Medicalized birth is a feminist triumph!

cropped view of woman pointing at pink feminist t-shirt, isolated on grey

Childbirth is a reproductive rights issue.

Every woman deserves access to high quality obstetric care, and every woman deserves access to state of the art pain relief. That’s because medicalizing birth is a feminist triumph and all women should be able to share in its benefits.

”A possible death sentence came with every pregnancy.”

Childbirth, in every time, place and culture, is a leading cause of death of young women and the leading cause of death of babies. As historian Judith Walzer Leavitt has noted in Under the Shadow of Maternity: American Women’s Responses to Death and Debility Fears in Nineteenth-Century Childbirth, until the last 100 years:

A possible death sentence came with every pregnancy.

Visit any cemetery, from any century, in any country, and you will find the gravestones of the countless young women who died in childbirth, many after days of horrific agony.

Maternity, the creation of new life, carried with it the ever-present possibility of death. The shadow that followed women through life was the fear of the ultimate physical risk of bearing children. Young women perceived that their bodies, even when healthy and vigorous, could yield up a dead infant or could carry the seeds of their own destruction… Nine months’ gestation could mean nine months to prepare for death.

The very real possibility of death during childbirth shaped women’s lives and relationships:

Perhaps more valuable to our understanding of the reality of maternal death is the observation that most women seemed to know or know of other women who had died in childbirth. One woman, for example, wrote that her friend “died as she has expected to” as a result of childbirth as had six other of their childhood friends. Early in the twentieth century approximately 1 mother died for each 154 live births. If women delivered, let us estimate, an average of five live babies, these statistics can mean that over their reproductive years, one of every thirty women might be expected to die in childbirth. In another early-twentieth century calculation, one of every seventeen men claimed they had a mother or sister who had died as the immediate results of childbirth.

Medicalizing childbirth changed that. Now no woman with access to medicalized birth expects to die during pregnancy.

But living through the birth was only the first hurdle for many women. Some sustained injuries that affected them for the rest of their lives:

In the past, the shadow of maternity extended beyond the possibility and fear of death. Women knew that if procreation did not kill them or their babies, it could maim them for life. Postpartum gynecological problems – some great enough to force women to bed for the rest of their lives, others causing milder disabilities – hounded the women who did not succumb to their labor and delivery. For some women, the fears of future debility were more disturbing than fears of death. Vesicovaginal and rectovaginal fistulas .., which brought incontinence and constant irritation to sufferers; unsutured perineal tears of lesser degree, which may have caused significant daily discomforts; major infections; and general weakness and failure to return to prepregnant physical vigor threatened young women in the prime of life.

Medicalizing childbirth changed that. Now no woman with access to medicalized birth expects to become permanently incontinent of urine and feces as a result of childbirth.

Women viewed childbirth not as the empowering fantasy so beloved of midwives and natural childbirth advocates, but as a specter of unremitting agony:

Apart from their concern about resulting death and physical debility, women feared pain and suffering during the confinement itself. They worried about how they would bear up under the pain and stress, how long the confinement might last, and whether trusted people would accompany them through the ordeal. The short hours between being a pregnant woman and becoming a mother seemed, in anticipation, to be interminably long, and they occupied the thoughts and defined the worries of multitudes of women. Women’s descriptions of their confinement experiences foretold the horrors of the ordeal.

The voices of these women have the power to move us profoundly more than one hundred years later:

Josephine Preston Peabody wrote in her diary of the “most terrible day of [her] life,” when she delivered her firstborn, the “almost inconceivable agony” she lived through during her “day-long battle with a thousand tortures and thunders and ruins.” Her second confinement brought “great bodily suffering,” and her third, “the nethermost hell of bodily pain and mental blankness. . . . The will to live had been massacred out of me, and I couldn’t see why I had to. Another woman remembered “stark terror was what I felt most.”

“Between oceans of pain,” wrote one woman of her third birth in 1885, “there stretched continents of fear; fear of death and dread of suffering beyond bearing.” Surviving a childbirth did not allow women to forget its horrors. Lillie M. Jackson, recalling her 1905 confinement, wrote: “While carrying my baby, I was so miserable… I went down to death’s door to bring my son into the world, and I’ve never forgotten. Some folks say one forgets, and can have them right over again, but today I’ve not forgotten, and that baby is 36 years old.” Too many women shared with Hallie Nelson her feelings upon her first birth: “I began to look forward to the event with dread-if not actual horror.” Even after Nelson’s successful birth, she “did not forget those awful hours spent in labor…”

Medicalizing childbirth changed that. Now no woman with access to medicalized birth expects to suffer severe, unremitting pain from the beginning of labor to the end. She can request and receive an epidural and simply rest and sleep through hours of contractions.

Indeed, so confident of excellent pain relief are women who have access to medicalized childbirth that some women actually think they’ve “achieved” something by refusing it.

One of the great deceptions of contemporary midwifery involves midwives fooling themselves and others that the philosophy of natural childbirth reverts back to unmedicalized birth. Nothing could be further from the truth. Natural childbirth is a philosophy of privilege, specifically the privilege of having easy access to medicalized childbirth. An “unmedicalized” birth can only be safe when embedded firmly within a society that provides unlimited access to obstetricians to rescue women from their own folly.

A midwife without an obstetrician is better than nothing at preventing death in certain limited circumstances, but virtually useless when it comes to saving lives in most emergencies. Without the ability to perform a C-section, midwives, like their ancient counterparts, are helpless in the face of everything from life threatening crises to simple failures of the baby to fit through the maternal pelvis. Without the ability to end a protracted labor by means of forceps or C-section, midwives are helpless to prevent obstetric fistula. Without the ability to offer epidurals, midwives are reduced to pretending that ineffective measures are effective, or, bizarrely, that labor pain is beneficial.

Childbirth is a reproductive rights issue.

Every woman deserves access to high quality obstetric care, and every woman deserves access to state of the art pain relief. They are only available in a system that medicalizes birth.

  • AmandaRoddy

    Every woman also deserves the right to birth control. I bet those women would have given anything for it.

  • fiftyfifty1

    Imagine being the mother of a daughter. Watching her grow up. Worrying for her future. Knowing the pain and danger she faced as she married, but helpless to do anything.

  • Donna Stiles

    Check out some of the complications and deaths at Touro Hospital in New Orleans. And they decline to discuss or improve!

    https://www.usatoday.com/in-depth/news/investigations/deadly-deliveries/2019/03/07/maternal-death-rates-secret-hospital-safety-records-childbirth-deaths/2953224002/

    Delivering at a hospital does not guarantee you will not be injured or die.

    • LaMont

      Driving sober does not guarantee that you will not be injured or die

      • Donna Stiles

        True. I agree.
        Did you read the article about this one hospital and its outcomes of death and injury?

    • Mel

      Delivering at home does not guarantee that you will not be injured or die.

      It just increases your risk of killing a first-born by 706% and a multip pregnancy fetal death by over 300% according to data collected by MANA of voluntary reported information from CPMs.

      You say that you worked in a postpartum ward at a BFHI hospital downthread. I assume that you never had to have anyone sign a consent form – but I had to sign one that was very clear that delivering in a hospital might lead to death, severe injury or minor injury for me or my son.

