Were you unable to walk during labor, lying on your back, or pressured into a C-section? This happens to too many American women. Here's what you should know.
American women need to become advocates for better care in the delivery room.
According to Lamaze International, a well-respected non-profit, in healthy, routine childbirth, it’s safest to opt for low to no medical intervention.
Many practices are simply not necessary and can do harm. Inducing labor, epidurals, and C-sections (Caesareans) all interfere with the hormones that are part of the normal labor process.
“Even the hospital setting can pose problems. Bright lights, loud noises, and frequent vaginal exams can increase stress levels [and] get in the way of a healthy labor and birth,” writes Debra Ness, president of the National Partnership for Women & Families.
At the same time, American women are more likely to die during pregnancy and childbirth than in other wealthy nation — such as Canada, Germany, and Australia — because low-income women have too little access to prenatal care and higher rates of obesity, diabetes, and heart disease.
Especially for poor women, money is spent unwisely for the convenience of the hospital and doctors at the expense of women’s needs.
What are the risks of a C-section?
This surgical procedure, when your abdomen is sliced open to deliver your baby, can be lifesaving if it’s medically necessary. Yet, that might be true in only about 10 percent of births.
In the U.S., nearly 32 percent of all live births are delivered this way. Doctors are generally paid much less for a vaginal birth than a C-section, and hospitals tend to be risk-averse, choosing the short-term disadvantages of surgery over the tragedy of losing a baby or mother.
But be clear: C-sections cause more blood loss and a higher risk of infection and blood clots. Recovery tends to be rougher and longer, and complications during future pregnancies are more likely.
In fact, pregnant women who are physicians are about 10 percent less likely to choose the procedure.
While vaginal birth is much safer than a C-section for most mothers and babies, sometimes the procedure is the safest option. Examples include:
- A baby in transverse position (positioned side to side)
- Placenta previa, when the placenta covers the cervix and interferes with delivery
- Breech position
- Fetal distress
You should know the possible harm or benefit of a C-section and weigh them against the risks.
What’s the best way to give birth?
Lamaze offers these guidelines:
- Let labor begin on its own.
- Walk, move around, and change positions throughout labor.
- Bring a loved one, friend, or doula for continuous support.
- Avoid interventions that are not medically necessary.
- Avoid giving birth on your back and follow your body's urges to push.
- Keep mother and baby together after delivery, which helps bond them through skin-to-skin contact while offering the opportunity for early breastfeeding.
A report from Childbirth Connection adds other guidelines, including providing adequate prenatal care and non-drug pain relief during birth.
What often happens in the delivery room?
In a survey of more than 2,500 mothers in California who gave birth in a hospital, four in 10 women reported that a health professional tried to induce their labor.
Of those who felt pressured into inducing labor, three quarters agreed reluctantly. Nearly 70 percent had an epidural, which may prolong labor and make pushing harder, and 61 percent were unable to move in the hospital.
More than half of the respondents said they definitely would either want or consider a midwife, rather than an obstetrician, for a future pregnancy. When midwives attend birth, C-sections drop by a third for first-time mothers, and 40 percent for women who have given birth previously.
What you can do
Your wishes about your own health are paramount and should be respected. Here are several ways to prepare:
- Take the time to explore evidence-based childbirth practices and maternity care. You are best off if you understand the medical terminology you may hear during delivery and know what you prefer. For example, an episiotomy, when the area between your vaginal opening and anus is cut, is not the same as a C-section, when your abdomen is cut
- Decide whether you want to work with a midwife or obstetrician. If you choose a midwife practice, it will often make arrangements for you to get to the hospital quickly, if necessary. Ask obstetricians you’re considering how often they use interventions like inducing labor, continuous fetal monitoring, episiotomy, and C-section. You have the right to refuse such procedures, which have not been shown to help the newborn and may even harm your baby or you and make labor more painful and difficult. In many cases, women are safer and healthier without them.
- Ask providers how long mothers stay in the hospital after giving birth and how long the delivery process generally takes. Longer hospital stays and more natural deliveries may signal better care.
- Discuss your birth plan with your obstetrician. If he or she is not supportive of your choices, consider finding one who is. Finding a supportive healthcare provider and delivery setting are crucial steps for a stress-free delivery.
- If you bring your baby’s father, a friend, or a family member with you to the hospital, make sure that person is informed about your wishes and has the confidence to speak for you during tense in-the-moment decisions. To be sure, you might hire a doula to accompany you.
December 15, 2022
Christopher Nystuen, MD, MBA and Janet O'Dell, RN