Long time trend for NO change in the United States

A videotaped lecture I watched tonight has me thinking about the work I have presented, and continuing to listen to the voices of maternal and infant health in the United States. When I wrote my thesis on The Greening of Birth, I discussed the various reasons why the maternal mortality rate could be so high in the United States. I spoke of intervention, Cesarean birth and maternal request Cesarean birth. Then, in my last post, I posed my own personal reflection/question: The journey of women, in birth, has been shortened and our power stripped from us, and I often wonder what it is about women these days that scares them (truly) about birth, that encourages them to let their deepest seated power be lifted, and that makes them willing to give up their personal rite to a higher hand or authority. If we still looked at birth as an event of empowerment, would women be fighting more strongly and choosing other paths as they walk into motherhood? Watching this lecture helped me out, reminded me.

In this lecture Dr. DeClercq asks the question, "Are US women the reason for the increasing Cesarean rate?" As a midwife it has been a lesson for me to learn about the real reasons behind Cesarean and intervention, and to accept the facts and reality of occurrence in the US. That lesson has also taught me to be compassionate and know when I can play the devil’s advocate. As I listened to the lecture, I was relieved to know that Cesarean birth by maternal request is low and not statistically significant in reports of the rising Cesarean rate in the US. The populations are still small, yet they are a reality. Dr. DeClercq diagrams the overall rates and patterns of Cesarean birth across the US and points out that Cesarean birth may trend toward "strong regional patterns" based around the way varying US cultures view Cesarean birth, rather than rising rates being a true reflection of evidence-based medicine practiced the same way across the country. Although we as a culture are often deemed homogenized, this brings to my awareness that medically we are very different and speak from different voices, and that we are truly a melting pot.  

In answer to the question of whether women themselves are the reason, research proves that the answer is no. Declercq argues that the reason for the increasing Cesarean rate in the US is practice changes. He continues on to discuss Dr. John Whitridge Williams, a pioneer in obstetrics, and how practice changes within the medical profession are the fundamental reason for "periods of undue enthusiasm," which in turn are reflected in the rise or increase of a medically indicated procedure. He also says that vaginal birth takes more time for the provider and "considerable technical dexterity."  While this researcher argues that the increasing rates of Cesarean are due to practice changes, mothers in the US feel they get very good maternity care and view the maternity care system to be better than the US healthcare system as a whole.

I ask myself, "Why do I keep working for this change in maternity care? Is there hope for change if there is 'a long term trend for no change'?" I keep watching the lecture. When Declercq poses the question of who could be at the center of the discord and disconnect between interventions in maternity care and the general belief of US women that they are receiving good care, the answer comes from a quote by Dick Cheney in the book One Percent Doctrine.  Dumbfounded by hearing the name "Cheney" and it not being Melissa Cheyney, I continue to listen and, like any great lecturer, he makes his point.  "When you set up a system that focuses on the 1% of problems that might occur, you undermine the care of the 99% of the mothers that don't need those services." This quote reflects the current philosophy of maternity care. That is so good to hear on so many levels and allows me to reflect on the disservice we as providers are put into place within our healthcare system. Declercq is clearly an advocate for home birth and midwifery, as seen in the last few minutes of this video. More important to me, he is an educated and passionate advocate working for improvement of the current trends and conditions of maternal and infant health and safety in the United States.  

In my journey to bear witness and participate in creating sustainable maternal and infant practices in the US, I have often been compared (by my family members) to a salmon swimming upstream. Yesterday, I picked up two reads. One was a short bit of poetry a friend had me read in her living room. The poet spoke of salmon, how they have soft mouths and when you hook a salmon you must play them gently or it is easy to tear the hook loose. The other book was The River Why. One chapter, "The Line of Light," stood out in my mind. It too is about a man and his relationship with salmon. At the end of the chapter, as light begins to sink into the day, the fish on her way and he back on his, he is touched by "the Ancient One" and knows that from this point on in his life there is no escape. There is no escape once you enter into something with full passion, something that drives you, something you love or fall in love with. You just have to figure out how to "play it gently" and, in some cases, get your butt kicked in the process of learning how to navigate the adventure.