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While all caregivers recognize that each birth is unique, the stories in BORN IN THE U.S.A. highlight major differences in the worldviews of medical professionals and midwives. Read the perspectives on these stories, based on interviews with a variety of caregivers as they share their opinions of birthing in three different settings: the hospital, the home, and an out-of-hospital birth center.
The Hospital: MeeAe's story
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I actually think MeeAe's birth is a really beautiful example of how biology pretty much rules what's going to happen in a birth. She was really impressive in her labor... she had really given it a tremendous try. Some things are just out of our control: the position of the baby's head is out of our control, the size of a baby, the shape of our pelvis, these things are really out of our control.
-Joanne Armstrong, obstetrician
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Story summary:
MeeAe is a healthy, well-educated woman who wants a natural childbirth, like her mother who gave birth to her naturally. This is her first pregnancy, and she loves and trusts her obstetrician. Considered low risk at the onset of her labor, the process stalls, and she ends up having a cesarean birth (c-section).
Obstetrical view:
Obstetrical training teaches physicians that birth, while a natural process, has inherent risks that require vigilant medical management. Hospitals are equipped to perform emergency surgery and provide pediatric support if the life of the mother or baby is perceived to be at risk. Most physicians and hospitals intervene with drugs and technology if a woman's labor varies from a statistical norm, or "labor curve."
In the hospital, an obsetrician faces many pressures. Physicians often manage more than one birth at a time in addition to their clinical work, limiting their ability to attend to the mother throughout labor or to provide continuous one-to-one care. Hospital economics also make it impossible for nurses to help a mother throughout the course of her labor. Liability concerns require that virtually all women be placed on a continuous electronic fetal monitor (EFM), which increases low-risk women's chances of having a c-section. Physicians must also deal with the reality of medicine in the marketplace, where patients expect and often demand a controlled, painless, perfect birth.
From the obstetrical point of view, MeeAe's birth is an example of how a low-risk situation can become high risk at any point. After over 18 hours of labor, doctors determined that her baby was too big: Her labor would require anesthesia, continuous monitoring and ultimately a c-section.
Midwifery view:
Central to the midwifery model of care is the belief that birth is a normal human event that requires medical intervention only as a response to specific risk factors. Data presented by midwives indicate that the continuous presence of a trained labor companion, such as a midwife or doula, reduces complications and limits the need for epidural and other medicinal pain relief, which can slow labor.
In MeeAe's case, many midwives would consider her hospital admittance premature because, while her bag of waters had broken, she was not really in labor when she entered the hospital. Once in the hospital, staff members often measure the progress of labor by the clock. Midwives point out that the rising use of drugs to induce labor (between 1989 and 1997, hospital induction rates doubled) also leads to higher c-section rates. They note that in the hospital a
vast majority of women receive epidural anesthesia, even while there is
controversy about the drug's effects on labor and the newborn.
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