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Pregnancy is not a pathology, chapter 1.

May 21, 2009

In the future, I’ll keep these behind a cut and tag them consistently as "the politics of birthing," for those that aren’t interested. But reading Pushed at the recommendation of my midwife last week has really made me regret my fickleness in 1995 that led me away from nursing school, which had been my intent until my marriage to George fell apart. My goal back then was to pursue nursing through to the graduate level and become a certified nurse midwife, but as George and I fell apart and I immersed myself more and more into creative writing (and I failed organic chemistry), I second guessed myself. Then things between me and George really disintegrated between 1996 and 97, and I lost all interest in school.

So anyway, being pregnant again has totally renewed my energies in that direction. And the more I read, the more I see that things have actually gotten worse for women in the 17 years since I was last pregnant.

So I’m posting this one posting without the cut, but I expect there will be more. My midwife wants to write a book about childbirth, but she’s a midwife who wants to be a writer. I am keenly interested in these issues too, and I am a writer who would have wanted to be a midwife.

I’m thinking she and I will be talking more.

Anyhow, you don’t have to read the entire book to get an idea of what I’m on about. This L.A. Times article, which was published yesterday, addresses it more concisely:

Once reserved for cases in which the life of the baby or mother was in danger, the cesarean is now routine. The most common operation in the U.S., it is performed in 31% of births, up from 4.5% in 1965.

With that surge has come an explosion in medical bills, an increase in complications — and a reconsideration of the cesarean as a sometimes unnecessary risk.

It is a big reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may, in fact, be doing more harm than good.


The cesarean rate in the U.S. is higher than in most other developed nations. And in spite of a standing government goal of reducing such deliveries, the U.S. has set a new record every year for more than a decade.

The problem, experts say, is that the cesarean — delivery via uterine incision — exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans also have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.

Inducing childbirth — bringing on or hastening labor with the drug oxytocin — also is on the rise and is another source of growing concern. Experts say miscalculations often result in the delivery of infants who are too young to breathe on their own. Induction, studies show, also raises the risk of complications that lead to cesareans.

Despite all this intervention — and, many believe, because of it — childbirth in the U.S. doesn’t measure up. The U.S. lags behind other developed nations on key performance indicators including infant mortality and birth weight.

And in at least two areas, the U.S. has lost ground after decades of improvement: The maternal death rate began to rise in 2002, and the typical American newborn is delivered at 39 weeks, down from the full 40. Public health experts view the trends with alarm.


So I’m sharing this first installment of "the politics of birthing" without a cut, and I do apologize to those of you who aren’t interested and want me to get back to babyblogging. I will. Future posts with cut, but also to be posted publicly and with the hope that at least some of you will find the information enlightening.

I should add that I don’t consider myself a radical. I’m not interested in a home birth, for one, and I do believe that obstetrics is an important field that should support midwifery, not the other way around and not competing with one another.

2 Comments leave one →
  1. May 22, 2009 6:46 am

    I had Mariam by C-section myself. Reason? My mother has 6 anyeurisms which they believe were antagonized by childbirth. She was born premature, as this says, because I developed toxemia and got dangerously sick very quickly. Though she was born at 37 weeks, she was able to breathe just fine, and was born at a healthy weight. this makes me think they may have miscalculated the due date or something.
    Even though the baby was fine, the c-section was more painful than I remember trans-abdominal surgery being (I had surgery on my kidneys and bladder as a kid). it was so intense. The nurses always seemed to want to examine my staples or some other painful thing either right before pain meds had kicked in, or right after they’d worn off, and I swear, there was nothing but red before my eyes as they’d do that. I used to close my eyes and reach for the Virgin Mary, who I’d see holding out her hand, beckoning. It was utterly harrowing.
    I wonder often if the other way would have been more bearable. I mean, sure, you gotta heal from all the stress and stretching “down there”, but it seems to me that people who go the way that God and nature intended are better off sooner.
    This was interesting. Thank you for posting it.

    • May 22, 2009 2:12 pm

      Oh, I remember my reaction when I read that on facebook–I was praying for you and Mariam to come through it all safely. Toxemia constitutes a reason for a medically indicated section, and since i had pregnancy-induced hypertension during my first pregnancy it is something that I’m wary of. Other reasons for medically indicated sections include placentia previa, active outbreaks of certain viruses such as herpes (which I have, thanks to my ex-husband, but thankfully I don’t get outbreaks very often). But I think dystocia, or failure to progress, is overdiagnosed and often results from interventions done during labor, such as epidurals and pitocin drips. It’s not that I think natural childbirth is superior, it’s that I think the obstetric model of medicine should only be applied when there is a pathology (as in your case), and pregnancy itself is not a pathology.
      This is one of the reasons I consider myself something of a middle-of-the-road-er, though. A lot of homebirth and unassisted birth advocates don’t consider the valid reasons for obstetric intervention, and take the more radical position that medical care is more harmful than helpful. It is my opinion that this is a backlash response to ACOG stances that are not based on sound health principles but on a foundation of liability protection and convenience for doctors. There has to be a middle way. 🙂

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