      • Donna Stiles

        I’m not saying home birth is any safer and I know those statistics for newborns. Isn’t that horrible? My premise is delivering in a hospital does not guarantee safety. Deaths for mothers are increasing! There is something so wrong about this. Do read some of the articles I’ve posted detailing deaths and horrific injury in hospitals.

        Life is full of risks and for childbearing women, we should be willing and able to do something about it, every hospital, everywhere.

        • swbarnes2

          No one is claiming that hospitals magically prevent all maternal death. NO ONE.

          Your reading comprehension is severely lacking.

          • Donna Stiles

            Medicalizing childbirth changed that. Now no woman with access to medicalized birth expects to die during pregnancy.
            That’s what it says in the above article.
            And I have a masters degree so please don’t personally attack me or assume you know me and my reading comprehension. I’m just trying to have a conversation here.

          • fiftyfifty1

            I read your links and even in those stories people interviewed were incredulous that their loved ones had died. Modern obstetrics has been so successful in reducing the maternal death rate that our society as a whole has forgotten how deadly pregnancy can be. Then the danger is that we slack off–for example the things that happened in the hospital where they were understaffed and residents apparently were often unsupervised (!)

            Modern obstetrics is a feminist miracle, but we can’t back off, we can’t take it for granted.

          • MaineJen

            It says “No woman EXPECTS to die” not “No woman dies.” No one expects to die while having a baby because almost no one has known anyone who did. At least, not in the modern era.

            The death of a mother while giving birth has become so rare *because* we medicalized childbirth.

            By de-medicalizing childbirth, by eschewing preventive measures that are routine in “medicalized” care, you’d be asking us to go back to a time when maternal death was not rare at all. That shouldn’t be the goal.

    • Amy Tuteur, MD

      No, but NOT delivering at a hospital in those situations guarantees that you WILL be hurt.

    • rosewater1

      Uh, who says it does?

      There are bad hospitals and bad doctors. And bad midwives.

      You punish the bad ones. You make right the mistakes that have been made. And you keep trying to make birth as safe as possible.

      Demonizing hospitals isn’t the way to do that.

      Educating women is one way to do so.

      • mabelcruet

        And in professionals employed by hospitals, there are regulatory bodies supervising their performance and with policies in place to ensure that poor practice is dealt with. In NHS hospitals we have a specific department dealing with complaints, and the procedure of complaining about the care received is widely advertised and laid on each hospitals website. There are regulatory and supervisory statutory bodies governing the hospital itself, and then professional bodies supervising the different types of staff. If you’re not happy with the response you get from the hospital, you can progress your complaint to the ombudsman. You can take it further to the midwifery statutory body, or the medical (the GMC) and as public bodies they have to respond.

        We make it very easy for patients to complain. And that’s the way it should be, we have to see complaints as a way in which we can improve. We know that not every interaction with patients will go well, we know there are occasional vexatious complaints but on the whole, when things go wrong, patients want an explanation, an apology and assurances that we will do our best to make sure it’s not repeated. That’s what professionals do-we are accountable. Unlike homebirth midwives, who have no insurance, no indemifying body, no overseeing body that can impose sanctions, no way in which they can be disciplined when they make a mistake. Yes, mistakes happen, some hospitals don’t deal with complaints in the way they should, and in the past there have been problems that persisted and not acted on quickly enough, but the NHS is a responsive body and we do try and learn and improve.

  • Donna Stiles
  • Donna Stiles

    over the past two decades, the US maternal mortality rate has doubled, making the US the only developed nation in the world with an increasing maternal mortality rate. So obviously we are not providing the best care to women that can promise them they won’t die in childbirth.

    • AnnaPDE

      Yes, and if you look at the specific reasons, they relate to lack of access to medical care during pregnancy. The problem is not that childbirth is medicalised. It’s that in the US, medical care is often unaffordable, while pre-existing medical conditions (from age to obesity) are rising.

      • LaMont

        Yeah, I wonder how “just go back to the perfect state of nature” is going to help those women who are dying… “just be healthier in the first place and pregnancy can’t hurt you” seems to be the one thing hippie lefties and authoritarian righties can agree on….

        • Donna Stiles

          I’m not saying going back to nature is going to help. I don’t need to be convinced that childbirth, though a natural function, can go dangerously wrong. I’ve been a provider for 40 years. I’ve seen it all.

          • Amy Tuteur, MD

            So what is your point?

          • Donna Stiles

            My point is going to a hospital does not always mean you will get the best care. Hospitals are many times part of the problem. Maternal morbidity and mortality have increased over the years and most babies are born in hospitals. Just going to a hospital is not a guarantee against injury and death.

          • The Bofa on the Sofa

            My point is going to a hospital does not always mean you will get the best care

            Where do you think you will get better care? At a different hospital, sure, that’s possible.

            Just going to a hospital is not a guarantee against injury and death.

            Who said it was?

            You are blowing a lot of smoke here fighting a straw man, it appears.

          • Donna Stiles

            Medicalizing childbirth changed that. Now no woman with access to medicalized birth expects to die during pregnancy.

            As stated in the above article. Women do die and are injured in medical childbirth in a hospital. The rate has increased inspire of the fact that most babies are born in hospitals.

          • The Bofa on the Sofa

            And still, and? Who has said anything otherwise?

          • rational thinker

            I think she is promoting midwife care in a birth center, but she does not want to say it outright.

          • fiftyfifty1

            “but she does not want to say it outright”

            Yes, because we would laugh her out of town. If I followed the same logic, I would be bragging about so many of my own patient outcomes. My own patients have lower rates of MI and cardiac death than patients seen by cardiologists! My own patients with diabetes have better outcomes than the patients of endocrinologists! Back when I delivered babies my CS rate was rock bottom low and I never lost a single mother or baby! Probably it’s the wonderful, individualized, culturally sensitive care I provide! Or maybe it’s the fact that unlike those cardiologists and endocrinologists, I don’t load up my patients with a lot of medicalized tests and medications. Under my care, most of my diabetics don’t even need insulin! Wow, more doctors should be like family physicians!

          • Amazed

            Bla-bla. Instead of being sleazy and “nicely” promoting dangerous practices, say it outright just how higher this “increased” rate is compared to the time birth was gloriously unmedicated.

            Only, you can’t, right? Because you know it’s STILL much lower. What’s your game? Give birth at home or with some of your fellow midwife bullies because hey, death rates in hospital have increased, although they’re still many times lower than when you bullies were in power?

            Of course, midwives of old times were no bullies. They were trying to help mothers to the best of their abilities, not their own self-centered agenda.

          • Cristina B

            You said above that higher risk/more complicated patients would get risked out, so I’m not sure how you can say you’ve seen it all? Do you still follow the patient if they’re beyond your abilities? Do you follow them to the ER if they develop problems while under your care in active labour? I’m honestly curious. My GP was in the OR when my breech baby was born, but she also would have been able to assist with the surgery if there wasn’t already a Fellow doing that.

          • Donna Stiles

            Low risk patients can become high risk. I had training to assist with cesareans. We also did follow up care postpartum if there were no problems.

        • Donna Stiles

          Yes, don’t blame the victim.

