Homework 42- The Ideal Birth System (and why)

What this is:

The original project I had in mind was an academic paper, but as I was writing it, I realized it was a better reform proposal. 

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The Birth System in America Today

In America, most births are delivered by a doctor, nearly 90%. This may seem logical, but it’s not. Doctors force many interventions upon women during birth such as: pitocin (to induce labor), episiotomy (to making getting the baby easier), forceps and vacuum extractors (to remove babies), and the very popular Caesarean-section (also to remove babies). These interventions aren’t bad when they’re needed, but the problem is they are being forced upon women who don’t need it. The national C-section rate is 32% and births with any intervention are near 85%. This is alarming because there are midwives who have much lower rates then these but they only attend 9% of births.

The Major Players In The Birth System:

Obstetricians (OB):

Overview: OBs are the biggest force in the birth system. They are certified doctors, who have special training to specialize in Obstetrics and Gynecology. According to The College of Obstetricians and Gynecologists, the organization holds over 51,000 members and, more than 90% of American board-certified ob-gyns are affiliated with ACOG.” This means that there are close to 56,000 OBs in the country. These doctors work out of private practices and work in hospitals, making them widely accessible.

Certification Process: Obstetricians-to-be are required to complete medical school and a 4-year residency underneath a licensed OB.

Contribution to birth: OBs are essentially baby catchers, or in many cases baby extractors. The way that most OBs practice, they aren’t there for the whole birth, they come in at the end when the mother is close to giving birth, or if the woman is taking to long to deliver, after a point where they think it has been too long. The national C-section rate is 32.2%, and is much higher with OBs then midwives.

Midwives:

Overview: Midwives are seen as the holistic approach to childbirth. They encourage natural and home births. Midwives are predominantly female, with only two male midwives in America.  OBs are usually against midwives, mainly because midwives are competition for the doctors. The C-section rate is significant lower with Midwives then with OBs.

Certification Process: There are two ways to become a midwife; the first is becoming a nurse-midwife. This process involves becoming a registered nurse with special midwife training, and to pass a test to earn certification. There are also just midwives. To become a certified midwife, the same certification test as nurse-midwives needs to be passed, on top of passing an Accreditation Commission for Midwifery Education (ACME) course.

Contribution to birth: Midwives are trained to deliver babies completely naturally. No epidurals, no c-sections, and no drugs. Midwives are there for the whole birth, helping the woman through the painful process step by step.  Midwives also make the decision, that if something is going wrong, to have a doctor intervene. The C-section rate with midwives is much lower then with OBs. “99 percent of ABC births were spontaneous vaginal births, compared to 55 percent in hospitals.” (Wagner, 135)

Minor Roles in The Birth System:

Doulas:

Overview: Doulas are birth aids that woman can hire for their birth. Doulas are present during many times during the pregnancy though, helping create birth plans, educating the woman on how things will happen, and even attending maternity classes with the women. During labor, a woman’s doula will be with her for the whole process.

Certification Process: Read required readings provided by DONA (Doulas Of North America), take attend birth and pregnancy workshops, and attend at least six births.

Contribution to birth: A doulas job as a birth aid is to help guide the mother-to-be through birth. This starts early, when the doula meets routinely with the mother-to-be during pregnancy. Doulas are like an extension of family as described by Dr. Jacques Moritz. They are there for the woman, and know her, but also are very knowledgeable when it comes to birth.

The Way it should be:

The ideal birth system for America is having women give birth in hospitals, attended by midwives, with doulas as supplements, and supervised by obstetricians.

Why it should be that way?

In hospitals:

Woman should be in hospitals because it cuts down steps in case there is an emergency. As Doctor Jacques Moritz explains, “Childbirth is 97% boring, and 3% terror. Doctors don’t need to be there for most of the time, but when there are those rare complications, they need to be there.” Which means most of the time childbirth is routine and simple. But it isn’t always routine and simple. Which is why it should happen in the hospital, where when a procedure needs to be done, it can be done faster then anywhere else.

 Woman may argue that a hospital isn’t a comfortable place to give birth. Under this system, they would pick out a room during a later stage in pregnancy and have that room, or one identical to it available for the weeks around her due date.

Attended by midwives:

Midwives have been proven to be the best low-risk birth provider. “Compared with physician-attended low-risk births, midwife attended low-risk births have 33 percent fewer newborn deaths.” (Wagner, 108) They let birth flow, and will do anything they can to allow a natural birth, they don’t push unnecessary interventions upon women. They are very well trained for what they do and usually know their limits.

With A Doula:

Births should be supplemented by a doula that the woman has been working with throughout her pregnancy. With doulas present, all intervention rates, including c-sections decrease. Also with a doula, the woman has somebody that repeatedly sees births and can use those experiences and apply it to her. The doula also knows the woman, as doulas meet with woman often during their pregnancy.

Supervised By a Doctor:

Doctors can’t be cut out from the birth system because when emergencies come up, they are the only ones that know how to perform the procedures that are needed to correct the situation. Obstetricians are specialists, so they should be available to use their specialized skills. Also doctors need to be the midwives insurance, making sure the midwives they are supervising aren’t messing up.

What has to happen to allow this system?

There are problems with midwives and doctors working together. Doctors attempt to be dominant over midwives; they feel threatened by them. Doctors and midwives have to accept their clear roles in this system.

There has to be a major midwife movement, where the rate of midwife-attended births is more significant then 9%. Midwives need to be supported and trusted.

Doctors need to be trained differently, so they don’t expect to deliver regular births, just to act when needed.

Women need to be educated about the differences in birth options they have. They need to be given facts about midwives vs. doctors.

Bibliography 

1. Wagner, Marsden. Born in the USA How a Broken Maternity System Must Be Fixed to Put Women and Children First. Berekely and Los Angeles, California: University of Berkely, 2006. Print.*

2. "The Credentials of CNM and CM's." American College of Nurse-Midwives. American College of Nurse-Midwives, 2008. Web. 5 Apr 2011. <http://www.midwife.org/The-Credential-CNM-and-CM>.

3. Nettekoven, Cami. "Value and Purpose of Labor Support." Babies Online. Babiesonline Inc., n.d. Web. 31 Mar 2011. <http://www.babiesonline.com/articles/pregnancy/valuepurposeofdoulas.asp>.

4. "The American College of Obstetricians and Gynecologists." The American College of Obstetricians and Gynecologists. The American College of Obstetricians and Gynecologists, 2010. Web. 5 Apr 2011. <http://www.acog.org/from_home/ACOGFactSheet.pdf>.

5. Winters, Heather. "Intervention involving traditional birth attendants and perinatal and maternal mortality." World Health Organization. WHO, 2011. Web. 5 Apr 2011.

6."Hospital Based Doula and Midwife Programs - A Guide For The Professional." Birthsource,com. Perinatal Education Associates, Inc., 2010. Web. 1 Apr 2011. <http://www.birthsource.com/scripts/article.asp?articleid=94>.

*Most of the information was from this book, it wouldn't let me transfer my notes into blogger.

**Some of the statements were made in an in-class speech