Two Styles of Childbirth in the Western World

Carly and I were born 9 days apart, and since then we have done everything together. All of our childhood and adolescent milestones were taken together; even our weddings were less than a month apart. When Carly announced her pregnancy, I freaked. This immediate exposure to this mysterious process of pregnancy and childbirth became very real to me as the girl who grew up with me and shared every milestone of life is pregnant. The only experience I have with pregnancy was my little brother when I was three—mom went to the hospital with a big tummy and then came back with a baby. Since then no pregnant woman or young infant came into close contact with me. Because of this lack of experience, I had no knowledge about the miracle of life. I decided that I could no longer remain ignorant of this very real fact of life and I researched the topic thoroughly using credible, unbiased sources.

In Western nations, childbirth practices have changed dramatically since the beginning of the industrialized revolution (Berk 2009: 109). Since the turn of the 20th century, childbirth moved to be in hospitals and doctors largely assumed responsibility for childbirth. In effect, women’s knowledge of it declined and extended relatives and friends no longer participated (Berk 2009: 109). A recent study conducted by the Child and Family Research Institute and University of British Columbia surveyed almost 1500 pregnant women and found that fewer than 30% attended prenatal childbirth classes and a high number of them did not know the pros or cons or safety issues regarding epidurals, episiotomies, cesareans and other childbirth options (Roan 2011). In contrast, women in non-industrialized cultures have very different childbirth experiences. Women are more knowledgeable about the childbirth process and there is a larger support group for the woman during delivery (Berk 2009: 108). Additionally in many of these countries the majority of births are not in hospitals.

In comparison, in North America only 1% of mothers choose to have their babies at home and this percentage has increased since 2005 (Rubin 2010; Berk 2009: 108). These numbers are comparable with the majority of other developed nations (Rubin 2010). Additionally, more women are choosing to deliver in birthing centers rather than hospitals. At home births or in birthing clinics come with many pros and cons. This alternative form of birthing is more family focused and brings back the feeling of community in childbirth. Additionally, these births have fewer medical interventions than hospital births (ACOG 2011). However, there are risks involved as well. Even low risk births can turn into medical emergencies that lead to maternal or infant death. The American College of Obstetricians and Gynecologists issued a report that says although the absolute risk of home births is low it does carry a three-fold increase in the risk of newborn and mother death compared with hospital births. The College does not support planned home births and emphasizes the risks to mothers and newborns that decide to do so. Of course, other sources challenge both the statistic as well as the objectivity of the College, which does have a pecuniary interest in discouraging homebirth.

Most mothers deliver their babies in hospitals in developed countries, including the United States. While there is the advantage of medical equipment and personnel ready at any moment, there are other risks involved. For example the high rate of caesareans in the U.S. Currently 32% of births in the U.S. are via caesareans (Grady 2010). There are several reasons for this increase but the scariest factor is the doctors’ quickness to do a caesarean because they feared lawsuits. According to a survey conducted by the Obstetricians’ College reported that one third of doctors said they were performing more caesareans because they feared lawsuits and 8% of doctors said they quit delivering babies mostly because of liability issues (Grady 2010). The sad truth is maternal mortality has risen in the past few decades partly because of the dramatic increase of caesarean rates (Grady 2010).

After conducting all this research I came to this conclusion on how to decide where and how to have your baby: consider the mother’s health and risk factors, consider the baby’s health and risk factors, consult with a doctor or certified midwife and ultimately make an informed decision. Ultimately every woman has a choice in how she wants to deliver her baby—it is her right. However, she needs to make an informed decision and must take a more active part in her pregnancy and labor experience. I know that I will want to do what is best for my baby and me and I will make that decision with confidence. I am no longer ignorant of the pros and cons of childbirth options, and you can bet neither is Carly!

American Congress of Obstetricians and Gynecologists. 2011. The American College of Obstetricians and Gynecologists Issues Opinion on Planned Home Births.http://www.acog.org/from_home/publications/press_releases/nr01-20-11.cfm (accessed July 1, 2011).

Berk, Laura E. 2009.Child Development: 8th Edition. USA: Pearson Higher Education.

Grady, Denise. 2010. Caesarean births are at a high in U.S. The New York Times,http://www.nytimes.com/2010/03/24/health/24birth.html (accessed July 1, 2011).

