The United States is a first world nation. So why, in a recent report by Save the Children, does the U.S. rank 61st on maternal health and 33rd in the report’s overall “Mother’s Index?” Why does the U.S. have a disproportionately high maternal morbidity rate? Why is women’s health care in the U.S. lacking?
There is, of course, a complex answer based on data, etc. But based on my experience, the U.S.’s shortcomings all boil down to women’s health care in the U.S., especially women’s reproductive health care, simply not being good enough.
Birth in our country has become increasingly medicalized. The U.S. has a staggeringly high c-section rate of 32.7% according to CDC data for 2013. The World Health Organization (WHO) recommends a rate of no more than 15% — less than half of the U.S.’s rate. Also, in 2012, the CDC reported the rate of induction in the U.S. was 23.3%. That report also indicated progress, however, as the induction rate was declining from a high of 23.8% in 2010.
I believe the underlying reason for the increased medicalization of birth is that we, as women, are generally not treated as active participants in our health care. We have been taught to view pregnancy and childbirth as complicated, dangerous medical events requiring numerous interventions. We have been taught that we shouldn’t question a provider and not to trust ourselves or our bodies. Women have lost our power when it comes to our medical care.
Pregnancy and childbirth are normal physiological events. Only about 15% of pregnancies in developed countries have complications requiring the types of interventions that have become routine in the U.S. The other 85% of pregnancies are routine and healthy, yet these are still typically treated as abnormal medical events.
Because I fell into that 15% group, I know from personal experience that intervention is sometimes necessary. But although my circumstances necessitated some intervention to address complications with my pregnancy, I still had to push back against requests for additional, unnecessary interventions. For instance, my water broke before the onset of contractions. After being admitted and placed in a room, a process that took about an hour, my contractions had still not begun. The doctor assigned to me wanted to immediately start administering pitocin, an induction drug. But I was adamant about not inducing then, especially because it seemed premature. My trip to the hospital was some of the only physical activity I had had since being put on bed rest 5 weeks earlier, which a doctor ordered after I went into pre-term labor at 29 weeks.
The doctor finally agreed to wait another hour or two. An hour later, my contractions had started and quickly became so fast and strong that I was given medication to stop them temporarily. In other words, the truly necessary intervention was the direct opposite of induction, and I can only imagine how my contractions would have been had I been given pitocin at the outset.
My situation was rare for an American woman. I was in the minority of women that experience complications, and I was also in the minority of women who felt empowered enough to question potentially unnecessary interventions. But empowering myself to question a doctor’s opinion while in the stressful situation of labor was not easy. Indeed, women who question and object to interventions are often made to feel selfish, putting their desires for a particular birth experience ahead of their children’s welfare. This tactic is effective, because no woman wants to feel like she is a bad mother, particularly at the moment she is finally going to be a mother.
What can women do to become empowered participants in their healthcare? How can we make our system better for us? The simplest answer is to educate ourselves. Five years ago, I was like most American women. I assumed giving birth in a hospital with an OB/GYN using an epidural was my only real option. But when I became pregnant, I realized I wanted to know all of my options. I wanted to know the pros and cons of possible interventions and when they would truly be needed, so I could know whether something was appropriate for me. I actually wanted to use a midwife provider. Unfortunately, securing a midwife’s services is difficult, and the issue became moot after I began experiencing complications in the early weeks.
However, when I selected an OB/GYN, I carefully read through bios to find one whose philosophy aligned with my own. But, as is often the case, my OB/GYN was not the doctor on call when I went into labor. Still, my research paid off. When an intervention I didn’t agree with was requested, I felt informed and strong enough to stand up and say no. I was doing the right thing for myself and my baby.
For some reason, education about women’s bodies and our health seems locked up tight in a vault, as if we can’t be trusted with the knowledge. But the information is there — it just takes more effort than it should to access it. I encourage each of you to find it. And once you have, share it with your friends and sisters. I firmly believe that once women know more about ourselves — once we know how normal, natural, and safe pregnancy and birth are — we will force the system to change. We will create demand for midwives and alternative birth settings. We will force our providers to talk with us, not at us. We will make ourselves partners with our providers in our care. Lastly, we will take our health care off of political agendas.
This is the final point I want to make. In the U.S., women’s health care is viewed as an acceptable political agenda item and talking point, furthering this idea that we can’t be trusted with our own bodies. In politics, there are no services solely affecting men’s health that are treated the way women’s services are. We need to stand up and say this is unacceptable.
I know it’s not fair that we as women in the U.S. need to do so much extra work to take charge of our health care. But it is the only option we have to make real changes that will better the system for us, our mothers, our sisters, and our daughters. We have the power. The question is: do we have the will?