|Posted by Sarah Al Hajjar on July 3, 2016 at 3:35 PM|
Childbirth Trust and Accountability
By Aisha Alhajjar, 2011
Recently I was required to read Born in the USA: How a Broken Maternity System Must Be Fixed by Marsden Wagner, M.D., M.S. Dr. Wagner is a medical doctor and an outspoken supporter of the midwifery model of maternity care. He also served as the director of Women’s and Children’s Health in the World Health Organization for fifteen years. He has personally studied, researched and witnessed both the medical model of maternity care that is most often applied in the USA (and Saudi Arabia) and the midwifery model of care. In his book he compares the difference between obstetrics and midwifery and makes a compelling argument in favor of midwifery care for low-risk women.
In my assignment I was also required to review a number of short articles about the United States’ ranking in terms of maternal and neonatal deaths (mothers and babies dying around the time of childbirth). What I learned about the way the medical model handles birth coupled with the poor outcomes as indicated by low rankings was alarming. I want to share with you my completed assignment, which was to write a personal reflection of what I read.
Please note before reading that I completely support the need for obstetric surgeons to care for women who encounter complications. However, I truly feel that the midwifery model is better equipped to care for the majority of low-risk women who chose natural birth. The system should always provide obstetric back up for women who may experience complications as well as fully manage the small percentage of high-risk maternity cases. There must be mutual respect, yet autonomous separation between midwifes and obstetricians and a referral from a midwife to a surgeon should be as professional and welcomed as that of a general practitioner to a surgeon.
As I read through the assigned articles taking notes, it struck me, “Whom do we trust for birth?” The answer is often times, “Obstetricians.” When we put our faith in humans we must then ask, “Where is the humanity and human accountability?”
In my opinion, misplaced trust is the biggest issue at hand. The theme over and over again displays women’s trust in their obstetrician’s management of birth more than Allah’s perfect design of their bodies for giving birth. Somewhere along the line of cultural evolution, women have been brainwashed into believing that the creation of the human female is flawed. The result is expectant mothers turning their bodies over to obstetricians, like cars to mechanics.
To make matters worse, obstetricians don’t trust in Allah’s perfect design of the female body. They put their trust in drugs and interventions instead. They work above the laws of nature and outside the evidence of science and impatiently override the divine plan for birth. The results, as shown in the assigned readings, are often times disastrous!
Ina May Gaskin’s Safe Motherhood Quilt gives us a real visualization of the number of women dying from pregnancy and childbirth related complications in the United States. [Looking at Arab News just this week you find an article, Hospital staff quizzed over deaths of women after giving birth, which supports my guess that Saudi’s experiences are probably similar.] The fact that we [the United States] spend more on maternity care than any other country, yet rank so low in terms of maternal death, is absolutely appalling. What’s worse is realizing that half of these deaths were preventable! I was totally unaware of the lack of regulation regarding reporting of such events, let alone the lack of investigation into them. I applaud Ina May for her creative vision to bring this virtually unseen epidemic into public view.
Even if the obstetric community succeeds at sweeping maternal and infant mortality under the rug, there are millions of women and babies who are suffering from various short and long term consequences of the unnecessary interventions that are forced upon them. The voices and stories of these families mostly go untold, as the women themselves are usually not aware of the iatrogenic [doctor caused] nature of their injuries. We are blinded by our trust in obstetrics and our lack of belief in our body’s ability to birth. This leaves women extremely vulnerable to human error.
As an American, I used to think that there was a level of accountability built into our government regulations, if not our cultural humanity. I had no idea of the “holier than thou” mentality that exists in the world of obstetrics. I would have never fathomed that protecting oneself from legal accountability for actions would come before patient needs and rights. I also had assumed that ACOG [American Congress of Gynecology, a powerful private body of obstetricians that most all American obstetricians belong to which makes recommendations to the U.S. government, courts, and practicing doctors regarding maternity practices] was a dependable source and had no clue that they are self-serving and put the defense of obstetricians ahead of best practices for women and babies. Reading Born in the USA was a real eye opener into the minds and workings of our obstetricians.
Until I began working with European couples in Saudi, I was unaware of midwifery models elsewhere. Based on my American, Saudi, and Egyptian experiences it appeared that the obstetric model reigned throughout the developed world. Wagner’s review of studies and midwifery examples was enlightening. I gleaned a better understanding about the differences and I realize there are better options to the obstetric model that I’ve come to know.
Considering that the majority of pregnancies and births are low risk, midwives really can fill the gap for millions of women worldwide. Educational and working costs are much lower in the midwifery model. Thus making the establishment of infrastructure a realistic task, if funds are appropriately reallocated away from expanding the current obstetric hierarchy.
What’s more, woman-to-woman care is inherently more compassionate and humane. Midwives are patiently confident in divine design and encourage mothers to trust their abilities to birth. They understand the importance of hormones in birth and work hard to encourage the natural flow while unobtrusively monitoring for signs of complication. Statistically speaking, planned birth with a midwife is at least as safe as hospital births for low-risk women.
Within the context of their work, midwives build intimate bonds with the women they serve. The relationship aspect of care ensures humanity and realistic expectations for outcomes and accountability becomes a byproduct of the union. Women are naturally empowered and take responsibility for care, as midwives spend a great deal of time educating the clients they serve.
As shown in the European countries where midwives serve the majority, care can be found in all neighborhoods. It should be a goal for the ethnicity of midwives to be as diverse as the areas in which they work. This goal alone will decrease racism and preferential treatment, as midwives would identify with the women they serve.
In my case, residing and working to bring midwifery to Saudi Arabia, I face many of the same challenges as described in these readings. Unfortunately, Saudi has copied the American obstetric model. When comparing the two countries maternity care I have always felt that the informed consent laws in the States afforded some sort of safety net. It wasn’t until I read Wagner’s behind the scenes account of American obstetrics that I realized that it’s nothing short of smoke and mirrors. I now feel it’s even more dangerous in America, where we have the illusion of informed consent and women are left ill prepared to advocate for themselves during the most vulnerable time of their lives.
My goal is to work with proactive members of Saudi government and society to establish community midwifery where women birth within their own neighborhoods and homes. Learning of the mistakes of the American system gives me an overview of the magnitude of such transformation. Infrastructure framework must be developed and resources dedicated for training midwives, educating the public, integrating obstetric back up, and collecting data to measure key indicators and maintain accountability. Fortunately, as a country founded on religious principles, trust in Allah’s design of our bodies and birth seems a natural concept.
Amnesty International. (2010) Deadly Delivery
Gaskin, I. Safe Motherhood Quilt
Midwives College of Utah. (2011) Introduction to Midwifery Syllabus Article
Wagner, M. (2006) Born in the Usa: How a Broken Maternity System Must Be Fixed. University of California Press: Berkley, CA.
Women’s Health USA 2010
World Health Organization: Maternal mortality ratio