Wednesday, July 8, 2015

Birth Doulas: How Support Could Change Childbirth in America

Birth Doulas:
How Support Could Change Childbirth in America
That first moment, when a woman and her newborn lock eyes and a child imprints upon its mother is unforgettable.  That beautiful, intense, instantaneous love that a mother feels for a person that she is only first meeting, but whom she has "known" for much longer, is incomparable.  The birth of a child is an experience like no other in a woman's life.  Ensuring that this occasion is as positive an event as possible should be taking precedence in society, should it not?  Sadly, American culture has begun to devalue mothers and the childbirth process, treating it as an everyday occurrence.  The emphasis once put on its importance seems to have waned.
Several factors have contributed to society's desensitization of the effects of birth on mothers, infants, families and even society itself.  One of those reasons is how birth has changed over time.  Birth used to happen at home, where a woman was comfortably surrounded by those that loved her, and attendant that knew how to deliver children this way-a way mentally and physically safe and healthy.  Now majority of births are occurring in hospitals, with very expensive and impersonal care that is designed to make the jobs of medical staff simpler, not to better accommodate a birthing woman or her unborn child.  A certified professional midwife named Ina May Gaskin (2003) wrote, “Most Americans are unaware that women ever die from cesarean operations, particularly when those surgeries are scheduled, rather than emergencies…Few people have any way of knowing that most maternal deaths take place in hospitals or that unnecessary surgery can actually cause a death” ( p. 288).  Another factor is the increased usage of pain medications (such as epidural analgesia), scheduled births, like inductions of labor (choosing a baby’s birthdate), augmentation of labor (using medical intervention to speed up the labor process), and cesarean sections.  This creates the feelings of a well-planned and uncomplicated event-but that is not the case at all.  Each of these choices comes with risks to both mother and child.  All too often these risks are under-explained, and their severity is underestimated.
High Mother and Infant Mortality Rates
The general public would likely be shocked to know the reality of death in childbirth. Americans take solace in the mere thought of living in such a privileged society.   Rachel Ward is the director of research at Amnesty International, a human rights organization.  Ward is the author of Deadly Delivery: The Maternal Health Care Crisis in the USA, which was published in 2011, and she understands the need for these facts to be brought to light.  Ward (2011) found that the World Health Organization’s recommended rates are nearly half as much as the current U.S rates, since there has been a sharp rise in cesareans and inductions performed in the past 25 years. (p.78).  Drug-induced labors are an estimated 23%, and the national cesarean rate at 32%.
Many organizations agree that interventions are too high, yet attempts to get them down have been unsuccessful.  Ward went on to elaborate on the risks of these interventions. In summation, she found induction of labor is related to higher risk of hemorrhage and cesarean sections in primigravida mothers (2011).  Cesareans carry their own set of significantly increased risks when compared to spontaneous vaginal birth, such as hysterectomy, kidney failure, pulmonary embolism, infection, and death (p. 78).
Rachel Ward is not alone.  Published by Francine Coeytaux, Debra Bingham, and Nan Strauss, Maternal Mortality in the United States: A Human Rights Failure (2011) also refers to the overuse of technology in childbirth.  Over the past 12 years, there has been a 56% increase in the amount of surgical births in the United States, and a sharp incline of births in which Pitocin was administered.  While there are no studies proving better outcomes, data exists showing misusing these procedures caused maternal and infant mortality rates to rise.  America is a country where access to medical care is just as big an issue as the over exposure to procedures where pregnancy and birth are concerned.  
                Moreover, these interventions are also quite expensive, and are contributing to higher maternity care costs across the board.  The same study describes how these interventions aren’t just limited to maternity care.  Performing inductions and cesarean sections when they are not advisable to improve outcomes leads to higher risk of hysterectomy (and further expenditures) in the future.
A Birth Doula’s Ability to Reduce Intervention
A birth doula is a professional support person for women and families before, during, and immediately after childbirth. A doula is trained and educated in methods of physical and emotional comfort, and has information to help women make informed decisions about maternity care. A doula may be a lay person, have taken special training, and/or be certified through organizations like ICEA, CAPPA, and DONA. While some effects are immeasurable, many clinical studies have found that doulas have a major impact on outcomes for both mother and child. 
Hodnett, Gates, Hofmeyer and Sakala (2012) showed continuous labor support to be effective in reducing the need for interventions such as pain medications/epidural analgesia, labor induction or augmentation with synthetic oxytocin (Pitocin), vacuum extraction and forceps deliveries (pp. 1-2).  All of which carry hazards to both mother and child. Risks range from mild, like chills, to more life-threatening problems like shoulder dystocia, brain damage, and hemorrhage.  Lower incidences of abuse, postpartum depression, and generally shorter, uncomplicated labors were also reported. Mothers in the study reported more pleasant feelings about their birth experiences in the doula attended group.  Perhaps more importantly, there are no known risks to mother and/or child from doula attended births.  Dr. John H. Kennell, MD is one of the founders of Doulas of North America.  Dr. Kennell (1998) once said, “if a doula were a drug, it would be unethical not to use it.”
Conclusions and Future Study

            Citizens of the United States are spending more money than necessary on maternal/fetal healthcare.  There is also a needless and preventable amount of maternal and fetal mortality/morbidity.  By providing continuous labor support to mothers and families, both costs and risks of injury and death can be driven down.  It is advisable for doulas to become an integral part of the maternal/fetal support team for each birthing woman, for the sake of cost and safety. Heidi Rinehart is a former obstetrician for Amnesty International, she says, “What works is not flashy, not expensive, but it’s human intensive” (as cited in Deadly delivery: the maternal health care crisis in the US, 2010, p. 92).

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