Investigative journalism lives at California Watch, which published this article about maternal mortality. An independent task force investigating the problem found “the most significant spike in pregnancy-related deaths since the 1930s…it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.” But the state has yet to release a report.

This investigation is not the first to reveal higher than officially reported numbers of deaths, but it appears to have gone deeper than previous reviews in Virginia, New York, and Florida. “The group’s initial findings provide the first strong evidence that there is a true increase in deaths — not just the number of reported deaths.” And unlike previous reviews, it sought to determine causes, which are usually attributed to women: obesity, older mothers, and fertility treatments. The data, however, suggest otherwise, according to Elliot Main, MD, the task force’s lead investigator: “What I call the usual suspects are certainly there,” he told California Watch. “However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase.” What then is to blame for the increase?

Main said scientists have started to ask what doctors are doing differently. And, he added, it’s hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased. The task force has found that changing clinical practice could prevent a significant number of these deaths.

While the findings appear to be languishing with the state department of public health, the Joint Commission, which certifies and accredits hospitals, is taking action. On January 26 it issued an alert, stating: “Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.”  After receiving the CA task force’s report, the Commission “issued incentives for hospitals to reduce inductions and fight what it called ‘the cesarean section epidemic.’”

Circle of Health International works worldwide in areas of conflict and crisis to address women’s health needs, and the group announced yesterday that it is sending a team of midwives, trauma specialists, and obstetricians to Haiti. Says the group: “Women’s health needs — often a matter of life and death — do not cease to exist in crisis and post-crisis situations. In fact, the already dire condition of women’s health in these communities is often further threatened in times of emergency. Before the earthquake, Haiti suffered from the highest maternal mortality rate in the Western hemisphere, with 670 women per 100,000 dying in childbirth. Sadly, we know that during times of such tragedy and unrest, rates of sexual assault and domestic violence escalate, further endangering the lives of women in such settings. COHI pledges to do everything in its power to prevent further worsening of women’s health status and to ensure these vital needs are met.” You can donate funds, supplies, or inquire about volunteering at www.cohintl.org.

In part III of its global survey on childbirth, the World Health Organization reports that C-sections have reached “epidemic proportions” worldwide. In 2005 the WHO surveyed hospitals in Latin America and found that where the cesarean rate had risen above 10-15%, women and babies suffered more complications and deaths. This latest survey, conducted in Asia, confirms the previous findings with data from 110,000 births. Women who gave birth by cesarean were more at risk for blood transfusions, hysterectomy, and death, and babies had higher rates of death and poor outcomes that led to extended hospital stays. “Together these findings provide strong multiregional support for the recommendation of avoiding unnecessary caesarean sections,” the authors write. “To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication.”

“The relative safety of the operation leads people to think it’s as safe as vaginal birth,” Dr. A. Metin Gulmezoglu, an author of the study, told the Associated Press. “That’s unlikely to be the case.”

Joy Szabo of Page, Arizona, was told by her local hospital that she wouldn’t be allowed to give birth vaginally there. She even met with the hospital CEO to discuss their policy of forcing repeat C-sections — a policy she equated with physical assualt — and the hospital responded by threatening to get a court order for the surgery. When the local paper headlined Szabo’s plight, the hospital backed off, but it still told her “No VBAC.” Instead of agreeing to the major surgery, Szabo pushed back. She found a willing hospital and provider in Phoenix, a six hour journey by car from her home, and made the decision to move there and await labor. She and her husband Jeff had to live apart beginning in mid-November, with Jeff remaining in Page with their three children (one already born by VBAC at Page Hospital!).

Finally, this week, CNN reports a happy ending: Szabo gave birth to her fourth son, Marcus Anthony (7 lbs, 13 oz) on December 5th: “It was such an easy birth,” Szabo said. “I was in the pains of labor for about four or five hours, then I pushed once, and he popped out.”

Congratulations, Joy. You are a hero and an inspiration to the hundreds of thousands of U.S. women facing the same coercive policies each year.

Women denied health insurance because they’ve been raped, because of domestic violence, because they’ve had a C-section… Insurers telling women who’ve given birth by cesarean, “Alright, we’ll cover you–but only if you get sterilized.” Parents denied coverage for their children because they’re too big, too small, because they hold their breath …(?!?) It sounds too outrageous/absurd/illegal to believe, but listen to the testimony of Peggy Robertson (courtesy of the Service Employees International Union’s campaign for healthcare reform):







Here Robertson illustrates the awful bind so many women are in: No hospital will take her for VBAC, she doesn’t want another cesarean, she feels she has no choice but to have one, yet she can’t afford it. Her health insurer’s answer to this? Don’t have any more children. So much for reproductive choice.

