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Dec
01

Better Birthing: It's About Time

Author // Cynthia Overgard

When Jenny arrived at her assigned birthing room, she wasn’t prepared for the clock. It was a large, digital timer, which hung over her bed and was started when the nurse walked in.

As the clock began running, she was told she had 10 hours to get to 10 centimeters. Then, for pushing her baby out in the second stage of labor, the clock would be restarted at zero and she would have “two hours till c-section.” They never asked Jenny how long she labored at home before coming to the hospital. No matter, apparently.

Sadly, Jenny is not alone. As a childbirth educator in the greater New York/Connecticut area, I hear stories like this on a regular basis.


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“Because-We-Said-So” Childbirth Protocols

Just for a moment, let’s give this protocol the benefit of the doubt. It seems there is a concern about the risk of prolonged labor. “Prolonged labor” is defined by the World Health Organization (WHO) as labor lasting “longer than 24 hours.” Thus, this tidy, round number of 10 is recklessly arbitrary and unsubstantiated.

When obstetricians implement policies and protocols—such as keeping women on their backs or depriving them of food and water during labor (both of which have been shown to increase risk and slow labor)—one of the first questions to ask is this:

Does this serve the birthing mother and her baby?


A Call for Common Sense

It would be difficult, if not impossible, for any woman to relax under such duress, because high levels of adrenaline in the system are a counterforce to childbirth. Jenny’s instinct was right on: She instructed her husband to cover the clock with a sheet. But each time the nurse reentered the room, the sheet was yanked down.

Prolonged labor is often called “failure to progress,” and does not imply obstructed labor. Prolonged means just that: a longer, slower labor. For what it’s worth, the average labor for a first-time mom is 12 to 18 hours, according to WebMD, and that website’s definition just applies to active labor. (Early labor is often much longer.) The course of a woman’s birth is more art than science. For some, labor can be stop-and-go for days. Tiring? Perhaps. Dangerous, no.

Time limits during childbirth aren’t serving women. They’re just another way to set the stage for a c-section—the most common major surgery in the United States.


First Do No Harm

This isn’t just about vaginal birthing for the joy and gratification of it, although that should not be discounted. Cesareans are significantly more dangerous for mother and baby.

Last year, the WHO reported: “Maternal mortality among women who undergo cesarean section is four to ten times higher than among women who deliver vaginally.” As for the baby, in a neonatal mortality review, the WHO reported: “Cesarean section and intrapartum complications were associated with neonatal death. In an urban population with good access to professional care, we found a high neonatal mortality rate, often due to preventable conditions.”

Women shouldn’t settle for providers who impose arbitrary time restrictions on them, because such practices are sending too many women off to the operating room when they were simply experiencing normal, healthy births. The U.S. cesarean rate continues to climb annually, and is currently at its highest rate, affecting 1 in 3 women and babies.

Nature isn’t failing us one third of the time. The system is failing us.


Internal Conflicts

“Bitter Pill,” an article by Stephen Brill in Time last February, revealed that pharmaceutical and hospital lobbyists succeeded years ago at getting Congress to categorize hospitals as nonprofit entities while allowing them to make profits. This has created an inherent conflict of interest in the healthcare industry.

One of the hospitals featured in his article was Stamford Hospital. He reported, “Stamford Hospital managed an operating profit of $63 million…. That’s a 12.7 percent operating profit margin, which would be the envy of shareholders of high-service businesses across other sectors of the economy.” He goes on to point out that it’s not uncommon for hospital administrators to earn seven-figure annual salaries.

So you see, what presents itself as a dot-org is actually a dot-com.


Connecting the Dots

What does this have to do with childbirth? Labor and delivery is the No. 1 revenue driver for many hospitals. But, the irony! With all the cancer, heart disease, obesity and diabetes in the U.S., the medical industry has achieved a most impressive feat: It has taken the healthiest among us—our young, pregnant women— and convinced them they require medical intervention at every turn. The problem is, too many low-risk women seeking normal, uncomplicated births are being pressured with protocols that unequivocally increase childbirth risk, such as Pitocin to induce or “speed up” labor, continuous electronic fetal monitoring, and deprivation of the most fundamental need for survival— food and water. What next, oxygen?

It’s too bad that natural birth generates the lowest possible maternity revenue for hospitals, whereas cesareans not only generate the highest (it is “major surgery”), but are enticingly quick procedures. How unfortunate that revenue must be a part of this conversation at all.


The Tipping Point

Right around this point in any article that supports a birthing woman’s choice and freedom, there always seems to be a disclaimer where the author feels the need to acknowledge that cesareans have saved lives. Indeed, they have been the right choice for many women and babies who were facing risks greater than the surgery itself.

But there is a tipping point, where cesareans stop saving lives and start taking lives. According to the Center for Disease Control’s Pregnancy Mortality Surveillance System, a pregnant American woman today is more than twice as likely to die from pregnancyand birth-related causes as in 1987. Time magazine’s March 12, 2010, article “Too Many Women Dying in U.S. While Having Babies” cited that a woman is five times more likely to die in childbirth in the U.S. than a woman in Greece. And the Los Angeles Times reported that California has seen a tripling in maternal mortality in recent years, with c-sections identified as a “major contributor” to the trend.

Dare we admit this: Vaginal births save lives, too.

Our national cesarean rate of 1 in 3 women is a warning to us all. It’s not that providers should stop performing c-sections—it’s that they should stop pushing interventions and protocols that are known to lead to c-sections. But this is the country we live in, and because this medical model isn’t likely to change…

We must change.

We must take greater responsibility for our health, our bodies, and our babies. We have to stop buying into the “doctor’s orders” way of thinking, and remind our doctors that we’ve hired them, so it’s their job to serve us. One human being has no moral or legal right to “require” tests, protocols, procedures or surgery on another. Constitutional informed-consent laws support this. But as a culture, we voluntarily relinquish those rights because we feel intimidated and uninformed.

Women recall and recite their birth stories thousands of times throughout their lives. It’s a life experience that changes us to the core. What an injustice to leave any woman wondering if she was possibly robbed of a healthier, better birth. Whether childbirth is natural, medicated or surgical, a woman deserves to be emotionally at peace with her birth all her life.


A Final Push

When the clock overhead was at eight hours and counting, Jenny’s doctor entered the room with a spring in her step. For one woman it was the middle of her labor; for the other, the end of her workweek.

“Look,” the obstetrician began. “It’s three o’clock on Friday and I’m leaving in two hours. I’m not on call this weekend, and I don’t know which of my colleagues you’ll end up with. So, what do you say? Do you want the A Team to deliver your baby, or the B Team?”

“Doctor,” how I wish Jenny responded, “it seems you neglected to consider whether I’d like to deliver my own baby.”


Pathways Issue 39 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #40.

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