Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Super Comment!: Maternal Death in the U.S., or TOP TEN Ways to Reduce Your Risk For Complications in Pregnancy and Childbirth May 27, 2009

Dear NursingBirth,

I’m a huge fan of your blog! Please keep the awesome entries coming! I am learning so much. I am just a novice birth-junkie rather than a birth professional and so am anxious to eat up all the great information you’re giving out here.

Anyhow…. Our state treasurer’s wife (that’s here in Arizona) died today in childbirth, and their baby is said to be in grave condition. They’re not giving causes or reasons. Here’s the link:

http://www.azcentral.com/news/articles/2009/05/26/20090526treasurers-wife0526-ON.html

Can you think of occurrences in hospital-birth that would end up with a dead mother and a baby in really bad condition? I’d love to hear from someone who knows her stuff. The things that came to mind for me were amniotic fluid embolism, severe uterine rupture, and cesarean gone really wrong.

Keep up the amazing work!!!
Diana

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

Dear Diana J.,

 

I just read the story you linked to and my heart goes out to that family.  Unfortunately the story you linked to did not go into any details, including the most important detail which is: Did the treasurer’s wife have a vaginal birth or a cesarean section, as the risks are significantly higher with a cesarean section.  I think your question is a good one and since this story has the potential to make national headlines, I think that it is an important enough question to put as its own post on my site.  I hope, however in posting about your question that moms out there who read my blog are not unnecessarily worried or upset that we are talking about maternal death as it is still a relatively RARE occurrence when you think about all the other causes of death in childbearing women. 

 

Let’s put it into perspective.  As the Arizona Central story stated, “In late 2007, the National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention, released a report showing that there were 13 maternal deaths per 100,000 live births in 2004 in the United States.” And since in 2004 there were 4.1 million births in the United States, if you do the math that would make about 533 maternal deaths in 2004.  And don’t get me wrong…that’s 533 deaths to many for sure!  However take a look at this chart published by the Center for Disease Control (CDC) entitled: Leading Causes of Death by Age Group, All Females- United States, 2004.  It shows the following:

 

Leading Causes of Death for 15-19 year old Females, 2004:

1)      Unintentional Injury (51.7%), 2) Suicide (8.8%), 3) Homicide (7.5%), 4) Cancer (7.3%), 5) Heart Disease (3.1%), 6) Birth Defects (2.8%), 7) Pregnancy Complications (0.9%)

 

Leading Causes of Death for 20-24 year old Females, 2004:

1) Unintentional Injuries (40.5%), 2) Homicide (8.4%), 3) Cancer (8.0%), 4) Suicide (7.6%), 5) Heart Disease (4.6%), 5) Pregnancy Complications (2.7%), 6) Birth Defects (1.9%), 7) HIV disease/Stroke (1.4%).

 

Leading Causes of Death for 25-34 year old Females, 2004:

1) Unintentional Injuries (25.3%), 2) Cancer (15.1%), 3) Heart Disease (8.2%), 4) Suicide (7.5%), 5) Homicide (5.8%), 6) HIV disease (4.4%), 7) Pregnancy Complications (2.3%).

 

And for women ages 35-44 years old, pregnancy complications don’t even crack the top 10. 

 

Okay so if you are a pregnant mom please know that dying of pregnancy/childbirth related complications is rare and I don’t want to completely freak you out.  But there is something very disturbing about the United States maternal mortality statistics which shocks most people when they hear it….

 

The United States ranks 42nd in the WORLD for maternal mortality rates, with 1 in 4,800 women dying from pregnancy complications in the U.S. in 2007.  That means that 41 countries other countries in the world have BETTER maternal mortality rates than the United States!

 

Many of our practices and current situations in this country, including our obsession with medically unnecessary labor induction, our over-medicalized maternity care system, the practice of defensive as opposed to evidenced-based medicine, the lack of a universal health care system, large differences in health disparities among different racial/socioeconomic groups, the obesity epidemic, and our skyrocketing cesarean section rate greatly contribute to our country’s maternal death rate. 

 

So what exactly is defined as “maternal death.”  According to the World Health Organization, “A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”  Therefore a death of a woman that died from complications arising from a cesarean section a month after she had the baby would be counted in the maternal death statistics where a pregnant woman who died in a car accident or murdered during a domestic violence dispute would not. 

