospital johnnies, nurses running in and out, or anything hospital-like. The midwife stood by with surgical equipment, ready to handle any likely emergency, and they knew how long it would take to get to the nearest hospital by ambulance: they were well-prepared, as anyone giving birth at home should be. Nothing terrible happened. The whole event was a wondrous and transcendent thing, and yet utterly "normal," too! It left a very deep impression on me.

I have to think that my friend's baby had a much better experience there than she would have had at a hospital. When Matthew was born, we did all we could to make his entrance to the world as gentle and wonderful as we could, but hospitals must follow policies. He therefore had to have eyedrops, and the Hep B vaccine, and a Vitamin K shot, and blood draws for disease tests. His "bed" was a hospital bassinet, and he had to be in it for all transport (mothers couldn't be trusted to carry their own babies in the hall; seriously). And the room on the maternity ward was just... dingy. It was clean enough, and the staff were lovely to us, but it couldn't possibly compare to home.

We got lucky with our hospital birth. My interventions only went as far as Pitocin induction, an IV, and continuous monitoring -- I refused all drugs and anesthetics, and I never got into a bad state medically. If I had, a C-section was only a few yards down the hall.

Did you know that 1 in 3 American births are C-sections? That's major surgery. Expensive surgery, with mostly predictable outcomes (healthy baby, long recovery for Mom, disrupted breastfeeding, infection risk). Think about that. Some women ask for C-sections, and other women get them for the flimsiest of reasons -- "you're just not progressing fast enough." The movie points out that the hour-by-hour C-section rate peaks at around 4 PM (dinnertime for doctor!) and 10 PM (doctor wants to go home!). Think about that.

Ina May Gaskin, a midwife who has been doing "natural births" for decades, didn't need to resort to a medically necessary C-section until birth number 293 or thereabouts. Overall, her C-section rate is 1.4%. Think about that. (Her clients might be self-selected for better-than-average health, but she's in rural Tennessee, not a wealthy coastal suburb.) Meanwhile, the ACOG claims that they're "concerned" about the 31% national rate, and is "committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate."

I call BS. Are all those C-sections really a last resort, after cheaper, gentler, and more time-consuming approaches have failed? I doubt it. If the ACOG actually wanted to reduce the C-section rate, they would have done so by now.

(Though I wonder if the high rate is due to one thing: malpractice suits. We all know that OBs are particularly likely to be sued, and it doesn't make sense to have a national conversation about birth options without talking about it. Perhaps the predictability and finality of the C-section makes it too tempting for an OB who doesn't want to be punished for following a mother's birth plan. Perhaps hospital policies are set up to intervene and "actively manage" at every opportunity, because of the potential malpractice risk if they're seen as "doing nothing." If Americans weren't so sue-happy, how would our nation's collective childbirth picture be different?... Still, malpractice risk doesn't explain the ACOG's astonishing hostility towards homebirth.)

Let me go back to that "process of giving birth over a healthy baby" comment. No mother wants to put her baby at risk. Women I know who homebirth recognize the very real risks of giving birth in a hospital, and they believe their chances at a good overall experience are better if they do it at home (with the opportunity to transfer to a hospital should something go wrong). And why mock our desire for a good birth process? What the ACOG fails to recognize -- as do countless obstetricians -- is that many women have perfectly valid goals for childbirth, in addition to "a healthy baby." Sadly, those other goals are often cast aside at the smallest threats to safety, or -- despicably -- convenience.

Personally, my goals included natural and anesthetic-free childbirth; a quick recovery; to be mentally and emotionally present at all stages of childbirth; immediate breastfeeding and physical closeness with our newborn; and a good, gentle experience for Matthew during his first days. My excellent midwives supported those goals, to the extent they were allowed, given the hospital policies.

There's the rub, of course. By going into a hospital in the first place, I tacitly agreed to a whole bunch of non-negotiable policies and procedures that conflicted with my goals. (Like induction within hours of membrane rupture. I wish I could have waited for natural labor to start, but they could not give me that option. Edited to add: Rich reminds me that there were other medical reasons to induce, but even without those, they would have induced within a day of membrane rupture.)

No wonder a lot of women decide to punt the hospital altogether! At home, you have a far greater degree of control. You have comparable risk. And you have a much smaller chance of unnecessary interventions, including C-sections and other unpleasant invasive procedures. Is that so hard for the ACOG to understand? Why threaten mothers and direct-entry midwives with a statement like this, when cooperation with them would lead to healthier and happier births?

Please, if childbirth is a relevant part of your life, go watch "The Business of Being Born." Encourage other parents or parents-to-be to watch it, too. The movie has a strong point of view, and it doesn't pretend to be objective journalism, but it's eye-opening. Please know that homebirth is not a "fringe" thing or a fad, and that when done with appropriate safeguards and medical personnel, it can be safe and wonderful.

[crossposted from http://comfort-and-joy.net]