About Birth
Normal Birth, Safe
Birth
Trust the natural process of your body.
By Christiane Northrup, M.D.
September 21, 2010
The
times have truly changed. According to the 2009 Shriver Report:
A
Woman’s Nation, women now make up half the work force for the first
time in written history! This means that our voices and skills are
impacting all areas of society more than ever before. The Shriver
Report also found that for both men and women, health is their
number one priority! Since women make the vast majority of
healthcare decisions in their families—and have the buying power to
do it—we women are in a very powerful position to influence the
future of healthcare in America. Nowhere is this more critical than
in the area of pregnancy and birth.
As an obstetrician/gynecologist, I have spent the last 30 years
educating women about the wisdom of their bodies, including their
innate ability to birth normally. Yet our so-called healthcare
system, which is a direct reflection of the beliefs of our culture,
sees the female body and its processes (like labor) as an accident
waiting to happen. Media images of birth as an emergency play right
into this. The truth is that labor and birth need not be the
emergencies we think they are. And the medicalization of birth
actually does more harm than good.
Progress Set
Us Back
I was a resident back in the late 1970’s when electronic fetal
monitoring (EFM) was first introduced and lauded as a panacea that
would prevent cerebral palsy and birth injuries. Thirty years later,
data indicates that the only thing EFM has done reliably is increase
the rate of Cesarean section (C-section) births. George Macones,
M.D., who headed up the development of the latest fetal monitoring
guidelines for the American College of Obstetricians and
Gynecologists, summarized it quite nicely: “Since 1980, the use of
EFM has grown dramatically, from being used on 45 percent of
pregnant women in labor to 85 percent in 2002. Although EFM
(electronic fetal monitoring) is the most common obstetric procedure
today, unfortunately it hasn’t reduced perinatal mortality or the
risk of cerebral palsy. In fact, the rate of cerebral palsy has
essentially remained the same since World War II, despite fetal
monitoring and all of our advancements in treatments and
interventions.”1
Monitoring also reliably draws the attention away from the laboring
woman herself, who needs the support, and transfers it to the
monitor screen—as if she and the monitor screen were two separate
entities.
Dangerous
Interventions Soar
Given our love affair with technology and the mind/body split that
is part of health in the United States and birth in particular, it’s
little wonder that our C-section rate is now a whopping 33 percent.2
This is particularly troubling given that the World Health
Organization says that an optimal rate is 5–10 percent, and that
recent research shows that anything over 15 percent does more harm
than good.3
The rate of births by C-section keeps going up every year, and over
the past decade, it’s increased by more than 50 percent. Way back in
1965, for example, the rate was only 4.5 percent!4
At least in part, these sky-high rates may be linked to doctors’
fears of being sued. In 2003, more than three quarters of all
American obstetricians were sued at least once, with a median award
of $2.3 million for medical negligence in childbirth. As a result,
many doctors are more likely to opt for performing a C-section at
the first sign of a complication.5
Then there’s the issue of labor inductions. In 2006, more than 22
percent of all pregnant women in the UNITED STATES had induced
labors, a rate that has more than doubled in the last 20 years.6
Similarly, women have been brainwashed into believing that because a
C-section can be planned it’s therefore preferable to a normal
birth—which, again, society sees as messy and inconvenient.
Labor proceeds on its own schedule. The exquisite timing that is a
result of the delicate interaction between a baby and her mother
needs to be respected. Our culture’s collective trust in C-sections
and labor inductions that increase the risk of surgical birth is
mind-boggling! The Shriver Report points out that women still seek
permission from authority figures far more often than men do. We
still don’t trust ourselves. No wonder we so willingly turn over our
bodies during birth.
Risky labor inductions for “convenience” and all the complications
associated with them—increased risk of prematurity, C-section,
bladder and bowel injury, and maternal death—are now on the rise all
over the country. It troubles me that more women don’t realize that
a Cesarean section is major surgery. And it carries with it a risk
of maternal death that is five to seven times greater than a normal
birth.7
More
Maternal Death Than Reported
Unfortunately, the American public in general (physicians included)
has a false sense of security about the safety of C-sections because
the statistics on maternal death in the UNITED STATES are
misleading. It’s well known that the maternal death rate in any
given population is a very good indicator of the overall health
status of that population, as is infant mortality. Unlike most other
developed countries, pregnancy-related death statistics for the
United States include only women who die within a six-week period
after a pregnancy ends. Other developed countries include deaths
that occur up to one year afterward.
According to the Centers for Disease Control (CDC), the number of
maternal deaths in the United States is probably up to three times
as high as the number reported in our national statistics because
not all maternal deaths are classified as pregnancy-related on the
death certificate.8
According to midwife Ina May Gaskin, who launched the Safe
Motherhood Quilt to bring this issue to public attention, the
maternal death rate has actually doubled in the UNITED STATES in the
last 25 years. It was 7.5 per 100,000 live births in 1982. In 1999,
that rate had risen to 13.2 deaths per 100,000 births. By 2005, it
was up to 15.1 per 100,000 live births! In some New York City
hospitals, it’s higher still. Moreover, Hispanic and Black women
continue to have much higher maternal death rates—perhaps four times
as high or higher.
Gaskin wrote, “When I first became curious about the maternal death
rate in the UNITED STATES, I wondered why it was so difficult to
unearth in the medical library. This was in the early 1990’s. I
noticed a sharp contrast between how maternal deaths are counted
here in the United States and the United Kingdom’s system of
Confidential Enquiries, where four countries cooperate to achieve
100 percent ascertainment of maternal deaths that are directly
related to pregnancy and birth. (They claim 97 percent accuracy.)
