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Here’s an Idea

I love this month’s cover. The photo by Emily Weaver Brown captures the absolute joy of meeting a newborn for the first time. It prompts me to think of my own childbirth experiences, as does Cheryl Murfin’s story in this issue on doulas, who are dedicated individuals trained to support women in their journey through childbirth.

A study released in March by the Centers for Disease Control also had me thinking about giving birth. It showed that the Cesarean rate in the United States rose by 53 percent over a 10-year period, reaching a stunning 32 percent in 2007. That means that 1 out of 3 children are now being delivered in the U.S. with major surgical intervention. (The World Health Organization says the appropriate rate in a developed nation is between 10–15 percent.)
Here in Washington, we should especially take note: Our state’s Cesarean rate increased by 73 percent between 1996 and 2007. Connecticut was the only other state where the numbers increased at a faster pace.

Experts are now trying to interpret this data since so many factors come into play. Is the increase due to a rise in the number of older women giving birth or to higher obesity rates? Perhaps it’s busy professional women wanting to minimize the inconvenience of childbirth or obstetricians fearful of lawsuits? Or maybe it’s our health care system with financial incentives for doing more rather than less?

One thing is clear, in all age groups, even for women in their twenties, the numbers are rising. Another thing that is certain is that Cesarean deliveries are not without risk to the mother. And maternal health is something we should be concerned about.

Since March there has been a lot of commentary on an Amnesty International report which outlined a rising rate of maternal mortality in the U.S. And California is grappling with a stunning increase in maternal deaths. Statistics were recently released showing a threefold increase in the number of Californians dying from childbirth-related causes over the last decade. Some of the increase is attributed to changes in the way pregnancy and childbirth-related deaths are tracked, but this doesn’t explain away the general trend.

All of this runs counter to global improvements in maternal health. A study by UW’s Institute for Health Metrics and Evaluation that was published in The Lancet in April shows that maternal mortality rates have dropped in 150 out of 181 countries.

The United States unfortunately is bucking this international trend with an overall increase of 2 percent. The only countries with higher rates of increase are in sub-Saharan Africa. Of course, the maternal mortality rate is significantly lower in the U.S. than in Africa — by a factor of 40 or more — but the fact that we are going in the wrong direction is of concern.

So how does all of this relate to us here in Seattle? It seems to me that it is time to start lobbying for better health care for pregnant women. One step might be to call on insurance companies to cover the cost of doulas. Some already provide this coverage, but they are the exception.

If, as studies have shown, having a doula decreases the likelihood of a Cesarean and reduces the risk of serious complications, then underwriting the cost of a doula would not only be the right thing to do for mothers, in the long run it would make sense financially. Nonprofit organizations like Childbirth Connections (www.childbirthconnections.org), which was founded in 1918 to improve the quality of maternity care through research, education, advocacy and policy, have plenty of other evidence-based suggestions for improving birthing outcomes. It’s time to start listening to groups like these.

Perhaps it’s also time to reinvent Mother’s Day, making it a day not just to celebrate mothers, but also a time to advocate for improvements in maternal health and welfare in all parts of the world.

Marianne Scholl
Publisher & Editor

©May 2010, Caliope Publishing Company