Created by: Caitlin Richman, Akilah Patterson, Allyssa Pena, Jessica Trygier, Erika Henry, Ellie Mendelsohn

Medicalization of Childbirth

What is the medicalization of childbirth?

Medicalization of childbirth: when medical professionals use technological medical interventions at any stage from pre-pregnancy to post-birth

What are ways this process has become so medically focused? pre pregnancy care- in vitro fertilization pregnancy care- electronic fetal monitoring, ultrasounds, pre natal

testing childbirth- epidurals, labor inducing drugs, fetal monitoring, cesarean

section post pregnancy- episiotomies, eye treatments, shots

The Business of Being Born

Why is it an Issue?

Why is it an issue?

Childbirth is a natural process… However, Over time, more physicians view the process as a disruption to health This causes pregnancy to be thought of more as an illness and nothing else

Not all mothers wish to have medical practices intervene with their pregnancy… However, Doctors use their expertise and authority to sway mothers during birthing

process, can often lead to unwanted use of drugs or even a C-Section

Currently, doctors are seen as the primary managers of reproduction This frequently restricts women from playing an active role in their own

pregnancies and childbirth

History

History of the Medicalization of Childbirth Until the 17th century: Births in most parts of the world were

exclusively in the home and prenatal care was little to non-existent

19th and 20th century: Stronger medical influence set in Development of new forms of anesthesia Cesarean sections Safe blood transfusions

20th century: Hospital births became more common Forceps introduced in the birthing process

In the past, hospitals were only used if a problem occurred Monitoring, managing and potentially intervening in childbirth

Now, medicalization of childbirth is commonplace for what once developed as a last resort

Current Status

Current Status

The vast majority of births in the U.S. are delivered in hospitals.

In 2012, 98.6% of all U.S. births occurred in hospitals. Doctors of medicine attended 85.8% of all hospital

births, certified nurse midwives (CNMs) attended 7.6%, and doctors of osteopathy 6.0%.

Out-of-hospital births generally had a lower risk profile than hospital births.

Cesarean Section (C-section)

In 1965, a little over 4% of all babies were born surgically

Today, 1 out of every 3 births (33%) In a study of 15,500 women who received care from

midwives: 1 in 16 (6 percent) of participants required a cesarean birth Compared to nearly 1 in 4 (24 percent ) similarly low-risk women

cared for in a hospital setting

Costs

According to the WHO analysis, the United States had the third highest number of unnecessary Cesarean sections in the year 2008, costing the country an estimated $687 million.

Average total cost for hospital birth for a woman with 80/20 insurance, a $500 deductible, and one baby in the United States is:• Natural birth at hospital: $10,000.00. Cost to patient = $500 +

$1900 = $2400.00• C-Section birth at hospital: $25,500.00. Cost to patient = $500 +

$5100 = $5600.00• Conclusion: Birth Center or home birth are extremely cost

effective.

Pre-Natal Care

Pre-Natal Testing

What is it? Carrier Tests

Maternal blood tests Screening Tests

Maternal blood tests Diagnostic Tests

Amniocentesis Chorionic Villus Sampling Fetal blood sampling

Controversy

Procedure is very invasive to the fetus• Miscarriage is a risk 1.9% rate after CVS and 1.4% after

amniocentesis• Can be risky for both mother and baby• Tests do not always yield accurate results Non-Invasive Prenatal Testing DNA from the fetus circulates in maternal blood Indicates genetic mutations mainly trisomy 21 (Down Syndrome) Blood is drawn from only the mother and is not invasive on the

pregnancy Pregnancy is not at risk during this procedure

Labor

“There is no other circumstance in which it is considered acceptable for a person to experience untreated severe pain, amenable to safe intervention, while under a physician’s care.” -American College of Obstetrics and Gynecology (ACOG)

“Unnecessary intervention poses unnecessary risks” –NIH

Inducing Labor

Inducing Labor Pitocin: A synthetic form of oxytocin, a naturally occurring

hormone, which causes uterine contractions

Reducing Pain During Labor Epidural: A regional anesthesia that offers pain relief in

lower body region during child birth, usually given when mother is 4-5cm dilated

Caesarean Section

When baby is surgically removed from mother’s abdomen 1 in 3 (about 33%) babies are born this way in the U.S. 18% is the average C-Section rate for low-risk deliveries Major surgery, but relatively safe for both mother and baby Longer recovery period May be unable to have vaginal birth in future WHO recommends C-Section rates between 5%-10%

Why and when is it used? Any unexpected problems Health problems in mother Baby’s position* Baby is too large to fit through vagina* Possibly for mothers with more than one baby* Inducing labor increases the risk for C-Sections

Why the increase?

