Historic Dangers of Childbirth

[Jana814]

Such a sad situcation. Their was just a story in NY back in November. A woman had twins & died soon after. She have birth @ one of the best hospitals in the country! Their still not sure why.

[meda]

Even poor uninsured women have access to state healthcare for prenatal care and delivery. I had medi-cal for my first birth and it covered everything. That's what a huge percentage of people here have in southern CA.

But we also have a very high rate of premature births, and we try to save them at a young gestational age and they often die. That must contribute to it.

No, they do not in all states in the US, and that does have a real impact on the C-section rate and infant outcomes. You and MRs S2004 may want to remember when discussing these issues that this country is made up of more than California

http://thinkprogress.org/security/2011/ ... ?mobile=wt

[DrWhat]

Our infant mortality rate in the US is poor compared to other industrialized nations, this is due to a variety of things, but mainly because doctors insist on so many interventions. First they induce, then its drugs and catheters and breaking your water for you and before you know it you have failed to progress and its surgery time (csection rate of 34% in the US). A csection has a higher mom and baby mortality rate.

For years the Netherlands had the best infant mortality rates and a majority of their births are attended by midwives, and like 1/3 are homebirths. Their csection rate was very low. Countries in Europe where midwives deliver a lot of babies (keep in mind these are very trained midwives) tend to have less interventions and much better outcomes.

Infant mortality is not the number to look at to judge birth safety because it measures death from birth to one year of life. The US is high because we have lots of SIDS and accidents. Perinatal mortality measures death from 28 weeks of pregnancy to 28 days of life, and therefore reflects deaths related to childbirth. The Netherlands has one of the worst perinatal mortality rates in Europe (http://www.midwiferyjournal.com/article/S0266-6138(13)00073-9/abstract). The US has one of the lowest in the world.

I agree that the outcomes for c-section are inherently worse because the mom or baby is SUPPOSED to be in trouble already if they are receiving one.

[Mama Mia]

While I was looking for stats, I found a report saying that the increase was among non-whites, and it's not that the incidence of complications was any higher, but that the outcome for a given complication was worse. Essentially, that if you are brown or black you're less likely to be sucessfully treated for a complication.

The reason might be as simple as assertiveness against authority figures. I would be interested if socioeconomic factors were controlled for, because prior medical care and nutrition could play a role. I hope prejudice doesn't.

.

Wow to the bolded. Have you considered that it isn't because of a lack of assertiveness - but that the Medical establishment does not listen to nor give a damn what lower-income, minority and/or young mothers have to say ?????

[DarkAnts]

In Afghanistan women can only see women doctors, even if they are dying, and there are not that many women doctors. I think I watched a documentary on this.

Our infant mortality rate in the US is poor compared to other industrialized nations, this is due to a variety of things, but mainly because doctors insist on so many interventions. First they induce, then its drugs and catheters and breaking your water for you and before you know it you have failed to progress and its surgery time (csection rate of 34% in the US). A csection has a higher mom and baby mortality rate.

For years the Netherlands had the best infant mortality rates and a majority of their births are attended by midwives, and like 1/3 are homebirths. Their csection rate was very low. Countries in Europe where midwives deliver a lot of babies (keep in mind these are very trained midwives) tend to have less interventions and much better outcomes.

C-section rate is higher now because many hospitals are not allowed to offer vbac to those who have had one c-section. There are regulations in place for what the hospital needs in order to do vbac. Many hospitals outside of big cities cant afford to have everything required like a fully staffed trama OR in pace at all times. Then there are the insurance companies. Many malpractice insurance companies dont allow vbac due to the increase risk of injury for mom and baby.

[NotALoserLikeYou]

While I was looking for stats, I found a report saying that the increase was among non-whites, and it's not that the incidence of complications was any higher, but that the outcome for a given complication was worse. Essentially, that if you are brown or black you're less likely to be sucessfully treated for a complication.

The reason might be as simple as assertiveness against authority figures. I would be interested if socioeconomic factors were controlled for, because prior medical care and nutrition could play a role. I hope prejudice doesn't.

Many of my friends, and I would have died or lost our baby if we were not in the first world. Both my oldest child and I would be dead, and that's without c-section or transfusion.

