The Unkindest Cut

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"I'm afraid of something happening to me that I don't want," I said. The other women nodded their heads. "Yeah," said another, "when you're out of it."

We had been instructed to form a group separate from our partners to discuss our fears about the labor experience and our expectations of what we would get out of this Childbirth Education Class, now in its first session. But for some of us it was like therapy in a bomb shelter. The issue looming overhead was not the risk our own bodies might present to us, but the risks we knew were standard protocol in the hospitals we were suddenly being farmed out to.

... we learned in mid-May that no more births could take place ... [at] the Birth Center ... the Birth and Women's Health Center had been part of the for-profit Associates in Women's Health Care for the past four years. But midwifery, the care provided at the Birth Center, is not terribly profitable when placed alongside the cash cow of modern obstetrics ...

... "One cannot help an involuntary process. The point is not to disturb it." So renowned French physician Michel Odent articulated the philosophy that has been the cornerstone of birth assistance worldwide since human birth began.

... in the early 1800s the average woman in this country gave birth at home attended by a woman midwife ... However, in the 1900s birth moved to the hospital, due in part to industrialized America's starry-eyed wonder at technology and the male-dominated medical profession, and in part because physicians who'd formerly shunned poor women began to offer their services at free clinics for the purposes of experimentation and instruction ...

... "Over the past 30 years, obstetric management has converted what should, in most cases, be a healthy, normal process into a high-tech event." And while some would argue that we're better safe than sorry in our caregivers' preparedness for crisis ... the vast majority of hospital births in this country find mother and baby at greater risk for complications due to unnecessary medical intervention ...

... "The best way to avoid a c-section is to be informed," ... Despite informed consent laws and assurances from administrators that all procedures are the mother's decision, few women go into labor confident that they know better than their doctors which procedures are useful and when ...

... hierarchical protocols in hospitals sharply reduce the authority of midwives in favor of the medical model, making the obstetrician the authority.

Why not trust the obstetrician? Won't she or he want what is best for the patients? The answer is complex and alarming: Not always ... For example, a woman's likelihood of having a cesarean depends very little on her or her baby's physical condition. The factors that sway the statistics much more include where she is giving birth (a hospital, freestanding birth center, or at home), who is assisting (an obstetrician, family practitioner, or midwife), hospital culture and policies, and--the strongest determinant--her caregiver's cesarean rate. These factors influence not only who has cesareans, but who receives most of the medical procedures and drugs currently in fashion. These include fetal heart monitoring (the machine that goes ping!), episiotomies, IV, labor induction, epidural anesthesia, forceps and vacuum delivery and a host of other technologies that studies show compromise the health of the patients with little or no benefit.

One more factor significantly increases the likelihood of unnecessary procedures: profit. Obstetricians often receive hundreds of dollars more for ceseareans than vaginal births, and hospitals can receive thousands of dollars more. An epidural jacks the bill up another grand. Fetal heart monitoring saves hospitals money by allowing one nurse to monitor several babies, as does the heartless practice of whisking the baby away to the nursery once born.

The philosophy of obstetrics management posits that childbirth is a pathological condition requiring the intervention of surgeons. Hospitals are our culture's centers of crisis and disaster, and that is why the majority of births do not belong there.

... In the 1970s, women's dissatisfaction with the medical model of childbirth gave rise to the concept of the freestanding birth center. Birth centers, usually located close to but separate from a hospital, provide more supportive, less technologically oriented maternity care for low-risk women by certified nurse-midwives. By 1989 there were 132 freestanding birth centers operating in the US, delivering about 20,000 babies each year ... birth centers offered medical care comparable to hospitals for low-risk women, often at half the price ...

I asked the eight women in Childbirth Education class if any were planning a home birth, and only one raised her hand ... Home birth in Tucson, together with prenatal and postnatal visits by a midwife, costs around $2,000--a pittance compared to the astronomical costs of hospital birth, which can be over $10,000. Ironically, though most of us had been "lucky" enough to have insurance that covered the birth center, none of our plans cover home birth however inexpensive, so hospital birth has become our only affordable choice.

... Now the 49 women who were due to deliver at the birth center next month, and those like myself who were due not long after, are hauling our backaches around Tucson to check out our alternatives.

Melissa Maimann, Essential Birth Consulting 0400 418 448