O’Callaghan, Tiffany. 2010. Too many C-sections: Docs rethink induced labor. The New York Times.http://www.time.com/time/printout/0,8816,2007754,00.html (accessed July 1, 2011).

Roan, Shari. 2011. Pregnant women show an amazing lack of knowledge about childbirth options, study shows. Las Angeles Times. http://articles.latimes.com/print/2011/jun/14/news/la-heb-childbirth-20110614(accessed July 1, 2011).

Rubin, Rita. 2010. Slight increase in home births reverses 15-year decline. USA Todayhttp://www.usatoday.com/news/health/2010-03-04-homebirth04_ST_N.htm# (accessed July 1, 2011).

—by ABN

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4 thoughts on “Two Styles of Childbirth in the Western World

  1. Jules says:

    It saddens me to see the amount of women I talk to who honestly have no idea what will happen during delivery. Many have thrown up their hands and said “Let the doctor do his work!” I truly hope that knowledge can become empowerment as more mothers take control of their own life and the welfare of their baby.

  2. GoodReason says:

    I agree with this post . . . if you carry out your obligation to learn as much as you can about birth, you will be led to make the right choice for your family.

  3. Sue Donym says:

    So many things trouble me about this post. “Since the turn of the 20th century, childbirth moved to be in hospitals and doctors largely assumed responsibility for childbirth. In effect, women’s knowledge of it declined and extended relatives and friends no longer participated (Berk 2009: 109).” What you fail to mention is that this move to hospitals resulted in a drastic drop in mortality rates. From 1915 through 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000 live births, and from 1900 through 1997, the maternal mortality rate declined almost 99% to less than 0.1 reported death per 1000 live births (7.7 deaths per 100,000 live births in 1997) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm). Thanks to modern obstetrics, extended relatives and friends get the opportunity to participate with a live baby and mother long after the day of birth.

    “In contrast, women in non-industrialized cultures have very different childbirth experiences.” Well, they do if they survive. According to the WHO, 99% of maternal deaths occur in developing countries (http://www.who.int/mediacentre/factsheets/fs348/en/k). These deaths occur due to hemorrhage, infection, and pre-eclampsia. “In many of these countries the majority of births are not in hospitals.” QED.

    “At home births or in birthing clinics come with many pros and cons. . . . These births have fewer medical interventions than hospital births.” So interventions are “cons”? What if we replace the word “interventions” with “preventive medicine”? What if we call them “lifesaving procedures”? And what if we acknowledge the fact that home birth attendants may disparage interventions because they are neither authorized nor qualified to perform them?

    “In North America only 1% of mothers choose to have their babies at home,” and yet “other sources challenge . . . the objectivity of the College, which does have a pecuniary interest in discouraging homebirth”? Really? For 1% of the market? OB/GYNs are not looking for more patients; in fact, they’re overburdened. In 2010 about half of US counties lacked a single OB/GYN (http://www.ncbi.nlm.nih.gov/pubmed/22525913). I find it hard to believe that ACOG would be going after that 1%. I find it easier to believe that OB/GYNs, the majority of whom are now women, are sincerely interested in the well-being of women and children, and that is why they discourage home birth. And if you don’t like ACOG’s statistics, you can go to the CDC Wonder site and do the math yourself: planned home birth with a non-nurse midwife carries at least three times the risk of neonatal death than hospital birth.

    “The sad truth is maternal mortality has risen in the past few decades partly because of the dramatic increase of caesarean rates (Grady 2010).” The sad truth is you are citing a New York Times article here which says nothing of the sort! If you have a valid scientific study which says that, I’d be glad to see it. But otherwise, you’re speculating. The Times article also says that the WHO suggests a 15% c-section rate, but in June 2010 the WHO officially withdrew that statement, saying, “There is no empirical evidence for an optimum percentage. What matters most is that all women who need caesarean sections receive them” (http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf).

