The reality of childbirth improved for women in the US for a time. There have been dips and surges in the safety of childbirth and the outcomes of birth for mothers and babies, but what is concerning at the present is that the US and Canada both are "low on the list of optimal perinatal and maternal outcomes" when it comes to industrialized countries and even some developing countries (Klein, The Journal of Perinatal Education, 20(4), 185-187, 2011).
Many attribute this change and poor outcomes for mothers and babies to the high rates of surgical birth (c-section) in the US - 34% or 1 in 3 women. But, a recent study conducted in Canada by Dr. Michael C. Klein, MD, CCFP, FAAP revealed that "a substantial number of women, even late in pregnancy, were uninformed about the risks and benefits of key procedures and approaches that might be used in birth." Dr. Klein wrote an editorial about his findings and his recommendations to address those findings in the most recent edition of The Journal of Perinatal Education cited above. He also stated that, "Only 30% of the women had attended childbirth education classes; books and the Internet were their main sources of information."
Looking at the sources of information women are accessing during pregnancy and the fact that so many remain uninformed show a possible lack of finding truly useful or reliable information from the books they choose and the websites women visit and a disconnect between women and their care providers when it comes to patient education. There are many great books and websites for pregnancy and birth, but there are also many inaccurate information sources. We also have seen a reduction in the number of care providers offering complete childbirth education either through their private practice or the birthing facility. Many "childbirth classes" meet only a few times and include basically what to expect when it comes to hospital routine and policy as well as a tour of the maternity ward. These are important classes for women to take so that they can be prepared and anticipate certain experiences during their birth, but there is also a great need to have complete childbirth education including pregnancy nutrition/exercise, stages of labor, comfort techniques for labor including both natural and medical coping strategies, possible medical interventions that might be necessary and the risks and benefits of each, breastfeeding, postpartum, newborn procedures, and early newborn parenting. In order to cover all of these topics, it is imperative that women and their support persons meet with their educator over an extended period. Many childbirth educators who are certified through the various organizations in the numerous styles of education have a required amount of hours or equivalent of those hours that they must meet in order to label their classes as - Lamaze, Bradley, Hypnobirthing, Brio, CAPPA, ICEA, etc... This hourly requirement ensures that educators and the women they serve have the necessary time to cover all of these important topics that allow women to have the ability to act on the information they receive.
Another very disconcerting aspect of Dr. Klein's study revealed that obstetricians younger than forty "were less favorable to birth plans, less likely to acknowledge the importance of the woman's role in her own birth experience, and more likely to view cesarean surgery as 'just another way to have a baby'. They were also more likely to believe that women who had cesarean surgery 'did not miss an important life event.'" Physicians also had misinformed beliefs on cesarean surgery being "as safe or safer for mothers and babies as vaginal birth" - 20%. "Half of OBs were not supportive of doulas, and 70-80% of providers felt that home birth was unsafe. Epidural analgesia was another area where many providers, especially obstetricians, felt that the procedure did not interfere with labor or increase the frequency of instrumental birth (Klein)." This is despite the scientific evidence showing the contrary on all of the four points above. Klein points out however, that it is important to recognize that 20% of the OBs in the study had attitudes that aligned with midwives. So, we see that though a minority there are OBs who feel otherwise about routine intervention and the risks involved in normal birth. Klein found that women who were attending midwives for their care were less favorable to the use of technology and more supportive of women's roles in their birth experiences, possibly illustrating the difference between the obstetric and midwifery model of maternity care.
The following photo is linked to an interview with Julie Daniels, CNM of Frontier University describing the difference between the obstetric and midwifery models of care. This post is continued after the jump.
But, the real issue to address here is women having access to the information they need to make informed decisions and then the support they need to access their options. The beginning is the recognizing of a need for information. It is the recognizing that women deserve better. It is understanding that childbirth is a normal bodily function of the female body, and should not be treated as an illness, but as a very special time in which extra attention must be paid to health, safety, comfort, and proper support. What raises this recognition - education. It is so important for educators to reach both women and their care providers, for we are all working toward the same things - as positive outcomes as possible in individual situations, and satisfaction and dare I say pure joy in the experience of giving birth.