Turn essay into claim policy essay.

Does the United States need more Midwives?

Madison Courtney

Georgetown College

Author Note

This paper was prepared for English 125, taught by Professor Burch

Abstract

Does the United States need more midwives? This is the question this paper will explore by looking at the fact that the US has a very high newborn mortality rate and that we use more OB-GYNs for deliveries than any other country. I find that there is a correlation between OB-GYNs and the high infant mortality rate due to the fact that OB-GYNs are surgeons and they use surgery (cesarean sections) that is a lot more risky than a vaginal birth. Midwives only use surgery when necessary and their less risky tactics lead to lower newborn death rates or labor complications. Therefore, I concluded that the United States does need more midwives.

Does the United States need more Midwives?

The United States newborn death rate is the second highest in the world, this is a fact that many people are unaware of today. With the amount of money the US spends on healthcare, we should not have a rate this high. Because OB-GYNs are used more in the US than any other country, you have to wonder if there was a correlation between the two. After research, I have found a correlation between OB-GYNs and newborn death rate because of labor interventions that lead to cesarean sections. Midwives don’t have the same outcome as OB-GYNs. Midwives aren’t as quick to use interventions and their cesarean section rate is a lot lower than OB-GYNs leading to lower risk labors and therefore a lower newborn death rate. Therefore, the US needs more midwives.

Literature Review

In a documentary by Lake it is said that among 33 industrialized nations, the United States is tied with Hungary, Malta, Poland and Slovakia with a death rate of nearly 5 per 1,000 babies, according to a report from Save the Children (April 2006). This is the second worst newborn death rate in the developed world. The five countries with the lowest infant mortality rates (Japan, Singapore, Sweden, Finland and Norway) midwives were used as their main source of care for 70 percent of the birthing mothers (2008).

Cesarean sections have many more risks than vaginal births. C-sections are more likely to occur because of the interventions during labor. Pitocin is a common intervention that puts the baby in stress during labor, which leads to a cesarean section. OB-GYNs are a lot more likely to use these interventions than midwives. Lewis Mehl-Madrona, MD, PhD, coordinator of Integrative Psychiatry and Systems Medicine at the University of Arizona College of Medicine Program in Integrative Medicine, comparing 1,046 home births to 1,046 hospital births found negative outcomes consistently higher in hospital births. These included a fetal distress rate six times higher in hospitals, a respiratory distress rate 17 times higher in hospitals, babies requiring resuscitation 3.7 times higher in hospitals, maternal postpartum hemorrhage three times higher in hospitals and 30 birth injuries in the hospital compared with none occurring during the homebirths (2008).

In America, midwives attend less than 8% of all births and less than 1% of those occur outside a hospital. “In 1900, 95% of all births took place in the home. In 1938, half the births took place at home, and in 1955, 1% of births took place at home (Lake, 2008).”

In the 30s doctors routinely took x-rays of the pelvis, resulting in babies with cancer. In the 70s, use of the drug thalidomide, used for morning sickness, caused birth defects, while in the 90s, the drug Cytec was used to stimulate contractions in mothers who had undergone previous Cesarean section. This was later found to cause ruptured uteruses and high infant mortality (Lake, 2008).

“Hospitals were offered as this gleaming, wonderful place where you could go and have a baby that would be cleaner and safer. The reality of course was that giving birth with an obstetrician at that time was much more dangerous than giving birth with a midwife because as doctors were graduating from medical school, many had not witnessed a live birth before they went out to practice (Lake, 2008).”

They were actually given the drug scopolamine in the 40s, 50s and 60s that put mothers into a kind of “twilight sleep” that didn’t stop pain, but merely eliminated the memory of pain by attacking the brain functions responsible for self-awareness and self-control, resulting in a kind of psychosis, followed by post-traumatic stress-like memories in thousands of new mothers They were strapped to the bed using sheep’s’ wool so it wouldn’t leave marks (Lake, 2008).