      • Donna Stiles

        The problem is also some of the hospitals. Please look at the articles I posted for very real deaths and horrible morbidity and then the hospital taking no accountability nor making changes,

        Some hospitals are great and other are not. There are some states making statewide mandates for maternity care and cutting the rate in half.

      • Donna Stiles

        I agree. And sometimes the medical care is awful. The worse cases are sometimes in cities like New Orleans. Have you read any of the articles I’ve posted?

    • rational thinker

      How many of those hospitals are baby friendly I wonder? Often times in baby friendly hospitals when a mother complains she is not feeling well or something isnt right the nurse is more likely to not tell the woman’s doctor and ignore the patients request. There is an abundance of women who have been treated this way. In BFHI the nurses tend to look down on you if you get an epidural or are not planning to breastfeed. There are moms that had pain killers prescribed by doctors for them after the birth and the nurse decides she knows better and refused to give mom her meds. Also if you are breastfeeding they are less likely to tell doctors that mom is bleeding too much or has high blood pressure because then they may be put on meds and then they may not be able to breastfeed and the nurses care more about their breastfeeding numbers than mom getting the medical care they need. So the real question would be how many of those hospitals are BFHI.

      • Donna Stiles

        I don’t think one can generalize about that and having worked in a baby friendly unit, I can tell you it wasn’t the case where I worked. the nurses were attentive and kind and in my experience called about any concerning development regardless of the hour. And didn’t hesitate to call back.

        • Mel

          That’s your experience of your colleagues. Did your patients agree?

          • Donna Stiles

            I read very high commendations from surveys given to. Each patient. We had studies to study time to answer a call bell.

            Why can’t you believe that I worked in an awesome labor and delivery unit.
            I am a retired certified nurse midwife. My practice had an11% cesarean rate. Our obstetrical physicians are rock stars and supportive of midwives. My hospital was supportive of “natural” birth, water birth and medication as desired by request (IV, nitrous oxide, epidural).

            Why can’t you believe my hospital is awesome.

            People coming in as transfers from home births were treated with respect per the direction of our head OB. They could have midwifery care as long as emergent Care was not indicated. Many of the families transferred into the hospital from home were very impressed and pleased by the care they received.

            Why can’t you believe the unit I worked on was awesome? They are.

          • rational thinker

            I would be cautious about delivering at a hospital that has a low section rate, When they try to lower their section rates women and babies suffer.

            I hope your hospital was not letting women give birth in the water cause that is very irresponsible medical care.

          • Donna Stiles

            Women were allowed to give birth in the water after it was researched by the department and found to be a safe alternative, the hospital did not have a low cesarean rate, our midwifery group did.

          • The Bofa on the Sofa

            after it was researched by the department and found to be a safe alternative,

            ACK!!!!

            How did they “research” it? In what journal did they report their findings?

          • Donna Stiles

            The head of the OB department researched this many years ago. Pediatrics signed on and there have been waterbirths there for almost a decade. There are parameters of course.
            If there were any bad outcomes they wouldn’t continue. They continue to this day in both hospitals of the area.

            One thing also needed in obstetric Care is care in a hospital for women who want water births, low intervention births, Births without medicine. Our department did it’s best to have people birth in a hospital where medical help for mom and baby were immediately available instead of in the home or birth center.

          • The Bofa on the Sofa

            I notice you didn’t answer my question: In which scientific journal did your head of department publish their research findings?

          • Donna Stiles

            He did a review of the literature.

          • MaineJen

            What do you do when the mom poops in the birthing tub?

          • mabelcruet

            You know those little nets that you get if you keep goldfish? The ones that you use to scoop out your fish so that you can clean the tank? It would double up nicely for a maternal pooper-scooper.

          • KQ Not Signed In

            That is literally what they do. They sell those little nets as part of birthing kits

          • StephanieJR

            I threw up in my mouth a little.

          • KQ Not Signed In

            Better there than in the pool; it’s not a puker-scooper.

          • Cristina B

            I used to follow the blog STFU Parents and a post about a water birth with poop in the pool is what led me here. Actually, googling something along the lines of water birth being incredibly unhygienic did it. We tell our kids to wash their hands before eating for health reasons, but they can be born in a pool contaminated with literal shit and it’s a safe alternative?! Honestly, the thought of a vaginal tear, even a small one, in a contaminated pool skeeves me out.

          • MaineJen

            OK that is disgusting.

          • mabelcruet

            How else are you going to establish the correct microbiome? It’s probably on a list of recommendations somewhere-the optimal time to leave the floating debris in order for it to seed the water with the healthy bacteria…

          • Who?

            I wouldn’t go all the way out to ‘nicely’.

            So gross. Much better to be on a bed where they can deal with it as a simple tidying and laundry issue.

          • mabelcruet

            I was thinking about home water birth with the whole family joining in-dad could be rubbing mum’s back, oldest child could be helping mum with her affirmations and breathing, youngest child could be on poop-scoop duty with the fishing net keeping an eye out for floaters….

          • rational thinker

            I wonder what she does if mom gets the runs.

          • mabelcruet

            Remember the olden days when women had an enema before labour? Maybe going back to enemas would help preserve the sanctity of waterbirths. Personally, I’m quite comfortable with maggots, decomposition, liquefying organs and viscera, and cleaning out my diarrhoeal cats litter tray, so I can hardly be said to be squeamish, but the thought of giving birth in a pool with floating turds really does not appeal.

          • Donna Stiles

            Scoop it out.

          • momofone

            Would you be recommend dipping a baby not born in water into a tub of feces-filled water?

          • Donna Stiles

            Not really but a water birth may or may not be my choice or yours.
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210671/#!po=15.2778
            An excerpt from the article as it pertains to newborns:
            No relationship has been found between hydrotherapy and infections or an increase in admissions to special care nurseries. In Oregon, the Oregon Health and Science University (OHSU) has been teaching safe water birth in the nurse-midwifery education program since approximately 1999 when Sig-Linda Jacobson, one of the perinatologists on the staff who had completed a fellowship in England, where water birth was routine, worked with the midwives to create the guidelines that are still being used in that facility (Mack, Pechovnik, Andronici, Tallman, & Lowe, 2005). That OHSU program continues today without any evidence of added risk to the neonate.
            A 1996 Scandinavian study of women with premature rupture of membranes and prolonged latency, in which part of the study group took baths once labor began and the rest labored conventionally, compared rates of infection in neonates following the births. The bath group had significantly lower rates of infection than the bed group, concluding that even with waiting for 72 hr for labor to begin, using hydrotherapy did not increase infection (Eriksson, Ladfors, Mattson, & Fall, 1996).
            The subject of fecal matter in birth pools always comes up when infection risk during water birth is discussed. Dr. Rosenthal (1991) began offering water birth to clients at his free-standing birth center in Claremont, California, in 1992, after hearing a lecture by Dr. Michel Odent. Dr. Rosenthal, being one of the first U.S. board–certified obstetricians to embrace water birth, was often interviewed and asked about this. He explained in numerous interviews that the dilution effect of the water actually reduced the exposure to any harmful bacteria and then went on to explain that every baby needs to be exposed to the bacteria from the mother’s vagina and rectum to create the proper microbial protection for the baby. He was 20 years ahead of his time when he stated that “the solution to pollution is dilution.” Recent studies that looked at group B Streptococcus exposure to babies born in water revealed that the tendency was for less colonization of bacteria on the water babies compared to the land-born babies (Zanetti-Dällenbach et al., 2007).
            No relationship has been found between hydrotherapy and infections or an increase in admissions to special care nurseries.
            The bottom line in preventing infection and cross contamination in birth pools and equipment is to make everything either disposable or cleanable. Having infection control policies in place for all birth settings, even home births, is necessary to prevent serious infections from occurring, especially with multiuse birth pools and installed bath tubs.

