An example of another way to do it – musings on birth

I saw this article in the New York Times this week:

NYT: Lessons at Indian Hospital About Births

The article shows how rising costs don’t have to be part of maternal healthcare:

As Washington debates health care, this small hospital in a dusty desert town on an Indian reservation, showing its age and struggling to make ends meet, somehow manages to outperform richer, more prestigious institutions when it comes to keeping Caesarean rates down, which saves money and is better for many mothers and infants.

What if this could be a model for other hospitals providing maternity care?

Tuba City will not be on the agenda, but its hospital, with about 500 births a year, could probably teach the rest of the country a few things about obstetrical care. But matching its success would require sweeping, fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery.

Changes in malpractice insurance would also help, so that obstetricians would feel less pressure to perform Caesareans. (The hospital and doctors in Tuba City are insured by the federal government, and therefore insurance companies cannot threaten to increase their premiums or withdraw coverage if they allow vaginal births after Caesarean.) Patients, too, would have to adjust their attitudes about birth and medical care during pregnancy and labor.

Read the article – it’s interesting. Yes, many obstetricians seem intrigued by the idea, but admit that it’s going to require changes. You can’t do the kind of obstetrical medicine that we’re doing today and have this kind of outcome.

But why do we have the obstetrical care that we have today? Isn’t it a cycle – birth appears dangerous, so patients want safety, which creates new ways of controlling the situation, which now turns out to be less safe?

What I wonder is, what do women want here? What has our culture taught women about labor and birth that makes us want all the interventions? Safety? Responsibility? Choice? What does that mean, exactly, and do we as women in this culture begin to understand what our real choices are?

I don’t think we do, overall, and so I’m glad to see these articles continue to come out and help frame the discussion for women and families so that we can become educated about what the possibilities are and maybe, just maybe, things will shift enough so that changes are possible.

In the article, midwives describe having whole families come into the delivery room to be present for births. Then, when some of the younger girls become mothers themselves, they’ve seen births already and it is familiar, not scary.

Just like death, birth in our culture has moved out of the ordinary into the private and extraordinary – even secret. These events – two of the most sacred of our lives – are now locked away behind a closed hospital door. No wonder people are scared. We hear stories and whispers, but we’ve never seen it until it’s our turn to go. We starkly face the unknown. Therefore, we fear. We want it over with as quickly and therefore safely as possible (because in our conventional wisdom, the shorter the labor, the safer the baby and mom…), numb us please so we don’t have to feel anything, and if something goes wrong, it’s a doctor’s fault and we sue.

There has to be a balance. What goes around, comes around. The wheel turns. The pendulum swings. Fashion moves on. We’re back where we started.

It interests me to see the flood of articles on the newswire on this topic lately.

Do you think this discussion would be as lively now if it weren’t for health care reform and cost discussions? I wonder…

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