I ask my self this question a lot. Maternal mortality in the United States has gotten worse over the last 20-30 years. When I started as a postpartum doula in 1991, the U.S. maternal death rate was 10.3 deaths per 100,000. Now, in 2020, the U.S. maternal death rate is 17.4 per 100,000.
We have more doulas than back then, and information is at our fingertips in an instant.
What is happening to cause this significant increase?
The United States spends the most money on health care, yet we have the sickest nation and more mothers are dying in childbirth or from pregnancy and childbirth-related causes. This is inexcusable.
I could tell you the increase in deaths is because we have so many obese and unhealthy mothers. Access to prenatal care is not available to every woman. I could tell you that giving birth in the hospital is a factor in the maternal death rate. There is some truth to all of these. Yet, if we look at trends in childbirth, particularly the cesarean-section rate, we might find the real answer.
In the 1970s the cesarean-section rate was around 5% in the United States. Currently, we are hovering around 32-33% nationwide. In some hospitals, there is a 50% rate. Cesarean surgery comes with risks. And, repeat cesareans come with more risks. Death is a real risk with any surgery. According to the World Health Organization, there is a point at which an increase in cesarean sections does not equal better outcomes. Saving lives is the goal.
Is the need for many cesarean-sections created by interventions such as induction, and constant fetal monitoring?
Why is a vaginal birth after cesarean (VBAC) unavailable for many women?
Why aren’t women saying, “hell no?”
I am not going to answer these questions. However, I would like to ask them and inspire you to look for the answers. I can tell you that I have witnessed interventions and watched the cascade of more interventions. I have witnessed unnecessary cesarean-section. And also I have heard many birth stories of emotional and physical trauma.
Ingrained beliefs form well before pregnancy
The U.S. maternity care system is broken. We live in a consumer-driven culture, which runs on supply and demand. Currently, the vast majority of women give birth in the hospital. I believe that if women demanded differently, things would be different. I also believe that learning about options in pregnancy, birth and beyond at 6-7 months pregnant is late in the game.
When women and mothers are thriving, and well cared for, the world is thriving. Likewise, Pregnant women deserve to know the truth about childbirth, about the providers of prenatal care, about cesarean section rates, about breastmilk, about newborn behavior, about real motherhood.
What are young girls learning about their amazing bodies? Where are they learning about the miracle of birth? When is the right time to begin this learning?
Childbirth classes are for information. You won’t learn how to give birth. You already know.