birth care | Talk Birth

Two things came to my attention today that made me think about how ironic it is that the medical system “lets” or doesn’t “let” women do so many things with regard to pregnancy and birth care and yet if something goes wrong, the locus of control shifts suddenly and it is now her fault for the situation. I see this often with things like “failure to progress”—“she’s just not dilating”—and even with fetal heart decelerations (“the baby just isn’t cooperating”). With induction—“her body just isn’t going to go into labor on its own”—and with pain relief—“she’s just not able to cope anymore” (yes, but is she also restrained on her back and denied food and drink?!). There are other ugly terms associated with women’s health that blame the “victim” as well such as “incompetent cervix” and “irritable uterus” and even “miscarriage” (and its even uglier associate, “spontaneous abortion.” And then for women with recurrent pregnancy losses we have the lovely, woman honoring term, “habitual aborter.” EXCUSE me?!). And then today, via The Unnecesarean, I read about a doctor inducing “labor” and then performing a cesarean on a non-pregnant woman.

Okay wow. So much could be said about that, but the kicker for me is that the woman was blamed—“The bottom line is the woman convinced everybody she was pregnant.” Huh?! So random surgery is totally acceptable if the person is “convincing” enough? What happened to diagnosing something first? Or, for taking responsibility for an inaccurate diagnosis?

The final thing that happened is that I got a completely unexpected refund check for over $400 today from my own local medical care system. While I’m not complaining about $400 that I thought I’d seen the last of, I had to shake my head in disbelief at the reason for the refund—“you overpaid”—excuse me, but I think the real reason is, “you overcharged me.” I checked back through my bills and I paid what I was billed (which, now that I think about, did seem like a heck of a lot for services NOT-rendered. If I had been in less of a state of grief and shock perhaps I would have questioned it more!), but now it has become “my fault” (in a sense) by switching the language to my overpaying vs. them overcharging.

What interesting dynamics these are…

In Sept. 2007, Citizens for Midwifery published a useful new fact sheet summarizing the evidence basis for the 10 Steps for Mother-Friendly Care. The fact sheet is two sided and packed with information. The Coalition for Improving Maternity Services (CIMS) has a mission “to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.” To this end, they created the evidence based
Mother-Friendly Childbirth Initiative (MFCI). This Initiative “provides guidelines for identifying and designating “mother-friendly” birth sites including hospitals, birth centers and home-birth services.” There are ten steps for mother-friendly care and ample evidence supporting each step.

CIMS also has a very useful consumer handout–“Having a Baby: 10 Questions to Ask“–that helps expectant couples ask questions of their health care providers to determine if the care they are receiving is the evidence based, mother friendly care all pregnant women deserve.

The 10 Steps are:

“A mother-friendly hospital, birth center, or home birth service:

Offers all birthing mothers:
- Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
- Unrestricted access to continuous emotional and physical support from a skilled woman-for example, a doula or labor-support professional:
- Access to professional midwifery care.
Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
Provides culturally competent care — that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
Has clearly defined policies and procedures for:
- collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
- linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
- shaving;
- enemas;
- IVs (intravenous drip);
- withholding nourishment;
- early rupture of membranes;
- electronic fetal monitoring;
Other interventions are limited as follows:
- Has an induction rate of 10% or less;
- Has an episiotomy rate of 20% or less, with a goal of 5% or less;
- Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
- Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
Educates staff in non-drug methods of pain relief and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
Discourages non-religious circumcision of the newborn.
Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding…”