Medicalization of Birth

Dear Student
In spite of the evidence that birthing outcomes are better with less interventions, the medicalization of birth continues. The cesarean section rates, the number of inductions and the generalized interference with the normal processes of birth are escalating each month. I am doing a short survey to seek your opinions. Your participation is voluntary and there will be no personal data collected. Your completion and return of this survey indicates your consent to participate. If you have any questions, please contact me . . . . Thank you for your time and participation. Sincerely, E


So, here are my answers:

1. What do you think are the main causes for the present medicalized approach to birth and the increasing interventions into the birth process in the United States.

History: OBs took birth out of the home, and into the hospital. In other countries, the midwives went with women, but not in the US.

Technology: Technology is fun! Right? Helps us do things faster, easier, etc. Use a machine rather than your hands. Ugh. During my training I was frustrated to work with wonderful family doc residents who didn’t know how to do Leopold’s maneuvers . . . so just used the ultrasound every time to check presentation at the onset of labor. Ugh. I kept trying to tell them that they won’t have access to ultrasounds at every hospital/labor floor!

Mainstream media: messages that birth is fast, furious, dangerous, scary. I cringe almost every time I see a birth on TV or in a movie . . . her water breaks, everyone freaks out, and the baby is born within minutes. Right. Or a movie where I saw the OB coaching an unmedicated woman to push . . . and then the mom died, somehow, but why that was never clear. Awful.

Media & history lead to: what women want. Women want epidurals because birth is painful. They have no idea about the effect of epidurals on their labor. And most don’t care, when you tell them. They just want to be distanced from the pain, the experience.

Fear: fear of clients and fear of providers. Watching someone in pain is not comfortable for many, and especially with the current cultural/hospital value of minimizing pain (pain scales, taking care of pain) – that works backwards in the L&D unit, where pain is an indicator of progress, of a normal experience, and when too extreme, of something going wrong. Clients/patients are scared of pain. Pain is not seen as good in our culture. We try to minimize pain, rather than learn to cope with it and learn from it.


2. How is your educational program preparing you for the reality of our Obstetrical/intrapartal care in addition to exposure to birth centers and/or home births? What is being taught to give you the skills to practice midwifery in the hospital/institution setting.

My education focuses/d on typical hospital intrapartum care. I think our clinical sites prepared us for the reality, at least as much as or more so than the book learning, but of course, each preceptor & each site plus luck of that shift give us the experiences that we get. Overall, I think our education is preparing us for what hospitals are doing now, rather than teaching us to make change in those hospitals, even though our professors (for the most part) are truly believers in the midwifery model of care.

We kept track of “skills” we learned, including IUPC, FSE, fetal monitoring, etc. We did not keep track of “skills” we learned, in terms of hands on or observational skills, unfortunately.

I had the opportunity to have some exposure to OOH birth three of the five quarters I had intrapartum clincials. Two of those quarters, I was with a CNM who offered both hospital and OOH birth; my Integration quarter I spent training at a Birth center that also provides home birth. I set up that site myself because I was motivated to learn more about & get more experience with OOH birth. I will have over 10 births OOH when I complete my program . . . and more than 20 in hospital.


3. How are you planning to make a difference when you graduate?

I will be working at a Birth Center/home birth practice after I graduate. I’m excited to be working in a place that lets women’s bodies birth without unnecessary interventions, and believes in the power of the human body to know how to birth.

After I get some experience, I will precept students in OOH birth. Then I will do some formal teaching – nursing school? We’ll see . . .