The Problem with Maternity Care in America

Rising Cesarean Birth Rate in the United States

The number of women delivering by Cesarean section in the United States has been increasing in recent years. The California Maternal Quality Care Collaborative (CMQCC) suggests that the Cesarean rate in the U.S. has risen by over 50% in the last 15 years! (CMQCC, 2016).  In fact, in Louisiana in 2017, the Cesarean rate reached a high of 37.5% of all live births in that state.

Minnesota is still significantly above the recommended Cesarean rate of 10% to 15% as advised by the World Health Organization with a whopping 27.4% of all live births in 2017 being births by Cesarean section (CDC, 2017). Surprisingly, the Cesarean section statistic varies from institution to institution. Certain hospitals have higher Cesarean rates than others (CMQCC, 2016).

Higher Cesarean rates have been linked to reasons such as induction of labor, having a high-risk pregnancy, failure on the part of health care providers to allow adequate time for the normal course of labor, and fear of being sued. Although it is excellent that women in the U.S. have access to surgical care when required, women are also paying the price for delivering by Cesarean section.

Just one delivery by C-section can increase a woman’s risk of suffering from future pregnancy and birth complications. Moreover, many women are still discouraged from having VBAC (vaginal birth after Cesarean) deliveries due to the fear of uterine rupture, even though evidence supports offering women the option to attempt a VBAC (Motherly, 2018).

In summary, if women are not aware of the risks associated with birthing by Cesarean section, I expect that the rates of delivery by Cesarean section will continue to stay at an all time high and even potentially increase as women begin to accept this method of delivery as the new normal. Currently one in three moms in America gives birth by Cesarean section (StatNews, 2015). Giving birth by Cesarean section is becoming the new normal.

 

Rising Maternal Mortality and Morbidity Rates in the United States

A recent Minnesota Public News article points to the rising maternal mortality and morbidity rates in the U.S. (MPR News, 2018). Sadly, the U.S. ranks below many other developing nations in terms of maternal mortality and morbidity (Maternal Health Task Force, n.d.). This may seem surprising given all of the access to technology, medications, and surgical options in this country. However, one of the downfalls of access to all of these excellent tools and opportunities, is the risk of overuse especially in situations that are truly low-risk.

In fact, the failure to focus on this growing problem of maternal mortality can be seen in the fact that maternal deaths related to pregnancy, birth, and postpartum complications are not required to be reported as such in all states (The Pacific, 2017). Many maternal deaths are improperly recorded as caused by another event, even when the death was very likely caused by sequelae associated with pregnancy, birth, or postpartum complications.

 

Postpartum Depression Rates

Numerous magazine and nursing journal articles have pointed to the prevalence of postpartum depression in new mothers in the United States. It is estimated that rates of postpartum depression in new moms can be as high as 1 in 5 women (CDC, 2017). Unfortunately only a fraction of all women with clinical signs of postpartum depression ever receive adequate treatment. Some of the reasons postulated for why the rates are so high are: isolation, lack of community support, lack of sleep, difficulties with breastfeeding, and birth trauma.

The high numbers of women struggling with clinical signs of postpartum depression is not surprising given the limited support that women receive after delivery. Most women are not seen until 6 weeks postpartum after they are discharged from the hospital. Moreover, many women experience the reality of their partners returning to work after just one week of paternity leave.

European health systems have pointed to the fact that this significant gap in care delivery is unacceptable. It’s important to realize that there are many issues that can be identified and successfully intervened upon before the 6 week postpartum visit. Issues that, if left untreated, are likely to get worse.

 

How Can Virtual Doula Support Help?

Virtual Doula Support can help tackle this complicated array of issues in maternity care today by offering evidence-based educational information and materials that are delivered in a format that expecting moms are desiring, specifically via online courses, webinars, and videos. Moms today are busier than ever working at demanding jobs in their careers and managing their homes and families. I hear often from expecting moms that they struggle to find time in their calendar to fit in a prenatal education or birthing class. As a result, overscheduled moms are missing out on getting access to valuable information that can help them and their partners make healthcare decisions that are aligned with their values and potentially save their lives as well.

Another key point to consider is that the majority of women of childbearing age are not familiar with midwifery care as an option. In fact, many moms tell me that they do not know the difference between a midwife and a doula and there is a huge difference! This example shows the lack of information that is being passed on to women about their choices for healthcare providers, especially if they desire to have a vaginal, low-intervention birth.

The use of birth doulas in the U.S. is still not a mainstream practice and in many instances is reserved for those women that can afford to pay out of pocket for the service (Evidence Based Birth, 2017). Even though we know that having a doula present as a support for moms at a birth improves birth outcomes, many women are still not aware of or able to access this valuable service. Virtual Doula Support aims to connect moms and partners with critical information to help them have the best chance of avoiding a Cesarean section and recovering from childbirth with wraparound support.

Additionally, because Virtual Doula Support offers expecting moms the opportunity to participate in community via the private Facebook group, moms are less likely to feel isolated as they navigate pregnancy and the challenging postpartum time.

 

References

I look forward to connecting with you!

 

Elizabeth Summers, RN, BSN
Pregnancy Coach, Birth Doula, & Registered Nurse
Owner & Founder of Elizabeth Summers Wellness

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