REPRODUCTIVE JUSTICE

MEDICALIZATION IN MATERNAL HEALTHCARE

**NOTE**  Medical advancements have saved the lives of women and babies at risk for injury or death during pregnancy and birth.  This site is not about the doctors who properly use interventions to save lives; it is about those who use them unethically for profit or convenience.   Improperly used interventions have led to harm and death of women and babies and obstetrics  is the only field in which mortality rates are rising and non-medically needed interventions such as c-sections are related to 66% of maternal deaths. 

**NOTE**  This site is designed to share valid evidence for those working to change the maternal healthcare system who do not have access to databases of peered research. 

**NOTE** Chronological order allows users to find new data.  It also begs the question of why, when we have known for decades that such practices are harmful, do they not only continue to be used but are increasingly used.

INTERVENTIONS IN PREGNANCY AND BIRTH: GENERAL INFORMATION

THE NEED FOR MEDICAL INTERVENTIONS IS LESS COMMON THAN MOTHERS AND FAMILIES ARE LED TO BELIEVE

Let’s be clear that there are times when medical intervention is critical. When medically necessary, interventions, including caesarean sections, can prevent death and serious complications in mothers and babies.  This section is about the use of medical interventions when they are not medically necessary.

The World Health Organization (WHO) – has for years found that the ideal rate of C-sections is between 10% - 15%.  Rates above 10% show no evidence of decreased mortality rates (WHO, 2021) and in fact mortality rates actually increase as interventions increase.  While some have tried to justify higher rates, their position has not changed. 

C-sections are not the only interventions, which while occasionally needed, should not be part of routine maternal healthcare or deliver.

Interventions disturb the normal physiology of labor and birth and restrict women’s ability to cope with labor (Lothian, J, 2014).  “The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy is far from restrictive” (Lothian, J, 2014).

 Rather than decrease problems, these interventions often increase complications and risk of harm for mothers and babies.  This page shares literature about non-medically necessary c-sections.  For information about interventions other than c-sections see table of contents for relevant page.

What does the literature say?

2019

MacDorman, M & Declercq, E. (2019). Trends and state variations in out of hospital births in the United States, 2004 - 2017.  Birth (Berkeley, Calif). 46(2).279 - 288 https://doi.org/10.1111/birt.12411

• Lack of insurance or Medicaid coverage is an important limiting factor for women desiring out-of-hospital birth in most states. Recent increases in out-of-hospital births despite important limiting factors highlight the strong motivation of some women to choose out-of-hospital birth.

Roberts, J. and Walsh, D. (2019). Babies come when they are ready: Women's experiences of resisting the medicalization of prolonged pregnancy. Feminism & Psychology, 29(1). 40-57. https://journals.sagepub.com/doi/10.1177/0959353518799386

• From abstract: Experiential knowledge played a key role in resistance, but women found this was devalued. Some healthcare staff used risk discourse to pressure women to comply with induction protocols but were unwilling to engage in discussion.

Georgia Birth Advocacy Coalition (2019). 6 scary statistics about the dangers of unnecessary birth interventions. Accessed https://georgiabirth.org/blogcontent/2019/8/2/stunning-statistics-about-unnecessary-birth-interventions-and-unscientific-care

• Some medical providers point the finger at these patients, asserting that avoiding interventions plays a role in maternal or infant mortality. The data says otherwise. Most people who die giving birth do so after receiving and consenting to a wide range of interventions. In many cases, these interventions played a role in the woman's death. Unnecessary birth interventions and ovemedicalization are not a triumph of modern medicine. They are a primary culprit in maternal mortality.

2015

Jou, Judy, Katy B Kozhimannil, Pamela Jo Johnson, and Carol Sakala. (2015). Patient-Perceived Pressure from Clinicians for Labor Induction and Cesarean Delivery: A Population-Based Survey of U.s. Women. Health Services Research 50, no. 4: 961-81. doi:10.1111/1475-6773.12231.   Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545342/

• CONCLUDED: "The results of our analysis suggest that over one-fifth of women who gave birth in U.S. hospitals may perceive pressure from a clinician to induce labor or deliver by cesarean, and that perceived pressure from health care professionals is associated with significantly higher odds of labor induction and cesarean delivery among these women. These findings are consistent with previous research that finds clinician preferences, opinions, and information are important to women making decisions about labor induction or cesarean (McCourt et al. 2007; Moore and Low 2012; Johnson and Rehavi 2013). Such pressure may be appropriate when intervention is medically necessary, and women have an extremely high level of trust in their maternity care providers (Childbirth Connection 2013). By uncovering a significant effect of perceived pressure on procedures used without medical reason, this study’s findings are suggestive of potential undue pressure, overuse of procedures, and/or miscommunication in maternity care decision making."

2014

American College of Nurse-Midwives. (2014) Normal, Healthy Childbirth for Women & Families: What You Need to Know.  Accessed: https://mana.org/pdfs/Normal-Healthy-Childbirth.pdf

• CONCLUDED: (from article) "Since 1996, the World Health Organization has called for eliminating unnecessary intervention in childbirth. Yet in the US, birth interventions have reached epidemic proportions. Sadly, there is a lack of resources available to women to help them achieve their goals of a normal, safe, and healthy birth. The norm for birth in the US today includes the use of technology and interventions that are not proven to benefit health women and babies  during childbirth."

Lothian, J. (2014).  Healthy  birth practice #4: Avoid interventions unless they are medically necessary.  Journal of Perinatal Education, 2014 Fall; 23(4): 198–206.  Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235054/

• CONCLUDED "The purpose of this article is to review the literature related to the evidence base and the outcomes associated with the interventions routinely used in labor and birth in the United States. The findings make the case for the value of maternity care that avoids the use of routine interventions."

2013

Jansen, L., Gibson, M., Bowles, B. C., & Leach, J. (2013). First do no harm: interventions during childbirth. The Journal of perinatal education, 22(2), 83–92. https://doi.org/10.1891/1058-1243.22.2.83 Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647734/

• CONCLUDED "Every nurse attending a childbearing woman must recognize the possible consequences and risks of each intervention he/she initiates to weigh the possible benefits against its potential detrimental effects. Care must be taken to enhance normal childbirth processes to minimize the need for interventions. When interventions become necessary for valid indications, the nurse must make the mother aware of the necessity as well as the risks so that she can give informed consent. The nurse must also use appropriate precautions to ensure that interventions do not impose unnecessary risks for the patient. Unintended consequences of typical intrapartum interventions make it imperative that educators work with nurses, physicians, and anesthesiologists to promote natural processes for childbirth and advocate for policies that focus on ensuring informed consent and alternative choices. Interdisciplinary collaboration is necessary to ensure that intrapartum caregivers “first do no harm.”"

Macdorman, Marian F., Eugene Declercq, and Jun Zhang (2010). "Obstetrical Intervention and the Singleton Preterm Birth Rate in the United States From 1991–2006." American Journal of Public Health100, no. 11 (2010): 2241-247. doi:10.2105/ajph.2009.180570.  Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951941/

• CONCLUSION: "In conclusion, given the frequency of preterm birth after labor induction or cesarean section without a trial of labor, the 88% increased odds of preterm obstetrical intervention in 2006 relative to 1991, and the recent lack of decline in US infant and fetal mortality rates,^7,46 further research is needed into the decision-making process surrounding obstetrical intervention in preterm births. Because of the increased risk of morbidity and mortality for preterm infants relative to term infants,^7–9,51 it is important to ensure that all preterm obstetric interventions are truly medically necessary.".

INTRODUCTION PAGE

Last updated Jan 2023