Identifying the real dangers of normal childbirth in healthy women
Links to previous posts for: Part One, Part Two, Part Three
When it comes to identifying the actual dangers associated with normal childbirth in a healthy childbearing population, the American public and a majority of the medical profession frequently see dangers where there are none, while failing to identify the actual risks. This perspective sees childbirth in the human species as a defective or pathological aspect of female biology. It sees physiologically-based management as old-fashioned, inadequate, dangerous, irresponsible and all-together a bad idea.
As a result, most people believe that medicalizing normal childbirth is an absolute necessity, that each increased level of medicalization actually makes childbirth substantially safer and that an elective Cesarean delivery is the safest of all options, as it totally circumvents all the unpredictable dangers of normal birth.
Actual Facts: The common complications of normal childbirth in healthy women living in developed countries with functional healthcare systems are relatively rare and relatively easily and safely dealt with by modern medicine.
Artificial Dangers: However, when the same medical and surgical interventions that are so successful at treating the relatively rare (but real) complications of childbirth are routinely used on healthy women, it introduces the unnecessary risk associated with iatrogenic and nosocomial (hospital-related) complications.
As a result, highly-medicalized care in healthy women is associated with a 2- to 10-fold increase in medical interventions (EFM, immobilization in bed, induction, Pitocin-augmented labors) and Cesarean surgery (currently 33%). Unnecessary medicalization of labor and birth in healthy women is associated with increased maternal morbidity (serious complications) and elevated rate of maternal mortality in the US.
Both of easily preventable dangers are the result of the general misunderstanding of the real risks of childbirth in the 21st century.
The real elements of safety & danger as revealed by “Five Models, Five Perspectives, Five Insights:
The real source of danger for healthy childbearing women in the 21st century is lack of access to a functional health care system (Afghanistan, sub-Sahara Africa, etc) or a failure to use available maternity services, whatever the reason. This can be due to economic issues (no health insurance, trying to save money), religious or cultural beliefs, immigrations status, other personal circumstances (such as PTDS), or the result of a state-sanctioned denial-of-services by hospitals, doctors and midwives.
State-sanctioned denial of maternity care services occurs when the laws in a state allow hospitals to have policies that legally (but unethical all the same) “ban” vaginal childbirth. The result is to force unwanted Cesarean surgery on certain categories of healthy women, such as those with a ‘big’ baby, having twins, a breech baby or who previously had a Cesarean delivery. A similar legal but unethical denial-of-services occurs when malpractice carriers are allowed to lawfully prohibit obstetrical groups from providing vaginal birth services to this same subset of health women who were expecting to have a normal birth.
The last type of denial-of-services occurs when state laws for professional midwives purposefully restrict their legal ability to provide care to a subset of childbearing women. Typically this applies to essentially healthy women who have an identified risk but are decline to be medicalized against their wishes. This frequently happens to previous-CS mothers who expected to have a normal vaginal birth but finds that all the hospitals within reasonable driving distance offer only an unwanted and highly risky repeat Cesarean section.
According to constitutional law and as formally acknowledged by the American College of Obstetricians and Gynecologists (ACOG opinions #664, 214, 166 and earlier versions), adult women have a legal and ethical right to self-determination when it comes to all aspects of maternity care and childbirth services. But very often these principles are not applied to healthy childbearing women who find themselves in these situations.
When trapped between the Devil and the Deep Blue Sea by a lawful but unethical state-sanctioned denial-of-services, many of these families either seek care from lay midwives or plan an unattended birth; both decisions will unnecessarily increase easily preventable risks to mother and baby.
These are completely PREVENTABLE risks.