    When you mention consulting with a doctor or a certified midwife, I wonder if the reader realizes that there are two types of midwives in the US. One, the so-called certified professional midwife (CPM) is licensed by the North American Registry of Midwives (NARM). And what does NARM require? Well, until last year it didn’t even require a high school diploma. The only real requirement is that the candidate pass the CPM test. This type of midwife would not be allowed to practice in any other industrialized nation. Midwives in Canada, Australia, and Europe must have a 3-4 year university degree, as well as clinical training. Their US counterparts, certified nurse midwives (CNMs), must be registered nurses with a masters-level degree and clinical training. CNMs work in hospitals and hospital-based birth centers. CPMs have no hospital privileges; some states bar them from practicing at all.

    Other than that, I have no comment . . .

  4. Sue Donym says:

    Since it seems my first comment has not passed moderation, I’ll try again. This post states, “Since the turn of the 20th century, childbirth moved to be in hospitals and doctors largely assumed responsibility for childbirth. In effect, women’s knowledge of it declined and extended relatives and friends no longer participated (Berk 2009: 109).” This statement appears to be an attempt to show the difference between the two styles of Western childbirth: a home birth where mothers have more autonomy and family members are present, resulting in a more family-friendly environment, or a birth in a cold, impersonal setting. What is not mentioned is that this move to hospitals resulted in a drastic drop in mortality rates. From 1915 through 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000 live births, and from 1900 through 1997, the maternal mortality rate declined almost 99% to less than 0.1 reported death per 1000 live births (7.7 deaths per 100,000 live births in 1997) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm). Thanks to modern obstetrics, extended relatives and friends get the opportunity to participate with a live baby and mother long after the day of birth.

    The post states, “In contrast, women in non-industrialized cultures have very different childbirth experiences.” Well, they do if they survive. According to the WHO, 99% of maternal deaths occur in developing countries (http://www.who.int/mediacentre/factsheets/fs348/en/k). These deaths mainly occur due to hemorrhage, infection, and pre-eclampsia. “In many of these countries the majority of births are not in hospitals.” Which is why women die of hemorrhage, infection, and pre-eclampsia, all of which can usually be remedied in hospitals.

    “In North America only 1% of mothers choose to have their babies at home,” and yet “[ACOG] . . . does have a pecuniary interest in discouraging homebirth”? I find it hard to believe that ACOG is interested in that 1% of the market. OB/GYNs are not looking for more patients; in fact, they’re overburdened. In 2010 about half of US counties lacked a single OB/GYN (http://www.ncbi.nlm.nih.gov/pubmed/22525913). I find it easier to believe that OB/GYNs, the majority of whom are now women, many with children of their own, are sincerely interested in the safety of women and children, and that is why they discourage home birth.

    “The sad truth is maternal mortality has risen in the past few decades partly because of the dramatic increase of caesarean rates (Grady 2010).” The New York Times article cited does not say that, nor does any valid scientific study that I know of. The Times article does say that the WHO suggests a 15% c-section rate, but in June 2010 the WHO officially withdrew that statement, saying, “There is no empirical evidence for an optimum percentage. What matters most is that all women who need caesarean sections receive them” (http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf). Thankfully, that is beginning to happen in some parts of the world. The maternal mortality rate in the Republic of Congo has fallen dramatically, due partly to mothers now being offered free cesareans (http://america.aljazeera.com/articles/2013/9/18/in-republic-of-congoarevolutioninmaternalhealth.html).

    Part of a woman’s research on childbirth options should be that there are two types of midwives in the US. One, the so-called certified professional midwife (CPM) is licensed by the North American Registry of Midwives (NARM). And what does NARM require? Well, until last year it didn’t even require a high school diploma. The only real requirement is that the candidate pass the CPM test. This type of midwife would not be allowed to practice in any other industrialized nation. Midwives in Canada, Australia, and Europe must have a 3-4 year university degree, as well as clinical training. Their US counterparts, certified nurse midwives (CNMs), must be registered nurses with a masters-level degree and clinical training. CNMs work in hospitals and hospital-based birth centers. CPMs have no hospital privileges; some states bar them from practicing at all.

    This post concludes with an affirmation of the importance of making an informed decision in childbirth. In March 2013, at the request of the Oregon legislature, Judith Rooks, CNM presented data that demonstrated that planned home birth with a licensed midwife in 2012 had a death rate 6-8 times higher than a comparable risk hospital birth (https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585). I believe this is the kind of information women need to make an informed decision.

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