Labor is a business. If a midwife is getting a lot of births at a hospital they will be fired because they don’t bring in as much money. Midwives are also less accepted people are uneducated about what a midwife does. Midwives are normally very well educated in the birthing process. Midwives are far better trained to do natural and vaginal deliveries than an OB-GYN. upon leaving medical school; most OB-GYNs have never witnessed a live birth. OB-GYNs are trained to do surgery rather than just letting a woman’s body deliver the child on its own, so they are only really necessary for high-risk patients. However, as medical anthropologist Robbie Davis-Floyd points out, the medical- industrial complex – the relationship between hospitals, the powerful lobby group the American Medical Association, and the insurance companies – has a history of discouraging home births, and discouraging midwives who practice in a hospital setting (Lake, 2008).

Once men were involved in the labor process, rather than trusting their bodies to deliver a child, they relied on medical processes. “Childbirth, until modern times, was a natural event in the life cycle and treated as such. Over time, men became involved inadvertently when they were called upon to assist in extremely complicated childbirths. The shaman, priest, physician, or barber-surgeon of the middle ages came to the aid of the distressed midwife. He had tools to extract the baby, perhaps in pieces (Brodsky, 2006).”

“Modernism overtly and covertly conveys an illusion of right answers, of one way to give birth. Truth be told there id no right way to give birth. As childbirth educators we must continue to encourage expectant parents to ask questions, to investigate the literature, and to recognize the politics behind decisions that are made (Savage, 2002).” Gould Suggests that doctors do not cause cesarean sections but by patients making the decision because they believe it is safer. While there is no evidence that supports the fact the cesarean sections are safer, popular culture makes them seem easy and attractive. There is even such thing as ‘designer births’ where a woman will get a C-section and then a tummy tuck immediately after.

Discussion

There is an apparent problem in the United States when it comes to labor. We would like to think the large amounts of money that we are spending on healthcare makes our healthcare is superior, however because of our surprisingly high newborn death rate it is apparent that we are not superior. The rate of newborn death is higher because of high rates of cesarean sections and labor interventions. Labor interventions such as a labor-inducing drug called Pitocin, put the baby in distress, once the baby is in distress they need to perform a cesarean section in order to save the baby. Cesarean sections are major surgery, recovery time is a lot longer for the mother and the child may be at risk.

These interventions are very common when it comes to OB-GYNs in order to speed up the labor process. In hospitals, where OB-GYNs are the primary care source, the fetal distress rate was six times higher in comparison to home births, a respiratory distress rate 17 times higher, babies requiring resuscitation 3.7 times higher, maternal postpartum hemorrhage (bleeding from ruptured blood vessel) three times higher and 30 birth injuries in the hospital compared with none occurring during the homebirths (Mehl-Madrona, 2008). While this data compares home births and hospital births rather than OB-GYNs and midwives, it is safe to assume that the home births were midwife assisted and the hospital births OB-GYN assisted. Because in America, midwives attend less than 8% of all births and less than 1% of those occur outside a hospital (Lake, 2008). Even in hospitals, midwives rates of complications continue to be significantly lower than OB-GYNs simply because they are less likely to use interventions.

Drugs are not carefully tested when used on pregnant women or during labor. In the 30s doctors routinely took x-rays of the pelvis, resulting in babies with cancer. In the 70s, use of the drug thalidomide, used for morning sickness, caused birth defects, while in the 90s, the drug Cytec was used to stimulate contractions in mothers who had undergone previous Cesarean section. This was later found to cause ruptured uteruses and high infant mortality (Lake, 2008). These methods and drugs seemed safe at the time and they were only questioned after they caused problems. If these issues were older it would be easier to overlook, arguing that today we are more cautious. But there was something used under 20 years ago that was killing mothers and newborns. It seems much safer to go the natural route. (I’m pretty sure there was something they used recently that they thought was causing issues, need more research)

It is very obvious which route of birth is safer, so why do we continue to favor more medical/surgical processes. The reason we have this mindset was because during the feminist movement during the 30s women had the understanding that the reason women have labor pains was because of Eve’s sins, they believed it made them stronger women by not having the pains. “Hospitals were offered as this gleaming, wonderful place where you could go and have a baby that would be cleaner and safer (Lake, 2008).” They were actually given the drug scopolamine in the 40s, 50s and 60s that put mothers into a kind of “twilight sleep” that didn’t stop pain, but merely eliminated the memory of pain by attacking the brain functions responsible for self-awareness and self-control, resulting in a kind of psychosis, followed by post-traumatic stress-like memories in thousands of new mothers They were strapped to the bed using sheep’s’ wool so it wouldn’t leave marks (Lake, 2008). Therefore, the mindset the US has is not a very solid one and it should be changed for the safer route, rather than the more popular one.