          • MaineJen

            Yeah…at that point the birth tub turns into a toilet, and it probably isn’t safe to have a baby under the water.

          • Donna Stiles

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210671/#!po=15.2778
            Here is information about Dr Duncan and his review of the literature which led to availability of water births at the 5 hospital.
            Here is some of the article:
            Dr. Neilson is chair of the Perinatology Department and vice president of both Women’s Services and Surgical Services at the Legacy Emanuel Hospital in downtown Portland.
            In 2006, Dr. Neilson did an independent review of all the literature on water birth, including obstetric, nursing, midwifery, and pediatric. He concluded, “There is no credible evidence that water birth is a potential harm for either mothers or babies.” He reported that most of the water-birth studies have been done and published in Europe with large numbers in retrospective analyses Alderdice et al., 1995; Geissbuehler, Stein, & Eberhard, 2004; Gilbert & Tookey, 1999; Zanetti-Dällenbach, Lapaire, Maertens, Holzgreve, Hösli, 2006). What has been published in the United States is largely anecdotal and has involved very small numbers of case reports from home-birth or birth center transfers into a neonatal intensive care unit (NICU; Bowden, Kessler, Pinette, & Wilson, 2003; Nguyen et al., 2002; Schroeter, 2004). Dr. Neilson even pointed out that Jerold Lucy, MD, the editor of the American Journal of Pediatrics, put the following commentary in a sidebar in this research journal: “I’ve always considered underwater birth a bad joke, useless and a fad, which was so idiotic that it would go away. It hasn’t! It should!” (Neilson, 2007).
            The publication of such prejudicial statements makes it difficult for pediatricians to look at the European research without skepticism. Dr. Neilson concluded that American doctors were not getting the complete picture. After a comprehensive review of water-birth literature, Dr. Neilson concluded that water birth is a safe birth option that provides other positive obstetric outcomes. He helped set up a Legacy research committee, and the parameters for water-birth selection were created, using current recommended selection criteria followed by other Portland hospitals offering water birth. Hospital selection criteria strictly enforces a policy that includes a pregnancy that has reached term of at least 37 completed weeks and is a singleton with a head-down (cephalic) presentation with no visible signs of infection.
            Upon Dr. Neilson’s recommendations, the entire Legacy system has adopted water birth. The most recent hospital to begin water birth was Good Samaritan in Portland, which conducted their first water birth in February of 2014. Dr. Neilson is currently reviewing the statistical data on just more than 1,100 water births in the Legacy Health System and made the following comments in a recent interview.
            The large-scale observation studies from other countries which ACOG cites (e.g., Geissbuhler et al., 2004) do show neonatal outcomes that are at least as good as, and often somewhat better than outcomes from conventional care, but this likely reflects the ability of care providers to select low patients rather than any benefit from the water immersion. The consistent valid point, which can be gleaned from observation studies, is that there seems to be no increased risk in these studies involving certified experienced birth attendants in adequate facilities with protocol-driven care paths (N. Duncan, personal communication, March 28, 2014).

          • rational thinker

            Giving birth in water is NEVER safe!

          • Donna Stiles

            Also it was our group that had the low cesarean rate. Not the hospital.

          • fiftyfifty1

            “Also it was our group that had the low cesarean rate. Not the hospital.”

            Which is exactly as it should be if a CNM group is risking out appropriately. I’m a family physician. I no longer deliver babies but when I did, my CS rate was about the same as yours. Was I magically talented? No. But my patient panel was low risk (for CS) and I was sure to keep it that way. The hospital as a whole had a much higher CS rate than my own, of course. I don’t brag about my CS rate because it was made possible only by the fact that I was embedded in a system of advanced OB care.

          • Daleth

            I don’t brag about my CS rate because it was made possible only by the fact that I was embedded in a system of advanced OB care.

            Bingo. If patients are properly risked out, then you end up with a low-risk group and therefore a below-average rate of c-sections. The thing to be proud of there is not your low c-section rate, but the fact that the system you worked in used appropriate risking-out criteria.

          • Donna Stiles

            We comanaged some moderate risk patients with our extremely supportive OB doctors and neonatologist such as Gestational diabetes, obesity, women over 35. We worked with a neonatology group that recommended inductions for various reasons. I’d define our clientele as low risk, medium risk. I worked in the best of conditions. I was blessed.

          • Heidi

            But why take pride in the C-section rate? Why not take pride in the fact that you made the most informed, best decisions that resulted in favorable outcomes REGARDLESS if a C-section was done or a vaginal birth was possible? If I’d been left with a fistula or incontinence, I’d tell you to take that pride and shove it.

          • Donna Stiles

            I loved my work. I was blessed to work in a supportive office and hospital and I am proud to have been a part of it and proud of the cesarean section rate.

          • Heidi

            But why? That is scary to me. I would not want to give birth with someone who takes pride in a rate. What if the deck you were dealt necessitated 22% of women needed C-sections?

          • Donna Stiles

            Then that would be the cesarean rate. It is what it is. We kept track of this, the reason for the cesareans, complications etc. we also submitted to ACNM. we would use them to study our service to improve our outcomes.

          • Heidi

            I still don’t understand why you take pride in any particular rate. I don’t take pride in the fact I birthed vaginally and I’d be confused if my OB was proud of herself because I did so. Neither of us did anything to take pride in? I lucked up and had a complication free birth with a well positioned baby and through nothing I did I have a pelvis that allowed a baby to exit. If shit hit the fan and she called an emergency C-section then yeah she can take pride in all her skills. I sure hope she doesn’t think, “But my rate might go up and I sure take pride in that rate. She and baby will probably survive…so even though it might hurt her pelvic floor and her baby might be injured, boy, I like my low C-section rate. . .”

          • Donna Stiles

            I loved my work and the place I worked and the hospitals I worked. I am proud of my career.

          • momofone

            Was maternal request c-section available, or was there an emphasis on avoiding c-sections? (Your comment about the 11% rate leads me to believe it is the latter.)

          • Donna Stiles

            Anyone wanting a section was referred to a physician for discussion. These are women who desired midwifery care and desired vaginal birth. I’m proud of an 11% cesarean rate.

          • momofone

            Red flags go up for me when I read about “pride” in a low c-section rate.

          • The Bofa on the Sofa

            Anyone wanting a section was referred to a physician for discussion.

            For “discussion.” Yeah, right. So they can try to talk them out of it, right?

