Obstetric care in the United States???

Question

I was hoping that some of your would share your opinions of what you think about the standard model of obstetric care in the United States, and why or why not you feel that way?

And what opinion do you have about childbirth in general?

Answer 1

I would never even consider having a baby in the United States. I would consider it a very dangerous thing to do to my unborn child.

The American obstetric model of care is conducted by doctors - SURGEONS - who have no place attending healthy women healthy babies. An obstetric surgeon attending a normal childbirth is analogous to a paediatric surgeon babysitting a two year old. Being two years old is not an illness, neither is being pregnant or giving birth. In both situations having such over-interventive medical care on hand is likely to lead to more problems than it solves.

Doctors are, by definition, in the profession of tending the sick. If there is no illness, there is nothing for them to do and no place for them in the process of childbirth. It is a strange and dangerous situation that in order for them to keep on attending regular births they have convinced many, many women; through a culture of fear; that their orchestration is needed. Childbirth, instead of being a wondrous and normal, common, uncomplicated event, has become a terrifying medical ordeal performed behind closed doors, surrounded by strangers. Every aspect of this completely normal physiological event is monitored, medicated and interfered with to such a degree that childbirth is now viewed as an agonising and inherently dangerous process.

Let me now clarify this situation by saying that obstetric care has proved it's worth again and again in pregnancy and birth with complication and illness. But it is truly wrong that so much is done to pregnant and labouring women purely 'just in case'. It is truly wrong that women are subjected to so many invasive procedures just so that the doctor can cover himself against litigation. It is truly wrong that women's bodies and the natural birth process is interfered with as standard merely to convenience the medical staff.

The truth of the matter is that, if women were left alone during pregnancy and labour, and the natural process of birth was trusted to do it's thing as it has for millions of years, the hugely vast majority of women and babies would be just fine.

In the US the average length of pregnancy is down to 39 weeks due to all the inductions, and there are hospitals have 99% epidural rates, 45% c/s rates.....and the foetal mortality rate is the 25th worst rate in all the countries in the world, including all third world countries. Most of the drugs they use for inductions have never been licensed for use to induce labour. Cytotec has never been licensed as anything other than a stomach ulcer drug and has been proven to increase the risk of uterine rupture. It's own manufacturer warns against it's use to induce labour.

Obstetricians get paid by the drug/intervention....best case scenario for them is an induction (fits into schedule and costs more) where they can intervene early (epidural, breaking waters etc....more money) and cause the problems....(drop in heart rate, failure to progress) ....then they can step in and 'save the baby' by doing an emergency c-section just in time to get home for tea...(lots of money) and the women walks away happy and thankful to the doctor who saved her baby...... Not only that she is told she can never give birth vaginally (in some states VBAC is illegal too, or insurance won't pay for it) so there's money to be made in future births too. I personally would not trust anyone who would prefer a c-section as they'll be paid more. Or would rather perform an episiotomy than not, because then they can bill you for it...and for stitching you back up too.

I love in the UK and in a lot of ways it's much better than the US, despite our comparable C-section rates and suchlike. Unfortunately the UK is in danger of following the US into the obstetric model of care and a lot of the problems in the US system are becoming more prevalent here as well.

However. There are many advantages to the UK.

Our care is provided by midwives, our hospital delivery wards are staffed by midwives, and the vast majority of women go into labour with the plan to do it as naturally as the situation allows. Only 12% of women having a normal birth in the UK opt for an epidural. The epidural causes so many problems in labour it cannot be underestimated, and is only used here as a last resort.

Speaking only from my own experience, I didn't see a midwife until 26 weeks of pregnancy. I went for my one and only scan. (Opinions are divided on ultrasound scanning.....there has never been any evidence to show that's it harmful.....but also none to show it's harmless....think about it)
I had my other appointments at 31, 34, 37, and 40 weeks. Each time the midwife came to my home. No internal examinations were carried out, nor do they need to be. My midwife palpated my belly to check position, did a urine sample, checked my blood pressure and asked about any problems. This is all that needs to be done unless these simple tests show problems.

I requested to avoid the hospital at all costs and so was routinely offered a home birth, as I was low risk. I was booked for another appointment with the midwife at 41+1, but I went into labour and delivered my daughter at 41 weeks exactly. The midwife was present for just 20 minutes before my daughter was born.

I had only intermittent foetal monitoring with a doppler, no pain relief, no episiotomy, no tears, in fact no interventions of any kind. My daughter and I are just fine. I will have my future babies in the same way, circumstance permitting.