C-sections have higher mortality rates because they're already in trouble.

The US infant mortality rate is mostly because there are a lot of black women, black women have preemies and preemies die more. I'd find a link, but here comes breakfast, I have to pretend to be asleep.

Csection rates have a higher risk for the mother not because she is already in trouble but because she is having major surgery and that has a lot of risks. When you read about women dying in childbirth in America these days they have almost all had complications due to Csections

Also the act of being squeezed out is good for the baby, it forces liquid out of its lungs. A normal natural birth is safer for mom and baby.

[NotALoserLikeYou]

No, they do not in all states in the US, and that does have a real impact on the C-section rate and infant outcomes. You and MRs S2004 may want to remember when discussing these issues that this country is made up of more than California

http://thinkprogress.org/security/2011/ ... ?mobile=wt

That article makes me sick! Wtf. Let's just ignore pregnant women and hope they go away. What a plan!

[DarkAnts]

C-sections have higher mortality rates because they're already in trouble.

The US infant mortality rate is mostly because there are a lot of black women, black women have preemies and preemies die more. I'd find a link, but here comes breakfast, I have to pretend to be asleep.

Csection rates have a higher risk for the mother not because she is already in trouble but because she is having major surgery and that has a lot of risks. When you read about women dying in childbirth in America these days they have almost all had complications due to Csections

Also the act of being squeezed out is good for the baby, it forces liquid out of its lungs. A normal natural birth is safer for mom and baby.

[Freyacat]

Csection rates have a higher risk for the mother not because she is already in trouble but because she is having major surgery and that has a lot of risks. When you read about women dying in childbirth in America these days they have almost all had complications due to Csections

Also the act of being squeezed out is good for the baby, it forces liquid out of its lungs. A normal natural birth is safer for mom and baby.

You say that almost all women who die in childbirth in America have almost all had c-section complications, but that doesn't actually in any way disprove what August said - that the complications are because women who have c-sections are already higher risk for complications. So yes, I would accept that a large percentage of women who die in childbirth in the US today had c-sections. I do not, however, think there's enough proof to claim the c-section in any way caused their deaths. I think there may be an underlying root cause for a lot of them that led to the c-section *and* to their unfortunate death, so in many cases mom and baby were already in bad shape by the time the c-section was suggested.

[August]

Wow to the bolded. Have you considered that it isn't because of a lack of assertiveness - but that the Medical establishment does not listen to nor give a damn what lower-income, minority and/or young mothers have to say ?????

If you read my post, I said I hoped it wasn't that. And yes, talking back to doctors, teachers and other authority figures is a race-based thing, reported in peer-reviwed journals and all.

[August]

Comparing different nations' infant mortality rates isn't really a great way to compare birth in those countries, though. First, it includes deaths all the way up to one year, so how can you be sure it reflects deaths due to things than happen in birth? It might be that a higher infant mortality rate indicates more about a lack of access to ongoing medical care during infancy. Plus, I've read that not all countries count deaths the same. If a baby is born in great distress and dies soon after, in the US that goes in our infant mortality stats, but in a lot of Europe a baby in that situation is counted as a stillbirth.

And now I'm depressed because in a perfect world there just wouldn't be a need for any methodology to count babies who die, because babies just shouldn't die. Ever. :(

The third world is a not unreasonable proxy for the 16 or 17th century. There were not great records that long ago. The 19th century is not easy because rates are over-reported for maternity homes, where purpureal fever killed many, and under-reported for home births. Perinatal mortality rate is not easy to find for the third world, whereas maternal and infant mortality are widely reported. And, when you're trying to confirm or refute a 50% death rate, then a figure which includes more deaths and still doesn't reach 50% effectively refutes it.

[August]

Csection rates have a higher risk for the mother not because she is already in trouble but because she is having major surgery and that has a lot of risks. When you read about women dying in childbirth in America these days they have almost all had complications due to Csections

Also the act of being squeezed out is good for the baby, it forces liquid out of its lungs. A normal natural birth is safer for mom and baby.

No.