          • Donna Stiles

            I didn’t follow up on the conversations. So I don’t know and neither do you. Why must you put down doctors? And assume you know them all?
            I’m trying to have a civil conversation here. I’ve been called a liar, and accused of having minimal reading comprehension. For a group that doesn’t want to shame mothers, some of the words here are shaming and name calling and assumption.
            One could be nice and ask the question “did the doctors talk them out of it? What was your hospital policy on cesarean on demand?”
            I do know women who got a cesarean after benefits/risks discussion because they want to have one. The hospital had little to say about this and scheduled cesareans when asked to do so.

          • Amy Tuteur, MD

            You’re trying to have a civil conversation? Then why did you come barreling in, implying without evidence of any kind, that obstetric interventions cause maternal deaths?

            We don’t want to shame mothers, but you’re participating in the discussion as a provider and we have no problem shaming providers who make irresponsible claims that they can’t defend.

          • Donna Stiles

            I thought one was free to make comments on this discussion. If I barreled in, I’m not aware of that so thanks for bringing that to my attention. I know I can be blunt but it doesn’t seem to be a problem for many commenters here.

            I’ve been called a liar, had my reading comprehension questioned, had many assumptions made about my intentions and my life and what I am thinking. Also assumptions about my place of work and the people I work with.

            My main point was delivering in a hospital is not a guarantee of safety. I did not mean to imply that delivering at home or in a Birth Center was the safest.

            Much needs to be done to support women to have a safe birth. I don’t think I ever said medical intervention causes death and injury.

            I am blessed to work in a highly functioning office and hospital where immediate back up is available and respectful communication and teamwork are valued. I wish all women had this.

            One can disagree without shaming and name calling.

            That is all.

          • swbarnes2

            No one thinks you are blunt. Quite the opposite. “Look at how awful this hospital is…no, everyone has to read this” is so obviously moronic it makes quite clear that you have some alternate agenda.

            “My main point was delivering in a hospital is not a guarantee of safety.”

            Sure. I’m sure it totally makes sense to you that a board where a neonatal pathologist frequently posts about baby autopsies would require you to sally in and inform us, including the people who work in maternity, that sometimes, childbirth is lethal.

          • Donna Stiles

            The first quote implies I said it but I didn’t.
            And I really don’t understand the second paragraph. Perhaps you could clarify.

          • rosewater1

            Believe it or not, you aren’t being shamed or name called. It may seem like it, but you aren’t.

            The people engaging with you are frequent contributors, for the most part. They care about mothers and babies. They are willing to fight for the truth to be told. When you come to this page making assertions such as you have made, you are challenged and expected to back up what you are saying. Given the subjects being discussed, I would call that reasonable. Are they perfectly polite? By your definition it seems not. Bear in mind that many of the posters on this page work in the medical field. Many of them are parents. Many of them have had to deal with pregnancies and births that are less than picture perfect. Many of them feel that they owe the medical field a great deal.

            If you don’t like the answers, then you do have the option to leave. If you are that easily offended, then go a or start a place where your words are taken as they should.

          • momofone

            How did your group identify an ideal rate?

          • Donna Stiles

            Not sure we had identified a goal beyond providing safe and appropriate care regardless if it was a vaginal birth or a cesarean. At the end of the year, we did our statistics. That’s just a fact, 11%

          • LaMont

            All that means is that you likely didn’t serve a high-risk population, though – not a problem in itself, but not something to be proud of either.

          • Donna Stiles

            I loved my work. I took pride in its many aspects.

          • Amazed

            IOW, your hospital was NOT supportive of elective c-sections. Nothing to be proud of here to send women to be patronized and fake-nicely bullied out of the c-section birth they desired.

            That’s why I can’t believe your unit was awesome. In these circumstances, I can easily see you brainwashing women into “natural, beautiful, we’re so proud of” to make them feel out of place if they didn’t feel you deserved glowing recommendations.

            Not that it’s great where I am, but were I in the US, I would have avoided your person and your great unit like the plague.

          • Donna Stiles

            You’d have to tour the hospital and make your own decision. It’s a lovely and safe facility for childbirth with options, really. I’d recommend it. And I never brainwashed anyone. My philosophy of care was to support women in their choices as long as they weren’t dangerous choices.
            My hospital scheduled elective cesareans when doctors asked them to do so.

        • rational thinker

          I did not say all of them were BFHI just that it may occur more often in a BFHI hospital. Also how many of those deaths were home birth or birth center transfers? How many were under midwife care vs under care of an OBGYN? How many of these women were african american? There are a lot of situations to consider.

    • swbarnes2
      • Donna Stiles
        • swbarnes2

          Yes, of course I understand that maternal mortality is a problem, especially among non-white women. Everyone here does. But that doesn’t mean I trust USAToday and a pile of anecdotes to be accurately describing the real problem.

          • Donna Stiles

            Do you think the anecdotes are made up? Did you read the articles. Did you see the photos s of the women who lost her limbs due to a misdiagnosed infection? I’ve personally been involved in a 2 week delayed pp hemorrhage where the ER had her waiting in the waiting room.

          • swbarnes2

            Now you are just a liar. I never said the stories were made up. Never.

          • Donna Stiles

            An anecdote is defined as a short amusing or interesting story. A second definition is an account regarded as unreliable or hearsay.
            Really, I just want to have a conversation here and not call names. I am not a liar.
            I am curious to know if you read the articles.

          • swbarnes2

            In the context of a scientific discussion, a pile of anecdotes means a cherry picked set of data points, unsuitable for drawing broad conclusions. I think you knew that when you said what you said.

          • Donna Stiles

            Have you read the articles?
            Of course the stories are cherry picked to demonstrate the articles purpose, which is to demonstrate poor care and poor outcomes in certain hospitals.
            And seriously, now you can read my mind?

          • PeggySue

            Donna. WHAT IS YOUR POINT? People who comment on this page know that care in hospitals can vary in quality, and this has been called out many, many times here. You are taking the post sideways. The point of Dr. Amy’s post was that “medicalized” childbirth is in fact the result of improving the process and outcome of childbirth so that mortality and morbidity has been substantially reduced compared to the days when very few interventions were available. How you got from there to a critique of medical care in some hospitals I do not know.

          • momofone

            You seem to be placing a lot of weight on these articles. What exactly is it that you want to get across?

          • Donna Stiles

            USA TODAY won Pulitzer Prize for explanatory journalism in 2018. I don’t think you can discount them. Have you read any of the articles?

      • Donna Stiles

        I think I’ll trust the CDC.
        Since the Pregnancy Mortality Surveillance System was implemented, the number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.2 deaths per 100,000 live births in 2015

        • swbarnes2

          The point is the the surveillance system might be flawed:

          In Texas, unintentional user error in reporting pregnancy status may be responsible. Texas’ current electronic death registration system displays pregnancy status options as a dropdown list. The “pregnant at the time of death” option is directly below the “not pregnant within the past year” option; this could have led to erroneous selection and could explain why pregnancy at the time of death was reported for nearly 76% (n556) of the 74 obstetric-coded deaths with no evidence of pregnancy on review.

          and

          For example, right now, if “sunburn” is written as the cause of death, and if the pregnancy or postpartum checkbox is checked, United States coding rules code this as a maternal death. This coding is clearly not in keeping with the spirit of the World Health Organization maternal mortality definition of maternal death

          • Donna Stiles

            I’ve read that. (Was sunburn really written as a cause of death). The system maybe flawed but the agency is doing the statistics year often year using the same flawed collection and shows maternal morbidity increasing. Any increase is not good. Please read some of the articles I posted about real live cases of stunning neglects. And misdiagnosis and lack of accountability.

