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else, where would you assume this child was born? The answer seems simple – a hospital. After all, this is the place where around 99% of all births occur and have occurred since the late 1960s (MacDorman). However, why has this institution become the „normal‟ place to have a child, when if you were to have asked a person in 1900 this same question, they would have easily assumed the birth had taken place at home? Yes, 1900 is over a century ago, but what has changed about the birthing process that has needed this change in location and method of labor? The answer to this question is nothing. Nothing has changed about women and their childbearing abilities, yet society has over time created a misunderstanding of natural births and home births and has changed women‟s minds about where and how they should have their babies. This problem needs to be brought to light and fixed. Women ultimately have the right to choose how and where they birth their child, but they should not simply assume hospitals are the best place to do so, when in fact natural home births are a viable (and as I argue, an overall better) option. Ever since the early 1900s, midwives have been looked down upon as dirty and oldfashioned in comparison to the newer hospitals and practices (The Business of Being Born). “In the early 1900s, physicians, mostly in the east, but also in the deep south to some extent went on a very effective smear campaign against midwives” (The Business of Being Born). Posters were made that showed different pictures of midwives in filthy conditions delivering babies (The Business of Being Born). They would often say things like, “Is this the person you want assisting your birth”? “It was sort of a cultural shift where midwives were portrayed as a vestige to the old country; they were dirty, they were ignorant, they were illiterate – and so hospitals
Britton 2 were offered as this gleaming, wonderful place where you could go and have a baby that would be cleaner and safer” (The Business of Being Born). But was this true? Were these places actually the best option? No. “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 doctors were graduating from medical school. Many of them had not witnessed a live birth before they set out to practice” (The Business of Being Born). Unfortunately, it was already too late; the concept of what was normal and socially acceptable had changed, and has not turned back since (The Business of Being Born). However, we must not overlook the educational needs to become a midwife versus to become a doctor in today‟s times. This can oftentimes be one of the many fears women have about midwives; are they trained well enough to handle a natural, low-interference birth? Contrary to popular belief, between the two (OBGYNs and midwives), midwives are actually more qualified to handle natural births (The Business of Being Born). Obstetricians are trained surgeons (The Business of Being Born). Doctors have gone through a minimum of eleven years of schooling (including four years in medical school), yet are not fully trained within these years on specific practices for a healthy pregnant woman (“Doctor or Midwife?”). A small number of doctors have ever truly observed a normal birth, neither in medical school nor in the hospital. “It‟s almost an oxymoron” (The Business of Being Born). However, midwives on the other hand specialize in this. Most Certified Nursing Midwives have at least a bachelors degree (most with masters degrees) and all have received their degrees from midwifery schools across the globe which focus specifically on the care of a healthy, child-bearing woman (“Doctor or Midwife?”). According to JustMommies, a website designed for pregnant women and mothers, “A CNM can safely care for a normal, low risk
Britton 3 pregnancy” (“Doctor or Midwife”). The only thing Certified Nursing Midwives cannot do is perform Cesarean sections or tend to high risk pregnancies (“Doctor or Midwife?”). This fact may unnerve many women, but it should not. “If you develop a complication during pregnancy, your CNM is trained to recognize symptoms and would likely transfer care over to a doctor” (“Doctor or Midwife?”). Also, “home births have a lower risk profile than hospital births,” and this is proving that midwives are only allowing women with lower risk pregnancies to use their services (MacDorman). If a woman is expected to have a higher risk pregnancy, she will most likely not become a patient of a midwife, but rather a doctor who can perform a surgery in the likelier chance that it is needed. Then why even risk it? Why, as some women may ask, put yourself and your baby in that position when you can (more easily) have your child birthed in a hospital where you know he/she will be safe? As simple of a question as this one is, there is also a simple answer. “Highrisk complications occur in only six percent to eight percent of all pregnancies” (“High-Risk Pregnancies”). And, as stated before, these few women will most likely not be advised to use a midwife. From 1990-2009, “the percentage of home births that were preterm was six percent, compared with twelve percent for hospital births” (MacDorman). Also, during this time, the percentage of hospital births that were low weight was double the percentage of that in home births (MacDorman). Even a study done in late 2009 in British Columbia supported this argument. It “showed that planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death” (Shoo). It also showed a trend that these births had less obstetric interventions in comparison to that of planned hospital births with physicians or midwives (Shoo). High-risk births are simply not common enough, as statistics show, to create the need for as much doctor and hospital intervention as society deems women
Britton 4 need. As a certified obstetrician at St. Luke‟s Roosevelt Hospital, Dr. Jacques Moritz even says "for normal, low-risk woman, it's overkill going to a doctor. It's just too much” (The Business of Being Born). But what if a woman is in fact low-risk and planning to have a homebirth, when suddenly complications arise? If this emergency occurs (which it does on a rare basis), midwives have an alternative plan already established with their patients (The Business of Being Born). They have met with the woman during the prenatal time period of her pregnancy (most of the time for all of her actual checkups and tests, seeing as women often use their midwives as their main caretakers in the process) (The Business of Being Born). There is an alternative plan (of transportation, location, etc) for these instances where surgical intervention needs to take place, and the midwives and women are prepared in the case of this unfolding. However, as stated before, these times are rare and can often be pinpointed way before the actual birth takes place. With all of this being said, there seems to be only one angle of this concept that is left to consider; by actually having a child in a hospital, what is a woman missing out on? What is she gaining from having her baby at home which she, in effect, is losing by using a hospital‟s services? There are two overall themes that seem to respond to this question best; one theme is the idea of simplicity and the other is the essence of childbirth. As discussed previously, women over a century ago would never have dreamed about using medications and institutions such as hospitals to assist with their babies‟ births. By having a child in a hospital, a low-risk pregnant woman is putting more money, possibly more medication and possibly more stress into the situation than is needed. As of 2012 in the state of Washington, uncomplicated vaginal births with midwives costs around 2,500 dollars, where as births inside the hospital run around 10,000 dollars (Weeks). “The cost [of a midwife] doesn't
