The State of Mothers

C-section birth.jpgAmerican 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, 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)

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  1. It is a shame that we rank that low and that NJ has the highest c-section rate.
    When I delivered my 2nd daughter, I ended up getting a doctor on staff who I didn’t know, because my OB took the weekend off. He made a joke that he hadn’t delivered a baby like this (vaginal delivery) in a long time. All the nurses laughed. He also was adamant that I get an episiotomy, even though I had delivered my first almost 9 lb. baby with out one or even a tear. I said no, he was upset and in the end, who do you think won?
    My recovery was worse. The nurses basically ignored me. One day, a nurse came into my room at 8 am and not one person came back to see me until 8 pm that night. Not one. I had friends who delivered at this hospital and had c-sections who said the staff was wonderful, attentive, and professional. I felt like having an easy, run-of-the-mill delivery was boring these days.

  2. Just after moving to NJ and at 4 months pregnant, an OB told me that I would need a C-section because my baby was “so big”. I switched practices–unfortunately (in hindsight) to another OB.
    Of the four women in my birthing class, the only one who had a C-section was the one attended by an OB (me).
    I wonder how many NJ mothers out there attended by an OB had their C-sections because of “failure to progress” and CPD.
    I wonder how many women attended by midwives fail to progress and have a disproportionally small pelvis.
    just wondering.

  3. Thank you for your comments. And Brookdalemama – that is exactly the whole point! The link to the ICAN of NJ or the HPC Community Doulas website I believe give some of those statistics. Failure to progress is not considered a legitimate reason to induce and the weight of the baby can be drastically off and so is also not a good reason to do a c-section. And the doula site gives you stats on birth experiences when done with a doula – and the reduced rate of everything!

  4. Kuddos to Stacey for doing amazing research covering this topic. Since I am quoted in this article and literally JUST returned from a birth from Overlook Hospital, I am taking this space to exhale. Healthy client 40 weeks told she must have an induction—no medically indicated reason, estimates of sonogram of 8 lb, 3 oz–cervidel gel and Pitocin does not work bc baby is so high in the pelvis (station -3). She does not dilate beyond a fingertip. C-section called. Baby is 7 lbs. 2 oz. If an induction had not been ordered, her pre labor and early labor most likely would have started today and she would have delivered Sunday. Now, we have a mother recovering from major abdominal surgery. BTW

  5. Almost exact same thing happened to me with my twins. Took me about 3 years to feel well after their birth. The state of childbirth in America is truly horrifying. Thanks for all the wonderful work you and other doulas are doing to raise awareness!

  6. Women need to educate themselves about childbirth and stop putting so much faith in their doctors and find faith within themselves. I had the same OBGYN as jhcelestin and loved him, he has since relocated his practice. However, he and I had two different due dates, his was earlier mine was later, he agreed to meet me halfway.
    The doc was going on vacation and wanted to schedule an induction, I said go ahead and schedule it I just won’t show up. He realizes he won’t win with me. I go into labor naturally at 42 weeks, stayed home for about 14 hours, contractions finally a few minutes apart, then head to the hospital. My OBGYN won’t be back for another day so I have a covering doctor who is not so happy about me not opting for an epidural.
    Another 18 hours of labor and I’m only at 6cm and the covering doctor tells me I need a C-section, I tell her absolutely not. I’m not that stupid, it’s now Friday morning and she has office hours to get to. I’m then told my other option is pitocin and an epidural, once again I said no. My tired husband, not my strongest advocate at that moment, talks me into the drugs. Not the best decision, however my OBGYN did come in 6 hours later for the delivery and it went very well.
    Bottom line, I wish I had a doula. Any woman that wants a natural childbirth should have a doula and she be informed about doula’s at their doctors office. A natural childbirth is no walk in the park but it is sooo worth it, the worst part of my labor was the last 6 hours when I was given the drugs! And to think so many women actually opt for a C-section. Do they not realize it is major surgery? Do they not realize that the doctors are just making it easier for themselves and their schedules? What about the well being of the moms and the babies?

  7. The first sentence of the above post, that women need to educate themselves perpetuates BLAMING WOMEN, NOT making the SYSTEM REFORM into being accredited as mother friendly-baby friendly. First Lady Michelle Obama’s new Let’s Move campaign ENDORSES the UN/WHO BABYFRIENDLY Policies adopted in hospitals so breastfeeding can have less obstacles. The system needs reform and it not just one woman’s fault….just my two cents since I see this all the time.

  8. Windweaver, you are absolutely right that the system needs a major overhaul. Women and babies are paying a terrible price in the current culture. But dawniedo makes another excellent point: women really do need to educate themselves – because it’s empowering, and because that’s how change happens.

  9. One more thing. Doulas are not just for natural childbirth. Their job is to support the woman in whatever decision she makes whether in a hospital or at home, natural or w/ epidural – anything the woman wants. This is something I learned in the course of researching the article. It is unfortunate there is so little awareness of doulas and their services in this country. I think the information should be a routine part of the whole process.
    The fact is women have been giving birth since before there were doctors so why now is everything done in an unnatural way? I’m not saying women should go all natural (I gave birth in a hospital w/ epidural). I’m saying we should be given the information and the support to make the decision that is right for each of us.

  10. I agree. I was educated. The first time, I was nervous and trusted my doctor’s expertise. The second time, I was not listened to or respected.
    The entire hospital setting did not support my wishes. I was pushed constantly to let my baby sleep in the nursery, despite telling them numerous times that I wanted my baby with because I was breastfeeding. I was pushed to supplement with a little formula. I was pushed to give the baby a pacifier.
    I was pushed to take percocet after delivery even though I felt fine and didn’t request it. When I said I didn’t need any pain medication, the doctor still insisted on having it sent in and giving me a prescription to take home. I didn’t take it.

  11. By no means am I BLAMING WOMEN, however we are just expected to do what the doctors tell us and most women do because they may not know any better. EDUCATION IS EMPOWERMENT and that is exactly how I meant it. We need to educate ourselves about our options because if we don’t we can very easily be persuaded to do something that may not be in our best interest.
    Like Stacey Gill commented, women were giving birth for centuries without doctors and now most women wouldn’t even consider a midwife as an option.
    Whatever way you decide to give birth, it should be YOUR decision. Not every birth plan goes the way a woman wants it to go. Certain circumstances can and do arise during labor and delivery that change that plan. Not being educated, not knowing all of your options is allowing someone else to decide for you and that is just wrong.

  12. Articles like this one are invaluable in educating women about their options and empowering them to trust the wisdom of their own bodies. I would never, ever, ever give birth without a doula present. I had two (!) wonderful doulas attend the birth of my twins, and it was the best decision I ever made. The birth was difficult and full of medical complications, but because I had my trusted doulas and a wonderful, enlightened OB, I was able to make peace with the fact that I did not have the natural birth I wanted. Women need to have other experienced women around them to feel empowered to have the birth that is right for them and for their babies. I should add that Dads need the doulas just as much as Moms – just ask my DH!

  13. Your article on the cesarean delivery rate illustrates two basic problems that we have, first is an increasing cesarean delivery rate that everyone is complaining about but no one is doing anything to correct and second is articles that demonstrate that they are written by people who don’t understand the statistics in their own articles.
    You state:
    “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.”
    The rates that you report for New Jersey is total cesarean deliveries divided by total deliveries yet you compare this rate to the World Health Organization’s recommendation which is ONLY for first time mothers at term with a singleton pregnancy where the baby is head first. You might as well compare apples to milk shakes.
    If you are interested in learning more about how to understand the numbers that you are using or in a plan that can actually make a difference. Educate yourself at

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