Per the CDC

This graph shows percentages of pregnancy-related deaths in the United States in 2006–2008 caused by—

Cardiovascular Diseases, 14.6%

Cardiomyopathy, 12.4%

Non-Cardiovascular Diseases, 11.9%

Hemorrhage, 11.5%

Infection/Sepsis, 11.1%

Hypertensive Disorders of Pregnancy, 10.5%

Thrombotic Pulmonary Embolism, 10.3%,

Amniotic Fluid Embolism, 5.9%

Cerebrovascular Accidents, 5.7%

Anesthesia Complications, 0.6%

The cause of death is unknown for 5.5% of all 2006–2008 pregnancy-related deaths.

27% heart and circulation...From a peer reviewed paper

A report presenting data about maternal mortality in the UK from 2000 to 2002 showed that the majority of maternal deaths occurred in women with previously undiagnosed heart disease.1 The haemo-dynamic burden of pregnancy can unmask previously asymptomatic heart disease. For example, it is not uncommon for women with rheumatic mitral stenosis to be diagnosed for the first time during pregnancy because the volume overload and increase in heart frequency cause symptoms that did not occur before pregnancy. The case reports of peripartum cardio-myopathy and coronary artery dissection in this issue illustrate that life-threatening heart disease can also develop as a new disease related to pregnancy.

[Lady]

"My grand/great so and so had 10 kids' is commonly used to defend having large fmailies. They fail to see is was due to not only lack of birth control but hoping some of the kids would survive until adulthood.

True. My great grandmother had 13 children, one of them the result of a rape. A bunch of them were kidnapped by their abusive biological father. Only 4 lived to adulthood, which includes 2 of the ones that were kidnapped.

[DrWhat]

The danger of c-section mostly comes with the risk for FUTURE pregnancies and deliveries, particularly with multiple c-sections. So if you are quiverful, it is a good idea to avoid one. Having a deadly complication from the first surgery itself without other complicating factors is rare, though. Slow hemorrhage from uterine incision and wound infection with a drug-resistant bug are the main deadly culprits in healthy women, and even these can usually be treated.

Mostly, many women aren't aware of how difficult the recovery will be, which is admittedly something I would like to avoid when I have a newborn to enjoy! Recovering from surgery is painful! You can not sit up or lift well. Your bowels do not work for a bit after surgery and this can become a problem. When women are less active they are also at increased risk for blood clots. My mom said she wanted a VBAC because she wanted an easier recovery. She said it wasn't any better for her! People conveniently seem to forget the list of unpleasantries that occur when recovering from vaginal delivery and not c-section. Urinary Incontinence, pain with urination for weeks, painful sex, damage to the clitoris, and prolapse are not that uncommon. Not to mention more serious complications.

[DistantStar]

I think there may be an underlying root cause for a lot of them that led to the c-section *and* to their unfortunate death, so in many cases mom and baby were already in bad shape by the time the c-section was suggested.

Exactly. Anybody having an emergency c-section is already in some trouble. If mom's crashing and they do a c-section to get the kid OUT NOW so they can try to handle whatever's happening to the mom but whatever else they do isn't quite enough, well, you have a seriously bad situation, but not due to the surgery itself - due to the situation that caused them to do it.

I would be more worried if the numbers didn't reflect a high number of c-sections under those sorts of circumstances because it would mean that the docs were not doing their jobs.

[lilith]

I could have very easily become one of the women railing against the medicalisation of childbirth and the overuse of interventions. The reason I'm not is cause I have three healthy children.

When I was pregnant with my first I read everything I could, educated myself, and was sure I wanted a natural birth, with pain relief as needed. I was young, fit, and assertive regarding my medical care. I had unexplained bleeding throughout the pregnancy, so I had weekly ultrasounds for the last 6 weeks. Between 36 and 37 weeks, the ultrasound measurements indicated that my daughter not only wasn't growing, but had lost weight. I was induced at 37 weeks, had a common induction experience of long hard labor that didn't progress, manually broken waters, and progressing from gas to pethidine to begging for an epidural. After 27 hours, I was exhausted and baby's blood oxygen was going down, and I ended up with an emergency caesarean. When I booked out of the hospital a sheepish nurse told me that they had heard from the ultrasound tech, and my healthy baby girl had been growing just fine - they had simply got the measurements wrong.

