Born in the USA (46 page)

1
.  The FDA has stated explicitly that Cytotec is not approved for labor induction. See FDA Drug Information Sheet, “Misoprostol (Marketed as Cytotec),” May 2005, posted at
[email protected]
.

2
.  See M. Plaut, M. Schwartz, and S. Lubarsky, “Uterine Rupture Associated with the Use of Misoprostol in the Gravid Patient with a Previous Cesarean Section,”
American Journal of Obstetrics and Gynecology
180, no. 6 (1999): 1535–40; and H. Blanchette, S. Nayak, and S. Erasmus, “Comparison of the Safety and Efficacy of Intravaginal Misoprostol with Those of Dinoprostone for Cervical Ripening and Induction of Labor in a Community Hospital,”
American Journal of Obstetrics and Gynecology
180, no. 6 (1999): 1543–50.

3
.  For an excellent overall review of the data on risks of pharmacological induction of labor, including studies showing that uterine stimulant drugs increase labor pain, see H. Goer,
The Thinking Woman's Guide to a Better Birth
(New York: Penguin Putnam, 1999).

4
.  For information on who “attends” birth in highly industrialized Western countries outside the United States, see World Health Organization,
Having a Baby in Europe
(Copenhagen: World Health Organization, 1985). This publication is a detailed description of national maternity care systems in European countries. There has been no significant change in these systems since it was published. Midwives continue to attend most births in these countries.

5
.  
For information on who “attends” birth in the United States, see
A National Survey of Obstetric Practices
, published October 24, 2002, by the Maternity Center Association of New York City (now named Childbirth Connection). Also, data on the number of U.S. births attended by midwives and doctors can be found on the Web site of the National Center for Health Statistics,
www.cdc.gov/nchs
.

6
.  S. Daniels and L. Andrews, “The Shadow of the Law: Jury Decisions in Obstetrics and Gynecology Cases,” in
Medical Professional Liability and the Delivery of Obstetrical Care
, ed. V. P. Rostow and R. J. Bulger (Washington, D.C.: National Academy Press, 1989), 2:161–91. However, U.S. recordkeeping practices prevent a definitive statistic on who “attends” births in the United States—that is, who is actually present during the labor and delivery. Birth certificate data is considered the official government data on who “attends” a birth, but if an obstetrician is responsible for the overall management of the women's care during the labor and birth, the obstetrician's name will appear on the birth certificate even if that obstetrician is present for only a few minutes or not at all. Further evidence that obstetricians are absent during their patients' labor can easily be gathered by a visit to any labor and delivery ward in any U.S. hospital at any time, day or night.

7
.  J. B. Gould, C. Qin, and G. Chavez, “Time of Birth and the Risk of Neonatal Death,”
Obstetrics and Gynecology
106 (2005): 352–58.

8
.  Daniels and Andrews, “Shadow of the Law.”

9
.  For more information on labor and delivery nurses, including their roles, responsibilities, and distribution, visit the Web sites of the Association of Nurse Advocates for Childbirth (
www.anacs.org
) and the Association of Women's Health, Obstetric and Neonatal Nurses (
www.awhonn.org
).

10
. The effectiveness of continuous one-on-one support by the same caregiver for women during labor and birth has been demonstrated by systematic reviews of randomized controlled trials; see M. Enkin et al., “Social and Professional Support in Childbirth,” in
A Guide to Effective Care in Pregnancy and Childbirth
, 3rd ed. (New York: Oxford University Press, 2000), pp. 247–54. This textbook also includes “Fragmentation of Care during Childbirth,” in a table of practices that should be abandoned (table 5, on p. 500). In addition, a randomized controlled experimental trial showed that women having the same caregiver throughout labor and birth had fewer drugs for pain, less Pitocin for augmentation of labor, shorter labors, and fewer babies showing distress at birth. S. Flynn, “Continuity of Care during Pregnancy and Birth: Effects on Outcome,”
Journal of Family Practice
5 (1985): 375–80.

