Drawing Attention to Poor Maternal Health Outcomes in the U.S.

I am concerned about the lack of coverage for the daily violation of women’s rights that occurs on the labor and delivery unit.

There are currently three times as many births in the U.S. per year than there are abortions. Yet, media coverage is fixated on abortion as the sentinal issue in the area of women’s health. One would be hard-pressed to find a more pro-choice individual than I, but as a nursing student on my way to becoming a Nurse-Midwife, I am concerned about the lack of coverage for the daily violation of women’s rights that occurs on the labor and delivery unit.

One of the arguments we use as pro-choice advocates is that abortion presents less risk to the woman than continuing with a pregnancy and birth. In the U.S., this risk disparity is attributable not only to the safety of the abortion procedure, but also to the many maternal health risks we fail to manage appropriately. Obstetrics is widely recognized as the field of healthcare that provides the least evidence-based care. This means that we are terrible at using scientific evidence to guide our practice and ensure better outcomes for women and babies. As evidence of this, the U.S. experiences some of the worst maternal and infant mortality rates among all industrialized countries, and women of color in this country are even more likely to be represented in these shameful statistics.

We are overusing interventions that fail to improve outcomes – and in some cases worsen outcomes – while we underuse methods of supporting the natural birth process that have been shown to improve the health of moms and babies. We all know women who have experienced routine episiotomies, continuous fetal monitoring and “back lying” during labor, all of which are practices that scientific studies have shown promote poor health outcomes during labor and delivery.

At the same time, we are underusing or avoiding practices that have shown to be either beneficial or not harmful. Manual techniques of turning breech babies to avoid a cesarean, continuous labor support (such as by a doula), non-back-lying positions during labor, and water birth for pain relief are all practices that have been shown to decrease the need for harmful interventions. These are also practices that are either not provided or are prohibited by many hospitals and providers.

The World Health Organization states that if a population’s cesarean rate is above 10-15%, it is certainly excessive. In other words, a maximum of 15% of women in a given population will require a c-section to preserve the health of the mother or baby. Currently in the U.S., about one-third of deliveries are c-sections, which means that twice as many women as is necessary are experiencing the short and long-term negative health consequences of this major surgery. For those who may think that women are usually choosing this procedure – what is known as an “elective cesarean” – consider that providers are responsible for helping women make decisions based on the known risks and benefits, and that providers stand to gain from a mode of delivery that promises about twice the reimbursement rate.

These are a few examples of widely used obstetrical practices that are designed to serve the needs of physicians and nurses, instead of women and babies. But providers cannot be held fully responsible for this backward system. Obstetrics is one of the most litigious medical specialties, and fear of litigation certainly influences practice. In deciding whether a provider is responsible for poor outcomes during labor and delivery, the courts consider not only the scientific evidence behind the practice, but also the common practice in the provider’s community. This means that an obstetrician or midwife who wants to provide evidence-based care has to worry that, if taken to court, she will be penalized for a practice that differs from that of her colleagues, even if her colleagues are providing inferior care.

Is this surprising? For pro-choice, pro-woman healthcare advocates, it shouldn’t be. We have seen in the abortion debate that our society places many priorities ahead of the health of women and their families. We offer bus seats to pregnant women and melt at the sight of new babies, but somehow we have allowed our healthcare providers to continue offering care that is usually substandard and, at its worst, abusive.