Let us compare this to what could easily have happened in an American hospital. I have heard many people clain that their doctors don't "let" them go past a certain amount of weeks. So I could easily have been induced before 41 weeks of pregnancy. That would entail internal examinations, pessaries, IV lines, continous foetal monitoring, breaking of waters etc etc. Pitocin, Cytotec.....ugly words.

What do you think would have happened in a hospital had my waters broken full of meconium and the heartrate dropped to under 60bpm??? I think an emergency c-section.....and if I didn't have the epidural in place, that would mean general anaesthesia. This did happen, and it happened at home, as part of my normal delivery, and was fine.

How different it could have been for me.

To give another example, a woman's labour is induced for a non medical reason. They give her prostaglandin pessaries to soften her unripe cervix. Once contractions start, which can take days, they'll put her on a hormone drip, usually oxytocin or pitocin in the US. This artifically hyperstimulates the uterus, causing unnaturally aggressive contractions that are painful for the mother and sometimes distressing for the baby, who is yet to move into the optimum position for birth. Due to the hormone drip and IV, the mother cannot move around as her care providers have a foetal monitor continuously monitoring her baby's heart rate. She cannot get comfortable, the contractions are strong, she isn't allowed to move. She starts to consider pain relief and is usually given gas and air or administered an opiate drug through her IV line. These drugs are always administered with an anti-emetic which attempts to stop you vomiting, but this is not always successful. These types of drugs are proven to be transmitted to the baby and can make it sleepy, or cause heart decelerations. The baby cannot descend against gravity as the mother is strapped to the bed, and cannot move into the optimum position for birth. The baby cannot pressure the mother's cervix so progress is slow. To fix this, the care providers turn up the drip to increase the contractions and when the cervix begins to open, they will artificially break the waters with a long hook. This starts the clock, many carers will have a set amount of time you are 'allowed' to labour after rupture of membranes, and if you exceed this they will take other measures for example a Caesarian Section. The effect on the baby is like that on your rubber duck when you pull the plug in the bath. It is sucked downwards and whichever bit of it's body plugs the hole first will be the presenting part, again the baby has had no opportunity to get into the optimum position for birth and now it's head is descended, it would be difficult for it to turn. This can result in back labour for the mother, which makes her go for more pain relief, so an epidural is administered with a needle in her spine that she has to endure and sit still throughout her contractions; or risk epidural headache or even paralysis. The epidural is administered. Over 15% of women experience no or partial pain relief with an epidural, so it is not a magical cure all. The woman is now numb from the waist down, unable to feel her baby, unable to feel the urge to push, usually catheterised instead of being able to use the toilet. It then becomes an unnatural waiting game. Vaginal examinations are performed regularly which increase the risk of infection to the baby. An electrode is screwed to the baby's scalp with wire to monitor it's heart rate more closely. This uncomplicated pregnancy is now a high-risk labour and birth - any induction or epidural birth is high risk, requiring constant monitoring. If the baby is too distressed by the artificially strong contractions bashing it's head againt the mother's unripe cervix that the mother can't feel, the mother will be rushed for a Caesarean Section.This is easier to do with an epidural already in place. If your baby tolerates it, then it's the magical time, your care provider says you can push, so you push. You're on a clock. Most places will again have a length of time you're allowed to push for before they intervene. Without the natural urge to push, it's a skill you have to learn, and as you can't feel it, you have to rely on someone else to tell you how effective it is. This all takes time, reducing the amount of time you have to get your baby out. The baby's heart rate drops. This is fairly common during pushing but foetal heart traces highlight this occurance and make it impossible for the doctors not to act on this. You may be prepped for c-section or taken to the operating theatre to attempt ventouse or forceps delivery. Or both. The scissors are brought out and an episiotomy cut into your perineum . On insertion of the forceps, this turns into a third or fourth degree tear. The instrumental delivery fails. Your baby's heart rate has plummeted due to the stress of being yanked about by the head. It is at a terrible angle. Your epidural becomes a spinal, they slice though your abdomen and womb and within minutes your baby is out. It's head is misshapen due to the ventouse and bruised from the forceps. It requires suctioning to breathe due to it's chest not being squeezed through the birth canal. It needs oxygen due to being stuck in the wrong birth position for so long. Eventually you'll get to see it whilst you are being stitched up inside and out. When you get to the recovery room you may be able to hold it. For the next few days you'll be on strong painkillers which can effect breastfeeding, immobilised for hours afterwards due to the epidural and spinal. Unable to move for days afterwards due to the pain and soreness, unable to care for your baby, and hospitalised for the first week of your baby's life at least. Physical recovery from a situation like this can take months, and emotional recovery can take even longer. The physical and mental scars from this birth will affect future pregnancies and births. Yes, you have a "healthy" mother and baby. But is that really the only consideration here??