11
. The American College of Obstetricians and Gynecologists (ACOG), after review of the evidence, states that for low-risk births, intermittent auscultation of the fetal heart with a stethoscope is as reliable as electronic fetal heart monitoring and ACOG does not recommend routine electronic fetal
heart monitoring of all women in labor. See
www.acog.org
. An excellent review of the evidence regarding routine electronic fetal heart monitoring of all labor and birth is found in Goer,
Thinking Woman's Guide
, pp. 85–98.

12
. For a discussion of the risks of using Pitocin for labor induction, see Enkin et al.,
Guide to Effective Care in Pregnancy and Childbirth
, p. 388. For an excellent review of the risks of labor induction, see Goer,
Thinking Woman's Guide
, pp. 49–74.

13
. There are three excellent studies on the risks associated with epidural: B. Leighton and S. Halpern, “The Effects of Epidural Anesthesia on Labor, Maternal and Neonatal Outcomes,”
American Journal of Obstetrics and Gynecology
186 (2002): 569–77; E. Lieberman and C. O'Donoghue, “Unintended Effects of Epidural Anesthesia during Labor,”
American Journal of Obstetrics and Gynecology
186 (2002): 531–68; and L. Mayberry and D. Clemmens, “Epidural Analgesia Side Effects, Co-interventions, and Care of Women during Childbirth,”
American Journal of Obstetrics and Gynecology
186 (2002): 581–93. In addition, for a thorough review of the risks and benefits of epidural anesthesia for normal labor pain, see Goer,
Thinking Woman's Guide
, pp. 126–48.

14
. A review found that women with episiotomies were 53 percent more likely to suffer pain during intercourse three months after giving birth, see K. Hartmann et al., “Outcomes of Routine Episiotomy: A Systematic Review,”
Journal of the American Medical Association
293 (2005): 2141–48. For an argument that routine episiotomy is the Western form of female genital mutilation, see M. Wagner, “Episiotomy: A Form of Genital Mutilation,”
Lancet
353 (1999): 1977–78.

15
. There have been no studies on the effects of intentionally delaying birth when the cervix is completely dilated, perhaps because maternity care providers generally do not want to admit that it is done. It is clear, however, that when the cervix is completely open, the baby should be allowed to move on out of the mother's birth canal. Uterine contractions are involuntary. When the uterus continues regular contractions after the cervix is completely dilated, attempts to hold the baby inside mean that the baby's head is repeatedly pushed against the bones of the birth canal, unnecessarily risking head and brain damage.

16
. The World Health Organization, the American Medical Association, and the American College of Obstetricians and Gynecologists have all published strong statements supporting the right of a woman giving birth to have fully informed consent over any intervention proposed. In addition, the case described occurred in California, and there is a California state law that explicitly requires that all patients give fully informed consent prior to any medical intervention. Other states have similar laws. Informed consent is further discussed in chapter 7.

17
. 
Only two states have laws mandating public disclosure of maternity practices, achieved only after a long struggle by women's groups and against strong resistance from medical groups. It is the law in Massachusetts that all cases of maternal mortality must be disclosed to the public, and it is the law in New York that hospitals must disclose obstetric intervention rates to the public. Similar regulations have been proposed in other states, but have not yet become law.

18
. The high rate of lawsuits against obstetricians is discussed in Daniels and Andrews, “Shadow of the Law.” Also see chapter 7.

19
. The following data are from “Mothering Perinatal Healthcare Index,”
Mothering
68 (Fall 1993): 44–45, which takes statistics from various official agencies: “Percentage by which U.S. health care expenditures exceed those of Canada, 40%, Germany, 90%, Japan, 100%.” The Centers for Disease Control and Prevention also state that the United States spends more than twice per birth on maternity services than these or any other countries do. See
www.cdc.gov/nchs/birth
. That maternity services are far more expensive when obstetricians attend normal births than when midwives attend normal births is documented by a number of studies reviewed in M. Wagner, “Midwifery in the Industrialized World,”
Journal of the Society of Obstetricians and Gynecologists of Canada
20, no. 13 (1998): 1225–34. For example, studies cited in this review document that the average total cost for care of an obstetrician's patient is $548 higher than the average total cost for care of a midwife's client, and that a large U.S. HMO achieved a 13 percent reduction in payroll costs in its obstetrics and gynecology department by using more midwives.

