Currently, all across the United States we have seen an increase in medical interventions used routinely in normal low risk birth that coincides with physicians being the primary prenatal caregivers and birth attendants. Since the writing of the last entry, the Center for Disease Control has released the most recent update of the cesarean rate for the US. 32.3% of babies in the US are born via cesarean surgery. In Kentucky, 34.6% of all babies, or roughly 1 in 3 are born via cesarean surgery. The CDC states the reason for the increase as follows: “In addition to clinical reasons, nonmedical factors suggested for the widespread and continuing rise of the cesarean rate may include maternal demographic characteristics (e.g., older maternal age), physician practice patterns, maternal choice, more conservative practice guidelines, and legal pressures (11–13).” C-sections are not the only medical intervention on the rise, but is the most drastic medical intervention in childbirth and thus should be performed only when a medical situation is present making it the safest mode of delivery for mother and baby.
Over the last fifty years we have seen a drastic shift in childbirth practices in the southeastern Kentucky that parallels that of the entire country. The nation as a whole, with cesarean trends for example, exists in more than double the recommended rate of cesarean delivery issued by the World Health Organization of 10-15%. In the 2007-2008 statistical year, Whitesburg Appalachian Regional Hospital (Letcher County) held a cesarean rate of approximately 26.37%. Hazard Appalachian Regional Hospital (Perry County) held a rate of approximately 49.56% for the same year. There can be many factors affecting the statistics, as stated in the previous CDC report, among others. It seems we started far in one direction and swiftly swung far in the opposite. Meeting somewhere in the middle of the spectrum would be of the best interest to all involved, and would create the best results.
The following video discusses current practices and their consequences along with where the future can lead us. A full view of a c-section delivery/vaginal delivery is shown.
In southeastern Kentucky, it is now a rarity that a woman gives birth at home. Currently, there are no CPMs (certified professional midwives) or DEMs (direct entry midwives) close enough to our area to serve us for homebirth. If a woman in our area chooses homebirth, she will either have to find a midwife willing to travel 2 or more hours to attend her birth, find a midwife close enough in Virginia or Tennessee who is willing to travel, or birth unassisted or husband/partner assisted. Kentucky medical licensing boards have placed strict rules on the licensing of midwives, and no longer licenses CNMs (certified nurse midwives) for homebirths.
We are fortunate in eastern Kentucky to have many CNMs working with obstetricians in our local hospitals, many of which graduated from the Frontier Nursing School. The midwifery model of care is still available to us with the plus of physician back up if our pregnancies become a high risk situation. It is still important no matter if you choose a CNM or an obstetrician, especially if they are in practice with others, to educate yourself and to ask many questions as to their routine procedures for handling birth. Make sure you are satisfied with the care you are receiving, and if you are not ask questions and/or change providers. Remember that a midwife working in the hospital setting practices under the rules and regulations set by the entire practice and the hospital facility where her patients give birth.
As a whole, our country is moving toward a dangerous place in our birthing practices. The United States ranks 41st in the world of 171 nations in maternal mortality(death rate). Even developing countries like South Korea have ranked higher than us. This rate includes pregnancy/birth related deaths as well as deaths that are a direct result of maternity care practices. Are we relying too much on medical expertise even in situations where medical intervention is not needed or necessary? Could mortality rate be a direct result of this mindset? The article published in the Journal of Perinatal Education in 2008 written by Ina May Gaskin, CPM titled “Maternal Death in the United States: A Problem Solved or a Problem Ignored?” addresses these questions.
There are solutions to these issues, and slowly our country is beginning to look into them with encouragement from birth activists all over the country. Recently, the National Institutes of Health reviewed policies on the state of VBAC (vaginal birth after cesarean) in our country and reached a consensus. In Kentucky we have seen a statistically significant increase in women choosing homebirth according to the CDC. Women are beginning to ask questions and take charge of their healthcare and that of their babies.
It seems to be a slow process in consideration of the evidence supporting the need for change. Encouraging statistics like those of Ina May Gaskin and her long standing midwifery practice, The Farm, can help us see the changes we need to make in this country. In thirty years, the practice has a c-section rate of 1.4% and a completion of birth in the home 95.1%, showing that low risk births can happen safely with little if any intervention in the home, birth center, or hospital.
At this point with the evidence in place in support of change, it has become a consumer issue. We choose the practitioners who attend our births. We choose who has control of the situation. When we as women start asking more – not more, but better – of our care givers, we will see change. Each choice we make has consequences. Some say that ignorance is bliss, but is it really? Every woman has the option to educate herself of the choices surrounding her pregnancy and birth, and to then choose the practice that best suits her. For some women it may be homebirth. For others it may be a hospital birth. For yet others, they may realize that they require medical intervention to birth safely. The important part of the equation is that we as mothers are in charge of those decisions, and become informed enough to make the decisions along with our practitioners. Homebirth is not for everyone, and for some is not an option, currently. You should birth where and with whom you feel the safest. Obstetricians are crucial to keeping our options open in childbirth. Their expertise is needed in many situations. Men or women can make awesome birth attendants. But, it is when they do so in a way that is ethical, without misusing technology or medical procedures, and with the fully informed mothers.
Do we just take a fashionista’s word for it when it comes to what we wear? How many of us buy a car without doing research or asking questions? When buying a home, do we make our decisions based on the outward appearance and a realtor’s description? Should it be any different when we choose the person to attend and the setting in which we give birth?