    • Amy Tuteur, MD

      Women, particularly black women, are dying for LACK of highly medicalized care. The leading cause of maternal death is cardiac disease. We need MORE perinatologists, MORE maternal ICUs, and GREATER access to high tech care.

      • Donna Stiles

        I agree women need access to prenatal care, safe delivery, adequate postpartum care and knowledgeable Emergency Room services. Many many hospitals are failing in this and don’t want to take any accountability or make changes.
        Women also need to have care that is sensitive to their situations. If someone is low risk, they can have a nonintervention birth with careful observation that they continue to be low risk.

        • fiftyfifty1

          Most women do not have a “nonintervention birth” as their goal. But for those who do, it can be safe, as you say above, with careful observation as long as they remain low risk.

  • Queen Khentkawes

    Long-time lurker, first-time commenter here.
    My grandmother had pre-eclampsia. She gave birth to a seven-months child on Christmas Eve and died on the 27th. The baby followed ten days later. My grandfather was married a second time to a woman who made Cinderella’s step-mother look like Mother Teresa.
    Why anyone would want to return to those thrilling days of yesteryear is beyond me.

    • Heidi

      My grandmother also suffered pre-eclampsia in the late 50s, twice. Neither baby survived. One was born well into the eighth month. Almost all babies today survive at 35 weeks. The baby’s lungs collapsed, something that is no longer a death sentence for a premature baby.

      • Amazed

        My grandmother suffered pre-eclampsia or perhaps downright eclampsia, who can say? She wasn’t, you know, conscious when they drove her (in a donkey cart, if you please) from her village to the new small-town hospital. But she certainly had a full-blown eclampsia IN the hospital – at the time, they couldn’t have prevented it. Scared the shit out of other mothers when she started convulsing. The best the hospital could do was treat her AND line everything around her bed in soft linens, AND have a midwife sleep in the next bed (with a curtain to separate them from the rest of the room) to call the doctors and hold her when the seizures started as they knew seizures would.

        She left the hospital with a healthy baby and a healthy self after a long stay. The hospital couldn’t believe their own luck. In the few short years since their opening, she was the second eclamptic mother they got. The first one died along with her baby. I have to say, they led the natural life our earth enthusiasts so covet. Why, Grandma even arrived by an ecological… vehicle. And still, the other woman and her baby died and my grandma and mom almost did. Nature did shit for them.

        Last year, a dear friend got a pre-eclampsia and a 30-weeker. The difference in treatment was enormous but the drive was the same. Two days ago, I was at her place and her little girl would come over to me again and again to give me an eskimo kiss. Oh, and she also looked at me SO lovingly when she wanted me to show her how to open my phone.

        Nature can shove it, as far as I’m concerned. It did precious nothing for my nerves as I was housebond for two months (neuralgic trouble) and I don’t trust it to do more for my nether regions.

    • The Bofa on the Sofa

      I have a great-great grandmother who died due to complications of childbirth. My great-great grandfather was so destitute that he killed himself. Their two daughters and an older brother (I believe) went to live with their (the kids’) cousin.

      The two daughters are both my great-grandmothers, through both sides of my family. One is on my mom’s grandmother, and the other is my dad’s grandma.

      I do not know what happened to their brother.

    • momofone

      My great-grandfather came to the US with his young first wife. They had nine children, and she died of childbirth-related problems after the ninth was born. He remarried, had nine more children, and his second wife died after the ninth was born. He remarried yet again, and had nine MORE children, with his wife’s death following the birth of the ninth. I’m not sure if he married again, but there were no more children. It’s so sad to imagine these 27 (!) children without their mothers. I don’t know much more detail, but my assumption is that there was probably little if any medical care for any of them, and certainly none of the babies would have been born in a hospital.

    • HailieJade

      Doing my family tree the other day when I realised my grandfather had a baby sister who lived for 48 hours. She was my great-grandmother’s only daughter and apparently she never fully recovered emotionally. Seriously f- anyone who tries to romanticize that era.

      • EmbraceYourInnerCrone

        My 18 year old great-grandmother died after delivering her second child, probably from postpartum hemorrhage. The baby girl survived the birth but died two months later, most likely from malnutrition. Side note, her sister-in-law died of pre-eclampsia at age 16 around the same time. My grandmother (maternal) lost one of her 8 children to Rh factor issues. My paternal grandmother lost one of her 3 children to post dates still birth.
        The good old days were not so good…

        • HailieJade

          My great-grandmother was about 18-19 too. Such a traumatic thing to happen so young 🙁
          Definitely not so “good” those days!

      • KQ Not Signed In

        That’s another thing that drives me crazy when they are so dismissive of death. Not only is history full of women and babies dying, but it’s full of women who were “never the same” or “never recovered” from losing a baby. Again, just look at any media based on history if you can’t stomach actual history – it’s there. Which means babies dying was always a big deal that people desperately tried to prevent.

        • HailieJade

          Yep, I’m also getting so sick of this myth that our forebears were so much “tougher” and somehow less affected by death than us. While it’s true that yes, death was a common, everyday occurrence for most people and yes that would naturally desensitise you to it somewhat, it most certainly doesn’t mean people were blasé about it! You just have to look at the prevalence of religion and belief in the afterlife throughout history – people were scared of and heartbroken by death back then just as they are now.

          • The Bofa on the Sofa

            1) I posted below about my great-great grandfather, who killed himself after his wife died in childbirth and left him with three young children to raise on his own. Clearly, it all affected him.

            2) In terms of putting up with it, what was the option? They had to, for better or worse, deal with it, and they did that in the best way they could. What does anyone expect them to have done? Curl up in the fetal position and rock in the corner? You can do that for a day or two, but at some point, you have to do things to survive.

      • Janie4

        My grandmother had twin brothers who died six weeks after birth, because they were premature. This was the 20s.

        • HailieJade

          My great-aunt was born and died in the 20s too. Just over a hundred years ago, it’s hard to fathom how far medicine has come in such a short time (and yet apparently long enough for natural parenting types to have forgotten and formed a rose-coloured image of those times!)

  • KQ Not Signed In

    Hate to bring it up yet again, but it’s relevant. Don’t study history? Well, do you read? Watch movies? Watch TV? How many literary characters can you name that suffered or died or lost their babies because that’s just what happens? when there isn’t modern medical care?

    • The Bofa on the Sofa

      Never heard about fairy tales? Why do you think there are so many “stepmothers”? What do you think happened to Cinderella’s birth mother?

    • Donna Stiles

      In the past two decades, the US maternal mortality rate has doubled, making the US the only developed nation in the world with an increasing maternal mortality rate.

      • LaMont

        Yes, *losing* access to advanced health care is bad. So we all agree!

      • fiftyfifty1

        What is your point?

        • Donna Stiles

          Going to a hospital is no guarantee against death and injury. Not all hospitals are good. Hospitals must be held accountable and make changes to the way Care is provided. Did you read the articles I posted?