20
. Data on maternal mortality by country is published on the World Health Organization's Web site at
www.who.int/reproductive-health
. Countries with lower maternal mortality rates than the United States include Australia, Austria, Belgium, Canada, Croatia, the Czech Republic, Denmark, Finland, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Kuwait, Lithuania, New Zealand, Norway, Poland, Portugal, Qatar, Serbia and Montenegro, Slovakia, Spain, Sweden, Switzerland, and the United Kingdom. (France, Israel, and Slovenia have rates equal to those of the United States.)

21
. The rates of maternal mortality in the United States, the causes, the fact that many cases go unreported, and the fact that there has been no decrease in maternal mortality in the United States since 1982 can be found in
Safe Motherhood: Preventing Pregnancy-Related Illness and Death
(Atlanta: Centers for Disease Control and Prevention, 2001).

22
. The comparison of infant mortality rates and the fact that our infant mortality rate is rising are reported in two op-ed pieces by Nicholas Kristof published in the
New York Times
on January 14 and 17, 2005. The articles cite data from the Centers for Disease Control and Prevention and the latest
C.I.A. World Factbook
. Also see
www.cdc.gov/nchs/birth
. The countries with lower infant mortality rates than the United States include Japan, Sweden, Finland, Switzerland, Canada, Singapore, Hong Kong, Netherlands, France, Ireland, Germany, Denmark, Norway, Scotland, Australia, Northern Ireland, Spain, England and Wales, Belgium, Austria, and Italy. (There is a slight variation from year to year in the rates published in the
Factbook
. On the global list of national infant mortality rates, the United States generally ranks between twentieth and forty-first. In the past ten years the United States has never ranked better than twentieth.)

23
. Of the countries with lower maternal and infant mortality rates than those of the United States, those in which the majority of births are attended by midwives include all of the Western and Central European countries, Australia, New Zealand, and Japan.

24
. In the Netherlands, which has a lower maternal mortality rate and a lower infant mortality rate than the United States, more than one-third of all births are planned home births attended by a midwife. Other countries with lower maternal and infant mortality rates than the United States and a significant number of planned out-of-hospital births include the United Kingdom and Denmark.

25
. For a study of four million births in the United States showing that for low-risk hospital births, midwives are safer than doctors, see M. MacDorman and G. Singh, “Midwifery Care, Social and Medical Risk Factors, and Birth Outcomes in the USA,”
Journal of Epidemiology and Community Health
52 (1998): 310–17. For a review of the scientific literature on midwifery, including research showing the safety of midwives, research showing that midwives use fewer unnecessary interventions during labor and birth than doctors, and research showing that midwives provide higher levels of satisfaction to women, see Wagner, “Midwifery in the Industrialized World.”

26
. For a discussion of the ways in which midwives have been subjected to witch hunts in modern times, see M. Wagner, “A Global Witch Hunt,”
Lancet
346 (1995): 1020–22.

27
. See
National Survey of Obstetric Practices
. Also, data on the number of U.S. births attended by midwives and doctors can be found at
www.cdc.gov/nchs
.

28
. The
Journal of Medical Economics
surveys U.S. physician incomes every few years. In the March 19, 2001, issue, page 141, the survey reported that an obstetrician's
net
income averages close to $200,000; a midwife's income averages less than $100,000. Also see note 19.

29
. For further information on the investigation of New York City hospitals and their noncompliance with the state Maternity Information Act, see the Public Advocate for New York City's Web site,
http://pubadvocate.nyc.gov/
, specifically the report titled “A Mother's Right to Know: New York City Hospitals Fail to Provide Legally Mandated Maternity Information” (July 2005).

30
. 
For further information on the Coalition for Improving Maternity Services and its mission, see
www.motherfriendly.org
.