The medical model of childbirth is broken right to the core.
When I was just getting started with this birthing thing I was pretty enthusiastic. I did a lot of reading. I wrote optimistic essays about birthing choices for my shockingly bad website. I tried to be a doula, though I’m not sure I was ever a particularly good one. I went to conferences and training days by the dozen. I believed that I could make a difference. I believed that positive change was inevitable, that the facts were lining up and soon everyone would have to agree on the appropriate approach. All we had to do was be firm, keep tabulating research, and make it available. Wait the change out and it would happen.
But as I say, I was a perhaps not very good doula, and in the main the births I ended up attending were those of strangers, often strangers that I hadn’t met before I found them in the labour and delivery room at a local hospital (ah, the free referral service of the local doula organization), and by the time I got there things were already on their downward spiral. The induction was on and it was only a matter of time before someone became exhausted and bored and suggested a c-section. Hapless women of colour with poor English and their equally hapless husbands and partners were funnelled through to the operating room and for all my enthusiastic soothing and panting and rocking and walking and changing positions there was nothing I could do to change it.
In all the births I attended at that time, there were only two decent ones, one a homebirth, the other a hospital birth, older white mothers full of determination. They knew what they wanted. They fought for it, and they were very clear about what they wanted from me. So, it worked, you see. They had the education, experience, determination and white privilege to get what they wanted, a birth that wasn’t abusive or horrible. It certainly helped that they were women having second babies, as second babies are always more responsive to the arbitrary timelines of the medical model. It was a gift to be their doula, it really was.
In between births I did postpartum doula work, some volunteer, some for a pretty good wage. Here too I could see how damaging the medical model was. One young woman I was helping for free was in Canada alone, her husband in Malaysia waiting on his visa application. She’d given birth alone, a young non-white woman with no apparent partner and poor English. She’d had a good nurse, she felt, but the doctor, a woman, was rough and impatient with her, and had performed an episiotomy that resulted in a fourth degree tear, very painful and with a difficult and perhaps surgical recovery.
Another woman I served for a few weeks, helping out through the nights, had been pregnant with twins. Her babies were delivered via c-section, for no other reason than that they were twins. She was struggling with the continuing pain of her incision, not being able to breastfeed her son, who wouldn’t latch and would only take a bottle, and pumping around the clock to supply them both with breastmilk. She was exhausted.
Another woman was in Canada from England, but was not yet covered by health benefits. The doctor she saw would not permit her to attempt a trial of labour after her previous c-section, so she was forced to undergo another surgery and pay for the entire thing out of pocket as well.
I was called to help with breastfeeding with another older couple, who gave birth at home with registered midwives. She had a tear which required stitching and while the midwives were stitching it up they kept the baby in another room away from her. For an hour and a half. The first time she tried to breastfeed after her birth her baby was already through its wide awake period and slept instead. Two days later, still not nursing.
All of this is a very long-winded way of saying that after a few months of thinking about birth! and babies! with stars in my eyes! and then attending a weekend workshop in which women imagined awesome births and inspirational stories were told by the doula instructors of how they had saved women’s births and so on, I somehow plunged headfirst into the deep end of how awful and how broken the medical model of birth really is.
I’m making this all sound a little grim, that’s because it is a grim business and the statistics bear that out. In British Columbia (BC), where I live, the current c-section rate is over 30%. It’s not a stretch to suggest that for every three women who give birth in this province, one will end up with major abdominal surgery. This is not a supportable rate. The World Health Organization recommends that a reasonable c-section rate should be no more than 10-15%, and this rate has been shown repeatedly to produce the best outcomes for mothers and babies.
Now if a reasonable rate with the best outcomes is 10-15% and our current rate is over 30% then 15-20% of birthing women are having unnecessary surgery.
Let me repeat that.
The medical model of birth as practiced in British Columbia (and the rest of Canada and much of the United States) results in 15-20% of all birthing women, perhaps as many as 1 in 5, having unnecessary surgery. 50% or more of the c-sections performed do not improve outcomes for mothers and babies.
And of course, it’s not as though the women who are giving birth vaginally are getting off scott free in this system. They’re birthing under the ever present threat of major abdominal surgery, for one thing. Forceps and Vacuum extractor are used 3.4% and 6.3% of the time, so that means another 10% of women at the very least are having episiotomies and having their babies pulled out with varying degrees of skill. 45% of women have epidural anesthesia, which is certainly successful, most of the time, at blocking sensation, but also makes far more likely the perceived need for “augmentation” of labour, including artificial rupture of membranes and syntocinon augmentation – I couldn’t find a rate for syntocinon usage, but it tends to be fairly high, often as much as twice as high as the c-section rate. 21% of women in BC also have their labour artificially “induced”.
Women are having pretty awful birth experiences. Not universally, of course. But a lot of them.
I used to explain to people how the cascade of interventions worked, how one intervention would lead to another and then another, and how one simple bad decision on the decision tree could lead to a seemingly necessary (but really unnecessary) c-section. And in my explanation, I’d pile them on a little. My hypothetical birthing women experienced as much intervention as I could believably throw at them in order to demonstrate the point.
And people were a little disbelieving. Who could blame them? It does seem a little outrageous that doctors, who are in the main probably well-meaning people, could end up performing unnecessary major abdominal surgery on one fifth to a quarter of their healthy birthing patients.
But the problem with my hypothetical is I saw it played out or heard about it played out in almost exactly the ways I’d described far too many times. It wasn’t just an illustrative fiction, it was a common reality.
The last birth I went to as a doula was for an aboriginal woman and