If your labour is allowed to progress normally as nature intended, you will usually have an easier and shorter labour with less need for interventions. If the above story sounds outrageous, it is exactly what happened to a friend of mine in the US, when she was induced at 39 weeks due to the doctors telling her she had a large baby. Her daughter was born weighing 6lb 15oz.

It's incredibly sad the state of care in the US, as any trip to US baby websites will tell you. The vast majority of 'care' puts babies and women at risk for the convenience and purse of the attending obstetrician.

Thankyou for your question. I hope I have been clear, if not concise.

Answer 2

Well let me start by saying that there is no country that I would rather give birth in then the US. Maybe because I'm american but the thought of having a baby anywhere else just scares me. Anyway, I love the care that I've gotten with both of my pregnancies. The doctor that I had with my first child was great. My whole labor and delivery was just wonderful. So far with this pregnancy I've also gotten great care and my doctor has been very helpful. I haven't given birth yet so I can't say too much about it. I do believe that nowadays doctors have become extremely lazy with the entire labor process. I've found that certain doctors don't want to wait until the mother is fully dialated and are so eager to do a c-section if things don't move along fast enough. I've seen that happen way too many times. I think when one goes to an OBGYN that they should research and interview the doctor before you decide he/she is the one you want to go with.

Answer 3

The standard model of OB care in the USA stinks.

The United States consistently earns a very low ranking in studies about newborn babies’ survival. A report released last year showed that, among 33 industrialized nations, the United States is currently tied with Hungary, Malta, Poland and Slovakia with a death rate of nearly 5 per 1,000 babies. The really disturbing news is that, among blacks in the USA, there are 9 deaths per 1,000 live births. This statistic is closer to the infant mortality rates in developing nations than to those in the industrialized world!

The lack of any national health insurance and short maternity leaves (practically non-existent for some low income mothers) likely contribute to the poor U.S. rankings. Those factors can lead to poor health care before and during pregnancy (sometimes no prenatal care at all). This lack of adequate health care increases the risk of a premature birth and a low birth weight baby, which are the leading causes of newborn death in industrialized countries. Other factors that may contribute to the USA’s low ranking are teen pregnancies and obesity rates.

In countries where midwifery care is the typical model of care, birth outcomes for mothers and babies are typically BETTER.

A typical OB visit for a PG woman only involves a few minutes in the room with her doctor before he rushes off to another patient.. A midwife visit usually includes *at least* 30 minutes of *face to face* time with the midwife educating the mother and listening to her questions and concerns.

Postpartum care in the USA stinks. Most OB's don't see you again until your 6 week checkup. Midwives will typically see you a couple of days postpartum, around 2-3 weeks postpartum and again around 6 weeks postpartum.

In general, I believe that childbirth is a natural process that a woman's body is designed for. I think that most OB's are far too quick to intervene in that process to "hurry things along" or to resort to cutting the mother open because she's not progressing at the pace they think she should. If more doctors could take an approach similar to the way midwives view birth - sit back, watch and wait unless something is wrong - birth in America would be much gentler and there would be many less c/s and women with birth horror stories. If only they would encourage the women to trust their bodies!

Answer 4

Doctors are, by definition, in the profession of tending the sick. If there is no illness, there is nothing for them to do and no place for them in the process of childbirth. It is a strange and dangerous situation that in order for them to keep on attending regular births they have convinced many, many women; through a culture of fear; that their orchestration is needed. Childbirth, instead of being a wondrous and normal, common, uncomplicated event, has become a terrifying medical ordeal performed behind closed doors, surrounded by strangers. Every aspect of this completely normal physiological event is monitored, medicated and interfered with to such a degree that childbirth is now viewed as an agonising and inherently dangerous process.

Answer 5

An anesthesiologist is frequently an MD whose best or a minimum of important activity is to place a surgical sufferer to sleep for surgical procedure and hold a watch at the sufferers important indicators for the duration of the surgical procedure.