Why I Support a Woman's Right to Make Informed Choices

So I posted a link about a mother's choice to give birth at home on my Facebook page, and a debate erupted between my natural-birth friends and my medical-birth relatives. While I certainly understand the position of medical-birth proponents, I am also a supporter of natural birth. Don't get me wrong, I am NOT anti-intervention. After all, I would not have survived my first birth without medical assistance. That said, I am against unnecessary intervention. I was up until 5:15 this morning writing an explanation of why a mother might choose something other than a medicalized birth. I hope my medical-birth friends and relatives will at least try to see the situation from a different point of view, even if their own priorities, values, and choices are different.

---------------

Ninety-five percent of women who give birth in an American hospital will be given Pitocin at some point in their birth process. If they’re not given it to induce labor, they get it to augment labor. If they make it all the way to delivery without, they’ll still get it post partum to return the uterus to normal. Now, there are certainly situations in which a mother or her baby will have a medical need to speed up the birth process. I know; I was one of them, and I’m grateful Pitocin was an option for me. But would it be a true statement to say that 95% of birthing women have a medical need for Pitocin? After all, this drug has only been around for 60 years or so while humans have lived for many millenia. How has the human race survived for so long if 95% of mothers and/or their babies would die or be seriously damaged for a lack of Pitocin-aided birth? You don’t need a medical degree to know that such a statement is ridiculous. You also don’t need a logic degree to conclude that at least some of the 95% are being given Pitocin without medical need. Is it a few? Half? Most? I don’t know exactly, but I would guess the number of truly medically necessary Pitocin-aided births is definitely more than 0% but considerably less than 95%.

If Pitocin were completely harmless, it wouldn’t matter. But it’s not. Pitocin is a drug, and like all drugs it has risks. It can cause harm to the mother. It can cause harm to the baby. The risks may be low, but they’re still there. So why is a risky drug in such widespread use in situations where it is unnecessary? I would guess most obstetricians feel the non-medical benefit is worth the risk. The non-medical benefit of Pitocin is simply convenience, being able to more accurately plan for a birth. Why wait for unpredictable labor to start on its own when Mom can instead make solid arrangements for post partum help? Why be on call for a possible weekend delivery when you can get it done on Tuesday? Why come out at 2am when you can speed up labor and have it done before supper? And after all, if anything does go wrong they can quickly perform a Cesarean section, and mother and baby will be saved, thus making the small risk acceptable. (Of course, a C-section carries its own risks, but let’s leave that alone for now.)

So most obstetricians obviously feel the non-medical benefits of Pitocin outweigh the medical risks, or they wouldn’t use it so readily. Most mothers must agree, since they give their consent to the drug, and often even ask for it for their own reasons. (Or perhaps they simply don’t fully understand the risks? But again, let’s leave that for later.) But not all mothers will feel the same way about what is and is not an acceptable level of risk. Seeing my baby’s heart rate drop on the monitor and being rushed off to surgery is not really my idea of a good start to my baby’s life. Yes, the baby will probably survive, but my definition of a healthy baby is more than just “not dead.” If I were having a birth with no medical reason to rush, I personally would not give my consent to Pitocin just for convenience’s sake.

Only in obstetrics do doctors take patients who are not sick, give them a risky medication they do not need, and if anything goes wrong, fix it with a risky and invasive major abdominal surgery that could otherwise have been avoided. But as long as no one dies, it’s all good. Except a small but growing number of women are saying it’s not all good. It’s not acceptable to put myself and my baby at unnecessary risk, small though that risk may be, just so my doctor can fit in a round of golf on Saturday without being interrupted by a pesky unplanned delivery.

Is that an unfair characterization of obstetricians? Perhaps. After all, they wouldn’t have become doctors if they didn’t want to help people. And yet time and again they are using Pitocin, a risky medical intervention, for non-medical reasons. They can argue that it’s the mothers who are asking for induction and they merely obey her wishes. But they are the professionals. They can refuse to induce. They don’t hesitate to refuse a mother’s wishes should she ask for, say, a vaginal breech delivery or a vaginal birth after cesarean (VBAC) if they feel it’s too risky, so why must they bow to the mother’s choice with induction? Because it’s convenient for them as well.

Of course, the obstetrician went to medical school and most patients have not. The doctor has the knowledge and experience that birthing women lack, and we should most definitely take their opinions into careful account when making choices. Yet women are capable of reading a newspaper, a book, a professional journal. Women are capable of asking questions and critically evaluating the pros and cons of various options. Women are capable of deciding what is and is not an acceptable risk based on their own values and priorities. And any woman with a hint of intelligence can see that Pitocin is being widely misused and abused by the doctors they are relying on for the care of themselves and their babies.

And if obstetricians are risking Pitocin unnecessarily, the logical next question is what about other common interventions? What about artificial rupture of membranes, or narcotics, or epidurals? What about planned c-section for breech birth? What about various other policies like not eating, directed pushing, and delivering in the lithotomy position (on the back)? Are we as patients and mothers getting a true picture of the risks and benefits of various policies and procedures before we decide to consent to them? Can we really say that as long as no one dies it’s all good? Are we within our rights to question the policies of the doctors and hospitals we are relying on for the health and well being of ourselves and our babies, or should we simply follow along like good little girls knowing our doctors went to medical school and we did not? After all, we must live with the consequences of these choices, good or bad.

And what if, God forbid, someone does die? It is a well documented fact that the United States has the highest rate of maternal and perinatal (mother and baby) deaths among industrialized nations even though more than 99% of our babies are born in hospitals. Let me repeat that: The United States is losing more mothers and babies than any other industrialized nation. We are surrounded by the best of the best of technology, yet we still die at unacceptable rates. It is in this state of affairs that women are beginning to stand up and say we want better for ourselves and our children. We want to know what other countries are doing differently that are resulting in better outcomes. We don’t want to blindly accept our doctor’s recommendations based on policies that are not working well.

Most American women would be surprised to know that in Scandinavian countries that have the lowest birth-related mortality rates in the world, almost all low-risk births occur at home attended by well-trained, licensed midwives without any of the interventions used routinely in American hospitals. Perhaps it is the interventions themselves, or more accurately the use of these risky interventions in situations where they are not needed, that is leading to the increased deaths of American mothers and babies. Or maybe American mothers are just weak from fast-food diets and TV-watching lifestyles, and that's why we die surrounded by the best care in the world. Hm, makes you think, doesn't it?

This is why women are questioning their doctors and looking at other options. Not because Rikki Lake says homebirth is cool. Not because we’re rebellious children who want to stick it to the man. Not because we value an idealized, quasi-spiritual birth experience over the outcome of a healthy baby. But because we truly want what is best for ourselves and our children, and we’re starting to lose trust that we can find it in traditional maternity care.

In a perfect world, women would be allowed to birth naturally without risky, unnecessary interventions and policies while still having the doctors and technology nearby in case of a true emergency. They would be fully informed about the risks and benefits of all their options and would be allowed to make decisions based on their own values and priorities. Sadly, that is simply not the case in today's hospitals. Mothers are forced to choose between putting themselves and their babies at risk of unnecessary interventions in a hospital or putting themselves and their babies at risk of a delay in emergency treatment at home. I certainly respect the right of women who prefer the risks of the hospital. I merely ask that they respect the right of women who prefer the risks of the home.