In the years I’ve spent researching and writing about birth and newborns, I’ve interviewed doctors, midwives, health care professionals, nonprofit administrators, government officials, corporate employees, new parents, and dozens of others.
So many of the stories I hear keep me up at night:
• The government official (who spoke to me off the record) who publicly and vociferously advocates for vaccines and has published peer-reviewed scholarly articles about the benefits of childhood vaccination but who privately chose not to vaccinate his youngest child.
• The second-time mom whose baby was breech and was “not allowed” a trial of labor by her obstetrician. After the Cesarean birth she got methicillin-resistant Staphylococcus aureus (MRSA), a hospital-acquired infection that almost killed her, leaving her so sick she couldn’t hold her baby for months.
• The second-time birthing woman whose obstetrician—who had been paged more than a dozen times and showed up in a Tie-dye shirt with wet hair—cut an episiotomy so long Grandma, who was watching the birth, told her later she was “horrified.” It took weeks for this mom to be able to urinate without extreme pain. Two years later, when I interviewed her, she told me things still “don’t feel right” down there.
• The third-time healthy young mom who would like to have a vaginal birth after cesarean but who cannot find a doctor anywhere in her state who will even let her try. Too afraid to have a home birth and wanting to be in the hospital in case something goes amiss with the VBAC, she has been bullied into accepting a scheduled C-section.
Here’s another story that still haunts me. Names and some details have been changed to protect privacy.
Julia, a homebirth midwife in California, brought her client, who was in active labor, to the hospital because she was worried. This third-time mom—a healthy, albeit overweight, 32-year-old hoping for a vaginal birth after a previous C-section—was becoming exhausted and possibly dehydrated.
An experienced homebirth midwife, Julia was concerned about the mom and about the baby, who she thought might be in distress.
Sure enough: once at the hospital the fetal heart monitor showed little variability in the baby’s heartbeat.
“I think this baby needs to come out now,” Julia told the doctor on call.
Refusing to acknowledge that Julia was talking to him, the doctor only addressed the laboring mom, who confessed she was still hoping for a vaginal birth. He recommended getting her hydrated and waiting for the results of some lab tests before making a decision. Then he left the room.
When Julia sought out the doctor to tell him the baby wasn’t improving and the heart beat seemed dangerously low, the doctor saw her coming down the hall, swiveled in his chair, and turned away.
It took more than two hours from the time Julia’s client was admitted to the hospital for the doctor—who had had one previously negative experience with a home birth transport—to finally perform a C-section.
“The doctor was in the room for less than five minutes total,” Julia remembered. “He wasn’t paying attention to the case, wasn’t asking me any questions. Both the labor nurse and I were trying to speed things up, I was literally hopping up and down on the balls of my feet, saying, ‘This baby doesn’t look good. This baby needs to come out. This baby looks like crap.’ The doctor just had such distain for homebirth and midwifery, and he probably had a fat bias, which a lot of doctors do, that he wouldn’t listen to us.”
It’s sad that some American obstetricians disdain homebirth, an attitude that comes partially from ignorance and inexperience, partially from professional hubris, and partially from being in the unfortunate position of only seeing homebirth moms when something goes wrong.
Doctors in America are trained to believe that birth, even low-risk birth, is dangerous. Pregnancy is at worst an accident waiting to happen, at best a disease that will be fatal without immediate and extreme medical intervention. Both pregnancy and childbirth, to the average American obstetrician, must be managed and controlled.
How could they think otherwise? Most American obstetricians have never even seen an unmedicated childbirth when they finish their residencies; very few these days (unlike in the not-so-distant past) has attended a home birth or given birth at home.
Despite the fact that a Fall 2012 Cochrane Library Review (considered the gold standard of independent inquiry and scientific objectivity) reports that home birth is as safe or in many cases actually safer than hospital birth, the American obstetrical community continues to publicly oppose homebirth, citing safety concerns as their main argument.
“…[T]heir train wreck or their disaster shows up at my doorstep and I become responsible for their irresponsibility,” said an Indiana-based obstetrician, who believes homebirth midwives do not practice an appropriate standard of care.
“We only see what goes wrong,” explained an East Coast obstetrician to me.
Julia believes that the problem between obstetricians and midwives is also exacerbated by how some midwives behave in a hospital setting, where they feel marginalized.
“As time goes on and I speak more candidly with physicians, I realize how little they know about what we do,” she tells me. “They didn’t know we use a Doppler to listen the baby in labor, for instance.” Most homebirth midwives also carry oxygen and pitocin. “It’s hard not to get frustrated with them,” Julia continues, “but the responsibility also rests on midwives for perpetuating these adversarial relationships … We know we have valuable information and a relationship with that mom. When we walk in there as midwives that have a chip on our shoulder, with a defensive posture, doctors perceive us being unwilling to cooperate.”
Guðrún Eggertsdóttir, the head midwife of the labor ward at Landspítali, the largest hospital in Reykjavik, Iceland, tells me that when a homebirth mom transfers to their hospital she is welcomed warmly. The birth professionals (the vast majority of whom are nurse midwives) at Landspítali do not scold the laboring mom for wanting a homebirth. Instead, they are glad to see her so they can help her have a safe and healthy delivery.
This positive attitude towards homebirth makes so much sense and is one clue to how we can make our birthing system safer: A baby slated to be born at home who is instead delivered in the hospital should not be seen as “a failed homebirth,” but as a safe delivery.
When a mom, like Kristina Delores Adkins, a healthy 35-year-old who died Thursday, March 7, in Coral Springs, Florida, from “complications during childbirth,” dies in the hospital the cause of death is not listed as “hospital birth.” Even when she dies from a C-section birth (which account for the vast majority of hospital childbirth deaths), we do not question the mom’s choice to have her baby in the hospital. Despite the fact that every year over 68,000 women have “near miss” experiences during hospital childbirth–complications so serious they almost die–we do not berate her for being stupid for choosing a hospital birth.
Birth should be a joyous, safe, and fun experience, whether a woman is birthing at home or in the hospital.
This is the 21st century. We live in America, a country that prides itself on freedom and tolerance.
It’s time to demand a safer, more evidence-based birth system.
It’s time for doctors and midwives to start talking and listening to each other, and to the birthing women in their care.
It’s time for all of us to set aside our anger and our prejudices and help women, their partners, and their babies have the best birth they can.
Jennifer Margulis, Ph.D., is a senior fellow at the Schuster Institute for Investigative Journalism. Her latest book, The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line, will be published next month by Scribner.