Ina May's 2 Cents Worth

Let’s be honest. The decision to take away the option for women to have a midwife-attended birth at St. John’s Pleasant Valley Hospital in Camarillo as of February 8 had nothing to do with concerns for the safety of women or babies. If it had, the hospital would not have cancelled privileges for midwives Lynn Olson and Joyce Weckl. There is plenty of evidence that indicates that putting midwives in charge of caring for healthy women during pregnancy and birth actually produces better results for mothers and babies with fewer interventions at lower costs than having an obstetrician (who is trained to deal with pathologies of birth, not with normal birth) be the sole caregiver for healthy women. There is no evidence that newborns or mothers at St. John’s were put at any increased risk because of midwifery care. CEO T. Michael Murray knew this, I suspect, or he would have presented some with his cowardly statement that rescinded the midwives’ privileges.

A recent U. S. study showed that nurse-midwives spend an average of 24 minutes with a woman during each prenatal visit, compared with obstetricians, who spend only 10 minutes per visit on average. Another study of more than 4 million U. S. births found that midwife-attended low-risk births had 33 percent fewer newborn deaths and 31 percent fewer babies born too small, which means fewer brain-damaged babies. It is well known that midwife-assisted births are far less likely to be induced or to result in a cesarean. No wonder approximately 60 women in the Camarillo area per year took advantage of this option last year. But that’s over now—at least in Camarillo. This bullying of pregnant women and midwives is outrageous; it is especially insulting to explain it as a “safety” measure.

Without exception, the European nations in which 75 percent of births are attended principally by midwives (usually with no obstetrician in the birth room) have lower rates of newborn and maternal deaths than we have in the U. S. None of these countries spends nearly as much money per capita on maternity care as we spend, and in none of these countries are licensed midwives kept from working in hospitals providing maternity care. The U. S. is the only country among the highly industrialized nations that even has the concept of midwives who must beg for privileges, which can later be summarily withdrawn without any right of appeal.

It’s ironic that the St. John’s decision against midwifery took place only days after Californians learned that maternal death rates in California had nearly tripled between 1996 and 2006. Some have suggested that this rise in due to better reporting, which is unlikely, because California has so far done very little to improve the accuracy and completeness of maternal death reporting. Even if it were due to better reporting, it is about 5 times the maternal death rate set as our national goal for 2010 (3.3 deaths per 100,000 live births).

Some might expect that such a shocking news report would have been accompanied by a systematic analysis of the causes for such a quick increase in maternal death—a problem that most people think was solved long ago by high-tech obstetrical care. That has not yet happened. In fact, the state Department of Public Health has so far refused to issue a report on this trend that could help people learn the reasons for the sudden increase in this worst of maternity care outcomes. Surely, California’s women of childbearing age deserve better than this.

For over a decade, I have been tracking the problem of poor reporting of maternal deaths in the U. S., because I was so shocked to find out that the Centers for Disease Control (CDC) is unable to fix the problem they first stated in 1998—that the true maternal death rate in this country could be three times what is officially reported. I began collecting the names of U. S. women who died from pregnancy-related causes since 1982, the year of our lowest reported maternal death rate. I recently learned that by using Google and taking reports from family members or friends of women who have died, I have a considerably larger database of maternal deaths than the Joint Commission, the closest thing we have in this country to a certifying organization for hospitals and other health organizations. (It is suggested, but not mandatory, for hospitals to report maternal deaths to the Joint Commission). Judging by the stories of maternal deaths in my database, the rise in the death rate has much to do with the rising rates of cesarean and induced labors.

There are also similar sounding stories of women dying in hospitals of hemorrhages following birth, suggesting that some hospitals may not be employing enough nurses to provide the kind of watchful care that is necessary in the hours following birth. Making a greater use of midwives is an obvious way to begin reducing high rates of cesareans and induced births.

Ina May Gaskin, PhD (Hon.), CPM, MA
Speaker/Author: Ina May's Guide to Breastfeeding, Ina May's Guide to Childbirth, Spiritual Midwifery
Founding member of The White Ribbon Alliance for Safe Motherhood
Curator: The Safe Motherhood Quilt Project
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The opinion of Ina May was reproduced with her permission. Comments welcome. Dr F