Amnesty International has declared maternity care in the U.S. a “crisis.” On Labor Day this year, families, birth workers and advocates will gather at Milam Park for the third annual Improving Birth Rally, hoping to gain recognition for the fact that our maternal health care system is failing mothers and babies. Out-of-date health care practices are putting mothers and babies at risk.
The national statistics are not great. The U.S. -- out of all industrialized countries -- spends the most money on maternal health care but has the worst maternal outcome, including the highest maternal mortality rate, placing it in the same realm as the rates in Iran and Hungary.
Amnesty International ranks the U.S. 41st in the world for maternal care. The World Health Organization defines maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”
Sadly, Texas also exceeds the national rate in this area, reporting maternal mortality as 24.63 of every 100,000 women dying of pregnancy or birth-related causes compared to the national rate of 19.2 of every 100,000 of live births.
About 9 out of 10 mothers receive care that increases risk of harm to themselves or their baby rather than decreasing it. There is a massive gap in the U.S. between routine, traditional practice and what current science shows is best for mothers and babies.
For example, while cesarean delivery (or surgical birth) is at times necessary and life-saving, it is a procedure that can be abused by practitioners. U.S. cesarean delivery rates hover at about 33 percent of all births. The World Health Organization recommends a level of only 10 percent, however.
According to the Metropolitan Health District, Brooke Army Medical is the only hospital in San Antonio that approaches the recommended rate. Every other hospital has much higher cesarean rates, with Methodist Stone Oak hospital reporting cesarean deliveries at a whopping 47 percent.
A cesarean delivery is a major abdominal surgery, and it carries many of the same risks that other such procedures do. In addition, each subsequent cesarean birth increases the risks of complications to the mother. The American Congress of Obstetricians and Gynecologists(ACOG) now recommends that qualified candidates should attempt a trial of labor, if they so choose, rather than a repeat cesarean delivery. Many obstetricians, however, including my own, will not even entertain the possibility of a vaginal birth after cesarean (VBAC) with their patients, in frank non-compliance of ACOG recommendations.
How does our local community fare? In the last couple of years, San Antonio birth statistics have exceeded the national ones in terms of cesarean births, overall maternal health and infant mortality.
Bexar County Health Profiles report the 2011 cesarean birth rate (the most recent health statistics published by Bexar County) at 36.5 percent. This is the second-highest cesarean rate in Texas. African-American mothers are more likely than other ethnic groups to experience surgical birth.
How did we get to this point?
There is no end to the social confluences that created this current reality. Obstetrical training creates highly specialized and competent doctors who have a tendency to view pregnancy and birth through a medical lens, understanding it as a medical condition instead of a natural one. They are trained to be able to respond to any problems or emergencies that arise during a pregnancy or labor.
A growing number of mothers feel their doctors do not view them as competent in childbirth, however. Another factor often cited as driving this maternity care crisis is a push for profit, which fails to implement the practices proven by science to be safest and effective.
Despite this factor, a slew of scientific studies examining evidence-based care practices have expanded the body of knowledge in the obstetrical setting. Improvingbirth.org defines evidence-based care as “Practices that have been shown by the highest-quality, most current medical evidence to be most beneficial to mothers and babies (reducing incidences of injuries, complications and death), with care tailored to the individual.”
Surgical births are not the full scope of the problem, however. Early medical inductions, attempting to estimate fetal weight and size via ultrasound, the misuse of pitocin, continuous electronic fetal monitoring, routine episiotomies, back-laying position and routine artificial breaking of the waters all are commonplace procedures whose efficacy is not necessarily based on scientific evidence but in traditional practice. Practices not based on evidence-based care are not best practices.
This is a fixable problem! What can we do?
- Empower ourselves through education and advocacy. Recognize those maternal health professionals who do give supportive, evidence-based care (San Antonio is lucky to have some great obstetricians, midwives and other birth-support professionals who already do this).
- Hold professionals providing maternity care to a high standard of evidence-based practices. As consumers, question your health-care providers. Remember, they work for you!
- For people who have had great birthing experiences, reach out to other mothers and fight so that same level of care is available to every woman and her family.
The push-back is happening. More and more people are beginning to speak out about their experiences with birth trauma. Please see Improving Birth's #breakthesilence campaign, birth rape, feelings of disappointment about difficult births, and discontent with current medical authority. Positive and supportive births are within our reach.
What makes a good birth?
Evidence-based care, active participation in decision-making leading to informed consent and refusal of procedures, patient-centered support, believing that women can be logical agents and decision makers in their own health care, and harnessing our power to advocate for ourselves.
This Labor Day, our community will stand simultaneously with thousands of people in over 100 cities around the country, in peaceful, family oriented gatherings, for the 2014 Rally to Improve Birth. Our purpose is to call attention to the dire state of our maternal health care system and to call for evidence-based, humane birth practices.
Please join us at 10 a.m. in Milam Park, 500 W. Houston St., to stand in support of San Antonio families and demand change. For more information, email firstname.lastname@example.org or visit our page on Facebook.
*Featured/top image: Welcome, baby. Photo courtesy of Marci Walther Photography.