Major differences in birth practices were exposed with the publishing of a landmark study on home birth in the Journal of Midwifery and Women’s Health earlier this year. There is a lot of conversation among birth professionals about what the study shows and what the numbers mean.
Here are some of the stats, posted on the Lamaze blog Science and Sensibility:
“Almost 94% of the women had spontaneous vaginal births. There was a 5.2% cesarean rate and an 87% VBAC rate. Only 4.5% of the sample required oxytocin augmentation and/or epidural.”
While the meaning of the study is being hotly debated in medical, midwifery, and birth circles, for most women the conversation isn’t even on their radar screen (or mobile phone screen!) If you wouldn’t even think about having a home birth, the likely question is, “What’s the big deal?”
Here’s the answer:
Looking at data from Listening to Mothers III, a study of new mothers’ pregnancy and birth experiences, we find that typically, women, the majority of whom are giving birth in hospitals with doctors, have the following outcomes:
- 69% of women have vaginal births and 31% of women gave birth by cesarean.
- Among only those women who had a cesarean in the past, 14% had a vaginal birth after cesarean (VBAC) for the most recent birth, while 86% had a repeat cesarean.
- 87% of women responding had at least one of the five big interventions (attempted labor induction, epidural, Pitocin augmentation, assisted delivery with vacuum or forceps, or cesarean.
Compared with hospital birth, the stats for interventions in home births are almost reversed on many counts. This suggests, and other research shows, that many of the high-tech, expensive interventions happening in hospitals could be avoided through a less interventionist style of care. In fact, it appears from the research that women and babies would be healthier and benefit from the midwifery model of care, which favors allowing the natural body processes of birth to occur undisturbed.
As sometimes happens with new research, it raises more questions than it answers. Also, everyone, from your doctor to your mother-in-law, has some opinion on the issue of how women should give birth, regardless of what the evidence shows. If you are a woman who wants high-quality, individualized care suited for your personal needs, you will have to make some well-informed decisions for yourself. That means you will need to learn as much as you can about the issues at hand. Studies, like the home birth study and Listening to Mothers, can give you a broader view to inform your decisions.
With all the focus on evidence-based care, the fact is there is a lot more that we don’t know than what we do know. The American College of Obstetricians and Gynecologists reports that at least a third of the decisions made by obstetricians are based on professional opinion, not scientific evidence. When your care provider says you “need” a certain intervention, your health may not be the reason. As a healthcare consumer, you won’t be able to tell the difference between fact, opinion, and wishful thinking if you have no clue what they are talking about.
While your body is made to give birth and can, most likely, do it just fine without any interference or intervention, doctors and hospitals get paid for doing “procedures,” not for watchful waiting as a natural process unfolds. Money comes into play with every healthcare decision, and fear of litigation is a motivator for avoiding even small risks. Women navigating the maternity care system need to be prepared to advocate for themselves and make sure their own interests are included along with the interests of the hospital, the doctor, and the other hospital staff.
When you engage a doctor or midwife and plan to give birth in a hospital you are entering into a business agreement with a large corporate entity. That entity is designed to work as efficiently as possible to maximize profit and remain competitive in a tight market. The fact that the product involved in the transaction is the health of you and your baby is, in many ways, incidental. If you wouldn’t think of going into any other business transaction totally dependent on an outsider to guide you through without doing some research on your own, then you shouldn’t go into your maternity care totally depending on your doctor, midwife, nurse or hospital to care for you without seeking out information for yourself to make informed decisions.
The data from these two studies illustrate clearly that where you receive your maternity care and from whom have important consequences in terms of outcomes. Even if you would never consider giving birth at home, seeing the range in those numbers should alert you to some “issues” involved in hospital birth. You don’t have to scratch very far below the surface to uncover the problems in American maternity care, nor do you have to look very far to find people who can help you through the maze. The home birth study published in the Journal of Midwifery and Women’s Health matters for you because it provides proof of a viable alternative to standard hospital-based maternity care, showing there is potential to improve the system. This gives you, as a maternity care consumer, a powerful tool to use as you advocate for yourself during your care.
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