After this movement, once men were involved in the labor process, rather than trusting their bodies to deliver a child, they relied on medical processes. “Childbirth, until modern times, was a natural event in the life cycle and treated as such. Over time, men became involved inadvertently when they were called upon to assist in extremely complicated childbirths. The shaman, priest, physician, or barber-surgeon of the middle ages came to the aid of the distressed midwife. He had tools to extract the baby, perhaps in pieces (Brodsky, 2006).” Women began to trust their bodies less and less and relied on doctors do unnatural exhibit a natural process. This made labor unsafe.

The reason that this mindset continues to exist is because labor is a business. If a midwife is getting a lot of births at a hospital they will be fired because they don’t bring in as much money. Even though midwives are far better trained to do natural and vaginal deliveries than an OB-GYN. upon leaving medical school; most OB-GYNs have never witnessed a live birth. OB-GYNs are trained to do surgery rather than just letting a woman’s body deliver the child on its own, so they are only really necessary for high-risk patients. However, as medical anthropologist Robbie Davis-Floyd points out, the medical- industrial complex – the relationship between hospitals, the powerful lobby group the American Medical Association, and the insurance companies – has a history of discouraging home births, and discouraging midwives who practice in a hospital setting (2008).

There is also a lack of education. There is a rebirth of women who are interested in improving labor conditions and pushing the use of more midwives. Before this, however many women had no clue what a midwife is. Many women picture a midwife as uneducated woman showing up at the door holding a towel and telling someone to boil water. In many states, midwifes cannot get liability insurance in order to do homebirths meaning that they deliver solely in hospitals. Midwifes are different in the fact that they spend more time with the patient and respect their wants and needs when it comes to childbirth. Many women write up their own contract stating how they want the process to go, such as not mentioning an epidural or saying the word contraction. This allows the woman to be on charge of the birthing process, rather than doing whatever the OB-GYN says is necessary.

It could also be argued that the hospital is the issue, not the provider. However most inductions occur at 4 and 10, implying that OB-GYNs are quick to speed up the labor process when they are ready to go home. It is the provider that makes these decisions, not the hospitals. OB-GYNs are still surgeons and they want to do the easiest route that they know best, surgery. While this is widely accepted in the US, it is not the safest route.

“Modernism overtly and covertly conveys an illusion of right answers, of one way to give birth. Truth be told there id no right way to give birth. As childbirth educators we must continue to encourage expectant parents to ask questions, to investigate the literature, and to recognize the politics behind decisions that are made (Savage, 2002).” Gould Suggests that doctors do not cause cesarean sections but by patients making the decision because they believe it is safer. While there is no evidence that supports the fact the cesarean sections are safer, popular culture makes them seem easy and attractive. There is even such thing as ‘designer births’ where a woman will get a C-section and then a tummy tuck immediately after.

The US as a whole needs to change its mindset if we have any hope of lowering our newborn death rate. Based on the evidence collected, it is very apparent that in order to lower our newborn fatality rate we need to change something and the best option is more midwives.

Lake, R. (Producer), & Epstein, A. (Director) (2008). The business of being born [Web]. Retrieved from http://www.thebusinessofbeingborn.com Lake, R. (Producer), & Epstein, A. (Director) (2008). The business of being born [Web]. Retrieved from http://www.thebusinessofbeingborn.com

Brodsky, P. L. (2006). Childbirth: A Journey Through Time. International Journal Of Childbirth Education, 21(3), 10-15.

Savage, J. S. (2002). Postmodern Implications of Modern Childbirth. International Journal Of Childbirth Education, 17(4), 8

Gould, D. (2007). Rising caesarean section rates: the power of mass suggestion. British Journal Of Midwifery, 15(7), 398.