I tried for a VBAC after my next child, but the midwives were only prepared to let me labor for eight hours because of the recent caesarean scar, and I ended up with another emergency caesarean because I didn't dilate quickly enough.

By baby three I had an elective caesarean.

Many women with my obstetric history feel cheated of the birth they wanted and victimised by the medical system, and I understand why and sympathise with them.

I, however, feel incredibly priveliged that I had three healthy babies in under three years, that I came out of it healthy and able to bear more children if I choose to, that I was given the pain relief and medicines I asked for, and that I was cared for by trained professionals in world class facilities at no cost to myself.

Very few women in history have had that level of care and the privilege of near certainty that they and their child would survive childbirth, and many women in the world still don't.

So while I understand why this is an emotive issue, and understand why women mourn for the birth experience they didn't get, the fact we have these options and can even have this conversation is a privilege that most women who have given birth could never imagine.

[August]

But, Lilith, that's like saying no-one should ever improve anything because what it's like now is better than [insert worse thing]. Like, they don't need to invent c-sections because forceps are so much better than dying of an obstructed labor. Or don't complain of your broken leg because someone else has cancer.

The choice is not between a massively interventive birth and a back alley. It's entirely possible to both keep birth safe and make it safer and better. Think of the women out there right now being shaved and enema'd before lying down in an operating room to deliver (they still do it in Mexico), or women getting a light patient controlled epidural, or sharing/not sharing a postpartum room. Having the lights dimmed while they labor. Having the baby in their room or in a nursery. Not having an episiotomy. Having a c-section instead of a tricky forceps delivery. Having an IV or no IV. Having one care provider through pregnancy instead of an ever changing roster. Getting the hell out of the hospital before you catch an infection.

That is, there are things that can make birth better right now that are not being implemented, and there are things they've already implemented that have made it better, and there are things they'll be able to in the future to make it better.

[Mama Mia]

I could have very easily become one of the women railing against the medicalisation of childbirth and the overuse of interventions. The reason I'm not is cause I have three healthy children.

When I was pregnant with my first I read everything I could, educated myself, and was sure I wanted a natural birth, with pain relief as needed. I was young, fit, and assertive regarding my medical care. I had unexplained bleeding throughout the pregnancy, so I had weekly ultrasounds for the last 6 weeks. Between 36 and 37 weeks, the ultrasound measurements indicated that my daughter not only wasn't growing, but had lost weight. I was induced at 37 weeks, had a common induction experience of long hard labor that didn't progress, manually broken waters, and progressing from gas to pethidine to begging for an epidural. After 27 hours, I was exhausted and baby's blood oxygen was going down, and I ended up with an emergency caesarean. When I booked out of the hospital a sheepish nurse told me that they had heard from the ultrasound tech, and my healthy baby girl had been growing just fine - they had simply got the measurements wrong.

I tried for a VBAC after my next child, but the midwives were only prepared to let me labor for eight hours because of the recent caesarean scar, and I ended up with another emergency caesarean because I didn't dilate quickly enough.

By baby three I had an elective caesarean.

Many women with my obstetric history feel cheated of the birth they wanted and victimised by the medical system, and I understand why and sympathise with them.

I, however, feel incredibly priveliged that I had three healthy babies in under three years, that I came out of it healthy and able to bear more children if I choose to, that I was given the pain relief and medicines I asked for, and that I was cared for by trained professionals in world class facilities at no cost to myself.

Very few women in history have had that level of care and the privilege of near certainty that they and their child would survive childbirth, and many women in the world still don't.

So while I understand why this is an emotive issue, and understand why women mourn for the birth experience they didn't get, the fact we have these options and can even have this conversation is a privilege that most women who have given birth could never imagine.

But it sounds like you had three healthy children in spite of un-needed medical interventions - not because of them. So I don't see how that is an argument in favor of major surgery when it isn't needed.

[lilith]

But it sounds like you had three healthy children in spite of un-needed medical interventions - not because of them. So I don't see how that is an argument in favor of major surgery when it isn't needed.

It's an argument in favour of erring on the side of caution, a d an acknowledgement that while the western medical system isn't perfect, it's a hell of a lot better than what most women have had access to, both now and historically.

