The De-medicalization of Modern American Birth:  Finding Balance through Childbirth Education and Midwifery

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Over the centuries, birth has been revered by cultures around the world as a sacred rite of passage, and celebrated with dramatically different spiritual, medical and cultural rituals.  Through the development of western medicine and the transition toward obstetric care from traditional midwifery, we have nearly lost the importance of mind-body connection during birth, and in turn, the spiritual and psychological significance that birth has on the female condition.  This has resulted in a shift toward medically treated care and minimized focus on individualized, support-centered care in our society, which has brought a rise in prenatal and postpartum depression, as well as higher cesarean rates and other medical interventions.

The 20th Century Shift Toward Obstetric Care

During the early 20th century, traditional immigrant and African midwifery in America was replaced with modern obstetric care, and for the most part, midwifery was only utilized in underprivileged communities of color.  White birthing parents were fully transitioned into obstetric care, and by “1921, the majority of [individuals] who gave birth under conditions that were indigenous, eclectic, spirit based, and not according to the standards of modern medicine, were the rural black birthing [individuals] of the South” (Kelena Reid Maxwell, Oct. 2009). Traditional methods of childbirth had been replaced with hospital-centered care, medication and later, machine monitoring.  

The spiritual and psychological processes of learning to trust, surrender control, and listen to our bodies during labor were nearly lost within the modern medical system. Fear-based mentalities that we are unable to safely handle the difficulties of birth without being medicated and carefully monitored by machines and obstetricians became the social norm leading into the 21st century.  Birth had fully transitioned from a normal physiological experience to a hospital based medical experience enmeshed with unnecessary intervention, and without evidence of effectiveness.

Currently, the United States holds the highest rate of maternal mortality in the developed world, which continues to rise as it declines elsewhere.  According to this National Geographic article, “more than 700 [birthing parents] die each year in the U.S. from causes related to pregnancy or childbirth. Black [individuals] have a maternal mortality rate three times higher than that of white [individuals]. At least 60 percent of maternal deaths are preventable.”

Minimizing Unnecessary Intervention while Increasing Support

The WHO estimates that almost 15% of birthing parents develop complications during pregnancy and childbirth.  In these cases, obstetrics can be life saving and beneficial. But in the other 85% of birthing parents, obstetric intervention may be unnecessary and pull focus away from support-based care, which can cause a significant impact on the birthing parent’s psychological health during and after childbirth.  This is where midwifery, a medical profession that focuses on normal, uncomplicated birth and continuous support during labor, can play a significant role.

According to a Canadian study of factors influencing parents’ satisfaction with the birth experience, “[birthing individuals] cared for by midwives were three times more likely to be satisfied with their care (OR 3.32 [95% CI 2.26-4.86]) when compared with obstetrician-led care.”   New guidelines by the WHO suggest that a greater focus on childbirth education, and a collaborative midwifery-obstetrician model of care (where care is provided primarily by midwives, and obstetricians provide 24-hour back-up support without competing clinical duties), along with insurance reforms that equalize fees for vaginal and cesarean births, can reduce overall cesarean section rates. An article from the British Journal of Medicine states that the de-medicalization of birth will require “taking pride in a low cesarean rate, developing a culture of birth as a normal physiological process, and having a commitment to one to one supportive care during active labour.”

In 2012, the University of Toronto published a paper in the Cochrane Database of Systematic Reviews. That report, which analyzed over 15,000 births, found that parents with continuous labor support are more likely to have a shorter, spontaneous vaginal birth and less likely to have a cesarean; they are less likely to require medication, and less likely to report dissatisfaction, while their babies are less likely to have low five-minute Apgar scores. This evidence shows that in most cases, when parents birth in a natural, physiological way, there are fewer complications for parent and child.  

Education is KEY.  

Continuous support is KEY.  

Insurance reforms that equalize fees for vaginal and cesarean births are KEY.  

Obstetricians and midwives working together to create a better system of care is KEY.  

There is no excuse for the United States to have such high maternal mortality rates. Use your voice, make an informed choice. Hire a doula. If you are experiencing a low risk pregnancy, do your research and find a care provider who specializes in low intervention and continuous labor support. We can make a difference in modern maternal care, but until we take steps to make change, there will be no change. Let’s make a conscious decision to make things better for birthing parents in the American medical system.

“There are two primary choices in life: to accept conditions as they exist, or accept the responsibility for changing them.”

— Dr. Dennis Waitley

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