If the incidence of a major surgery had increased by 50% in the last ten years, wouldn't it be big news? I imagine so. You'd probably see headlines like, "Researchers search for clues to dramatic increase in ____ surgery," or "Doesn't the ____ work anymore?"
That's what's happened to the cesarean section rate since 1997 and no one seems to have even noticed.
Well, that isn't entirely true. Mothering Magazine's current issue asks "Cesareans: Why so many?" on its cover and has an incisive article on the topic. But this message doesn't seem to have gotten any attention in the mainstream media at all. And this isn't some obscure medical procedure - it's the most basic of human experiences.
In the last few weeks I've seen the play "Birth" and the film "The Business of Being Born," and this issue has been on my mind a lot. The film was produced by Ricki Lake, who had one traditional hospital birth and one home birth, and decided to make a film about birth in the U.S. today.
First I have to recommend that anyone who cares about mothers and babies see this film. I was fortunate enough to see it at a community screening, but the national release won't be until November, and the DVD won't be out until next year (though you can put it on your Netflix queue now). Here's a list of community screenings in some lucky areas. You may also be able to arrange a community showing.
"The Business of Being Born" demonstrates some disturbing trends. First, it shows that vaginal birth is becoming endangered in this country. Labor under strict time frames, with induction, medication, and surgery is fast becoming the norm. Natural childbirth is just about extinct in most hospitals, and is viewed by many in the medical professions as a quaint pursuit having no particular value to the mother or baby (or worse, representing some kind of narcissistic "glory" for the mother).
The film shows what normal birth looks like, and it provides historical and context for birth in the U.S. (which helped me understand, for the first time, what "twilight sleep" really meant). And it hints at what birth looks like in other industrialized countries, where it's far less interventionist, cheaper, and with better outcomes for mothers and babies. (For a sense of how different it is in England, where women are now guaranteed the option of a homebirth, see this article) The film is also not unrealistic about the need for medical intervention in some cases.
When it comes time to offer some explanations for the current state of birth in the U.S., it discusses a number of factors, from money, to liability, to the unfamiliarity of most new doctors with normal birth. But I'm interested in another question: What is going to make this change?
Here's my theory: The only people who can change this trend is us. Sure, the insurance companies may wise up to the fact that they can pay less for births - and as a side benefit get better outcomes - but I'm not holding my breath. And as much as I believe in the power of our democracy, I doubt that this issue will ever make it onto the radar of our elected representatives.
For better or worse, this is the United States of America, where money talks. Birth is a business, after all, and you vote with your feet. That is why "The Business of Being Born" and "Birth" are so important. They might just open enough minds to the possibility of normal birth that we start demanding care that respects our ability to do the most human of all acts: birth our babies. I'd love to hear your thoughts in the comments section.
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