Maternal death rates high in US

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/03/MNER1BRFT4.DTL&tsp=1

A dear friend (Hi MT!) forwarded this article to me today about California's increasing maternal death rates. I've seen the stats before, but it's nice to see some attention brought to it. Basically, this country has horrible maternal and fetal death rates. They've increased during the same years that C-section rates have increased by 50%. I'm talking there are many second and third-world countries with better survival than we have. Why is this and what is being done about it? Shockingly, little. The various doctors associations can't seem to see to the end of their high-tech noses. Pregnancy is not a medical condition, no more so than menstruation is. But it has become medicalized. There are plenty of studies that show that the more intervention there is during labor, the more likely a c-section is going to happen. But, the medical community usually wants to do more intervention than less, and there are perverse monetary incentives. Here is what can happen.

(I really wish I had some quotes or footnotes, but you're just going to have to trust me) A long time ago, in the first part of last century, some doctor decided that a pregnancy is 40 weeks (the average pregnancy is actually 41 weeks, one day). This has become the standard so any deviation the obs try to avoid. If you go past 40 weeks, they want to induce (usually a dr. will push for it at 41 weeks). The biggest problem with this is that due dates are notoriously unreliable. Only 5% of women give birth on their due date. There is also really no way to know when you've ovulated or the zygote implants unless IVF is used. I have a five week cycle, but my ex-ob insisted on using a 4 week cycle to determine my due date, of course I went past that, but my midwives used the correct date and #1 was born four days early (I was terrified of a forced induction).

Anyway, this is what can happen when you're induced (yeah, yeah, yeah, I know plenty of women are induced without any problem, unfortunately, I know way more that had issues). You go to the hospital and they hook you up to Pitocin (the induction drug). Contractions start and they are super, super painful. So you ask for an epidural (and I can't blame you for that, I've heard Pitocin-induced labor can be quite unbearable). You relax a bit and labor slows down. They increase the Pitocin. Meanwhile, you're hooked up to a fetal monitor (which, BTW, is shown to NOT help and increases the risk of c-section) and suddenly, because of the stress on your body, your baby's heartbeat becomes irregular. Whether this would have corrected itself or not, you won't know, because the dr. is now wheeling you down to surgery for an emergency c-section. They slice and dice (I know, I'm so crude) and you now have your perfectly healthy baby, and a two-week, at least, recovery period from major abdominal surgery. If you're lucky, you won't get an infection (but I've known several women that this happened to as well and they got to spend time in the hospital without their baby).

This was seriously condensed, but the point is that once there is intervention it usually leads to more intervention. Even just starting at the epidural point can cause problems because getting an epidural can slow labor, which will make the dr. want to add some pitocin and you're back on that slippery slope.

The biggest problem is that labor is out of control. Your body usually knows what it's doing, but your body cannot communicate that everything is under control. Drs. want to be the ones in control (in general) and with a natural labor they can't be. A normal labor can start and stop and plateau for a while. Midwives understand this and react to what your body wants to do. Yes, there are women for whom a c-section is necessary and appropriate, but WHO has determined that this should be no more than 10%, not this country's 30% (and rising). If I can help prevent those additional 20% through education, then I will feel as though I've done my job.