Is the Medical Model of Birth Really Better - Guest Writer Colleen Mahon-Haft

Since the 1940s and 1950s, the maternity care system in the United States has overwhelmingly involved hospital births and an increasing number of surgical and drug-related interventions, making birth a highly medicalized event.  With this paradigm shift towards use of our advanced medical technologies and well-trained doctors, why does the United States not have better maternal and neonatal outcomes? 

The use of hospitals in the United States for childbearing started in the early 19th century for women who did not have suitable homes. In 1900, less than 5% of women gave birth in hospitals (Starr1984).  The proportion of births occurring in hospitals rose from 37% in 1935 to 97% in 1960, and reached 99% by the 1970’s (Rooks, 1997). By the 1940's, the standard was set, and hospital births became the cultural ideal. The idea was that at the hospital the doctor had all the "tools of the trade" readily available. Unfortunately, this was and continues to be a major downfall of hospital birth. Included in those tools were medications, forceps, surgical instruments, confinement to bed, enemas, pubic shaving, arm and leg restraints, and hospital nurseries with rigid schedules. Birth came to be seen as an illness that required medical attention.

• The modern medical way of birthing is not producing better results; it is interfering with the instinctual process of birth. The World Health Report (from the World Health Organization) indicates that the neonatal death rate (death in the first twenty-eight days of life) is greater in the United States than in thirty-five other developed countries (WHO 2005).
• The maternal mortality rate in the U.S. is the highest it has been in decades, according to statistics released by the Center for Disease Control (Hamilton et al 2005). According to the figures, the U.S. maternal mortality rate was 13 deaths per 100,000 live births in 2004. In 2006 a shocking one in 4,800 U.S. women dies from complications of pregnancy or childbirth (United Nations 2006).
• The U.S. ranks 41^st out of 171 nations, behind even some nations without similar technology and resources, such as South Korea. Despite our enormous wealth and highly advanced technology, the United States lags far behind most other industrialized countries, and even some developing nations, in providing adequate health care to women during pregnancy and childbirth. 
  

In countries where laboring mothers are not subjected to the medical model, the maternal and neonatal death rates are significantly lower. In the five European countries with the lowest infant mortality rates, midwives (who practice holistic care) preside at more than 70% all births. More than half of all Dutch babies are born at home with midwives in attendance, and Holland’s maternal and infant mortality rates are far lower than in the United States (Otis 1990). The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but the newborn death rate in the U.S. is higher than in any of those nations (Lawn, et al 2005).  

The international standing of United States (in terms of infant mortality rates) did not begin to fall until the mid-1950s. This correlates perfectly with the founding of the American College of Obstetricians and Gynecologists (ACOG) in 1951. ACOG is a trade union representing the financial and professional interests of obstetricians who has sought to secure a monopoly in pregnancy and childbirth services. Prior to ACOG, the U.S. always ranked in 10th place or better. Since the mid-1950’s the U.S. has consistently ranked below 12th place and has not been above 16th place since 1975 (Stewart, 1993).

Today in the United States, not only do nearly all births take place in a hospital, but they often involve unnecessary medical procedures that can actually make the natural birth process more dangerous. Women are wheeled in to “labor suites” where they are hooked up to machines, strapped with monitors, given (usually) unnecessary intravenous fluids, and put “on the clock.” 

Home and birth centers definitely have opponents, but the statistical evidence states that if you are a healthy low risk woman, having your baby in a hospital is riskier than home or birth center. One set of midwives in Tennessee had 2,028 planned homebirths from 1970 until 2000.  Ninety-eight percent of them delivered vaginally with a 1.3% emergency transport rate and a 1.4% Cesarean rate (Gaskin 2002).

There is not a hospital in this country with numbers as low as that. Why? Because the midwives let birth happen. They do not rush to induce, they do not perform unnecessary tests, they just let the mother birth her baby, and the majority of the time, it is uncomplicated and not a medical event. The paradigm shift towards medical birth is hurting this country, and unnecessarily killing and injuring many women and newborns each year.