As I am approaching my fifth anniversary of publishing Common Science®, I hope that it is apparent how much I enjoy writing these columns, particularly when the topic brings in threads of history, politics, economics, and culture along with the science. This is one of those weeks. And as often is the case, I will use some of my own family history to help in the telling of the story.
In 1940, the year my mother was born at home without the assistance of any trained medical professionals, the United States was still reeling from the Great Depression and home births were the norm. World War II brought economic prosperity, rapid industrialization, modernization of medical practices, and the commercial introduction of penicillin and other antibiotics. Further, the success of the U.S. armed forces during the war was at least partially attributed to advances in science and engineering, which helped to foster an attitude that most human problems could and should be addressed with technology.
Post-war economic prosperity drove the construction of a tremendous number of hospitals staffed with doctors and nurses trained either during the war or afterwards through funding from the G.I Bill. Within these shiny, new facilities, the view that educated men – and I say men on purpose – wielding the latest scientific knowledge could improve over Mother Nature held sway. This perspective was bolstered by benefits flowing from improved hospital sanitation practices and the use of antibiotics. During the post-war era, two important transitions in birth practices took place. First, there was a dramatic increase in the percentage of babies delivered in hospitals instead of in homes. Second, by the time my sister was born in 1964, birth had become highly medicalized and was treated more like an illness requiring the intervention of technology than a natural process. This was also the time period during which pregnant women were prescribed thalidomide for morning sickness, which resulted in thousands of birth defects. During my sister’s birth, my mother was given general anesthesia. Even today, 52 years later, you can sense that she can still feel the disorientation of going to sleep pregnant and waking up and being told that she had delivered a baby girl who was now in a different room.
In parallel with the changes in birth practices, the use and overuse of antibiotics in the U.S. grew dramatically after World War II. As I have discussed in previous columns (links), we now know that indiscriminate use of antibiotics in the U.S., in both humans and livestock, has been the key factor in driving increases in rates of obesity, diabetes, asthma, heart disease, and high blood pressure, as well as the rise of drug-resistant super bugs. We now also know that reducing the population and diversity of beneficial bacteria in women due to overuse of antibiotics results in their children starting life with a deficiency of needed bacteria, which can have long-term negative impacts.
The rise of the Women’s Movement in the 1970s brought a wide range of issues to the political forefront, including reproductive issues such as contraception, abortion, and choice of birth method. In all of these arenas, male-dominated legislatures and medical associations were dictating and limiting options for women. While public debates on contraception and abortion received more public attention, a movement to empower women’s choices regarding birth options also began. In particular, Rahima Baldwin’s book, Special Delivery, published in 1979, detailing the potential benefits of midwifery and home birth, attracted a dedicated following.
With that historical perspective in hand, let’s fast forward to 2016. Currently in the United States 99% of all babies are delivered in the hospital, one-third of those via Caesarian section. Utilization of the expensive and specialized equipment and personal in the hospital for all types of deliveries, ranging from the routine to the complicated, results in birth being a very high-cost procedure. But despite utilizing the full arsenal of tools available to the medical field, the United States is one of only a hand-full of countries in the world with a rising rate of maternal mortality. Currently 17.8 per 100,000 mothers in the U.S. die during or in the aftermath of childbirth, which puts the U.S. in 33rd place worldwide.
Maternal mortality is rising in the United States for a variety of reasons. These include:
- an increasing number of pregnant women who are in poor health due to obesity, diabetes, and high blood pressure;
- poor pre-natal care due to lack of access to affordable health care;
- an increase in the number of C-sections; and
- an increasing number of hospital-acquired infections.
This circumstance is similar to many other medical issues in the United States. We spend a tremendous amount of money but receive less than stellar results. So what can and should be done? The first two bullet points above are part of a general problem in public health in the United States. To address these issues, we need to ensure that everyone can afford to go to the doctor, find a way to ensure that everyone has access to nutritious foods, and transition to a more rational use of antibiotics.
The issues in the final two bullet points are intimately intertwined with the manner in which we approach birth options in the United States. This will be the topic of Part II next week, in which I will discuss how these issues are handled in the United Kingdom. I’ll also provide a summary of my conversations with Jane Gledhill, Certified Nurse Midwife, Nurse Manager at Women’s Birth and Wellness Center in Chapel Hill, NC and Secretary of the Legislative Committee for the North Carolina Chapter of the American College of Nurse Midwives regarding the future of birth options in the U.S.
Jeff Danner discussed this week’s column on WCHL with Aaron Keck.
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