          • Azuran

            What are you even arguing? Everyone here agrees that access to healthcare in the USA should be better. No one is claiming that all deaths are preventable.
            Hospital birth is still safer, and we all agree all efforts should be made to keep it safe and make it safer.

          • fiftyfifty1

            Yes I read your links. Cases where red flags were missed or ignored. Cases where residents weren’t properly supervised. Horrible care. We all agree this is unacceptable. And African American women bear the brunt of these low performing hospitals. Even so, these victims or their families all expressed shock. The journalist was shocked–that’s why it was a story. The word needs to get out in our society: Birth Is Dangerous. Dangerous for the baby, dangerous for the mom. Take your eyes off the ball for an instant, and disaster can occur. We need more money, better staffing, more research, universal insurance coverage, address racism, more standardized protocols that are drilled, drilled, drilled.

          • Donna Stiles

            Thank you for reading the articles.

          • fiftyfifty1

            Sure. So let’s discuss them. I say we need more money, better staffing, more research, universal insurance coverage, less racism, more standardized protocols (like routine managed 3rd stage etc) and drills drills drills. What do you say?

          • Donna Stiles

            Wow, wouldn’t all that be amazing!

          • fiftyfifty1

            Where would you start?

          • fiftyfifty1

            Odd. She seemed so insistent that we read her links, but now she doesn’t seem very interested in discussing them in depth.

          • rational thinker

            I noticed she has not posted anything since I said I think she is promoting midwife care in a birth center. It was getting pretty obvious that that is what she was arguing the whole time. So you were right and she left before we could laugh her out of town. I dont think she will be back to discuss those articles.

          • Donna Stiles

            The head of the OB department researched this many years ago. Pediatrics signed on and there have been waterbirths there for almost a decade. There are parameters of course.
            If there were any bad outcomes they wouldn’t continue. They continue to this day in both hospitals of the area.

            One thing also needed in obstetric Care is care in a hospital for women who want water births, low intervention births, Births without medicine. Our department did it’s best to have people birth in a hospital where medical help for mom and baby were immediately available instead of in the home or birth center.

            Are you a mind reader?
            I’ve done births at home, in a birth center and for the Last 30 years in a hospital. prefer having immediate access to anesthesiology, an OR, NICU and excellent OB consultants and nursing care.

          • rational thinker

            Water labors are safe, but not water birth. Mom needs to be taken out of the water before she gives birth. I think that is what studies that were done said.

          • Donna Stiles

            https://evidencebasedbirth.com/waterbirth/

            This is a review of the literature as it relates to water birth. Many other topics are presented.

          • rational thinker

            Any health worker who recommends that site for scientific facts should not be allowed anywhere near a pregnant woman or a pregnant cat for that matter.

          • Donna Stiles

            She certainly does a good review of the literature. And people researching gbs in pregnancy review and edit her site.

            She notes this at the bottom of her paper.
            I would like to acknowledge my reviewers for helping maintain the quality of articles published at Evidence Based Birth. In particular, I would like to acknowledge Dr. Jessica Illuzzi, Associate Professor of Obstetrics, Gynecology, and Reproductive Sciences, and researcher who studies Group B Strep at Yale School of Medicine, for her expert review and assistance in writing the original article published in 2014. I would also like to acknowledge Robert Modugno, MD, FACOG, and Shannon J. Voogt, MD, Board-Certified in Family Medicine, and 2 other anonymous reviewers (a GBS researcher and a microbiologist) for their review of the original article. This article was since updated by Rebecca Dekker, PhD, RN, APRN, in 2017, with the revisions reviewed by Julie Le, Microbiologist, Birth Doula CD (DONA), and Evidence based Birth® Instructor and Shannon J. Voogt, MD, Board-Certified in Family Medicine.

          • Donna Stiles

            She does a wonderful review of the literature.

          • Donna Stiles

            How do you know what I think and do? You could ask if I’m promoting birth in birth centers. I’ve done births at home, in birth centers and for the las6 many years in a hospital. When people ask me about birthing at home I say it can work out but there is no guarantee, no matter how low risk, that a complication might occur. And that people rarely have a neighbor who can provide emergency services to a newborn or a cesarean if needed.
            I am blessed to work in a practice and in a hospital that provides these services in a respectful manner when needed.

            Ask me questions but don’t think you know what I’m thinking. Thank you.

          • The Bofa on the Sofa

            But there isn’t really anything to discuss. Her entire spiel is a total red herring.

          • Donna Stiles

            You continue to put me down, be civil, be nice. I’ve been busy and not able to read any comments for several days.

          • The Bofa on the Sofa

            1) you are not a moderator
            2) I am treating you like a troll. If you don’t want to be treated like a troll, stop acting like one

            You’ve made it clear, repeatedly, that you have nothing to contribute. As far as I can tell, this is all just about you looking for attention.

            Prove me wrong. Provide something of substance. Actually respond to questions instead of just repeatedly posting the same lointless comments. Listen for a change.

          • Donna Stiles

            I have been busy. Where would I start?

            More access to adequate health care, better staffing where needed with better pay for nurses, practicing evidence birth, providing care appropriate to the level of risk and to the desire of the family as best possible certainly more accountability, drills, team work and good communication amongst providers.

            I thought it was a rhetorical question.

          • fiftyfifty1

            Can you elaborate on “practicing evidence birth”? Thanks in advance.

          • Donna Stiles

            Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.[1] Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations (“evidence-based practice policies”).[2] It has subsequently spread to describe an approach to decision-making that is used at virtually every level of health care as well as other fields (evidence-based practice).

          • fiftyfifty1

            Yes that’s the definition of evidence based medicine and we are quite familiar with it. I was wondering what you meant specifically about “practicing evidence birth.” I see now you probably meant to write “evidence BASED birth.” In any case I would like to talk about this in more depth. In what specific ways do you see low performing hospitals failing to adhere to EBM? If all hospitals did adhere better to EBM, which findings of EBM do you see as most vital? For me, my top 2 for maternal mortality are routine active management of every woman during the 3rd stage and aggresive DVT and PE prevention in higher risk mothers. For neonates my top 2 are routine GBS screening and antibiotics in labor (I can’t believe that this is still sometimes neglected) and increased access to induction to prevent stillbirth (even in low risk pregnancies.) Your 2 cents?

          • fiftyfifty1

            So puzzling. She was very adamant that we all read her links. Very adamant that we talk about maternal death rates. I have done so, and I am trying to have an in depth discussion about Evidence Based practices in birth (a topic she herself highlighted as important.) But nothing…, is she ill? On vacation? Somehow not willing to engage when in comes to details?

          • momofone

            She’s quite busy, you know!

          • Donna Stiles

            I mistyped.
            There is a woman who reviews the literature for birth related topics. Google Evidence Based Birth.
            Agree with your picks for most vital.

          • Amy Tuteur, MD
          • Donna Stiles

            Again I mistyped. I meant to say evidence based medicine and ACOG guidelines. I use evidence based birth articles when women want more information about the topics she does write about.