 

Okay, but you are probably thinking Why?  Why are so many women dying in childbirth in an industrialized, developed country like the United States at a much higher rate than other industrialized, developed countries like Japan, many countries in Europe, or Australia? 

 

Ina May Gaskin, midwife and founder of the Safe Motherhood Quilt Project, gives us some insight into the situation in her book Spiritual Midwifery, page 455, written in 2002:

 

“According to the CDC, there has been no improvement in the U.S. death rate (which is nearly twice as high as Canada’s) since 1982.  Sadly, the CDC estimates that the true death rate is as much as three times higher than that which is reported and that half of all the reported deaths could have been prevented through early diagnosis and good care.  Given the situation it makes sense for women to avoid unnecessary surgery while pregnant or in labor.  Women double or triple their risk of dying when they have an unnecessary cesarean.  Medical mistakes do happen, even to people who are well informed about their possibility.”

 

Also Ina May’s Safe Motherhood Quilt Project website also links to a Maternal Mortality in the USA Fact Sheet that is worth checking out!

 

The 2008 documentary Orgasmic Birth (which I highly recommend renting) has a 20- minute movie clip as part of the “special features” section of the DVD that provides some eye opening statistics about maternal and infant mortality rates in the United States as compared to other industrialized countries around the world.  In this short movie clip, entitled Birth By The Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today.  It is a MUST WATCH CLIP for anyone who is or cares about a mother.

 

Also, here are some articles from mainstream news sources published in response to the 2007 maternal mortality rankings that provide some insight:

 

1) More U.S. women dying in childbirth: Death rate highest in decades; obesity and C-sections may be the cause  Associated Press, August 24, 2007

2) Maternal Mortality Shames Superpower U.S.  Inter Press Service, October 13, 2007

3) U.S. ranks 41st in maternal mortality  Seattle Post-Intelligencer, October 12, 2007 

 

A flyer published by the medical journal The Lancet in 2006 entitled Causes of Maternal Death: A Systematic Review ranks the top 9 causes of maternal death related to pregnancy/childbirth complications in DEVELOPED countries as the following:

1) Other Direct Causes (21.3%), complication of the pregnancy, delivery, or their management which includes (among other things):

            –Anesthesia Complications* (responsible for about 3% of all maternal deaths by itself and includes:    management of the difficult airway in obstetric patient, aspiration of gastric contents under general anesthesia, local anesthetic toxicity, and high spinal or epidural block which paralyzes the breathing muscles of mother).

2) Hypertensive Disorders (16.1%), includes (among other things):

            –Preeclampsia

            –Eclampsia*

            –HELLP Syndrome*

3) Embolism (14.9%), includes (among other things):

            –Pulmonary Embolism (typically a complication seen post-op surgery)

Deep Vein Thrombosis (DVT) (more likely to develop for women on bed rest or post-op surgery

Amniotic Fluid Embolism (rare and more appropriately known as Anaphylactic Syndrome of Pregnancy)*

4) Other Indirect Causes of Death (14.4%), pregnancy-related death in a patient with a preexisting or newly developed health problem like cardiovascular disease, seizure disorder, respiratory disorder, diabetes, kidney disorder, liver disorder, obesity, etc.

5) Hemorrhage (13.4%), includes (among other things):

  – Obstetrical Hemorrhage (most common causes being uterine atony, trauma, retained placenta, and coagulopathy)

  – Placenta Previa*

            – Placenta Accreta, Increta & Percreta

            – Placental Abruption*

            – True Uterine Rupture*

6) Abortion (8.2%)

7) Ectopic Pregnancy (4.9%)

8.) Unclassified Death (4.8%)

9) Sepsis Infection* (2.1%)  (most likely to occur post-operatively but can occur post-partum or antepartum)

 

*Comes to mind for me as having the potential to cause a critical illness or death for baby as well.