RH Reality Check’s Jodi Jacobson has a novel idea: “I say the insurance industry as currently constructed is too sick to function and should be declared a national ‘pre-existing’ condition of which we should rid ourselves permanently.”

With the historic news that a majority of the U.S. workforce is now female, it’s clear that American women have more power than ever before, says OB/GYN and bestselling author Christiane Northrup, MD. But is that power reflected in the healthcare available to women? No, she writes in an essay for Huffington Post, especially when it comes to childbirth:

“Our so-called healthcare system, which is a direct reflection of the beliefs of our culture, sees the female body and its processes (like labor) as an accident waiting to happen…The truth is that labor and birth need not be the emergencies we think they are. And the medicalization of birth actually does more harm than good.”

Northrup criticizes the rising rates of cesarean section and labor induction, and cites the rising maternal death rate. “Studies have repeatedly shown that in healthy mothers with no risk factors, home birth is as safe as hospital birth. Increasingly, savvy women who trust their ability to birth normally [and, we should add, who have the resources] are opting to avoid the hospital altogether.”

Northrup concludes the essay with a call to action: “When it comes to pregnancy and birth, we as a culture and as individuals need to wake up and claim our right to literally birth right!”

In the latest example of a woman reclaiming her birth rights, Joy Szabo (left) of Page, Arizona, is refusing to have the cesarean section that Page Hospital is ordering. Szabo had her 1st child vaginally. Her 2nd child was delivered via emergency cesarean at Page — and she was very thankful for it. She had her 3rd vaginally (VBAC) on the same L&D ward. But now, because the hospital has changed its “policy,” it has told Szabo that VBAC is no longer allowed, and that her only option is a cesarean. Page Hospital’s CEO Sandy Haryasz (sandy.haryasz@bannerhealth.com, 928-645-2424) even threatened legal action. “I asked Sandy what would happen if I just showed up refusing a C-section and she said they would obtain a court order,” Szabo told the Lake Powell Chronicle. “They don’t want to allow VBACs because she said they aren’t equipped for emergency C-sections, but if they can’t do emergency C-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies — in case there is an emergency.”

Since coverage in the Chronicle and on CNN, the hospital has backed off the court bullying, but it is still deferring to its “No VBAC” policy. Szabo’s doctor supports VBAC, in theory, but told her he’s powerless. “He was wringing his hands, and said he would have to do [a cesarean] if the hospital told him he had to,” Szabo wrote in an ICAN blog post. “He told me he would lose his licence if he didn’t. I have looked into it and have yet to find where doctors lose their licence for having ethics. But it was clear to me that I was not safe in this hospital, and if I step foot in the building, I would have a cesarean, and my doctor would do it while I scream in protest.”

The closest hospital Szabo can find to support her choice is in Phoenix, 350 miles away. In order to avoid surgery, she will leave her family in mid-November and rent an apartment in Phoenix until she goes into labor. Her husband probably won’t make the birth. In the United States, it is illegal, unconstitutional, and medically unethical to force a competent adult to have surgery for any reason. And yet, some 800 hospitals officially “ban” VBAC and another 600 don’t have a single provider willing to attend, forcing hundreds of thousands of women into this situation every year.

“Mention that you are planning a home birth and it might be as if you had just brought up Sarah Palin or Palestine: brace for family feuds, public denunciations, and offhand remarks that imply you are selfish and stupid, your midwife is a quack, and your unborn child is a victim already in need of social services…Such is the pitch of the ‘home birth debate’ in the United States. And yet, the the research evidence suggests a more nuanced conversation.”

Read more on Babble.com.

Last time the New York Times reported on home birth it was in the “Home & Garden” section. Here’s another story, about the rise in birth video viewership on YouTube, in “Fashion & Style.” (Sigh. When will physiological birth get a page in the “Health” section??) Most of the thousands of birth videos are shot at home — as of today there are 10,900 results to the search terms “home birth” — because taping is rarely permitted in hospitals. It’s mindblowing to think that 30, 40 years ago, women didn’t have access to books or even photographs showing the normal birth process. Now you can spend a whole afternoon birth-surfing.

Here’s a favorite. Here’s encouragement for those carrying multiples. Here’s one of several women singing in labor. And check out this absolutely gorgeous birth shown in a Spanish ad for a bed! And look, a brand new video about midwives and health reform — perhaps the birth of a movement?

ADDENDUM: “The Birth of Amerlyn Grace” — a beautiful, intimate slide show shot in black and white by Austin photographer Lyndsay Stradtner.