The score ~ how childbirth went industrial

Pre-term birth is on the rise, too, for reasons yet to be determined.

Also, not that you state specifically otherwise, byt medicine if properly practiced *is* an art, and childbirth assistance as art is not the exclusive domain of those providers without medical degrees, now or ever.

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The end of the piece with the comment "whipped both ways" really resonated with me. My experience was similar.

On a related note, you might enjoy this new book:

http://welborn.blogspot.com/2006/10/birththe-surprising-history-of-how-we.html

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How timely!

I'm reading Jessica Mitford's "The American Way of Birth" which talked about everything this article does, but did it in a book in the early '90s.

Fascinating stuff!

I have to disagree that midwifery is in decline: it is on the rise. Since Ina May's Spiritual Midwifery was released in the 70's, midwifery has been slowing climbing back to prominence.

I know, in this area, where midwifery school, adjunct to local med schools, are sometimes harder to get into than med school and practicing midwives are so busy, pregnant women must call to try and get on the schedule the second they are physically able to confirm a pregnancy.

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Birth isn't becoming more scientific in the hands of doctors. If it was doctors would be practising EVIDENCE BASED MEDICINE.

They are NOT. They though episiotemies were great, they sped up deliveries, they saved babies, they prevented tears, a straight cut healed better. One doctor did them, them 5, then most, then it became a "Standard of Care" then they studied it and found they were wrong on all accounts. They do speed up deliveries by 1-2 minutes --which is nothing. They cause more and worse tears, straight cuts heal worse and require more stitches.

Breech babies are more likely to have complications because most healthy babies can and do turn. (Some of course are stubborn and just want to come into the world the hard way.) C-section doesn't save these babies it has the same rates of complications or worse. Although some of these deaths happen a day or more later and therefore aren't the doctors *fault*

I could go on and on and on about almost every standard of care in the medical profession past and present. Women need to start demanding better care and we need to become educated and empowered. And we need to stop doing things because a doctor said so. R

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Here in the Scotland most births are still what they call "midwife led". I really like the system here in Scotland (which has been held up as the best in the UK). Birth is a much different experience here than in the US, much more natural.

But, Dr's are always there if you need them. Both my babies were born in a midwife led unit, but when complications arose with my first baby the midwife alerted a doctor and they immediately came from down the hall to help. I was prepped for a C-section, but was told they would try once to deliver the baby without it, but if it did not work immediately I was having a section. The baby was born straight away and a C-section was avoided. I know in the US this probably would not have happened, they would have gone straight to C-section.

With my second baby things were very straightforward and just the midwife was involved.

Comparing notes with friends in the US their births were far more medicalised than either of mine were, as was their care beforehand. I have loved my care here and now would hate to have a baby any other way.

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Well, what I found the most graphic was why Ms. Apgar came up with the idea to rate the health of babies in the first place - that deformed, blue, or small babies were ofter set aside and let to die, described as stillborns. We know now that those are poor reasons since babies can often be born blue and be fine, as can small babies and deformed babies. I also was appalled that at one time a "crochet" was used to save a mom's life by breaking up the infant's head that was stuck in the birth canal. I forget how horrible life was at one time, and for me, the article gave me some sympathy for the doctors that attended my births. Seems to me that to be a doctor you have to have some insanely large gonads...

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Fantastic article. I love "Annals of medicine" in the New Yorker.

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Modern medicine, especially in these areas, is astounding. A lot of people like to say how horrible it is that the c-section rate is rising, that more women are having their babies in the hospital, etc... But when it comes down to it, it IS safer.
I really doubt even the most adamantly natural woman would make the choice to have a home birth if her baby were at serious risk. Without modern medicine there would be no easy way to know that the baby was at risk.

I made plans to do a water birth, in a very very nice, natural, and peaceful midwife "clinic". But at the same time, I went to a normal doctor just to be safe. If I hadn`t gone to a doctor - if I hadn`t had the miracles of modern medical care available to me - my son would have died. No ifs or buts about it. It would have been considered a miscarriage as I wasn`t even really far enough along for it to be a stillbirth.

If I ever do manage to have another child, I will definitely do everything at the biggest and best hospital I know.

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I was in labor for 19 hours with my son. About 10 hours into it my labor had barely progressed and then stalled and my OB (the youngest doc in the practice... about 35-ish) started talking c-section. Forunately after several hours things started happening and my son was born via an ucomplicated vaginal delivery.

I was in labor longer with my daughter and when it was nearing time to push, her heart rate started dropping. The first time I pushed her heart rate plummeted and my OB (this time, the oldest guy in the practice... probably aout 60 years old) reached for his forceps and in what seemed like an instant, my daughter was born. I remember before I started pushing he mentioned having the forceps nearby and he referred to this as his "trusty forceps".

Interesting that my experience correlates with some of the views expressed by Dr. Bowes in the article. The new guy was all c-section happy and the older doc was intent on vaginal with forceps if necessary.

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It's great that we have modern medicine when we need it. But most women can deliver just fine without it. Doctors are often too proactive (because of lawsuits?). I am involved with the midwife-run birth center in my area and a couple of women were tranferred to the hospital for emergency ceasarians but that's very rare. Midwives are not concerned about thier egos, and want the best and safest delivery for thier patients. They do not hestitate to contact a physician when a true emergency arises. They just define "emergency" differently. A stalled labor, for instance, is not usually considered an emergency in midwifery, whereas hospitals are pretty hesitant to let a woman labor beyond 24 hours from admittance.

