Digital Book Discontinued Birth Choices v1.1

Childbirth in the United States 2000 to the Present What is Being Done In preceding years, the effectiveness of many routine medical procedures, such as episiotomy, continuous electronic fetal monitoring, and breaking the bag of water, inspired research and debate. These and other procedures were found to lack benefit when used routinely, but many providers and hospitals are slow to change. Many organizations are working to improve care. ACOG published recommendations to reduce cesarean and intervention rates (summarized on page 5). They also published a Committee Opinion stating that it is unacceptable and unethical for a provider to use coercion or fear tactics to manipulate a woman’s decision about her care. Despite medical advancements, highly trained providers, and high spending on maternity care, the U.S. is far behind other industrialized countries in health outcomes for mothers and babies. The maternal mortality rate has been rising in the U.S. while falling in other nations. Families are rediscovering the benefits of midwifery care. Overall, research shows that midwives have better outcomes and provide more personalized care than physicians. Midwifery is making a slow comeback, with certified midwives and certified nurse-midwives now attending close to 10% of births (up from about 1% in 1980). 30 30 25 25 30 Maternal Deaths per 100,000 Births 20 25 20 25 15 20 15 20 10 5 15 10 0 5 0 Though the tide is slowly turning, many barriers to ideal care remain, including cultural beliefs and behaviors, profit-based systems, finances, politics, routine policies and practices, and fear of liability. The current maternity care system often does not serve the best interests of mothers and babies. Therefore, it is a critical point in time for parents to be informed and prepared so they can advocate for themselves. 30 15 10 10 5 5 0 0 1990 1990 1990 1990 2000 2000 2000 2000 2015 2015 2015 United States States United States Portugal Portugal Germany Germany France France United United Portugal States Portugal Germany Germany France Spain Spain Spain Ireland Ireland Sweden Sweden Italy Spain Ireland Ireland Sweden Denmark Denmark Finland Finland Japan Italy Sweden Italy Japan Belgium Belgium 2015 France Italy The culture of a birth location has enormous influence over its outcomes. This is clear 2015 2015 Belgium Japan Belgium from the vast range of cesarean rates, from United States Germany Germany France United Portugal States Portugal France 7% to 70% among U.S. hospitals. Dr. Neel Spain Italy Spain Ireland Ireland Sweden Sweden Italy Shah, Assistant Professor of Obstetrics, Denmark Denmark Finland Japan Finland Japan Belgium Belgium Gynecology, and Reproductive Biology at Harvard Medical School, said, “In 2017, your Source: The Lancet, vol 388 issue 10053: Global, regional, and national levels of biggest risk factor for the most common surgery maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 [cesarean section] is which hospital you go to.” 1990 2000 1990 Denmark Denmark Finland 2000 Finland Japan Documentaries, articles, and social media have helped maternity-care issues gain national attention. Advocating for themselves, many women began insisting that they be actively involved in decisions and receive evidence-based care. In addition, hospitals and care providers have begun to put more focus on positive experiences for families. The most often-cited reason (more than one-third of the time) for a cesarean is “arrest of labor,” also called “failure to progress.” In other words, the cesarean is not performed for a medical need, but due to a lack of patience. It may be helpful to ask your provider and/or birth location not only their cesarean rate, but also for the reasons why. Step 1: Understand the Context 7

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