Changes in Birth Practices in the United States
The history of obstetrics is the history of the effort of doctors and midwifes to find appropriate methods to make deliveries as safe as possible both for a mother and a baby. Many obstetricians built successful careers by inventing different methods and tools to help a mother and a baby in the obstructed delivery. The first invention designed for this purpose was called a crochet. It was a sharp-pointed instrument, which was used to crush the baby’s skull and pull out the fetus from woman’s womb. This procedure was performed in order to save a woman if her life was threatened by childbirth. Apart from this, various methods named after their inventors existed to help a woman deliver a child. For example, Lovset maneuver was used to help deliver a breech baby. Mauriceau-Smellie-Veit maneuver was used in the situation when breech baby’s arms were out, but the head was stuck. Finally, Woods corkscrew maneuver was used when the baby’s shoulder was dislodged.
Unfortunately, the researches of 1933 proved that hospital deliveries did not decrease the rate of deaths during childbirth. It turned out that the doctors had necessary tools but lacked the practical knowledge about how to use them safely. Hospital care brought no advantages. Women were having better deliveries at home with midwives.
Findings of these studies brought obstetrics to a turning point. Doctors had to figure out how to standardize childbirth. This was done by introducing strict regulations concerning individual practice. There were requirements established for doctors who helped in delivering babies. Hospitals set the rules about who could assist during deliveries, which steps needed to be followed, whether forceps could be used, etc. These standards substantially reduced the rate of mothers’ death, but, unfortunately, the situation with newborns was much worse: 1 out of 30 babies died at birth.
This statistics was very disturbing and, therefore, doctor Virginia Apgar introduced a revolutionary idea. She had invented an Apgar score, as we know it now. It became known universally and is used virtually in every hospital throughout the world. According to the Apgar score the newborn’s condition is rated on a scale from zero to ten. An infant got two points if the skin color at birth was pink, two for crying, two for taking vigorous breaths, two for moving all four limbs, and two if its heart rate was over a hundred. Ten points meant that a newborn was born perfectly healthy.
Nowadays, electronic fetal-heart-rate monitoring is used in more than 90% of deliveries. Intravenous fluids are used in more than 80%. Anesthesia is used in 75% and drugs to speed up labor are used in 50% of cases. 30% of deliveries in the USA are done through Cesarean section. Forceps have disappeared from delivery wards even though Cesarean section was found to have no advantage in comparison to forceps delivery.
In the USA modern medicine is an industry responsible for performing the safest possible deliveries. Therefore, doctors’ practices and procedures include only reliable methods. Homebirths do not adhere to the prescribed rules of conduct, therefore are perceived to be potentially unsafe. However, this does not mean that they are more unsafe than hospital deliveries, as complications can appear in any situation.
US view vs. Europe and England View Regarding Midwives and Home Births
Most births in the United States occur in hospitals, though in other highly developed countries, such as the United Kingdom and some other European countries many births successfully happen at home with the help of midwives. The roots of this phenomenon are in the history.
In 1910 and 1912 two reports on medical education were published. It was concluded that American doctors were poorly trained and hospitalization was recommended for all woman who were about to deliver. This was also done with a purpose to improve obstetricians’ training. In 1914 “twilight sleep” was introduced. It was a combination of medicines that caused women to have no memories about the birth. This method was initially welcomed by the upper-class women.
In 1915 Dr. Joseph DeLee described childbirth as a pathological, abnormal process. He further claimed that the deliveries should be only conducted with the help of special doctors, but not the midwives. He proposed a sequence of interventions designed to save women from hardships of labor. Of course, nowadays this view is not popular, but at that time it was welcomed as progressive. Doctors like DeLee argued that midwives were untrained and incompetent to help women in such life threatening experience as delivery, and the number of midwives reduced drastically. In Europe, doctors were focused on responding to problems during childbirth, not on their prevention. This was the reason for existing differences in the methods of deliveries – home births or hospitals.
Why Women Should or Should not Have the Choice to Give Birth at Home
My strong belief is that any woman should be given a right to have natural home delivery. There are several reasons why I support this statement.
First of all, I believe that delivery is a natural process. All the animals go through it without any help, and they deliver healthy and strong progeny. People are meant to deliver their babies in a natural way too. Therefore, no medical intrusion is needed. But of course, there are cases when the doctors need to intervene, but most likely the woman knows about any complications that might appear even in the process of the pregnancy, e.g. if the baby is in the wrong position it is better to have doctors and medical equipment nearby if it will be needed. In case of the complicated pregnancy the better option would be to deliver a child in a hospital with the assistance of trained obstetricians.
In case of a home delivery a woman should have a trained midwife who knows what to do in case something goes wrong. It is preferable to have a hospital nearby or easy access to the nearest hospital it case of necessity. But most likely, if the pregnancy was problem-free, the delivery would be problem-free as well.
Another obvious benefit of home delivery is an emotional aspect. It is more comforting to have relatives and close people nearby and to have a chance to bring a baby into the world in a quiet atmosphere of family home. Even if the hospital is of the best quality and the highest standards, it could never compare to the atmosphere of the home. Psychological comfort and positive attitude are very important here.
By delivering a baby at home, a woman has more chances to make decisions about the baby herself, or with the help of her partner. She does not have to rely entirely on doctors for whom her baby is just another baby out of a hundred they helped to deliver. It is also easier to avoid infections, which the baby or mother could catch in the hospital.
Of course, speaking about these advantages, I only take into considerations women who had no complications during pregnancy. In these cases deliveries would be a natural problem-free process. Otherwise, it is better to have hospital delivery. But in any case, the woman should have a right to choose the option she considers to be the best in her case.