Increasing labor interventions: Pitocin and Epidurals Physicians not offering vaginal delivery as a method Professionals casual attitude of surgery Time constraints and efficiency for health care

providers Not enhancing women’s ability to give vaginal birth

Post Birth Medicalization

Newborn Eye Treatments

What is it? Eythromyacin as a prophylactic treatment for

opthalmia neonatorumCaused by the STD’s gonorrhea or Chlamydia

Benefits Can prevent newborn blindness

Why it’s unnecessary Can cause severe irritation to the newborn Can be treated after an infant develops the infection

Current Status

Erythromycin prophylactic treatment is RECOMMENDED by U.S. Preventative Task Force American Association of Family Physicians American Academy of Pediatrics

Erythromycin prophylactic treatment is MANDATED by 32 U.S. States (Standler 2006)

Newborn Vitamin K Shot

What is it? Newborns are at risk for major blood loss through

Vitamin K deficiency bleeding (VKDB) Benefits

Can prevent bleeding out Why it’s unnecessary

Not “natural” child birth

Current Status

Newborn Vitamin K shot is RECOMMENDED by American Academy of Pediatrics State Laws about Neonatal Vitamin K shot vary

immensely20 States have no laws30 have inconsistent laws

We recommend that all newborns receive the Vitamin K shot and that consistent policies are implemented throughout states

Recommendations for Health Educators

Recommendations

Always have a plan Mothers need to have a well written birth plan Mothers need to write down decisions that might have to be

made during the delivery Have doctor and nurses sign plan

C-Sections, Pitocin, and Epidurals all have purposes, but health care providers need to treat labor and delivery as a natural process vs. a medical procedure

Health educators can encourage expecting mothers and fathers to choose a like minded practitioner.

Recommendations Continued…

Health educators should be able to serve as a resource for expecting mothers and educate them of different birthing options.

Health educators need to ensure mother’s have the resources they need to thrive before, during, and after birth.

Mothers need to make informed decisions and realize their birth plans may not go as expected.

References

A Natural Process? Women, Men and The Medicalization of Childbirth. Retrieved November 5 th, 2014, from Exploring the History of Medicine website: http://www.sciencemuseum.org.uk/broughttolife/themes/birthanddeath/childbirthandmedicine.aspx 

American Association of Birth Centers. (2013, Jan 31). New Study Shows Mid-wife Led Birth Centers Improve Outcomes and Lower Health Care Cost. Retrieved from http://www.birthcenters.org/content/new-study-shows-midwife-led-birth-centers-improve-outcomes-and-lower-health-care-costs

Cesarean Section. (2014, October 24). Retrieved November 11, 2014, from MedlinePlus website: http://www.nlm.nih.gov/medlineplus/cesareansection.html

¨Center for Disease Control and Prevention. (2014, June 23). Vitamin K Shot—Essential in Preventing Serious Bleeding in Newborns. Retrieved from http://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/kvitamin.html

Dekker, R. (2012, November 11). Is Erythromycin Eye Ointment Always Necessary for Newborns? Retrieved from http://evidencebasedbirth.com/iserythromycin-eye-ointment-always-necessary-for-newborns/

Epidural Anesthesia. (2014, July). Retrieved November 12, 2014, from American Pregnant Association website: http://americanpregnancy.org/labor-and-birth/epidural/

Hall, H. (2011, February 15). Childbirth Without Pain: Are Epidurals the Answer? Retrieved November 11, 2014, from Science Based Medicine website: http://www.sciencebasedmedicine.org/childbirth-without-pain-are-epidurals-the-answer/

Johanson, R. Newburn M. Macfarlane, A. Has the Medicalization of Childbirth Gone Too Far? (2002, April 13). Retrieved November 5, 2014 from The National Institutes of Health website:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122835/

Labor and Deliver, Postpartum Care. (2014, June 20). Retrieved November 11, 2014, from Mayo Clinic website: http://www.mayoclinic.org/healthy living/labor-and-delivery/in-depth/inducing-labor/art-20047557?pg=2

Pregnancy, Birth, and Medicine. (2011, February 17). Retrieved November 5, 2014, from Stanford Encyclopedia of Philosophy webstite:     http://plato.stanford.edu/entries/ethics-pregnancy/

References

MacDorman, M. F., Mathews, T. J., & Declercq, E. (2014, March) Trends in Out-of-Hospital Births in the United States, 1990-2012. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db144.htm

¨Martin, J.A, Hamilton, B. E., Osterman, MJ. K., Curtin, S. C., & Mathews, T. J. (2013, Dec 30) Births: Final Data for 2012. National Vital Statistics Report, 62, 9- 12. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf

Non-Invasive Prenatal Testing (NIPT) Factsheet. (2012, August 15). Retrieved November 12, 2014, from http://www.nchpeg.org/index.php?option=com_content&view=article&id=384&Itemid=255

Obstetrics and Gynecology, 19-24. Retrieved November 12, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/19504504 ¨Precious Passage Birth Services. (2014). Hospital vs. Out of Hospital Cost Comparison. Retrieved from

http://preciouspassage.com/?page_id=34 Screening tests for birth defects. (2014, April 1). Retrieved November 12, 2014, from https://www.acog.org/-/media/For-

Patients/faq165.pdf?dmc=1&ts=20141110T1125131189 ¨Standler, R.B. (2006, December 17). Statutory law in the USA: requiring silver nitrate in eyes of newborns. Retrieved from

http://www.rbs2.com/SilvNitr.pdf ¨Starr, T. (2014, May 12) Why are Cesarean Sections So Common When Most People Agree They Shouldn’t Be? Retrieved

from http://www.pri.org/stories/2014-05-12/why-are-cesarean-sections-so-common-when-most-agree-they-shouldn-t-be What Hospitals Don't Want You to Know About C-Sections. (2014, May). Retrieved November 11, 2014,from

Consumerreprots.org website: http://consumerreports.org/cro/2014/05/ what-hospitals-do-not-want-you-to-know-about-c-sections/index.htm

What is Pitocin? (n.d.). Retrieved November 11, 2014, from wiseGeek website: http://www.wisegeek.org/what-is-pitocin.htm