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Gloria Lemay

Marsden Wagner, MD

Gretchen Humphries

Sarah Buckley, MD

"Women are Dying Needlessly in Childbirth"

This Birth Love Column by LLM appeared in Issue 15.1, June 29, 1999 of the OBCNEWS. For a full listing of columns, go here.

This column came out of an online conversation I had with an obstetrician. Here's its essence:

Me- "Birth 100 years ago was most often delivered into the hands of lay midwives. Fatality rates often went up when medical doctors became involved..."

OB- "COULD I HAVE SOME DOCUMENTARY EVIDENCE OF THIS?"

So here goes...

It is a lie of enormous proportions that homebirth attended by midwives is dangerous, negligent, and a killer of women and babies. Sarah Stone, an eighteenth-century midwife and author of the Complete Practice of Midwifery, said that more mothers and children had died at the hands of the new "barber-surgeons" than through even the most incompetent of midwives.(1)

Study after study, decade after decade, has proven that normal birth is safest when it takes place without the attendance of rigorously-trained medical professionals. This was first illuminated in a major study of maternal mortality conducted in Aberdeen, Scotland, in 1929. It was found that mothers having homebirths with midwives in attendance experienced a death rate of 2.8 per 1000, while women attended at home by physicians had a rate of 6.9 per 1000. But physicians overseeing births in hospitals were found to have a startling maternal mortality rate of 14.9 per 1000 births.(2)

U.S. studies also revealed that women were dying needlessly in hospitalized childbirth. First, the 1930 White House Conference on Child Health and Protection found that American women were dying at a rate of 7 per 1000; the high death rate for birthing women was attributed to the 60-85% rate of instrumental deliveries, the exposure to cross-infection, and the "often false sense of security in the operating room"(3). More startling news was published in the Maternal Mortality in New York City: A Study of all Puerperal Deaths, 1930-1932. 66% of the 2,041 maternal deaths were discovered to have been preventable; also, that physicians were responsible for 61.1% of the deaths. And remarkably- only 2.2% of the maternal deaths were attributable to the errors of midwives. The committee who produced the study- the New York Academy of Medicine's Committee on Public Health Relations- also found that midwives had the lowest maternal death rate of any birth attendant- 1.4 per 1000, while obstetricians had a death rate of 5.4; surgeons, 9.9.(4)

A few years after the study was conducted, Iago Galdston, the secretary on medical information for the New York Academy of Medicine, reiterated that the frequent use of forceps, anesthesia, and surgery during childbirth were major causes of needless maternal deaths.(4)

Women of today are foolish to think their survival rates are exemplary. Data from death certificates compiled by the Center for Disease Control's National Center for Health Statistics revealed that more women are dying from pregnancy and birth-related reasons every year: the 1996 figures were eleven deaths per 100,000 births, compared to seven per 100,000 in 1987.(5)

Marsden Wagner- pediatrician, neonatologist, perinatal epidemiologist, and former Director of Women's and Children's Health for the WHO- believes that the increasing maternal death rate may be due in part to the increasing rate of cesarean section.

"Perhaps the most alarming data are those showing a rise in the maternal mortality rate in the US in recent years...Because the data give only the leading cause of death and not underlying causes, it is quite possible that the leading cause of death, namely hemorrhage is, in many cases, hemorrhage associated with cesarean section. With all the unnecessary cesarean section done today in the US...this could be part of the problem of rising maternal mortality...Another possible cause of the rising maternal mortality rate in the US is the epidemic increase of epidural anesthesia for labor pain…in Great Britain where there is a careful audit of all maternal deaths including underlying causes, epidural block is one of the reported causes."(6)

It is noteworthy that a study published in the British Journal of Obstetrics and Gynecology found that women are up to 16 times more likely to die in childbirth after a cesarean section rather than a vaginal delivery.(7)

More from Marsden Wagner, MD:

"350 to 1,000 women die every year in the United States around the time of birth. Although individual states have regulations that require such deaths to be reported, no one, including you or me or scientists wanting to study why these women die, can get access to information on these maternal deaths. We do know that at least half these deaths are not reported, that black women have a four times greater risk of maternal death, that nearly all these women die in the hospital rather than at home, and that with adequate medical attention many if not most of these women need not have died."(8)

Women giving birth with physicians in attendance have an increased rate of dangerous, interventional delivery. A 1992 study in the American Journal of Public Health compared more than 1,000 planned, direct-entry, midwife-assisted home births with approximately 14,000 statistically matched hospital births. Only 2.11 percent of the women who planned to give birth at home experienced such interventions as forceps, vacuum extractors, or C-sections; while 26.6 percent of those who planned to give birth in the hospital encountered these outcomes.(9)

And now, as in 1930, instrumental delivery, anesthesia, exposure to dangerous microbes,(10) and a "false sense of security in the operating room" are major factors contributing to a rising maternal death rate.

