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Pregnancy Is Not a Pathology

May 21, 2009

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 first marriage fell apart. My goal back then was to pursue nursing through to the graduate level and become a certified nurse midwife, but as we fell apart and I immersed myself more and more into creative writing (and I failed organic chemistry), I second guessed myself. Then things between us 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.

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.

I should add that I don’t consider myself a radical. I’m not interested in a home birth, not crazy about seeing certain common sense things I did with my first son now being proselytized as “attachment parenting,” and I tend to be moderate in most political arenas, mostly because being a journalist causes a person to be more circumspect in examining all sides of an issue. But I do believe that obstetrics is an important field that should support midwifery, not the other way around and not competing with one another.

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