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Tamyu, we almost lost Truman at 25 weeks. But we didn't because of our medical team. So, yeah, damn straight. Modern perinatology is amazing and should never be written off with this sort of cavalier attitude: it's all so cold, it's so impersonal, doctors think they know better than nature, whatever. If you want a more natural birth pursue both tracks, so that harsh, cold modern medicine is there to bail you out when nature takes a shot at you.

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Tammyu - that is why I like the system here so much. We see midwives, but I also had appointments with doctors throughout my pregnancies. As I was low risk I was in a midwife led unit in the big hospital (high risk people went dr led in the same hospital) but there were dr's on the floor who could be called in an instant if need be. Actually, with my first son was delivered by a consultant Dr in the surgical theatre as after an uneventful labour we had big problems at the end. I was very glad to be in the hospital and have all that great care. I personally would not deliver without it after that experience as my son and myself could have died.

I had the best of both worlds. I love modern medicine and am SO glad for the advances we have. I was also glad though that nothing that I didn't need was forced on me and I was allowed to labour as I pleased with both babies. :)

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I had a home waterbirth with two midwives attending. It went so very smoothly and beautifully. I would do it all over again in a heartbeat. While my birthing preferences may be different from other people, I do appreciate that we have access to medical care in the case of an emergency. Since my pregnancy was not a high-risk one, I felt fine about birthing at home. If it had been otherwise, of course, I would have not taken the risk birthing at home.

The article was really fascinating to read. I had no idea how the Apgar score came about. The culture of giving birth will continually change as it has been the last several hundred years. It is my hope that childbirth will have less medical intervention for healthy women. This includes midwives working in hospital settings.

A friend recently gave birth with midwives attending in her local hospital. I was so disappointed to hear that the midwives would not let her birth her baby in a position that was comfortable for her. Instead she was forced on her back to make it easier for the midwives to see the baby (wtf?). As expected, she tore really, really badly. If she had been allowed to birth her baby in a different position, I know she would not have torn as badly. We are still a long way from perfecting the 'art' of birthing.

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Reading the comments, I see a misconception that the clients of midwives do not have the immediate access of an obstetrician should a high risk situation or an emergency arise.

This is absolutely false.

Midwives are held to a very high standard of care. They must go to nursing/medical school to become certified. Those schools are often part of traditional medical schools. It is a fantastically competitive prospect, getting accepted to a midwifery program, that it rivals being accepted to med school.

Midwives are trained to provide perinatal/prenatal care for women with low-risk pregnancies. Should the woman suddenly become high risk in any way, an obstetrician is brought in to consult. Should the pregnancy be deemed high risk, the clients care is transfered to an Obstetrician who is trained to deal with obstetrical medical problems.

Midwives are also trained to facilitate the births of women who've had low-risk pregnancies, whether at home or in the hospital (my midwives have hospital privileges at both hospitals that allow deliveries in my city). At any time during labour or delivery, if the mum and/or baby deviate from normal, the midwives bring in obstetricians for consultationa and a transfer of care, if required.

So, if you are sailing along in your pregnancy but suddenly the baby goes into some kind of distress at 30 weeks, or you start bleeding at 22 weeks or something outside of normal, you are immediately given all the benefits of modern medicine to help you and your fetus.

No woman should feel that by having midwifery care she is somehow cut off from the best diagnostics and care that any money anywhere can provide.

Doctors heal the sick. Midwives help healthy women give birth to healthy babies.

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My doctor was wonderful and I think he did great, he didn't cut me in anyway but my daughter did give me a small tear. I was in labor for 38 hours and pushed for about 15 min. While I didn't want an epidural I still asked for one because I couldn't take the back pain. My mom said I "cheated" I was 7 cm when I went in, I did over 50% on MY OWN, I didn't "cheat" I just got a little help. I do regret the epidural though simply because I had problems afterwards, it was nearly 7 hours before I got feeling back in my right leg because I had moved the line.

I know with my next baby I am going to try NOT to have the epidural and see if the hospital will allow me to move around or walk or something. Now just to get pregnant, still trying.

Other then that I find the article interesting and I did learn something! I had a HUGE interest in babies and delivery starting at 5 years old, I read everything I could get my hands on for over 10 years, I no longer have the same interest, but it is nice to learn something new too.

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Mammaloo, thanks for your comments. There is definitly a negative stereotype about midwifery. I live in Michigan, and U of M has a VERY selective C.N.M. program (I think that's the what it's called, when midwives can deliver on their own as opposed to the vocational degree?). We also have in northern michigan a Traditional Midwifery School, which is vocational. I think it's wonderful that this option is becoming more available for low-risk women looking for non-medical births. I also think the personal relationship with midwives is great. Doctors often don't remember patients from month to month, or you may only see the doctor that delivers your baby one or two times beforehand. With the personal care of midwives, you can establish a relationship and I think that makes birthing so much more comfortable. Just my two cents.

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Wow - Ms. Roarke's experience was nearly identical to mine, except I only went 22 hrs before the decels were enough to scare them into a c-section and I was too wiped out to deny it anymore. What an interesting and informative article. I'm not sure if I wanted to know it all (I'm pregnant again), but thanks for sharing it anyways.

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