Yes, I think there were unnecessary interventions in my first birth that I believe led me to a caesarean, which led to subsequent caesareans. Would I have preferred to wait and see what happened when my baby was possibly in trouble in the womb? No way.

I didn't have the births I had imagined, but I had three healthy babies, and that's all that really matters, no matter how they got here.

I agree that childbirth is probably medicalised more than it has to be, but every mother wants those interventions available when it is the life of herself or her baby at stake, and I would much prefer that medical teams intervened too soon and too often than too late and not enough.

The fact that we have birthing options is a huge privilege. Whatever the methods, women in western countries go into labor with the near certainty that they and their babies will come through it alive. The method by which we reach that state, which has been beyond the grasp of almost all our foremothers, matters to me far less than the fact that we are there, and I only wish that women in the rest of the world enjoyed that same certainty.

While we in the west argue over the politics of birth and a woman's right to the birth experience she desires, and deride medicalisation and interventions, women in the third world and their babies are dying for the lack of those same interventions. Women are labouring for days on end with no pain relief to deliver dead babies while we complain about the interventions that ensure us live babies and bodies that can conceive again.

[DaffyDill]

I don't think Lilith is saying that the birth experience cannot/should not be improved upon.

Rather, she is saying that instead of railing about missing out on the birth experience they wanted or expected to have due to late term medical intervention, some women need to appreciate the levels of care and technology they have available, enabling them to successfully give birth to, and arrive home with a healthy baby. Because after all, isn't that the point of becoming pregnant? A healthy child?

It may not be the bith experience the mother wished for, but the payoff, a healthy child, is well worth it IMO.

[lilith]

But, Lilith, that's like saying no-one should ever improve anything because what it's like now is better than [insert worse thing]. Like, they don't need to invent c-sections because forceps are so much better than dying of an obstructed labor. Or don't complain of your broken leg because someone else has cancer.

The choice is not between a massively interventive birth and a back alley. It's entirely possible to both keep birth safe and make it safer and better. Think of the women out there right now being shaved and enema'd before lying down in an operating room to deliver (they still do it in Mexico), or women getting a light patient controlled epidural, or sharing/not sharing a postpartum room. Having the lights dimmed while they labor. Having the baby in their room or in a nursery. Not having an episiotomy. Having a c-section instead of a tricky forceps delivery. Having an IV or no IV. Having one care provider through pregnancy instead of an ever changing roster. Getting the hell out of the hospital before you catch an infection.

That is, there are things that can make birth better right now that are not being implemented, and there are things they've already implemented that have made it better, and there are things they'll be able to in the future to make it better.

I'm not implying that we shouldn't make birth better and safer for individuals. I am saying that doctors don't perform interventions just for the hell of it or out of ignorance - they do it to create better outcomes for mother and baby.

While it's an imperfect system, western childbirth methods have saved so many lives and are the envy of the world, and they didn't come about at the convenience of obstetricians or insurance companies, they came about cause they work.

I'm all for midwife assisted birth in birth centres or homes if medical help is available fast. But I think that any mother who consciously chooses to make medical intervention an impossibility or refuses it when her caregivers advise it is irresponsible and should think of the millions of women who have given birth without the option of interventions, often with tragic results, and be aware of the insanely privileged position they are in to have the choices they do.

[Mama Mia]

I'm not implying that we shouldn't make birth better and safer for individuals. I am saying that doctors don't perform interventions just for the hell of it or out of ignorance - they do it to create better outcomes for mother and baby.

While it's an imperfect system, western childbirth methods have saved so many lives and are the envy of the world, and they didn't come about at the convenience of obstetricians or insurance companies, they came about cause they work.

I'm all for midwife assisted birth in birth centres or homes if medical help is available fast. But I think that any mother who consciously chooses to make medical intervention an impossibility or refuses it when her caregivers advise it is irresponsible and should think of the millions of women who have given birth without the option of interventions, often with tragic results, and be aware of the insanely privileged position they are in to have the choices they do.

I think part of the problem is also that we are comparing different experiences in different countries and equating all western medical care as the same.