**Please note mothers undergoing cesarean surgery, especially repeat caesarean surgery are MORE at risk for anesthesia complications, pulmonary embolism, obstetrical hemorrhage, placenta previa, placenta accreta, and sepsis/infection than moms undergoing a vaginal birth.**

 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

You are probably thinking, “So what does all of this mean for me?” “How can I reduce my risk?”  Both are GREAT questions.  It is important to remember that I am not claiming that 100% of maternal deaths are preventable or even foreseeable.  No one is.  I also do not want anyone to get the impression that I am blaming mothers or putting unrealistic pressures on mothers to control things that are sometimes just happenings that are an unfortunate and very sad part of life.  For example, who could have predicted a fatal postpartum hemorrhage for a healthy mom after a normal uncomplicated unmedicated singleton vaginal birth?  No one could!  But what about a mom who experienced a fatal postpartum hemorrhage after elective cesarean surgery….well that one doesn’t sit so well with me!   And which do you think is more likely?  If you guessed the latter you are correct…by at least 4 times as much! 

 

So how does a mother reduce her risk of maternal morbidity and mortality related to pregnancy and childbirth complications?  The following is a short list you might want to keep in mind.  (Not surprisingly, many relate back to avoiding unnecessary surgery.)

 

TOP TEN Ways to Reduce Your Risk For Complications in Pregnancy and Childbirth:

1)      Obtain good and thorough prenatal care, keeping all of your appointments, preferably beginning in your first trimester.

 

2)      Make a conscious effort to eat a well balanced diet during conception and pregnancy that includes adequate amounts of fresh fruits and vegetables, healthy fats, and protein.  There are a variety of prenatal nutrition books out there as well as many childbirth books that have a section on prenatal nutrition.  If you don’t have one buy one or borrow one from the library!!

 

3)      If you don’t exercise, start!  Many gyms, community centers, and YMCAs offer low-impact, pregnancy-friendly classes for expectant moms.  Even a 30 minute walk three times a week will do!

 

4)      If you suffer from a chronic disease or illness or are obese, it is important to know that making appointments with health care providers and specialists that can help you to manage your disease and lose weight in a healthy way before and during pregnancy can ultimately help you to reduce your risk of life threatening complications during pregnancy and childbirth.

 

5)      Consider hiring a birth attendant that practices a midwifery model of care.

 

6)      Do NOT agree to a medically unnecessary labor induction.

 

7)      Do NOT agree to a medically unnecessary or elective cesarean section.

 

8)      If you have a history of a cesarean section, seriously consider a vaginal birth after cesarean section (VBAC) if you have no reoccurring or new reasons or medical indications for a repeat cesarean.  If necessary switch to a birth attendant that supports VBAC and has the cesarean statistics to prove it.

 

9)      Seriously consider avoiding interventions in labor that evidenced-based research have shown could increase your risk of a cesarean section, fetal distress, and infection including early amniotomy (breaking of waters), accepting pitocin to stimulate or augment contractions without trying other more natural methods for augmenting labor first, going to the hospital during very early labor, accepting continuous external fetal monitoring as opposed to intermittent auscultation for a normal healthy labor and a normal, reactive, and reassuring fetal heart rate pattern, and requesting an epidural or narcotic pain medication (especially in early labor) before trying all methods of non-pharmacological pain management techniques first.  (Check out my post: Top 8 Ways to Have an Unnecessary Cesarean Section)

 

10)   Empower yourself to make safe, healthy decisions regarding your pregnancy, your labor, your birth, and your baby by doing your own research!!  (Check out my post: Birth Resources EVERY Woman Should Know About).

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40 Responses to “Super Comment!: Maternal Death in the U.S., or TOP TEN Ways to Reduce Your Risk For Complications in Pregnancy and Childbirth”

  1. nursingbirth Says:

    Dear Readers,

    A few of my readers have encouraged me to have some sort of “Ask Nursing Birth” section of the blog. First off I would like to say that I am FLATTERED beyond belief that some of you amazing ladies would even want me to have a section like that! Believe me with the amount of comments I have been getting in the last few weeks (like 30 a day! Good gracious!) I have considered it. But there are a few things in play here:
    1) I am not a nurse midwife or physician, nor have I ever claimed to be, and hence this blog is not about “ask the expert.” It is mearly my attempt to empower women to educate themselves on their birth choices!

    2) I really enjoy when people post questions in the comment sections of my blog posts because I feel this blog has turned into a pretty awesome learning community where other readers will often answer other readers questions! I LOVE THAT and I don’t want to stiffle it.

