Mommy, What Did You Do in the Industrial Revolution? - Semaine Mondiale pour l... - The Diigo Meta page

• 26 Apr 09
  

  Elena LaVictoire

  Excellent article on the state of birth in this country. I had a couple of thoughts while reading it.
  
  A couple of years ago I had a discussion with a woman who had pretty much opted for a Cesarean at her first prenatal visit! She didn't with to be challenged on it either. I never considered the perspective that "high risk" in this country has come to mean "special." And that's how ACOG has come to make it so acceptable.
  
  I also wonder why the feminists and "green" people haven't picked on this. Industrialized birth today takes power away from women. This is just as bad ad the old day when women were tied down during labor, like my mother was, back in the 50s and 60s. Yet other than Ricky Lake, I'm not hearing a peep from them.
  
  As far s the green movement, I guess it's okay to keep the earth clean and pure but to savage women's body with invasive medical procedures seems to be okay.

  birth childbirth cesarean AGH

  • The cesarean rate in the US has been rising for decades, and in 2006 hit an all-time high of 31% (Hamilton, 2007.) This record is likely to stand for only a brief time, that is, until figures are
    released for 2007. Can it really be that one-third of women are unable to birth without high-level technological support? And is there an endpoint in sight? “In the next decade or so the
    industrial revolution in obstetrics could make Cesarean delivery consistently safer than the birth process that evolution gave us.” (Gawande, 2006, 8) Against such an argument, who could hope to
    stand?
  • Although he lauds the
    success—often unheralded-- of obstetrics in saving mothers’ and infants’ lives, I hear within the paean a threnody for the vanishing art. Skilled obstetricians like those legends of the past,
    whose names lived on in the maneuvers they devised to usher babies into the world, are vanishing from current practice: goodbye, Lovset; hit the road, Rubin; Mauriceau, it’s been swell, but we’re
    through.
  • 8 more annotations...
  • • If cesarean is a response to any
      perceived risk, why would women at statistically lower risk of a poor outcome have higher cesarean delivery rates? New Jersey has the highest cesarean rate among states, (Denk 2006) but no lower
      levels of maternal or perinatal mortality. (MacDorman 2007, CDC 1999) What it does have, however, is the highest median household income. (Census Bureau 2007)
    • Does this paradox reflect a differential understanding of risk? I have seen, over years of practice in maternal-fetal medicine, an odd and somewhat unsettling pride among women who announce that
      they have a “high-risk pregnancy.”
    • In some cases it is difficult to persuade a low-risk woman to continue her care with a general OBGYN practice instead. “But I’m high-risk,” she says.
      Does she really mean, “I’m high-status,” or “My baby is high-value,” specifically, more precious than someone else’s? Is it a statement of importance? Does it mean that she is special? Or is it a
      Disneyfication of a primal human endeavor, longing for the synthetic and dramatized experience in preference to the authentic? These questions are raised, but cannot possibly be answered, in this
      commentary.
    • Women who want to be high-risk (read: special) in their designation are nonetheless hugely risk-averse when it comes to the real thing. Obstetricians have tapped into that fear in daily practice.
      Vaginal birth after cesarean (VBAC), for example, is associated with a very low although measurable risk of uterine rupture. Presented with the figures and asked to sign a consent for VBAC which
      spells out that risk, most women now decline: the VBAC rate in 2005 was under 8%. (Martin, 2006) Whether this is driven by reluctance of doctors to offer or women to undergo VBAC is impossible to
      ascertain, but it is clear that fear is contagious.
    • For developing or low-income countries, where
      access to safe maternity care is an issue, a rise in national CS rates from 0% to 8-10% is accompanied by a drop in stillbirths, neonatal deaths, and maternal deaths. (Goldenberg 2007, McClure
      2007.) But across the developed world, or across medium- and high-income countries, there is no additional benefit of further increase in cesarean rate (Althabe 2006.):
    • Nonetheless, seduced by the promise of pain-free, risk-free childbirth, women and their doctors are driving the cesarean rate ever higher. Rates approaching—or exceeding-- fifty percent are now
      seen in some hospitals (New Jersey Star-Ledger.) This is the normalization of deviance. This is the new normal.
      
    • Let us enumerate what a full spectrum of childbirth choices entails. Women can give birth at home unaided; at home with family or with trained assistance; in a birth center, either freestanding
      or hospital-based; in the hospital delivery room with trained assistance; or in the operating room where they are acted upon. But of all these choices, extending across the entire range of
      reliance upon the medical profession (from none to total), exercising the options at the end of the spectrum where the physician has the least sway will get women the least support. The American
      College of Obstetricians and Gynecologists calumniates not only women who want a home birth but anyone who advocates leaving that option open. (American College of Obstetricians and
      Gynecologists, 2008.) Once in the hospital, women who might like to exercise their right to self-determination by choosing vaginal birth after cesarean, or vaginal breech delivery, will have a
      hard time of it. (Leeman and Plante, 2006) Is it not the opposite of autonomy to support only those choices which increase the woman’s reliance upon the physician?
    • Industrial obstetrics strips the locus of power definitively away from women.

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