Amnesty International minces no words in its new report on U.S. maternity care. Deadly Delivery: The Maternal Health Care Crisis in the U.S.A., reports that more than 2 women die per day in the United States from pregnancy- or childbirth-related complications, a rate that’s worse than in 40 other industrialized countries. “Preventable maternal mortality
is not just a public health issue, it is a human rights issue,” states Amnesty.

“Women in the USA face a range of obstacles in obtaining the services they need. The health care system suffers from multiple failures: discrimination; financial, bureaucratic and language barriers to care; lack of information about maternal care and family planning options; lack of active participation in care decisions; inadequate staffing and quality protocols; and a lack of accountability and oversight.”

The report profiles several women who died or nearly died because of inadequate, inappropriate, or discriminatory care: one woman dies of a blood clot following a cesarean section, which could have been prevented with simple circulation stockings (a standard prophylactic for other major surgeries); another woman bleeds to death following a C-section, even after she and her husband plead with medical staff to address her troubling symptoms; a high-risk woman experiencing complications late in pregnancy is turned away from a prenatal clinic because she can’t afford a $100 deposit; both she and her baby die after care is delayed.

Each death represents dozens of “near misses” that often leave women in worse health; of the 4 million American women who give birth each year, 1.7 million women experience complications that lead to adverse effects. “The US health care system is failing women,” says Amnesty. Read the full report here.

In today’s New York Times, Section A, a story about a tiny, impoverished Navajo hospital in Tuba City, AZ, doing birth better than anyone: “this small hospital in a dusty desert town on an Indian reservation, showing its age and struggling to make ends meet, somehow manages to outperform richer, more prestigious institutions when it comes to keeping Caesarean rates down, which saves money and is better for many mothers and infants.”

How do they do it? Midwives attend the majority of births; obstetricians are available if needed. All the providers are on salary, so the profit motive is gone. And the hospital is federally insured, so it hasn’t been bullied into banning VBAC like so many others around the country. Even though the patient population has risk factors like hypertension and diabetes, the cesarean rate is a mere 13.5%.

“Tuba City…could probably teach the rest of the country a few things about obstetrical care,” writes the Times. “But matching its success would require sweeping, fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery.”

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.

Most of us learn the word “elective” in high school, when we find ourselves with the newfound freedom to take a course like AP music theory, or advanced sculpture, or yoga. Elective implies freely chosen, life-enhancing. Laser eye surgery is elective. Tattoos are elective. But the vast majority of so-called “elective” cesarean sections are not, and it is inappropriate and disingenuous to call them so in the medical literature, as did a recent study… (Read the the entire commentary at RH Reality Check.)

On June 23, Amber Craig wrote a long, heartfelt, cogent letter to the president of the American College of Obstetricians and Gynecologists suggesting a reversal of the group’s restrictive policies on vaginal birth after cesarean (VBAC), which have lead hundreds of hospitals and legions of providers to “ban” women who’ve had previous cesareans from giving birth vaginally. ACOG wrote back with statistics and claims that are patently inaccurate. Craig wrote back again correcting the group’s claims with still more citations from the medical literature. If you’re following “VBACtivism” or ACOG’s recent attack on home birth, these letters are a must-read. They’re posted here.

OK magazine and other tabloids are reporting that Angelina Jolie, very pregnant with twins, is awaiting labor with a midwife and two French nurses in Monaco — and hoping for a normal, vaginal birth. Jolie’s first baby was breech and she gave birth by C-section. “She prepared for a natural child birth for Shiloh and was very disappointed when her doctors told her she would have to undergo a Cesarean section,” a friend told OK!.

Women carrying twins in the U.S. have a hard enough time finding a provider willing to support a physiological labor and vaginal delivery. Many women are told they will have to labor in an operating room with a mandatory epidural, and that if either baby is breech they will move to surgery, because most providers now lack the know-how to deliver breech (like Jolie’s first OB).  Women wanting vaginal birth after cesarean (VBAC) are also facing major obstacles, like physicians and hospitals who simply refuse them.

