Drugs, Knives, and Midwives

The U.S. maternity care system is in crisis. A grassroots movement to save it is under way.

The woman, who is expecting her first child, is a week past her due date. Even though tests show that her baby is doing well, her obstetrician decides to induce labor with Cytotec. It's a drug that has not been approved by the Food and Drug Administration (FDA) for pregnant women, and it can cause contractions that are strong enough to lacerate the anatomical barrier that keeps amniotic fluid separate from the mother's blood vessels -- a situation known as amniotic fluid embolism (AFE). AFE is almost always fatal.

The woman's contractions speed up immediately, but the doctor continues to give her Cytotec until her contractions are coming so rapidly that the baby is having difficulty getting oxygen. The fetal monitor shows that the baby is in extreme distress, so the doctor sets to work to save it.

Shortly after the birth, the mother starts to hemorrhage and goes into shock. The baby dies 35 minutes after birth. The mother dies a few hours later from AFE.

This nightmarish scenario is one of many from Marsden Wagner's book Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First (University of California Press, 2006). A perinatologist and a scientist, Wagner is a former director of women's and children's health at the World Health Organization (WHO). He's also an old-fashioned whistleblower. By his lights, the American birth industry is in a crisis because we have turned a natural event into a medical condition. As a result, we've allowed obstetricians -- and not the midwives who safely deliver the majority of the world's babies -- to control maternity care. The ironic result is that in our efforts to make birth as safe as possible, we have saddled American women and babies with a system that, despite being the most expensive on earth, puts us in the bottom tier of care for wealthy countries.

Today, more than 15 years after Jessica Mitford detailed the potential hazards of obstetrical forceps, fetal monitoring, and diagnostic ultrasound in The American Way of Birth and more than a quarter century after Immaculate Deception, author Suzanne Arms' expose of high-tech birth, sold more than 250,000 copies, the number of American women who die around the time of birth is on the rise. According to WHO, 28 countries -- including Croatia, Ireland, Kuwait, and Portugal -- have lower maternal mortality rates. Forty-one countries have lower infant mortality rates.

It's not just the shocking mortality rates that trouble Wagner and other reformers. Childbirth Connection, a New York organization dedicated to improving maternity care, recently published Listening to Mothers II, a national survey of 1,573 women who gave birth in 2005. Its findings document numerous indignities and dangers, most of which easily could have been prevented. Of the 25 percent of women who were given episiotomies (a cut in the muscle between the vagina and the anus to widen the birth canal), a startling 73 percent were not consulted before having the procedure.

12/26/2013 1:14:37 AM


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