American women are actually safer giving birth in Bosnia than in this country.
According to a report issued by Save the Children last week. The State of the World’s Mothers 2010, issued in commemoration with Mother’s Day, ranked the U.S. as 28th in its rating of best and worst places to be a mother. American mothers may want to return this gift. Or move. They could go to Slovenia, Latvia or even Croatia, all of which rank higher than the U.S. in terms of maternal and child health and well being.
How could the world’s leading power sink to this spot and keep slipping (it’s down a peg from 27 in 2009)? First, the U.S. has one of the highest maternal mortality rate, nearly 1 in 5,000, in the developed world. All of Western, Northern and Southern Europe (except Estonia and Albania) placed better than the U.S.
The U.S. also ranks poorly on mortality rate for children under five, coming in at 9th place. This puts the U.S. on par with countries like Slovakia and Montenegro. Additionally, the U.S. has the least generous maternity leave, both in terms of time off and wages paid, of any wealthy nation.
Around the world nearly 350,000 women die during pregnancy or childbirth every year. Most of these deaths occur in developing countries where mothers and children lack even the most basic health care and health workers are urgently needed. A majority of these deaths, however, are preventable by low-cost, low-tech solutions, according to the report. These solutions seem to hold in the U.S. as well, according to Jill Wodnick, a certified birth doula, holistic childbirth educator, founder of Montclairmaternity.com, and Doula Expert for Pregnancy Magazine.
“Our country can do a lot better,” Wodnick said. “In the U.S. we are overusing technology, which is part of the reason we have a health care crisis. Costly birth procedures are being employed rather than using evidenced based medicine.”
Indeed, childbirth in America is expensive, and yet infant and maternal mortality rates are high. Wodnick asks, “What, then, are the costs of overusing technology?”
This question is of particular interest to women in New Jersey. The state has the highest cesarean rate in the country, according to International Cesarean Awareness Network (ICAN) of NJ. In 2009, 39.4% of all births in NJ were surgical. The rate should be between 10%-15%, according to The World Health Organization. A rate higher than this puts the lives of women and babies at risk the WHO states.
“Rarely is it a life-threatening emergency but rather a failure to progress diagnosis that results in a c-section,” said Nancy Pandiscia, another local doula and certified childbirth educator. She notes Essex County has particularly high cesarean rates with one out of every two pregnancies at St. Barnabas Medical Center ending in a C-section.
Both Wodnick and Pandiscia speak of the benefits of the trial of labor, the natural process by which babies are born. This approach could serve both policymakers and the general public because it is cost-effective and has health benefits for mother and baby. Labor and the contractions that come with it prepare the baby to breath on his or her own, which is one of the reasons the trial of labor is so important. Another significant aspect, Wodnick said, is the unknown effects or potentially adverse effects of medical procedures.
A new study in last month’s issue of BJOG, a peer-reviewed journal of the Royal College of Obstetricians and Gynecologist, finds the best available evidence does not uphold many explanations given by medical providers for employing drugs or other means to induce labor. Some of the more common reasons to induce, such as a large fetus or breeched position or pregnancy with twins, now appear to be unnecessary and potentially harmful, according to the study.
Induced labor could unwittingly cause a premature birth since estimates of how long a fetus has been gestating can be off by up to two weeks. Inducing labor, then, can put the brain and lung development of babies at risk.
All this evidence points in the natural direction for childbirth Wodnick and Pandiscia say, but they emphasize the expectant mother is the one who should choose the right path for her and her baby. The doula’s job is to provide emotional, physical, and informational support to the woman and her family. Benefits of doula-assisted births such as reduced cesareans, reduced labor time, and reduced number of days newborns spend in NICU are listed on the website of HPC Community Doulas, a non profit maternal infant health agency.
But above all, doulas act in accordance with what their Greek name means “to serve women.” Wodnick said, “My soul’s work is to make maternity care mother-friendly and baby-friendly.”
(Photo: Flickr/SantaRosa OLD SKOOL)