How Safe is Birth in the US?
Most new childbearing families feel a sense of comfort birthing in the US from a perceived belief that our developed status makes us less prone to less than ideal outcomes. Reality, however, is not quite so...
What we know:
- The U.S. has the worst maternal health statistics of ALL developed countries (we rank 61st). Yes, even though we spend more per capita on health care and many [hospital] births are off the charts expensive, all our "knowledge" and technology is not exactly making birth safer. Home births may be expensive, but relatively they are much lower costs. Many women find that the cost of home birth is lower than insurance deductibles. (Although, unfortunately, licensure regulations and increase of promotion for midwifery certification are significantly increasing the cost of home birth to more synonymous with hospital birth).
- 99% of births are in a Hospital attended by nursing staff focused on a mechanistic view of birth (which developed in the industrial era) through technology rather than putting mom at the center of care, and obstetricians that are not present for labor. Shouldn't this increase our safety if women are birthing in a hospital believing they are receiving the best care? That's the thing, it's a perception, not a reality. While having *access* to these things does improve outcomes for mothers in all cultures, using them as the norm (and their overuse) starts to reduce the safety. It can be quite difficult to really tell what is happening in labor if someone is only focusing on monitors, "observing" a laboring mother from a completely separate room, or getting feedback from phone conversations. This does not happen at a typical traditional-midwife-attended home birth. Quietly knitting in the corner, possibly - but ever listening, observing, and providing calm energy and guidance when necessary.
- Countries with better health statistics have midwife-attended labors and births with home birth as an accessible option supported by obstetrician.
Yes, European countries have a model of maternity care that encourages midwives for normal healthy births collaborating with an obstetrician for higher risk births and surgical birth, but the pushing of licensure and the increase of technology-oriented births is not improving their outcomes either. Only 8% of births are attended by midwives in the US, and many of them have also never seen a home birth but rather learned from Obstetric and medically managed births in birth centers and hospitals.
- Studies show home birth is as safe as, with less intervention, than hospital birth. We have to start with the idea that providers actually understand the biology of birth. If they've never seen a normal non-intervened birth, then they can't adequately compare what is normal and what is managed. At most home births, a quiet and calm midwife with experience in home birth will watch and let mom do her thing in peace and love with her family. She may support emotionally, palpate, suggest positions, and listen to heart tones - but she starts with a perspective that birth takes time, nourishment, mobility, and love. If we go to medicine every time something isn't matching an outdated and limited-study chart, then we're seriously diminishing the birth safety for mothers from the get-go. Once that first intervention starts, it often snowballs into many others, and sometimes, walking out the front door is that first intervention because moms no longer feel calm and confident.
- Hemorrhage is the leading cause of maternal death. This is true everywhere; but what people don't realize is how much a medically managed birth increases this risk. Environments that don't support biology such as taking baby away from mom, medications surrounding birth, and anything that decreases oxytocin such as bright lights, noise, chaos, too many people in the birth room, and staff demeanor, will increase adrenaline which is an antagonistic hormone to oxytocin. Oxytocin is the hormone that contracts the uterus. A contracting uterus after the birth (which is also increased with baby being skin to skin and nuzzling the breast) clamps down on the capillaries and stops bleeding. This is only ONE influence, which happens in practically all hospital births, that increases risks of hemorrhage. Under nourishment is just as prevalent in the US as many other countries... US mothers just happen to feel full when they're malnourished and dehydrated and this malnourishment and dehydration is a significant influence on the function of the muslces and hormones needed to stop bleeding. Then move to the lack of breastfeeding support in the environment and the providers and the second supporting factor for reducing bleeding is damaged.
- 10-20% of US women suffer from postpartum depression. This doesn't cover prenatal depression... but why is this happening? We've created a culture that believes baby blues are a normal part of postpartum, for one. Many mothers are expected to feel a bit sad after birth, being told this is a normal symptom of hormone fluctuations. This is ridiculous. When a woman is designed to have a flood of happy hormones pour over her throughout birth, immediately after birth at higher levels than orgasm, and every single time she breastfeeds - what in the world would make postpartum such a depressing time? Let's think about the fact that 42% of women are induced and another 47% are augmented (sped up) both often with synthetic oxytocin (pitocin or syntocinon) which doesn't cross the blood-brain barrier and as such doesn't have the same psychological effects as natural oxytocin. Let's think about the 99% of women birthing in environments with bright lights, a lot of noise, and often chaos immediately after birth all of which decrease natural oxytocin, not to mention the lack of choosing healthy foods and the lack of access to healthy foods. Let's think about all those babies whisked away, screaming like crazy, handled like a rag doll, and jammed with all sorts of needles and suction devices and touching people that have no business touching the baby before mom. Let's think about the majority of hospital birthing women that receive a routine injection of pitocin post-birth to "prevent" postpartum hemorrhage (never mind the fact if the prior labor care was biological, natural oxytocin and immediate bonding/skin to skin could work as it should). Let's think about all the supplements and pacifiers not only at home, but given away in the hospital to reduce breastfeeding. Let's think about all the providers that know next to nothing, or completely wrong, breastfeeding information. Let's think about all the moms that go home and are expected to do it all, even some going back to work in 3-6 weeks before they're ever physically healed, let alone psychologically. Let's think about all those women that are expected to milk their breasts with a machine instead of having their baby with them as nature designed. Let's think about the lack of support women have during these stages when other countries literally pamper the mom for 4-6 weeks with food, love, and most of all encouragement to lie with her baby and rest and nurse. Let's think about what we're causing, not what to expect because we're unwilling to change practices. Let's think about the 33% of women birthing by cesarean, likely 1/2 of those being preventable through proper care, that have doulas and dads holding their baby on their breast to nurse because they're so medicated and tired they can't hold their arms up. Let's think about these cesarean birthers that are healing from birth trauma and major surgery that are told, "all that matters is a healthy baby" who are not just suppressed on telling their story, but never routinely counseled to process their birth. Where is the regular postpartum care for moms, and especially these 33% of women that are healing from major abdominal surgery and birth? (I love continuing to provide postpartum care to my home birth clients that need to transport).
- More women are birthing unassisted because of their fear of trauma from birth attendants and hospital policies. While I am among the few that support unassisted birth because I support autonomy and I believe in the body's ability - I am appalled that many women are choosing this not because they feel empowered to do so and are truly at peace with all birth scenarios, but because our maternity system is failing. It is increasing their fear of harassment, bullying, birth rape, safety for mom and baby, and ultimately parental confidence.
Now, make no mistake - all of this is real and true, but in most communities, we are certainly blessed to have the ability to choose home birth with experienced attendants. We are seeing more birth advocates in the hospitals and birth centers. Likewise, the relative risks are overall low in childbirth - not at all like it was when birth first moved into the hospital and providers were increasing risks of birth by causing illnesses simply from not washing their hands and racism. We've come a long way and have a lot of methods available to us to make birth safer. The key, however, is to use those methods when needed and not as a form of defensive medicine or out of fear for lack of biological understanding. There are so many great resources to help you learn more about birth in the US such as www.improvingbirth.org, www.primalhealthresearch.com, and www.childbirthconnection.com.
Feeling confused? Looking for options? Seeking the desire to free your mind of birth fear? Schedule a birth class or doula or home birth consult and let's talk about your situation and your options. Let's talk about your health to maximize your birth options and let's talk about how to navigate this birth industry for the happiest birth possible because a happy birth is a healthy birth.