    3) If I had a question-answer section I feel like I would spend way more time on the computer than I already do, which is too much! Haha! I wish this could be my main responsiblity in life but alas, it cannot! I would hate to have people posting questions and me not be able to get to them for days or weeks at a time.

    So for now I think things might have to stay the way they are. But again, I really really appreciate the thought!! I think my readers are the best readers in the blog world! 🙂

    Love,
    Melissa
    aka NursingBirth

  2. KhalilaAnn Says:

    Too bad on the no Q&A section, but I can see the logic in that! I think you and the other frequent visitors do a pretty great job at answering people’s questions anyway. Especially now with your Super Comment section!

    This one is great! I was really pleased with myself when I could say that I was doing 9/10 things to avoid serious complications. Especially since I’m one of those people that worry about everything even when told not to! Plus I learned a few things I didn’t know before ((HELLP for example…)), which is always great. 🙂 Another great eye opening post, keep up the good work!

  3. Emily Jones Says:

    Medical induction doubles your risk of AFE, and almost quadruples the chance you will die from it, should you get it.

    http://www.medscape.com/viewarticle/546393

    And I’m sure I read it somewhere, but can’t find the link now, but I *think* epidurals increase your risk for AFE as well.

  4. Diana J. Says:

    Thanks a bunch!!!!!!!! 🙂

  5. This was an awesome post! I learned so much.

  6. MrsW Says:

    I’m no statistician, but I am wondering how much the ranking of the US’s maternal mortality rates vs. the rest of the industrialized world is affected by the fact that so many other industrialized countries (especially Western Europe and Japan) have such low birth rates. It certainly doesn’t detract from the seriousness of the issue here but I was just wondering if perhaps that ranking of 42 was slightly inflated due to the fact that we simply have more moms giving birth here.

    • nursingbirth Says:

      MrsW, PLEASE check out that 20 minute video clip called “Birth By The Numbers” that I linked to in the post. It goes into all of the reasons people try to give for why the US’s maternal mortality rate is poor and it breaks it all down in a very easy to understand way. It is very very well done.

  7. Yehudit Says:

    Maternal mortality is calculated by dividing the number of maternal deaths by the number of births, so that you get a rate per 10,000. Therefore it is unaffected by the absolute number of women giving birth.

  8. atyourcervix Says:

    We had an AFE at work just the other night. She coded. Very sad. She’s alive, but in the ICU. My first ever known AFE in 8 years of nursing!

    • nursingbirth Says:

      atyourcervix…holy crap! That is crazy scarey! There has only been one in recent years at my hospital about 10 years ago, I wasnt there. But because of it we now have a post-mortem cesarean section tray on all code carts so it can be done right in the room if necessary to save the baby. Sad and scarey. Luckily VERY RARE!

  9. Diana J. Says:

    Just got the news that their baby son died last night as well. What a tragedy.

    Rumor has it that a c/s was involved at some point, but no concrete details yet. I’ll let you know if I ever find out more.

  10. This really the saddest thing that can happen in maternity care. The death of a mother and child. I can only assume the mom had an emergency C/S because something tragic happened to her in labor, like an amniotic fluid embolism or ruptured brain aneurysm. This would also account for the neonatal demise.

    BTW, in the state where I work we consider a maternal death any death that happens within the year of giving birth. The mom could die of a gunshot wound 9 months after giving birth, and we count it as a maternal death. I have no idea if it is calculated this way in other countries or states.

  11. Kathy Says:

    RR — I’ve looked at maternal mortality, and the various ways it’s calculated. And it’s confusing. I think the latest thing from the WHO is to count “pregnancy-related maternal mortality” as the death of a woman within a year of the end of pregnancy, regardless of how the pregnancy ended (miscarriage, abortion, stillbirth, or live birth), and regardless of the manner of death. The strictest definition is the death of a woman within 42 days of the end of her pregnancy due to complications of pregnancy or childbirth.

    It does vary depending on the country, or even on the state, with some counting it as 42 days and other as 365 days; and some requiring the death to be due to pregnancy/birth complications, and others will allow any cause of death. So there are lots of variations.

  12. Missy Says:

    Great information! This tragic story has definitely drawn a lot of attention on the subject. I posted a few of your links on my blog so I hope you don’t mind. Every mom should have this information. I had no idea how bad it is here in the US!

