American Childbirth: A Human Rights Failure?

by Ginger Garner

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Image source: iStockPhotos

Data from the United Nations shows that between 1990 and 2008, the United States maternal mortality rate nearly doubled, while the overwhelming majority of countries collectively decreased their rates by 34% (Coeytauz et al 2011).

We have a right to criticize the shameful state of American maternal care when more money is spent on childbirth than any of other area of hospitalization - $86 billion dollars a year; and with what Coeytauz et al deemed “a shockingly poor return on investment and human rights failure” (Coeytauz et al 2011, Andrews 2007, WHO 2010, Save the Children 2013).

Additionally, postpartum care in the United States is notoriously poorly tracked and poorly delivered, with Cheng et al calling postpartum maternal health “a neglected aspect of women’s health care” (Cheng et al 2006). Amnesty International cites the lack of attention to postpartum care as a reason for the high maternal mortality rate in the US and states the neglect is “more than a matter of public health, but a human rights failure” (Amnesty International 2010).

Women Deserve Better Birth

Most of the women I have met or work with concerning prenatal or postpartum care are fearful of birth. Not just fearful, they are scared to death.

And, they have good reason to be. Much of the care provided to women during labor and delivery is based on profit, not the evidence-base. Routine “admission strips” (intermittent fetal monitoring) on women in labor, according to the latest information from the Cochrane database and written by birth advocate Henci Goer, is clear: “According to the best evidence, the admission strip isn’t just ineffective, it’s harmful, and its use should be abandoned.”

A recent randomized controlled trial shows that planned cesarean sections for twins are not any safer, yet 75% of twins were delivered by C-section in 2008 as compared to 54% in 1995.   And the list goes on, what about unnecessary inductions and the high rate of single birth C-sections, that all sit in contrast to World Health Organization recommendations?

The shameful truth is that America is the least safe developed country to give birth in, with the highest infant and maternal mortality rate and the highest first day death rate for infants (Save the Children 2013). 

Effective Maternal Health Care

I believe there are three pillars of effective maternal health care, or any health care for that matter. Those three pillars are PSS, or Patient Advocacy, Solution Provision, and Standard Setting.

  1. Patient Advocacy:  Education. Mothers should be have the right to autonomous decision-making during the birth process and should be accurately informed of evidence-based options. 

     
  2. Solution Provision:  What will reduce the maternal mortality rate in the US? The State of the World's Mothers and the World Health Organization gives clear recommendations on what can lower mortality rates, including investing in low-tech health care workers, and addressing gender inequality, social support, and public policy issues. Providing de-medicalized, culturally sensitive, individualized care, including closing gaps in postpartum care are also part of the solution. But is the US listening? Currently nothing is being done in the US to overhaul prenatal or postpartum care, since the statistics are continuing to worsen for mothers and babies in the US.  

     
  3. Standard Setter:  What we need is compassionate, proactive, integrative care that follows a biopsyochosocial model (looks at holistic, "whole" person care). Mothers have to search for health care providers who practice using this model. 


Empowerment & Advocacy for You

As a mother, you have to look for a health care provider who advocates for you and your baby and who also treats you with dignity and respect (which does not always happen now). 

Women are often scared into medical procedures not condoned by the World Health Organization (like our high C-section rates, episiotomies, or continuous fetal monitoring, all of which are not supported to be a normal part of routine, low-risk birth) with the phrase “you need to do XX, because you would not want to harm (or kill) your baby would you?” Another scenario is a mother who thinks her health care provider (ob/gyn or midwife) supports her birth plan and is practicing evidence-based medicine, only to find out at birth that their provider was never listening. 

Those stories are too common, whether mothers were “blamed” for their stalled labor or failure to progress. Yet Evidence-Based Birth blogger Rebecca Dekker Phd, RN, wrote a brilliant post about the antiquated system currently used to diagnose “stalled labor or failure to progress.” The bottom line is health care providers are not using current evidence-based guidelines to attend births. This must change. 

It is our right as women and mothers (and future mothers) to educate ourselves about our options for birth. Jessica Bailey, Editor-in-Chief of Natural Mother Magazine is right when she says, "Anyone who discourages you from doing independent research is wrong."

Here are some resources on choosing the right birth facility and choosing the right health care provider. Finding the right support and health care provider during pregnancy and birth, and asking for physical therapy after childbirth, are important ways we can turn the American birth human rights failure around.

References

1. Garner, G. Excerpt from Yoga as Medicine for Pregnancy. Herman and Wallace Pelvic Rehabilitation Institute. Postgraduate Interdisciplinary Continuing Education Course Manual. September 2013.
2. Coeytauz F, Bingham D. and Strauss N. Maternal Mortality in the United States: A Human Rights Failure. Contraception 83 (March 2011) 189–193. Association of Reproductive Health Professionals. Elsevier.
3. Andrews R. The National Hospital Bill: the most expensive conditions by payer, 2006, in Healthcare cost and utilization project, statistical brief. Health Cost Utilization Proj Stat Brief. 2008;7
4. Organisation for Economic Co-operation and Development . OECD health data 2010. 
5. World Health Organization. Trends in maternal mortality: 1990 to 2008 estimates developed by WHO, UNICEF, UNFPA and The World Bank, World Health Organization 2010, Annex 1. 2010.
6. Save The Children, State of the World’s Mothers Report 2013. http://www.savethechildrenweb.org/SOWM-2013/
7. Cheng CY, Fowles ER, Walker LO. Continuing education module: Postpartum maternal health care in the united states: A critical review. J Perinat Educ. 2006;15(3):34-42. doi: 10.1624/105812406X119002
8. Devane, D., Lalor, J. G., Daly, S., McGuire, W., & Smith, V. (2012). Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev, 2, CD005122. doi: 10.1002/14651858.CD005122.pub4http://www.ncbi.nlm.nih.gov/pubmed/22336808
9. Amnesty International . Deadly delivery: the maternal health care crisis in the USA. New York: Amnesty International USA; 2010; http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.pdf. Last accessed September 9, 2013.
10. Goer H. Does the Hospital “Admission Strip” Conducted on Women in Labor Work as Hoped? Science and Sensibility: A Research Blog about Healthy Pregnancy, Birth, & Beyond. October 3, 2013. http://www.scienceandsensibility.org/?p=7409#.Uk4KmNDkoCA.twitter. Last accessed October 3, 2013.

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