Britton 5 touch additional savings from reducing the rate of often over-used medical interventions such as epidurals and inductions of labor” (Weeks). These facts from a recent Huffington Post article prove that the expense of labor (the most natural human process) is significantly greater just by having it take place under a hospital‟s roof. It also brings up the fact that doctors tend to use more medicines and surgical procedures than are oftentimes needed. “C-section rates are lower in those who use midwives” (Weeks). And as for medication, Pitocin (just one example) is given through an IV that is used for the induction of labor (The Business of Being Born). "Hospitals are businesses; they want those beds filled and emptied. They don't want women hanging around in the labor room," and with this idea in mind, often times Pitocin is used for the convenience of the institution rather than the health of a woman (The Business of Being Born). This medication, along with many other medicines and often times surgical procedures that doctors suggest, can create an unnecessary spiral effect (The Business of Being Born). "You get a one-sided story, and it's very easy to convince a woman to have this procedure, that procedure, especially because there's a huge power disparity [that disparity being between the
woman and her doctor]" (The Business of Being Born). This is all taking away from the simplicity
of what pregnancy can be like and should be like. Thus, tying in with the final theme, this is all taking away from the essence of childbirth. By adding unnecessary hype, women of today have lost sight of the beauty in this completely natural process and instead, are often times filled with fear of what it is like. And rightfully so! “Why should women feel confident about giving birth when the whole culture is telling them this is scary, this is dangerous" (The Business of Being Born)? With such shows as “Maternity Ward” and “A Baby Story,””…women expect to have traumatic experiences” (The Business of Being Born). This should not be the case; yes, childbirth is painful and life-altering, but it (at its
Britton 6 basic level) is the most natural process a woman‟s body has been created to undergo, and it is most often nothing like what society and media make it out to be. Women must realize that by adding extra medicine and extra stress and extra hype to childbirth, they are losing the very essence of what the experience is all about. In closing, if nothing else, one can see how the birthing process has been taken from its most simple form and turned into something so much more convoluted than needed. Have hospitals saved the lives of countless babies and mothers? Absolutely, and one would be ignorant to think otherwise. However, the idea that hospitals should be used regularly as a place to oversee such a completely natural process seems like giving a complicated answer to a simple question. Labor has happened since the beginning of time, and nothing in women has changed since then to have a sudden need for hospital care in most pregnancies. Regardless of a woman‟s decision as to where and how she will give birth, though, one thing is certain – the woman needs to be informed (Valigore). As with any choice in life, the better educated a person is, the better decision he/she will make. In this research process that she should go through, a woman must not overlook a simple but possibly deterring fact; midwifery is illegal in some states. The reasoning behind this is quite complex, but boils down to old laws that have not been modified since hospitals are the socially accepted places to have children and have been seen this way for centuries now (McIntosh). Each state treats midwives differently, but regardless of this, women need to be aware and know that they may have to make slight plan adjustments for the sake of using a midwife (McIntosh). This should all be a part of becoming informed. With this process of becoming informed, however, women need to first and foremost be made aware of their pregnancy options rather than going simply with what society portrays as
Britton 7 normal, and I believe if women were to step back from societies views and realize how intrinsic giving birth actually is, they would see how overcomplicated we have made it become. As researcher and OB/GYN Dr. Michel Dent so exquisitely puts it, the United States has forgotten to ask itself the most rudimentary of questions, that being, what are the basic needs of women bearing their children (The Business of Being Born)? The fact that midwives are used so sparingly today, he feels, is a symptom of that forgetfulness, and there‟s only one remedy (The Business of Being Born). “Like a traveler who suddenly can realize that he took a wrong way. The best thing to do in this case is go back to square one, the point of departure, and to take another direction” (The Business of Being Born).
Britton 8 Works Cited "Doctor or Midwife?." JustMommies. Internet Brands Health, n. d. Web. Web. 29 Oct. 2012. "High-Risk Pregnancies." UCSFHealth. The Regents of the University of California, n.d. Web. 30 Oct 2012. Lake, Ricki, prod. The Business of Being Born. Dir. Epstein Abby. 2008. Film. 20 Oct 2012. MacDorman, Marian F, T J Mathews, and Eugene Declercq. "Home Births In The United States, 1990-2009." NCHS Data Brief 84 (2012): 1-8. MEDLINE. Web. 15 Oct. 2012. McIntosh, Kristin. "Boston College Law Review." Boston College Law Review. 30.2 (1989): n. page. Print. Shoo K. Lee, et al. "Outcomes Of Planned Home Birth With Registered Midwife Versus Planned Hospital Birth With Midwife Or Physician." CMAJ: Canadian Medical Association Journal 181.6/7 (2009): 377-383. Academic Search Complete. Web. 15 Oct. 2012. Valigore, Brittany. Personal Interview. 15 Oct. 2012. Weeks, John. "Homebirth Midwives and the Hospital Goliath." Huffington Post. (2012): Web. 31 Oct. 2012.
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