  13. Jenny Says:

    I have nothing super interesting to add just wanted to say that I still love your blog and check it everyday for new entries. Keep up the great work!! 🙂

  14. Diana J. Says:

    Here’s the latest news on that story; I’m not sure how this would have affected a term baby. You probably know better than I!

    Cause of Kerry Martin’s death

    by Lynn French – May. 28, 2009 04:30 PM
    12 News

    The Maricopa County Office of the Medical Examiner has released the cause of death of Kerry Martin, State Treasurer Dean Martin’s wife. They say she suffered a ruptured benign tumor in her liver known as an adenoma. According to the American Liver Foundation, adenomas of the liver are rare and asymptomatic.

  15. Diane J.
    Thanks for the update. What a rare occurrence. My heart goes out to this family.
    The reason the ruptured ademoma would effect the term infant, is from blood loss. Maternal blood volume increases 45-50% in pregnancy, so a “benign” condition in a non-pregnant woman, can become a problem in a pregnant woman, if that condition is sensitive to blood volumes. The ruptured liver ademona could cause a catastrophic internal hemorrhage for the mom, thus causing hypovolemic shock in the infant. Very sad.

  16. Diana J. Says:

    Thanks for the info – I’ve definitely never heard of this one before!

    What a tragedy for this family.

  17. Aisha Says:

    From everything that I’ve been reading and from all the posts, it seems like interventions, inductions, drugs and c-sections are to blame for a number of complications.

    But when are the interventions, inductions, drugs and c-sections the best approach to a delivery? When are inductions necessary and safe? When are drugs necesary and safe? Which ones are better than others? What about c-sections, when is it warranted that a c-section is necessary? Sorry for the million questions. What should I do when I go into labor to be able to make the best decisions?! There’s soo much info!

    I’d love that Q&A. I feel like every new subject brings in a huge cascade of questions on my mind. I am 31 weeks pregnant with my first and I am one of those people that can’t stop researching stuff, so this blog helps me sum up many of the things that I have read. Keep them coming!

  18. Birth_Lactation Says:

    Melissa_ very well researched article/post and a very very sad tragic and rare situation. When I first heard the story, I thought of abruption or AFE or uterine rupture. My heart goes out to the family. I agree with RR ..and that was my first thought, that the baby had suddenly suffered intrauterine asphyxia or hypovolemia from a maternal incident. Very sad indeed. I guess his exact cause of death will be released soon.- AYC- We have had 2 AFE’s.. one coded and has some mild long term neuro-motor sequelae but otherwise intact and home with her baby. Another was victim of “nurse curse” … an ICU nurse actually and she and her baby did very very well. Her bronch confirmed amniotic fluid. That was so many years ago now, I don’t remember all the details. Wow…
    As always, I’ve learned again reading your posts..
    The other Melissa

  19. birthjunky Says:

    Hi all,

    NursingBirth – thanks for this informative post about US maternal mortality. It is a shame that we are ranking so poorly and I find it interesting to explore the many factors that contribute to this ranking.

    NY Times is running a three-part series on maternal mortality in Tanzania and the first article was entitled Death in Birth – Where Life’s Start is a Deadly Risk by Denise Grady. It’s interesting to posit this conversation into an international perspective…feel free to check out my blog reviewing the piece and opening up the discussion if you’d like: http://studentbabycatcher.wordpress.com/. (Feels odd asking people to visit my blog, but I’m taking the risk!) 🙂

    I hope you keep writing these great posts – they are awesome to read!

    Best
    BirthJunky

  20. What a well written, comprehensive and articulate article!!! i learned so much!

    I own “Orgasmic Birth” but never watched the extra features. I am so glad that you pointed out the 20 minute “Birth By the Numbers” piece.