The U.S. rates 68th in number of first day infant deaths. That is below Mexico, below Saudi Arabia, below Kuwait.

The U.S. ranks around the 50th in maternal mortality, behind Serbia, and one spot ahead of Iran.

The problem is often "blamed" on the high rate of minority, poor and teen births. Because maybe somehow doesn't count as much if the mother is minority and /or poor and/or young. Or maybe the excuse is that these populations just don't "speak up" enough. Even though the same conversation between a young/poor/minority woman and her health care provider will probably be perceived very differently than if the pregnant woman was an "appropriately" aged middle-class white woman. For example the physician might say that the 18 year old black woman on medicaid was "didn't understand medical advice" or that she "didn't understand what was required" if she questions some of the medical interventions being proposed. Where the same concerns posed by another woman might be seen as "seeking education and information" or "advocating for following her birth plan" .

What people in countries with universal health care don't have to deal with isn't just a lack of affordable and quality care - which is a huge problem in the U.S. - it is also the privacy that having universal care provides.

If a woman uses medicaid or other health care programs for low-income women - the clinic and hospital and physician all know she is poor , and their interactions are going to be colored by that. That tends to mean treating her like she is not as bright, it tends to mean either too many interventions or too few.

I know that this personal experience is not hard data - but - I was shocked and sickened by the difference in how my two daughters were treated during childbirth at the same hospital just a few years apart. One had midwives , is middle class with private insurance and in her early thirties with a white surname and extremely white husband. The hospital staff was wonderful to her ! When she screamed in labor they asked what they could do to help. When she asked about procedures they explained them to her and gave her options.

The other was young, with a latino surname and brown husband and on state insurance. When she screamed in labor the nurse told her to "toughen up". The hospital staff was rude and dismissive to any concerns she had and she ended up almost dying due to negligence. When she was too weak up to get up to feed her baby ( who was in the nicu due to the negligence ) - the Doctor actually said "Well you know how these teens are" - no actually she needed a freaking transfusion !

I have nothing at all against hospital birth and interventions when needed, I had all my kids in the hospital. But I think acting like women are oh-so lucky and shouldn't complain and that this is some sort of first world problem ignores the real issues many women face and has a sort of "look how lucky you are, now don't worry your pretty little head about it" feel to it.

[Freyacat]

I think part of the problem is also that we are comparing different experiences in different countries and equating all western medical care as the same.

The U.S. rates 68th in number of first day infant deaths. That is below Mexico, below Saudi Arabia, below Kuwait.

The U.S. ranks around the 50th in maternal mortality, behind Serbia, and one spot ahead of Iran.

The problem is often "blamed" on the high rate of minority, poor and teen births. Because maybe somehow doesn't count as much if the mother is minority and /or poor and/or young. Or maybe the excuse is that these populations just don't "speak up" enough. Even though the same conversation between a young/poor/minority woman and her health care provider will probably be perceived very differently than if the pregnant woman was an "appropriately" aged middle-class white woman. For example the physician might say that the 18 year old black woman on medicaid was "didn't understand medical advice" or that she "didn't understand what was required" if she questions some of the medical interventions being proposed. Where the same concerns posed by another woman might be seen as "seeking education and information" or "advocating for following her birth plan" .

What people in countries with universal health care don't have to deal with isn't just a lack of affordable and quality care - which is a huge problem in the U.S. - it is also the privacy that having universal care provides.

If a woman uses medicaid or other health care programs for low-income women - the clinic and hospital and physician all know she is poor , and their interactions are going to be colored by that. That tends to mean treating her like she is not as bright, it tends to mean either too many interventions or too few.

I know that this personal experience is not hard data - but - I was shocked and sickened by the difference in how my two daughters were treated during childbirth at the same hospital just a few years apart. One had midwives , is middle class with private insurance and in her early thirties with a white surname and extremely white husband. The hospital staff was wonderful to her ! When she screamed in labor they asked what they could do to help. When she asked about procedures they explained them to her and gave her options.

The other was young, with a latino surname and brown husband and on state insurance. When she screamed in labor the nurse told her to "toughen up". The hospital staff was rude and dismissive to any concerns she had and she ended up almost dying due to negligence. When she was too weak up to get up to feed her baby ( who was in the nicu due to the negligence ) - the Doctor actually said "Well you know how these teens are" - no actually she needed a freaking transfusion !