Midwives have the best maternal outcomes of any birth professionals;(11) midwifery services- from direct-entry midwives to certified nurse midwives- must be freely available to all women who want them. Birth is not about institutions profiting from women's coerced dependence on the false promises of modern medicine; birth is about women claiming their intrinsic creativity, beauty and power in dignity, safety and freedom.(12)

References:

1. Jane B. Donegan, Women and Men Midwives: Medicine, Morality, and Misogyny in Early America (Westport, Conn.: Greenwood Press, 1978), p. 31
2. "Doctoring the Family", transcript from 1985 Canadian Broadcasting Corporation television series (an excellent historical reference; write to CBC transcripts, P.O. Box 6640, Station A, Montreal, Quebec, H3C 3L4 to obtain a copy).
3. Judy Barret Litoff, "American Midwives- 1860 to the Present" (Greenwood Press, 1978), pp. 108-113. A must-have for anyone interested in midwifery and the origins of medicalized birth.
4. Ibid., 112.
5. National Center for Health Statistics. Vital statistics of the United States. Vol II -- mortality. Part A. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1967-1992.
   also- WHO's Maternal Mortality Rates.
6. Maternal Death Rate in the United States: WHERE ARE THE DOCTORS?
7. Sultan AH, Stanton SL. Preserving the pelvic floor and perineum during childbirth- elective caesarean section? Br J Obstet Gynaecol 1996; 103: 731-734 (Education and Debate- controversies in management -see the "risks and benefits" section)
8. Technology in Birth: First Do No Harm by Marsden Wagner. M.D.
9. Durand, AM The Safety of Home Birth: The Farm Study, American Journal of Public Health, March 1992: Vol. 82, No. 3:450-453
10. Struelens, MJ The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions BMJ 1998;317:652-654
    Also see News Reports of Hospital Acquired Infections.
11. S Twaddle, G McIlwaine, WH Gilmour, M Reid, I Greer, CB Lunan, M McGinley, I Johnstone. Randomised, controlled trial of efficacy of midwife-managed care. The Lancet, Volume 348, Number 9022, Saturday 27 July 1996 (pp 210, 213-18)
    Also see Homebirth is Safe: The Medical Journal Citations and Midwifery Advocacy and Statistics.
12. My own damned opinion.

Note that babies are dying needlessly in childbirth, too. In 1998, the Centers for Disease Control in Atlanta published the outcomes of a study of every singleton vaginal birth in the United States in 1991*. Excluding high risk births, and comparing similar obstetrical cases, it was found that babies' chances of dying in their first few days of life were 23% higher if they were attended by doctors rather than midwives in their births, and were 50% more likely to die in their first months of life if they were attended by doctors. *MacDorman, MF, Singh, GK. Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiol Community Health 1998 May;52(5):310-7

Also see:

Marjorie Tew. Safer Childbirth? A Critical History of Maternity Care: Chapman and Hall, 1990

Bogdan, Janet Carlisle. Childbirth in America, 1650-1990. Pp.101-120.

Ehrenreich, Barbara and English, Deidre, Witches, Midwives, and Nurses: A History of Women Healers. Oyster Bay, NY:Glass Mountain Pamphlets, 1973.

Leavitt, Judith Walzer. Brought to Bed: Childbearing in America 1750 to 1950. New York and Oxford: Oxford University Press, 1986.

Martin, Emily. The Woman in the Body: A Cultural Analysis of Reproduction. Boston: Beacon Press, 1987.

Rothman, Barbara Katz. In Labor: Women and Power in the Birthplace. New York and London: W.W. Norton & Company, 1991.

Scully, Diana. Men Who Control Women's Health: The Miseducation of Obstetrician - Gynecologists. Boston: Houghton Mifflin, 1980.

Scholten, Catherine M. Childbearing in American Society: 1650-1850. New York and London: New York University Press, 1985.

Wertz, Richard W. and Dorothy C. Wertz. Lying-In: A History of Childbirth in America. New York: The Free Press, 1977.

Obstetric Myths Versus Research Realities by Henci Goer; includes a chapter on midwives (23 abstracts) and one on homebirth (23 abstracts), as well as chapters on breech, epidurals, and other topics. The table of contents plus the entire chapter on episiotomy is online.

Midwifery Today Issue No. 50, summer 1999, Theme: Homebirth Articles include "Homebirth: What Are the Issues" by Sara Wickham, "Ultrasound, More Harm than Good?", by Marsden Wagner, and "Drugs in Labor: What Effects Do They Have Twenty Years Hence?" by Beverley Lawrence Beech-- all three of these have references. .