This is a topic that I feel very passionately about. I think most Americans think that this is probably the best country in the world in which to have a baby. But in actuality, it is nowhere near the safest country in which to give birth. Americans spend more money on childbirth than any other country, but when you look at the statistics below, you will see that we are not getting our money's worth.
According the the World Health Organization, in 2008 Ireland and Greece lead the way in low maternal mortality rates with Ireland having 3 maternal deaths per 100,000 births and Greece with only 2. The United States, on the other hand has 24 deaths per 100,000 births. That is 12 times Greece's rate. Most developed countries have rates between 5 and 10. Here's a list of countries that have lower maternal mortality rates than the United States:
Australia, Austria, Bahrain, Belarus, Belgium, Bosnia and Herzegovina, Brunei, Bulgaria, Canada, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Israel, Ireland, Italy, Japan, Kuwait, Latvia, Lithuania, Luxembourg, Macedonia, Malta, Montenegro, Netherlands, New Zealand, Norway, Oman, Poland, Portugal, Qatar, South Korea, Serbia, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, United Arab Emirates, and the United Kingdom.
We are tied with Saudi Arabia for 49th place. I find this shocking. When Kuwait has 9 maternal deaths per 100k births and the United States has 24, well, that pisses me off. What makes me even angrier is that our rate has not decreased in the last 25 years, but has increased. In the mid 1980s our rate was only about 12 deaths per 100,000 births. So it has doubled in the last 25years. If that doesn't concern you, it should.
So why is our rate increasing instead of decreasing? And why are 48 other countries kicking our butts in this area? A huge part of it is that most American obstetricians view pregnancy and childbirth as a medical conditon instead of a natural condition. OBs are trained to view childbirth as a very dangerous thing where all sorts of things can go wrong. Due to this, they often rush to intervene when no intervention is necessary. But if women are given proper care and support, and allowed to let nature take its course, interventions are rarely needed.
It is interesting that while our maternal mortality rate has increased over the last 25yrs, so has our c-section rate. Perhaps there's a correlation. The WHO says c-section rates should be between 10-15%. In Europe it is 19%. In the U.S. it is 30%. That means nearly one in three American women will give birth via c-section when only one in 7 women actually needs one. One of the reasons for the high c-section rate is that women who have had a c-section with a previous baby do not have a vaginal birth after caesarean (VBAC) despite 90% of those women being candidates for a VBAC. Reasons for this range from women not being given the opportunity to try for one or being unable to find a physician or midwife willing to attempt a VBAC delivery. Many hospitals do not allow for VBAC deliveries. About 75% of women who do attempt a VBAC are successful, and the risks of a VBAC for the vast majority of women are much lower than the risks of a repeat CS. Still many OBs and hospitals are against VBACs. One has to wonder if money and the convenience of a CS to the OB are some of the factors.
Another reason for America's high CS rates is that OBs tend to be CS happy. They give a woman so many hours to have her baby, and if she hasn't delivered within about 24hrs, off to the OR she goes with "failure to progress" as the reason--even if mother and baby are fine. Births in hospitals with an OB in attendance are also more likely to have interventions such as elective inductions and the use of epidurals. Whenever induction drugs or pain meds are used, it increases the chances of fetal distress and can slow down labor, necessitating the need for a CS.
Many women are scared into a CS because the doctor tells her based on the ultrasound that her baby is too big to pass through the birth canal. Well, ultrasounds are notoriously wrong in their weight estimates. I know several women who were told they were having a huge baby and pressured into a CS without even attempting a vaginal birth. When their babies came out, they were considerably smaller than what the ultrasound indicated. Those women probably could've had a vaginal birth. Often when the baby seems too big, a vaginal birth can be had if the mother changes into a position that works with gravity--squatting or getting on all fours. The traditional position for laboring (on one's back) is the least affective position for birthing. And being stuck in a bed hooked up to IV's, or with an epidural is also counterproductive to getting a baby out.
There are so many more reasons for our high maternal mortality rates, but it would make this blog into a novel. If you really want to look into this further and see how unmedicalized a birth can be, read Ina May Gaskin's "Guide to Childbirth." She is a very well-known and respected midwife around the world. Her birthing center in Tennessee has unbelievable statistics. Her CS rate is 2%. She has never lost a mother in over 2,200 births, and her infant mortality rate is lower than the national average as well. Ina May's theory is that women's bodies were beautifully designed to give birth vaginally. And she is quite sure that a lot of the reasons women fail to progress in hospitals is because of the cold and unsupportive atmosphere women in labor endure. Too many doctors and nurses fail to respect the mother's wishes and have terrible bedside manners, often belittling and scaring women into agreeing to procedures they otherwise wouldn't--and without giving her all the facts. Check out Ina May's website
http://www.inamay.com/
I just re-read her book, and it is so empowering to women. I recommend all pregnant women and women even thinking about having a baby read this book. I know too many women who have had bad experiences in childbirth that probably would've had better outcomes had they read this book. My experience with my first birthing was fairly good--my wishes were always respected by the nurses and my midwife. I did cave after 22hrs of drug-free labor and get an epi because my labor had stalled at 9cm and I was worried I'd need a CS if things didn't start moving again. I was exhausted and the epi took my pain away and helped me get some rest. May was born about 6hrs after I got the epi. My goals for this birth are to not be induced, to pass on the epidural, and to have a shorter labor.
Many people here are wary of using a midwife. But in most of the countries listed above that have better MM rates than we do, nearly all low-risk women use a midwife and not an OB. They also have more home births. Midwives spend more time with their patients during pre-natal visits and during labor. They have much lower rates of CSs and interventions. And despite what many people think, you don't have to give birth at home in order to use a midwife. Mine only does hospital births. But the studies show that a planned home birth with a qualified midwife is just as safe for both mother and baby as a hospital birth with an OB--and you're far less likely to end up with a CS.
If more low-risk women went with midwives," I have no doubt that our quality of care would increase dramatically.
