Some time ago I wrote a post on the Citizens for Midwifery blog about medical control as acceptable, in which I pondered the question of why do we care about birth, if many birthing women themselves don’t really seem to care? Why do we make it any of our business what other women choose to do with their births? And, is it any of our business anyway?
Well, I’ve been doing some thinking and I made and shared a list of why I care on the CfM blog. However, I wanted to go ahead and share my reasons on this blog as well. This is why I care about about other women’s births:
- Because women are suffering (birth trauma is real–see organizations like Solace for Mothers–and postpartum mood disorders are very common).
- Because babies are suffering–late pre-term births are increasingly common due to induction, many babies experience at least some post-birth separation from their mothers (which is not their biological expectation), and many babies spend time in the NICU. Infant mortality rates, especially for minority babies, are higher than in other industrialized countries.
- Because breastfeeding is suffering and thus public health is suffering (see my previous article on the birth-breastfeeding continuum)
- Because the physical costs of our current birth model are high (morality and morbidity rates are higher than necessary due to high volume of cesareans and many physicians and hospitals do not practice evidence-based care–continuing to deny laboring women food and drink and continuing to use Cytotec for inductions for example).
- Because the financial costs of our current birth model to society are high–birth is a multi-billion dollar a year industry. Some facts from CfM:
- Over four million births in the US each year (26.4 births per 1000 women aged 15-44 years in 2004).
- Second most common reason for hospitalization of women.
- Care for mothers and babies combined rank 4th for hospital expenses.
- Hospital costs for deliveries mounted to more than $30 billion in 2004. More than 30% of births by cesarean section. ranking seventh highest total on the “national bill” for procedures (over $17 billion per year).
- Of all births, 99% take place in hospitals, 90% are attended by obstetricians.
- Over 6 million obstetric procedures are performed – the most common category of surgical procedures.
The percentage of births paid for by Medicaid varies from state to state but can be as high as 50% or more in some states. Coverage by all insurers (Federal government, Medicaid, private, HMOs, etc.) varies; many will not reimburse for OOH births, and when midwives are covered, the reimbursement rate is only a percentage of the rate for physicians. We all pay for births, including unnecessary interventions and preventable complications and injuries, through our taxes, health insurance withholding, and individual policies.
- Because women’s birth memories last a lifetime (see Simkin, Not just another day in a woman’s life).
- Because women deserve better.
- Because I know in my heart that birth matters for women, for babies, for families, for culture, for society, and for the world.
Talk Birth 
After having many “debates” about the delivery of maternity care in our country, I have often pondered the same question… Why do I care so much if in fact so many women don’t care? There have been times when I tried not to care but that just simply did not work. I care for all of those reasons you mentioned. I care and speak out because I truly believe more women (and men) would care if they knew the truth and had more information. They often don’t care because they don’t realize they need to/should care. It can certainly feel strange… fighting a battle for women I don’t know, women who are not even interested. Example: I once had a patient who was undergoing an induction for pre-eclampsia. The on-call provider suggested we do a c/section because she had a hunch the induction was not going to work. She continued by saying that with the diagnoses of SEVERE pre-eclampsia she could easily justify a need for immediate delivery by c/section. While the patient was pre-eclamptic, the diagnoses of SEVERE pre-eclampsia was definitely arguable. This was her first pregnancy and I knew she, had planned for an unmedicated vaginal delivery. With that in mind, I THOUGHT the idea of an unnecessary c/section would be out of the question for her. I spoke with the physician about it and she laughed it off and decided to go home while the induction got underway. As I entered the patient’s room to start her induction she asks me
“What if I just decided to have a c/section right now instead?”
I was shocked to say the least. She was scared, she was distraught, she was frustrated that
“nothing I want is happening so I just wanna get this over with NOW.”
Long story short… after discussing risks/benefits of c/section versus vaginal delivery including risks of future pregnancies we gave her her wish; 2 hours later her newborn baby lay in the nursery as she lay in recovery in pain with repeated episodes of vomiting. I didn’t get a chance to talk to her about her feelings in detail post delivery but I did make note of a few things. She hardly had any contact with her infant during the first 24 hours and very limited contact with her infant over the first few days. Her breastfeeding suffered and she was supplementing with bottles far more than she originally planned. Her pain was not well controlled and she voiced openly that overall… she was not a happy camper. Would the induction that I tried to advocate for have been a better route with a different outcome? Who knows? A cesarean is always a possibility. If I had to do it again would I advocate for a chance at a vaginal birth again. ABSOLUTELY! I cant control the outcomes, they are definitely unexpected sometimes but I will continue to care about and argue for mother and baby friendly birth. I care about women and their birthing experiences because whether many realize it or not, I know women and their families are suffering due to the way maternity care is provided in our country today. Somebody’s gotta care. Why not us :-))
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