I have nothing at all against hospital birth and interventions when needed, I had all my kids in the hospital. But I think acting like women are oh-so lucky and shouldn't complain and that this is some sort of first world problem ignores the real issues many women face and has a sort of "look how lucky you are, now don't worry your pretty little head about it" feel to it.

I don't think anyone here is trying to say that mothers and babies who are poor, teen, or minority matter less. When people bring those factors up as reasons why some US moms have bad health outcomes, I don't think that means the people don't care about moms who fall into one or more of those groups. I think it's pointing to an awareness that moms in those groups are more likely to have a history of poor access to health care for many years prior to pregnancy, so they are more likely to have poorly managed chronic conditions or to have undiagnosed underlying health issues. Saying that poor or minority moms may have health issues isn't shrugging the issues off. And it's not a criticism of the moms. It's actually a criticism of the system that allows so many people to fall through the cracks and get inadequate care.

That said, there are always going to be racists and assholes in every field, and I'm sorry your daughter encountered some of them.

[LadyBlue]

C-sections have higher mortality rates because they're already in trouble.

The US infant mortality rate is mostly because there are a lot of black women, black women have preemies and preemies die more. I'd find a link, but here comes breakfast, I have to pretend to be asleep.

There are studies that control for that possibility.eg http://www.ecmaj.ca/content/176/4/455.full Note the increased risk of cardiac arrest In an emergency they're worth the risk, but at least half of current cesareans are unnecessary and the VBAC rate is far too low. Each cesarean increases the danger to both pretty dramatically, mostly due to serious placental issues, while VBAC decreases the risks. http://www.medscape.com/viewarticle/573948 http://www.deseretnews.com/article/865579668/Orem-mother-known-for-kind-heart-dies-during-childbirth.html

Article on reasons for cesarean increase. http://www.childbirthconnection.org/article.asp?ck=10456 Note the common excuses contributed minimally but

Incentives to practice in a manner that is efficient for providers

was a bigger contributer.

Also, if you read enough cesarean birth stories, you'll see an unacceptably high number that are forced/manipulated just before OB vacations, major holidays & even weekends. And then there's the "pit to distress" phenomenon.So yes, cesareans are actually being routinely performed for doctor convenience, not medical reasons. Although you can be sure the records reflect accepted reasons. Many a victim of coercion to have a cesarean has been shocked to find her records say she requested it or some other lie/manipulation of the truth.

Doctors are human. Some good, some bad. A few great, a few horrifying. And like most humans, they sometimes choose self interest over what other people want/need. Especially when they believe they know better and the other person is not only a woman, but one who is "irrational" because of labour.

The major contributions to decreased mortality were antibiotics, blood transfusions & getting doctors to wash their damn hands

[August]

I'm not implying that we shouldn't make birth better and safer for individuals. I am saying that doctors don't perform interventions just for the hell of it or out of ignorance - they do it to create better outcomes for mother and baby.

While it's an imperfect system, western childbirth methods have saved so many lives and are the envy of the world, and they didn't come about at the convenience of obstetricians or insurance companies, they came about cause they work.

I'm all for midwife assisted birth in birth centres or homes if medical help is available fast. But I think that any mother who consciously chooses to make medical intervention an impossibility or refuses it when her caregivers advise it is irresponsible and should think of the millions of women who have given birth without the option of interventions, often with tragic results, and be aware of the insanely privileged position they are in to have the choices they do.

You see, that's just not true. Take the IV for example. It's been shown there's no need to have an IV on a normal (low risk, etc) laboring woman, but it is policy to have it in some places. Even having a hep lock is unnecessary, but many many doctors require one. It doesn't create better outcomes, and it's done just for the hell of it. Even something as simple as oxygen on the mother when the baby's in trouble. Does not affect outcomes, possibly makes it worse because of the freakout factor, but makes attendants feel like they're doing something.

Same goes for enema, continuous monitoring, laboring in bed, episiotomy and many other things as routine.

Refusing any or all medical intervention is a totally different issue.