Courtney Worley is a young mother sharing the story of the time prior to giving birth to her first baby. She has informed herself about healthy birth practices, but is finding it hard to obtain support for her birth choices from her care provider despite the fact that she is having a healthy, uncomplicated pregnancy. In order to birth in a way that she feels is safe and healthy, she must travel to a midwife nearly an hour from her home, having to switch care providers just weeks before giving birth.
While giving birth used to be a dangerous event for women a century or so ago, birth is now a much safer event for women in the United States. Still, the United States’ maternal mortality rate of 15.1 per 100,000 live births places it at the bottom of all industrialized nations in the world . Mothers in the U.S. are at a much higher risk of dying from a cause associated with birth than women in other developed countries.
The infant mortality rate in the U.S. is also high at 6.9 per 1,000 live births, with huge variation by race–5.7 for white babies to 13.7 for African American babies . Kentucky’s infant mortality rate is very close to the national rate, and its maternal mortality rate is 8.8 . While Kentucky’s maternal mortality rate is lower than the national rate, it is significantly higher than the national goal of 3.3 per 100,000 live births by 2010 laid out by the U.S. federal government .
Given the fact that risk still exists during pregnancy and birth, it is very important for women to be informed of all the birth options available to them. Equally important is finding a provider and a facility that will partner with you to have a safe birth experience that fits your birth plan.
Several important technologies and medical knowledge have been developed to prevent and address the risks for both newborn and maternal death associated with birthing. Still, some women do not have access to appropriate care during pregnancy and birth, while at the same time many women in the U.S. and Kentucky are overexposed to interventions during labor and birth. While birthing technologies, such as cesarean sections (c-sections) can be life-saving interventions, medically unnecessary interventions can actually increase risks for mother and newborn.
The World Health Organization has stated that an ideal cesarean section rate, one that would reflect medical need, should be at around 15 percent of all births . According to a 2011 study, the U.S. c-section rate is at the highest yet, having increased from 27% of all births in 2002 to 34% in 2009. Kentucky’s c-section rate was even higher than the national rate, at 35% . The Kentucky rate for induced labor is 26% , meaning that 1 in 4 women have labor brought on through the use of medication rather than allowing their bodies to go into labor naturally.
Receiving prenatal care from the beginning of a pregnancy increases the chances that any medical problems can be handled appropriately to limit risks and complications during birth and postpartum for both mother and baby. Making a birth plan, a written document that states your preferences for labor and birth—within the boundaries of what is medically appropriate and safe for mother and baby, is a helpful way to communicate to your provider (and others you may want involved in the birth) what your preferences are for labor and delivery.
Options for birthing include:
• What type of provider(s) you choose (physician, Nurse-Midwife, direct-entry midwife)
• Who will be with you at the birth (partner, sibling, friend, parent, doula)
• What type of facility you choose to have your baby in (hospital, birthing center, home)
• What type of interventions you feel comfortable with and under what circumstances (cesarean, pain management, VBAC [vaginal birth after cesarean], episiotomy, induction, use of forceps or vacuum, among others)
• How you want to labor and deliver (walking, sitting, squatting position, etc.)
• As well as decisions about breastfeeding, rooming with your baby while at the hospital, and if you have a baby boy—whether to have a circumcision or not.
In 2006, Kentucky ranked 6th among all states for cesarean section rate
VBAC (vaginal birth after cesarean) is a safe birth option for most women
There are currently no birthing centers in Kentucky (35 other states have birthing centers)
There are many types of childbirth classes that can help prepare you for pregnancy, delivery, and postpartum—Lamaze, Bradley, Hypnobirthing, Birthing from Within
Do you believe women and their providers should be able to schedule a cesarean section or induction based on convenience or should it only be based on medical necessity?
Do you believe women are generally encouraged to learn about pregnancy and childbirth in your community?
Do you think women have the right to refuse medical treatment that they deem unnecessary or invasive based on their knowledge, preferences, and discussions with the care provider?
If you were going to write a birth plan, what are some things that would be important to you to include?
Do you have a birth story to share?
Resources and Links:
WebMD, Birthing Options
Birth True Blog
About.com, Pregnancy and Childbirth
March of Dimes, Childbirth Classes
Coalition for Improving Maternity Services
How to Have a Better Birth
Giving Birth With Confidence