          • fiftyfifty1

            I’m surprised that you say you are basing your medical opinions on the Evidence Based Birth blog, when they seem the opposite of what the author there endorses? You say that you are in agreement with routine testing and treatment of GBS as a most vital priority, but the author there disagrees. She does not support routine GBS testing but rather advocates for women to bring up the issue vs other methods (not testing, hibiclens, garlic, probiotics etc) with their providers. Basically the message that it isn’t a big deal and isn’t a priority. Likewise with induction to prevent stillbirth. She seems to be opposed except in extreme obvious cases. And as for maternal mortality issues, she is silent! Nothing on managed 3rd state that I can find. Nothing on DVT and PE prophylaxis. These are the big killers of women! The ones that cause maternal death rates to be high in the the low performing hospitals you are so concerned about. How can this woman be your go-to source when preventable maternal death doesn’t even seem to be on her radar? She is fiddling around with questions about herbs in labor when women are dying of cardiovascular catastrophes!

  • MaineJen

    My husband is an amateur genealogist, and the other day he found in his family tree a poor little girl who suffered a cruel fate hundreds of years ago: married at 13, died in childbirth at 14. (Her baby apparently survived as his ancestor) Just imagining what she must have gone through makes me shiver.

    He has found many, many men who married 2 or 3 times during their lives, after losing their wives in childbirth.

    Anyone who thinks this process is inherently “safe” is profoundly deluded.

    • Mel

      My great-grandmother was the third wife of an older man who had one wife die in childbirth.

      In Michigan, our local cemeteries are not very old; pre-Civil War graves are present, but scarce. In every cemetery, I’ve found at least one woman who died in childbirth or soon after along with a baby. One was a 17 year old woman who married at 16, died the same day that she delivered her first born child and the baby died two months later.

      I bring this up because the second story is the most obvious objection to the argument that women have evolved to survive labor. Unfortunately, you can completely pass your genes on while not surviving long enough to raise said child.

      • BeatriceC

        My mother’s father was an absolute ass. He abandoned his first wife and four children, got on a train, and started a new life in Miami. Absolutely nobody questioned his explanation that his first wife died in childbirth, and this was the 1940’s. He never admitted to surviving kids. That all blew up when he died and my grandmother applied for social security death benefits for her still-minor children only to find out that his first wife had been drawing death benefits for years at that point. After being unable to locate him for years, she had him declared dead, though the process that existed at the time. It was a giant mess.

  • Cartman36

    Dr. Amy, you deserve a standing ovation for this one!

    • Donna Stiles

      But the United States maternal morbidity has DOUBLED in the past two decades, making the US the only developed nation in the world with an increasing maternal mortality rate.

      • LaMont

        Again, how does this in any way contradict the 99% decrease in maternal mortality and 93% decrease in neonatal mortality that came with the obstetric revolution? In fact, it supports it, because that issue was caused by lack of access to obstetric care that has arisen here.

        • Donna Stiles

          When was the obstetric revolution?

          • mabelcruet

            https://ourworldindata.org/measurement-matters-the-decline-of-maternal-mortality

            The ‘obstetric revolution’ refers to mid 20th century change of practice. There was a relatively slow but steady gradual decline in maternal mortality in the early part of the 20th century, probably as a result of greater awareness of infection control and other public health measures. Around 1945-1950, obstetric-led maternity care became far more prevalent, there was increasing use of medical treatment such as blood transfusions, more women began to deliver in hospital, there were better and more readily accessible anaesthetic techniques for pain control, and the maternal mortality rate (in industrialised countries) rapidly plummeted over the course of a very few number of years. In the UK this period covered the inception of the National Health Service with uniform open access to free medical care to the population regardless of income, and we had a similar precipitatous drop in maternal mortality rates.

          • mabelcruet

            So the ‘Obstetric revolution’ refers to that period of transition in many industrialised countries where provision of maternity care moved from being primarily undertaken by midwives and delivered in the community, to being primarily provided by medically trained obstetricians with increasing numbers of hospital births as opposed to homebirths. Yes, there had been a decline in maternal and perinatal mortality in the few decades prior to this (1900-1950ish) when the vast majority of births were overseen by midwives, but the massive drop in maternal mortality only really came about once maternity care began to be routinely delivered by medically trained obstetricians.

          • Donna Stiles

            Thanks.

      • momofone

        Has it?

        • Donna Stiles

          I think I’ll trust the CDC.
          Since the Pregnancy Mortality Surveillance System was implemented, the number of reported pregnancy-related deaths n the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.2 deaths per 100,000 live births in 2015

          • Mel

            Describe the changes in reporting of maternal deaths between 1987 and 2015 at the federal level. You imply that there was one single implementation in 1987 – but that’s not accurate at all.

            After all, the definitions shifted hugely as well as requirements that all jurisdictions report deaths instead of a hodge-podge of reports, partial reports and no reports.

            A more honest statement would be that we failed to account for maternal death accurately previously and so we are uncertain of the trends in maternal mortality over time.

            But this is missing the biggest point: Dr. Amy has written extensively on how maternal mortality rates in the US suck. Going back to home-based midwifery care with marginally trained midwives will not help reduce deaths from cardiac issues or pre-e or hemorrhages – but reducing access issues to medical help for women of color and women of low socioeconomic status can.

          • Donna Stiles

            And having hospitals take accountability and make changes in their standard of care will help. Not every hospital is a good hospital.
            I am not advocating in any way shape or form that women have home births or care by marginally trained midwives. But they should all have excellent care available to them in pregnancy, childbirth, postpartum and Emergency departments.

          • fiftyfifty1

            “But they should all have excellent care available to them in pregnancy, childbirth postpartum and Emergency departments.”

            Who would disagree with this? Dr. Tuteur has long advocated for improvements in hospital maternity care, in particular focused on the preventable causes of maternal death. Examples are standardization to prevent PP hemorrhage fatalities such as routine active management of the 3rd stage and protocols and drills to stop any PPH that still may occur. Also maternal health specialized intensivists, cardiologists and ICUs for cardiopulmonary complications. Pregnancy and childbirth are risky times in a woman’s life. Hospitals that fail to intervene quickly at the first signs of problems WILL eventually have a preventable fatality.

          • AnnaPDE

            You may want to read a few older posts on this blog, Donna. Dr Amy has written extensively about unequal access to healthcare, and about quality issues with hospitals. Including the problem that the push to look “intervention free” and “non medicalised” leads to a tendency to ignore or rationalise away symptoms of dangerous complications, instead of addressing them early on.
            This specific post’s topic is just a different one, namely: Homebirth is definitely a way more dangerous choice.

      • Cartman36

        Donna,

        I don’t understand your point. Even if what you say is true, which I doubt (I don’t doubt that maternal mortality has risen but I doubt it has doubled in 20 years – that big of an increase is likely created by reporting errors, better classification, etc) but that doesn’t change Dr. Amy’s point. I agree we should all advocate for better healthcare but that doesn’t mean that the current healthcare we have (including childbirth in hospital) is not a medical marvel and enormously safer than homebirth or birth as it was 100 years ago.

      • BeatriceC

        Case study of one: Me.

        I am in the “obstetric morbidity” statistics. But I am alive. In times past the complications I suffered would have led to my death in no uncertain terms. But instead of being a mortality statistic, I am a morbidity statistic. That shows obstetrics did it’s job. There was a trade off, in that I was still injured, but the end goal of surviving the experience was worth the cost. As we decrease death, it is only logical that the injury rate would increase, for exactly this reason.