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TECHNOLOGY AND PUBLIC HEALTH:
HOW MUCH, HOW OFTEN AND FOR WHOM?
The American medical system is considered to be among the most technologically advanced in the world, and in a culture where we believe anything is possible, we expect this technology to improve our lives and solve our problems. We do, in fact, spend more per birth than any other country in the world. Each year, approximately 4 million babies are born in the U.S., most in a hospital with a physician in attendance.
Why then do we rank last among the industrialized nations in infant mortality and low birth weight (24th in the world)? Why are African American babies two to three times more likely to die during childbirth than their white counterparts and African American women four times more likely? What does our medicalized "average" childbirth reveal about our society's support of women and children?
Childbirth is an individual, singular experience with inherent risks and benefits. What should the average, healthy woman expecting a child know? What safe options exist? Are all options available? Should they be? For the average low-risk woman, what are the risks and benefits of technology in the birth room? Should every birth make use of the latest technology?
Midwives and obstetricians often disagree on the role of technology in the birth room. A standard physician-attended birth usually includes the administering of intravenous fluids (IVs), the use of continuous electronic fetal monitoring and the widespread application of regional and epidural anesthesia. Cesarean sections - where the baby is surgically removed from the mother's abdomen - occur in more than one in five births (22 percent); 40 percent of all vaginal births are accompanied by an episiotomy, a surgical cut to widen the vaginal opening.
Many midwives question the necessity of these interventions and point to current data that support their use only to correct specific medical complications. They claim that continuous one-on-one care reduces the need for most obstetrical interventions for low-risk women and that research supports the safety of out-of-hospital births for such women.
Few medical institutions can afford one-on-one care, the limiting factor most often cited by physicians. Obstetricians are generally responsible for more than one birth at a time, in addition to other clinical work, and the vast majority of obstetricians believe these "standard" medical procedures make birth safer. Many even believe that out-of-hospital birth is patently unsafe. Furthermore, doctors must balance their scientific knowledge against the threat of lawsuits and the competitive nature of the medical marketplace.
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Epidural Procedure
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Consumers also often demand a painless birth, which necessitates the use of technology. Indeed, early feminists clamored for pharmaceutical advances to help ease the burdens of childbirth. In the midwifery model, labor pain is managed by constant emotional support: walking, massage, baths, showers and giving the mother control over her environment.
While no caregiver wishes their patients' pain to consume the birth experience, medical research has raised concerns about the routine use of epidural anesthesia. Though generally considered safe, epidurals are associated with an increase in prolonged labor, back pain, nausea, severe headaches, the use of forceps, vacuum extraction and c-sections. There is little research exploring the long-term effects of epidural anesthesia on mothers and newborns.
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