According to the CDC, the actual number may be 1.6 to 3 times the
figure that is published annually. I find this shocking, especially
since we know that the maternal death rate has been rising in recent
years—something that isn’t happening in other countries “9
Currently, according to the World Health Organization and several
United Nations agencies, the United States ranks behind no fewer
than forty other nations in preventing maternal deaths (based upon
an official but unreliable number).10
Normal
Birth, Safe Birth
Studies have repeatedly shown that in healthy mothers with no risk
factors, home birth is as safe as hospital birth. Increasingly,
savvy women who trust their ability to birth normally are opting to
avoid the hospital altogether (or at least have the foresight to
hire a midwife or doula). And who can blame them? One study in the
Netherlands looked at almost 530,000 low-risk planned births and
found that with the proper services in place (such as a well-trained
midwife and good transportation), home births are just as safe as
hospital births.11 In fact, home birth may even be safer.
Ina May Gaskin reports that at The Farm Midwifery Center, the
C-section rate is only 1.4 percent—a safety rate unparalleled by
hospitals. And her experience is clearly not solitary. (Learn more
about Ina May Gaskin at
www.inamay.com.) A landmark study published in the British Medical Journal in
2005 found that natural birth at home, under the care of certified
practicing midwives, is safe for low-risk mothers and their babies.
This study, which tracked more than five thousand mothers in the
United States and Canada, also reported that home births with
low-risk mothers resulted in much lower rates of medical
interventions when compared to the intervention rates for low-risk
mothers giving birth in hospitals. For example, the episiotomy rate
was 2.1 percent for the home-birth group, compared with 33 percent
for hospital births, and labor was induced in only 9.6 percent of
home births, compared to 21 percent of hospital births. The rate of
electronic fetal monitoring, C-sections, forceps or vacuum delivery,
and epidurals were also much lower with home births.12
A Woman’s
Birthright
The Pulitzer Prize winning journalists Sheryl WuDunn and Nicolas D.
Kristof, authors of Half the Sky: Turning Oppression into
Opportunity for Women Worldwide (2009), point out that focusing
on the needs of women and girls is the number one issue of this
century. I couldn’t agree more. One of those needs is fostering a
woman’s trust in the processes of her body instead of making them
into surgical emergencies that aren’t medically indicated.
When it comes to pregnancy and birth, we as a culture and as
individuals need to wake up and claim our right to literally birth
right!
References
1. American College of Gynecologists and Obstetricians,
“Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring:
Nomenclature, Interpretation, and General Management Principles,”
Obstetrics & Gynecology, vol. 114, no. 1 (July 2009), pp.
192-202.
2.
B.E. Hamilton, J. A. Martin, and S. J. Ventura, “Births: Preliminary
Data for 2007,” National Vital Statistics Report, vol. 57,
no. 12 (March 18, 2009), p.3.
3.
F. Althabe and J.F. Belizan, “Caesarean Section: The Paradox,”
The Lancet, vol. 368 (2006), pp.1472-3.
4.
S. M. Taffel, P. J. Placek, and T. Liss, “Trends in the United
States Cesarean Section Rate and Reasons for the 1980-85 Rise,”
American Journal of Public Health, vol. 77, no. 8 (1987), pp.
955-9.
5.
American College of Obstetricians and Gynecologists (ACOG) 57th
Annual Clinical Meeting: Papers on Current Clinical and Basic
Investigation. Presented May 5, 2009.
6.
American College of Obstetricians and Gynecologists, “Practice
Bulletin No. 107: Induction of Labor,” Obstetrics and Gynecology,
vol. 114 (2009), pp. 386-397.
7.
M. H. Hall, “Commentary: Confidential Enquiry into Maternal Death,”
British Journal of Obstetrics and Gynaecology, vol. 97, no. 8
(Aug. 1990), pp. 752–53; N. Schuitemaker et al., “Maternal Mortality
After Cesarean Section in the Netherlands,” Acta Obstetricia et
Gynecologica Scandinavica, vol. 76, no. 4 (1997), pp. 332–34.
8.
Centers for Disease Control and Prevention, “State-Specific Maternal
Mortality Among Black and White Women—United States, 1987–1996,”
Morbidity and Mortality Weekly Report, vol. 48, no. 23 (June 18,
1999).
9.
A. de Jonge, et al., “Perinatal Mortality and Morbidity in a
Nationwide Cohort of 529,688 Low-Risk Planned Home and Hospital
Births,” BJOG: An International Journal of Obstetrics and
Gynaecology, vol. 116 (August 2009), pp. 1177-84.
10.
Gaskin, I., Northrup, C. Safe Motherhood Quilt,
www.drnorthrup.com. (August 2009).
11.
Hill, K., et. al. “Estimates of maternal mortality worldwide between
1990 and 2005: an assessment of available data,” The Lancet,
(August 13, 2007) 370, 1311-1319.
12.
K. C. Johnson and B. A. Daviss, “Outcomes of Planned Home Births
with Certified Professional Midwives: Large Prospective Study in
North America,” British Medical Journal, vol. 330, no. 7505
(June 18, 2005), p. 1416.
Christiane Northrup, M.D., a board-certified ob/gyn, is a visionary
pioneer; beloved authority in women’s health and wellness. Website:
http://www.drnorthrup.com
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