It’s been a decent week for birth in the news
Oftentimes when I see anything birth-related covered by the national news, I end up feeling very underwhelmed (to say the least). One-sided coverage (mostly from ACOG’s perspective), exaggerated risks and benefits of various procedures or processes, and even a blatant lack of research on a given topic all seem to pervade the segments on pregnancy and birth that I’ve seen in recent years.
But the past week has been a relatively good week for transparent and seemingly fair (though, admittedly, not always cheery) coverage of a few birth-related issues. And in my opinion, each of the following news pieces is worth checking out–not just for the decent news coverage but also for the helpful information.
Senior medical correspondent and “Empowered Patient” columnist Elizabeth Cohen examines the relative risks and benefits of VBAC and cesarean section within the context of two current news stories: 1) the fact that some insurance companies have denied women health care coverage after considering their previous c-sections to be “preexisting conditions” and 2) the story of Joy Szabo, a mother in Arizona who must travel 300 miles to the nearest “VBAC-supportive” hospital just to have her second VBAC (and who was threatened with a court-ordered cesarean by her local hospital if she attempted to have a VBAC there).
All in all, I am impressed with Cohen’s discussion. Could she have done a better job of reporting the risk of uterine rupture? Sure. (For what it’s wort, the rate of uterine rupture during a VBAC is less than 1% for most women: .4% if labor begins on its own, .9-1.1% if labor is augmented or induced with pitocin, creating a rate of approximately .7% for all VBAC attempts, induced or not.)
But Cohen does a superb job of addressing issues that are often overlooked in the coverage of cesarean sections and VBAC. For one, she is careful to place the risk of uterine rupture alongside the risks of cesarean section. This simple exercise in good reporting helps to dispel the illusion that VBACs are a “risky” option when compared with “easy” and “risk-free” cesareans.
In addition, Cohen points out that patient-chosen, non-necessary elective cesareans make up a very small percentage of the cesarean sections performed in the United States. This is especially noteworthy in light of the fact that some medical professionals (though certainly not all) have often pointed to “too posh to push” cesareans as one of the primary reasons for the nation’s rising cesarean rate. But their “mother-blaming” (in addition to being inherently misogynistic) simply doesn’t pan out when one considers the relative infrequency with which patient-chosen, non-necessary elective cesareans occur.
You can watch the following video to see more about what Cohen has to say about VBAC, c-section, the related issues:
The very title of this article left me smiling: “Hospitals to crack down on induced labors.”
An even better title, however, would have been “Hospitals to crack down on UNNECESSARY and EARLY induced labors.” Because as the article reports (and as studies have demonstrated), these inductions–especially those performed before 39 weeks–can lead not only to iatrogenic (or doctor-caused) prematurity but also increase a baby’s risk of NICU admission and increase first-time mothers’ risk of cesarean section.
So don’t worry–if you and/or your baby’s health requires an induction, hospital regulators and administrators are not going to deny you an induction. But they may restrict your care provider’s ability to schedule convenience inductions–and that’s all with your and your baby’s health in mind.
From the BBC
And finally, this week the BBC news published an overview of maternal mortality across the world. In their examination of the United States, they found that:
The US spends more money on mothers’ health than any other nation in the world, yet women in America are more likely to die during childbirth than they are in most other developed countries, according to the OECD and WHO.
The article points to the lack of health insurance and coverage, poverty, the staggering c-section rate, and obesity as potential contributing factors to this sad and disheartening state of affairs. What’s more, it sheds brief light on the fact that African-American women are “three to four times more likely to die during childbirth than white American women,” even when one compares the outcomes of wealthy black women to wealthy white women. (Notably, many people have speculated that the stress of racism has a significant effect on the disparity of maternal outcomes between black and white women in the United States.)
But what this article also illuminates is the fact that we must demand better maternity care for women in the United States (and in all countries, for that matter). We need better prenatal care (which should include not offhand castigations about “gaining so much weight” but respectful and helpful nutritional counseling from the first trimester and beyond). We need better labor and delivery care (with more emphasis on evidence-based maternity care and not on unnecessarily intervention-heavy birth). We need health care coverage for all pregnant women (period).
At least that’s what the BBC article illuminated for me!
(For more on issues of maternal mortality in the United States, please see Ina May Gaskin’s Safe Motherhood Quilt Project.)