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Throughout the past century women in America
have pursued a solution to the discomfort of childbirth. A focus on the use of chemical anesthetics led first to experimentation with chloroform, then to four decades of scopolomine and morphine (the twilight sleep—or twilight nightmare.) Cervical blocks were tried, general anesthetics, and then finally epidural blocks. These highly specialized pain relief techniques have helped to drive birthing mothers into the hospitals and into the care of medical doctors. The expectation of
many pregnant mothers now is that birth can be relatively free of pain.
But something about the mechanism of giving birth in the US seems to be misfiring. The US has a very high proportion of hospital-based births, with home births making up less than one percent of the total. The US has a high proportion of physician attended births, with doctors overseeing 92% of deliveries. The US has a high rate of medical intervention in birth (for example, episiotomies are done in 90 % of births.) But in spite of all this medicalization the infant mortality rate is startlingly high. The US has a higher infant death rate than thirty-six other nations, and now has infant mortality about the same as Poland and Serbia (6 to 6.5 deaths per thousand births–statistics from the CIA world factbook). The rate of caesarean births has risen to 31% (in defiance of the World Health Organization’s recommendation of a c-section rate between 5 and 10 %), and the rate of maternal deaths (mothers who die from childbirth), at 16.7 per 100,000, is higher than 38 other countries, and is four times the death rate of Italy—a shocking fact in a nation that has the best medical trauma care in the world. (statistics from a study published in Lancet Medical Journal)
Somewhere in our quest for modern medical care we have missed the mark. With medical intervention in birth, more is not necessarily better. Consider, by comparison, the Netherlands, which has less than half the rate of maternal deaths compared to the US, and a significantly better survival rate for babies as well. The Netherlands has a c section rate of only 7 % and an episiotomy rate of 6%. The Dutch are doing much better than we are—in a country where 30 percent of births are home births attended by midwives rather than doctors.
Emotional trauma may play a role in our childbirth problems. Women giving birth in the hospitals often report feeling powerless, even victimized by procedures that disregard their preferences and minimize their sense of autonomy. The “medicalization” of childbirth involving IVs and fetal monitors often restricts the mother to lying in her bed, a position that is far from ergonomically optimal for childbirth. Doctors pop in occasionally, doing very little to provide steady coaching and emotional support.
The c-section rate is likely a major factor as well. Unnecessary c-section births increase the risk of bleeding, infections, blood clots and other complications in the mother, and increase the risk of respiratory problems in the infant.
In this first segment of a three-part series, Diana Hoffman will be joined by special guest Diane Hopkins to explore the strategies, techniques and emotional support components that can reduce trauma in childbirth. What are the benefits and drawbacks of epidurals? What are the roles and impact of birth companions, doulas, hypnotic childbirth, or natural childbirth courses? What impact do childbirth practices have on partner bonding between the parents of the baby, and on materanal-infant bonding? What are the risks and advantages of birthing centers, midwives, and home births? How can birthing mothers resist the pressure to have a c-section and other medical interventions? What is research showing we can do to create safety, comfort, nurturing and bonding in a variety of birthing situations, including hospital settings ?