In a former post, I mentioned that I’ve been working on starting a non-profit. Actually, I can’t take full credit - me and a few other local birthy-types have been working on this something. It’s part of why blogging has been unusually slow for me.
Back when I first started birth work - you know, WAYYYY back in June - I took a very hospital-friendly stance. I would not stand up to doctors, get in their way, respect their medical opinions. This is still true in many ways, as during a birth is, I still strongly feel, absolutely the last place I should be an activist. If I stand between her and her doctor, I’m just one more person speaking FOR her, telling her what’s best for HER, and she’s just another patient without an opinion or authority to speak for herself for her care. Although I know what a woman’s general birth preferences are when I’m at a birth, I also realize that a lot can change in the middle of it all. And I still think that my kindness and compassion to a woman is my biggest tool to help foster a positive birth memory. If I’m creating tension with doctors and nurses, I’m not doing my job. My best tools in the room are to help the mother formulate questions they can ask the medical staff to get some answers about how urgent a situation is, what happens if they do nothing, what risks are involved, and what alternatives they have. I can also suggest they ask about specific alternatives. I will never talk for a mother.
However.
I’m also learning that there is a big difference in being a pain in the ass in the delivery room and being a pain in the ass outside of it. The more I learn about birth in our country, the more I realize that many things need to change. The United States, for all our wealth and technology, has pretty poor maternity statistics when compared to the rest of the developed world. Case in point - let’s check out the statistics from the World Health Organization in 2007:
Neonatal Mortality Rate (rate of death in the first 28 days of life, per 1000 live births):
The United States ranks behind Iceland, Singapore, Japan, the Czech Republic, Finland, Monaco, Norway, San Marino, Slovenia, Sweden, Belgium, Cyprus, France, Spain, Andorra, Austria, Denmark, Germany, Greece, Israel, Italy, Luxembourg, the Netherlands, Portugal, Switzerland, Austria, Canada, Malta, New Zealand, the United Kingdom, and Belarus. We are number 31. Sure, the point spread isn’t horrible, but just tell that to the families whose child would have lived if it had been born in Iceland or Singapore.
Maternal Mortality Rate (rate of death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggrevated by the pregnancy, per 100,000 live births):
1) Ireland - 4
2) Finland - 5
3) Spain - 5
4) Austria - 5
5) Italy - 5
6) Canada - 5
7) Australia - 6
Denmark - 7
9) Switzerland - 7
10) New Zealand - 7
11) Qatar - 7
12) Sweden - 8
13) Portugal - 8
14) Czech Republic - 9
15) Germany - 9
16) The former state union of Serbia and Montenegro - 0
17) Japan - 10
18) Norway - 10
19) Belgium - 10
20)Greece - 10
21) Slovakia - 10
22) Croatia - 10
23) Poland - 10
24)United Kingdom - 11
25) Hungary - 11
26) Kuwait - 12
27) Israel - 13
28) The former Yugoslaw Republic of Macedonia - 13
29) United States of America - 14
The Netherlands and France are the only European countries who rank below us in this regard - Iceland doesn’t report maternal deaths, but looking at the rest of their numbers I would highly doubt they rank worse than us. Maybe Iceland doesn’t report this number because it is so low it isn’t even on their radar screen?
Yes, our numbers are still fairly high when compared to countries with poor nutrition and maternal care (Sierra Leone reports 2000 maternal deaths out of 100,000). But there is room for improvement.
We spend the most per person on maternal health care, but our outcomes are not representative of this. What are these other countries doing that we are not?
First off, American populations generally eat less whole foods and living more sedentary lifestyles, highly reliant on their cars to get even a few blocks. This could increase morbidity (general health), raising risk factors for things like preeclampsia, for example.
But sometimes, all that technology at our fingertips is actually getting in our way. We look at a machine to measure contractions instead of looking at the woman. We induce labor, just to be safe, but actually increase our odds of things going wrong, such as a prematurely born infant that we induced too soon or a stressed infant because of the strong, unnatrual contractions caused by Pitocin, Cytotec and other drugs used for induction. We use Cesarean birth far too often, sometimes because we can say that “we did everything we could” and avoid a lawsuit, but outcomes might have been better for that mom and child if her body was trusted that it knew what it was doing. We think of a Cesarean as no big deal any more as they are so common, but it is still MAJOR SURGERY. It leaves a woman with a poor start at motherhood: long recovery times impact her ability to parent, her ability to breastfeed and her chances of postpartum depression.
I’m not saying that all medicine in obstetrics is a bad thing. Far from it. Inductions, cesareans and the like have saved countless lives when things go wrong. I don’t think that OBs deserve all the hate that some midwives and doulas carelessly throw in their direction. They entered the field, most always, with a respect for women and a joy for childbirth.
It is interesting that many of the countries ranked above us heavily utilize a midwifery model of care for normal, uncomplicated pregnancies and births. Many countries give home birth as an option. And their success rates are higher than our own. How do they do it? Less interventions, not more. Every time we use a piece of medical equipment or perform a medical task, we are putting a woman at a risk (albeit small). And the more machines and cords a woman is hooked up to, the more she must remain in bed. Unable to move to cope with the pain. Unable to change positions much to facilitate a vertex (head down), occuput anterior (baby’s face towards the tailbone) position. Unable to use gravity to her advantage during the second (pushing) stage of labor. And cesareans have proven to be more risky than vaginal births, even if it is a repeat cesearean.
It’s hard to work with pregnant women when they don’t know all this information. I want to be a part of the solution, not a part of the problem. I want to help. So please welcome my latest entry in the world of activism. Welcome the Mid-Columbia Birth Network.
www.midcolumbiabirthnetwork.org
And if you live in my area, stop by the TRAC in Pasco at the Kidz and Baby Expo this weekend to say “hello”. If you are pregnant, you’ll get a free rice sock and a foot massage, and a whole lot of local support.
Back before I ever contemplated a career as a doula, I would see episodes of “A Baby Story” on TV and occasionally there would be a woman who would get a belly cast. I kind of liked the idea but couldn’t figure out any good reason to ever have one myself - would I really hang a 3D image of my naked torso up on my bathroom wall? - so I never had one done. But now I get it.
Throughout history and culture, there have been rituals to celebrate a woman’s pregnancy and birth. A woman’s ability to concieve and grow a new human being inside her womb was seen as nothing short of goddess-like. Images and icons of a pregnant or birthing woman resurface over and over in ancient culture.
Archeologists have uncovered hundreds of Stone Age sculptures, yet only five of these are male. These women are big and strong - reminders to us that human survival would not be possible for those millions of years if women were seen as physically and mentally weak. Most of these icons are rounded vessels, portraying large bellies, breasts and thighs, but very small or nonexistent extremities such as feet and heads. A headless pregnant woman - did the ancients understand the art of losing one’s thoughts and becoming one with the birth?
Did our ancestors worship the pregnant body? What customs and rituals were attached to seeing a woman into motherhood? I suspect much has been lost, but we do know of a few modern birth rituals from other countries (From “Birthing From Within”):
In the Philippine islands, it is customary to put a key (unlocking) and a comb (untangling) under the laboring woman’s pillow; the moultings from snakes or other animals may be used to make a belt for the parturient woman; a house ladder may be turned upside down, knives unsheathed, recently made furniture unnailed, recently sewn seams ripped open and drawers, trunks and cupboards unlocked.
Also in India, prolonged labor may be treated by placing a tightly furled flower beside the woman in the belief that as it unfurls so will a woman’s cervix dialate.
What People are Saying on American Mum