December 6, 2009

Ina May Gaskin And The Safe Motherhood Project

Hillary, please don't read this post.  You don't need to be thinking about these issues right now.  

I've been digesting Ina May's lecture slowly.  Because it was profound and heartbreaking.

I've known since I began to study midwifery, that the United States ranks about 41st in maternal and infant mortality rates in the world, according to The World Health Organization.   But last night Ina May broke that down for me.  She put faces and circumstances to the statistics.   I had gotten blowzy about that number.   Unconsciously, I think I had decided the number was mythical.  Because I don't know any women who have died in childbirth or directly postpartum.    Then again, most of the women I know use the midwifery model of care, a profoundly safer choice.   The number is not mythical.  It is political, racial, and a feminist nightmare. 

Oh, there is too much to say.   Let me break it down to the quick.  It is dangerous to have a baby in the hospital.  They do not want you to know this.  But it is dangerous.  Cesareans are not casual, despite what women are currently taught.   Consider that maternal death reporting is not mandatory.   Consider that women die of amniotic fluid embolisms, meningitis from epidurals, and complications due to cesarean that are not even counted as maternal deaths.  Why?  Possibly because if they were counted, no one would want to have their babies in hospital.

In response, Ina May started the The Safe Motherhood Project and she is sending packets of information to all state legislators.   

I used to think I was supposed to be a midwife.   Unlike the national average of 35%, the cesarean rate for most midwives hovers well below 3%.   The mortality rate for women in the United States who choose the midwifery model of care is lowest; the countries with the lowest maternal and infant mortality rates all employ the midwifery model of care.  But now, I think doula work may be more important.  Because most women in the United States don't question the medical model of care.   And, Lord God Almighty, they have no clue how dangerous it is to walk through those doors.  

*In this report, maternal mortality ratios are based solely on vital statistics data and are underestimates because of misclassification. The number of deaths attributed to pregnancy and its complications is estimated to be 1.3 to three times that reported in vital statistics records (6). Misclassification of maternal deaths occurs when the cause of death on the death certificate does not reflect the relation between a woman's pregnancy and her death. In addition, the inclusion of deaths causally related to pregnancy that occur between 43 and 365 days postpregnancy can increase the number of maternal deaths identified by 5%-10% (6).~ CDC report on Maternal Mortality from 1982-1996


Heather said...

This: "But now, I think doula work may be more important. Because most women in the United States don't question the medical model of care."

It reminds me very much of new teachers entering the public education system. It's a treacherous path, trying to help people in a system that hurts them. I could say so many things about that. But just, steel yourself. Because, as you know well, doing what's right is so much harder than ignoring the truth.

Michelle said...

I'm a Canadian transplant to SC, a doula, and due with my fourth child. I've had three beautiful homebirths and am hoping to have my fourth the same, but have been finding navigating the US system to be more than a little discouraging. Just wanted to say I agree with your post and it makes me pretty certain that, if we stay in the US, I don't think I have the fortitude to work as a doula here... I'm a little burnt out as it is. I think women in NC definitely need you to return to your doula work. :)

Sarah said...

Every time a woman hears I gave birth at home they say "I'd be too scared to do that."