Achieving a supported twin VBAC in the U.S. would be a long, bumpy, uphill battle — maybe even for a celebrity. Did Jolie, like so many C-section moms, try and fail to find a willing provider? Did she encounter hospitals with official VBAC bans? Physicians whose insurance policies prohibit them from delivering twins, or midwives whose licensing regulations prevent them from attending VBACs? Was she pushed to give birth in Europe? Maybe we’ll find out after the twins arrive.

The New York Times is on a roll this week. One article reports on a study linking the rising cesarean rate to the rise in “late preterm” infants — those born at 34 to 37 weeks, when they are at a higher risk of breathing problems, breastfeeding difficulties, and spending their first days of life separated from their mothers in a Neonatal Intensive Care Unit. Another article blows the whistle on insurance companies denying individual plans to women who’ve previously given birth by cesarean. Treating the first cesarean as a pre-existing condition, the insurers argue such women are at a higher “risk” of having another surgery — which they are, because so many physicians and hospitals are discouraging, or refusing outright, women a vaginal birth after cesarean (VBAC). The Times reports that 500,000 U.S. women anually give birth after previous cesarean, and it has previously reported that at least 300 hospitals have official VBAC bans.

The medical insurers blame physicians and women for a glut of “elective” C-sections, which cost them more; physicians blame women and their own malpractice insurers. “I think there is pressure by patients on physicians to deliver early-ish when someone’s uncomfortable,” said Sarah J. Kilpatrick, head of ACOG’s obstetric practice committee, “and there is medico-legal pressure. Obstetricians are afraid of being sued,” so they may “proceed with a Caesarean to deliver the fetus when the fetus is probably fine.” What Kilpatrick doesn’t say is that the ACOG committee she heads is responsible for the de facto VBAC ban, which plays a huge part in the rising cesarean rate — and, as the study suggests, the rising rate of preterm babies.

The losers in all this, of course, are women and their families: going through unnecessary primary cesareans, then being discouraged or flat out denied normal, physiological birth for their next pregnancy, on top of that being denied health insurance because the repeat cesarean their providers are insisting upon would cost the insurer more money, and having babies at higher risk of being born too early, not to mention the risks of repeated major abdominal surgery for mom. And we call this maternity “care”?

While this author has been busy traveling and speaking (see the “Tour” schedule here), the birth blogosphere has been putting out some great material worth directing your attention to. First, check out Tina Cassidy’s VBAC chronicles. Bostonian and author of Birth: A Surprising History of How We Are Born, Cassidy gave birth to her first baby by unplanned cesarean four years ago. When she became pregnant again last year, she started investigating her options and, like many women, found little support for a vaginal birth after cesarean (VBAC) at local hospitals and even birth centers. So she decided to find a midwife and order a birth tub. Read all about her “HBAC” here (start with “Installment #1″ for the full narrative).

New York women, you’ll especially be interested in this recent post on the NYC Moms blog about one woman’s dissatisfaction with her birth experience at St. Luke’s Roosevelt Hospital. This mom wanted a normal, drug-free labor, as she’d had with her first baby. But, she writes, “I don’t judge anyone who has had or wants an epidural now that I have had one for my second child. I understand why people get them. We live in a culture of fear (of pain, consequences, failure) and instant gratification and an era of a disproportionate sense of entitlement. Mostly, however, I blame the environment one labors in.” The blog is titled, “Epidurals Are For Tolerating the Hospital, Labor Is The Easy Part.”

How would you rate your birth environment? If you gave birth in NYC in the past three years, you can fill out the online Birth Survey. It’s a new initiative, in pilot stage, of the Coalition for Improving Maternity Services (CIMS); the Survey hopes to go national next year and build a database of feedback and ratings on providers and hospitals across the country–think of it as a Zagat’s of maternity care. It’s part of a larger movement toward “transparency in health care.”

Finally, a little gossip: the British celebrity site Fametastic reports that Minnie Driver, due to give birth in late summer, is planning a home water birth.