Nearly 4 million babies are born each year in the United States, with statistics showing a slight decline in births in 2021 to 3.7 million. Currently, the majority of births (98.4%) happen in hospital settings (1). Before the pandemic, one-quarter to one-third of birthing parents reported their births as traumatic (2). The US has the highest maternal mortality rate among developed nations, with an exponential number of women nearly dying (severe maternal morbidity). The CDC (2022) reports that in 2014 for every parent who dies in childbirth, 70 nearly die, resulting in a morbidity rate of nearly 50,000 per year. Patient safety groups report that number is much higher, with 80,000 parents reporting “severe maternal morbidity.” (3) Birth trauma, perinatal depression and anxiety, and PTSD are on the rise. (4) Looking closely at these statistics, we will find that death and morbidity are frequently caused by cesarean section and medical interventions. (And absolutely not by out-of-hospital births where “something went wrong”).
There is another Model, social construct, skillset, and belief system for giving birth beside the Obstetric Model (medical model, used for hospital births, even low-risk) used in the US, which is the Midwifery Model of Care. Used in much of Europe, Scandinavia, New Zealand, Australia, and more, this model of care does not have similar rates of trauma, cesarean section, morbidity, and mortality. The midwifery model consists of personalized prenatal care, continuity of care (same care provider throughout pregnancy and birth), hands-on labor support, including diagnosis and non-invasive management of labor variations, women-supported, belief in the normal physiological process of birth, and the benefits of NOT interfering and NOT controlling the natural process, albeit with safe medical backup for true complications. The health care systems in many of these countries also differ from ours, supporting the Midwifery Model and taking advantage of the lower costs of less intervention and better outcomes.
Women in the U.S who want a normal physiological birth, at this point in time, must make a very concerted effort to go outside our current maternity care system, facing social criticism and including paying approximately $6-8,000 for a safe, out-of-hospital birth. As doulas raise their prices with the cost of inflation, up to $3-5,000, it would behoove women to think about this option. As couples spend significantly higher amounts on their wedding day, which arguably will have less of an impact than the birth of a first baby, it would behoove women to think about this option. As women justify the hospital choice, thinking it is safer (for low-risk women) and hoping and gambling not to become another statistic, it would behoove them to think carefully about perceived risk vs. actual risk. As induction rates skyrocket to epidemic proportions due to a temporary trend in Obstetrics and a misinterpreting of the 2018 Arrive trial, it would behoove women to wonder how babies have been born for millions of years, and suddenly gestation has become an abnormality that their body does not know how to regulate. Women are being told and pressured to induce by doctors who believe they are improving outcomes. The Arrive Study showed NO improvements in baby outcomes, so they looked at the moms. If we ignore all the elements skewing the Trial (it was done only on women who were fine with inducing, 94% were cared for by doctors, some of the women in the “non-induced” group were actually induced, etc.), there was a reduction in c-section rates from 22% to 18%.
As some of the drugs used for induction are literally labeled as contra-indicated for pregnancy, it would behoove parents to ask themselves whether they would expose their babies and children to the same risks. With blind trust in the medical profession, it would behoove women to ask themselves whether pregnancy and birth are high-risk medical procedures and, if so, why the outcomes are so much better when medical interventions are not used. Perhaps most importantly, it would behoove women to ask themselves, if my doctor cares so much about me that they are recommending/enforcing an induction to prevent a c-section, why are they not recommending/enforcing that all their women have doulas at their births. Research has proven the enormous benefit of doulas (continuous labor support) in improving outcomes and preventing cesareans. If the goal of the care provider is a good outcome, physically and emotionally, doulas have proven much more effective than induction for this outcome.
Induction is a microcosm of a system and a society that disrespects and devalues women and nature. The due date is an arbitrary construct of the past approximately 100 years. The baby’s brain tells the mother when it is ready for labor to begin.
I believe 1000% in birthing classes to educate women and help prepare for a rewarding, positive birth experience, and I believe that every woman chooses what is best for herself. I also believe that women go into the hospital setting, where I see them, for the most part, being treated kindly and gently, with the cards stacked against them in a paradigm that makes it difficult to have a normal physiological birth. It is hard and unfamiliar for hospital staff not to interfere with the unfolding of physiologic labor; indeed, it is almost not their job. They have procedures, questions, IVs, monitors, exams, and time frames. They are good at high-risk and emergencies. They are not good at seeing you as healthy and uncomplicated until proven otherwise. And women who think they want to be there “in case” they become high risk do not understand the normal physiology of labor and birth and what helps it to unfold in the healthiest environment, with medical backup. Lamaze and childbirth education are essential. The following is a list of options for Midwifery care in Los Angeles.
- losangelesmidwives.com
- birthingrhythm.com
- hearttohomemidwifery.com
- amytinney.com
- lamidwifecollective.com
- madreluzla.com
- midwifenerissa.com
- homebirthservice.com
- purebirths.com
- southbaybirth.com
- mothertreemidwifery.com
- venturabirthcenter.net
- serenitymidwifery.com
- mamanurturedbirth.com
- lotusmoonbirth.com
- alumbramidwifery.com
- naturalbirthcenter.com
- socalbirth.com
- westhomebirth.com
- tlcwomanscenter.com
- birthgoddess.com
- gracefull.com
- beachcitiesmidwifery.com
- birthrevolutionmidwifery.com
- newlifemidwifery.life
- crimsonfig.com
- borntobelovedbirth.com
- kindredspacela.com (for women of color)
*** For possible insurance coverage, ask your potential midwife for her specific Provider code
(1) MacDorman & Declercq, 2019
(2) Simkin, 2016
(3) NPR, 2018
(4) Basu, et al, 2021