  21. Erin Says:

    I’ve been reading around your blog and I have a question for you. I have one child, 13 mo, and wanted a natural childbirth. My husband & I put a lot of thought into where to birth him, because I was afraid of hospitals and interventions (way more afraid than of the birth itself) – we ended up finding a fabulous birth center, though it was an hour and half from our home. . . I won’t go into all the complicated details but it turns out that our little boy did require some interventions, though happily not a C-section – and we had to transfer to a regular L&D. I was overall happy with my care, etc, but one thing I learned about labor was how out of it I was – unable to think, let alone decisions. And I think the same was true for my husband. Now we’re contemplating a second baby, but we’ve moved too far to go back to the same birth center. I’m wondering what advice you might have in getting the birth experience (natural, no unnecessary interventions, no taking baby away) at a conventional hospital, since there are so few birth centers anymore. It seems like doctors routinely ignore and disrespect birthplans at your hospital. How can a laboring mom and freaked out dad insist that the birth plan be followed, esp since doctors always couch the intervention in terms of “the baby’s in danger! the baby’s in danger! Well you could wait, if you want your baby to DIE!” or whatever?

    It makes me so sad that we live in an industrialized nation with such talented doctors and nurses and such great hospitals and I’m still TERRIFIED to put myself into their hands for a birth.

    • nursingbirth Says:

      Erin, you have asked a question that is very important and very very common. I hear it all the time! I am working on a post about birth plans now (man I am so busy I havent been dedicating the time I want to this blog….so sorry!!! I need to start writing again!!) so I’ll better answer your question hopefully in a post soon but for now, I would seriously consider hiring a doula. I know that you probably dont have a few hundred bucks just lying around, especially since you already have a little one in your life :), but a doula is someone who is more than just a labor coach. She is a consistent voice, someone who has more experience in assisting women in labor than even the most savy moms & dads who have a ton of kids :), will advocate for you and your husband and your birth plan, is someone who you can trust when many of the people you will meet that day are strangers (hopefully nice strangers but strangers nonetheless). She “mothers the mother” and supports the father too even!! She can be a voice for your birth plan when you can’t. And she might be able to know when someone is pulling the wool over your eyes (ie Nurse: “It’s our policy to take the baby to the nursery for her first checkup” Mom: “I want my baby to stay here for her checkup.” Doula: “I have had many mothers at this hospital deliver that keep their babies with them and ask the pediatrician to do their first checkup right in the room. Would that be possible in this circumstance?”………….You get the idea!!) So please think about it. Visit http://www.dona.org and learn more about them!

  22. Angie Says:

    Dear Melissa,
    I have only just stumbled across your blog and I think it (and you) are fabulous. Such important information for women to have before they experience childbirth. I only wish I had had some of this information before my first delivery (in Australia) 4 years ago. I had an induction at 37 weeks, pitocin, prostaglandin, early rupture of membranes which lead to fetal distress and emergency caesarean, during which my bladder was injured, complications ensued and breastfeeding did not establish. Had I known that starting off with just one intervention for my baby 4 years ago would have set me on this track for everything else… well I never would have agreed to it. But my doctor didn’t really give me a choice at the time, I have no idea what I signed, I had no information about repercussions or anything.
    So – good on you for writing about your experiences and please don’t stop. Women need information and doctors unfortunately don’t often provide it.

  23. KhalilaAnn Says:

    As a side note to Erin:

    I was running into the same issue, and then I found out there was a midwifery center located IN my hospital! The best part is that it was covered by my insurance. They allow water births and have their own separate area of L&D. Plus you have immediate care should you need intervention of any sort a midwife cannot do. I did some research into them before deciding to switch from my OB and found out that they really are midwifes and not OB’s masquerading as midwifes. Maybe you can look into something like that?

  24. Red Pomegranate Says:

    As a fellow L&D nurse and a former blogster who just couldn’t deal with the nastiness I applaud your blog, I can see I will be coming here frequently. Thank you for bringing your insight, your EXPERIENCE, but most of all your compassion to these important topics.

  25. Erin Says:

    Thanks for the advice! We had a doula last time, and though we generally liked her, we found that she was WAY too passive for us, in terms of the advice she gave and her interaction with the hospital. I’ve realized since then that I need to be more pro active when choosing a doula to make sure her style fits with us. Her philosophy was to do whatever the mother wanted and not interfere with the natural process -w hich sounds great on paper, but it turns out I DID need advice and recommendations on positions, etc. I was also vomiting throughout early labor, which she said was normal, so we didn’t call the doctor for a long time until I was dangerously dehydrated, which was probably what caused the labor complications (being stalled out and me too exhausted to function for hours and hours and hours). . .

    Also, the birth center where I labored was in fact a center within a hospital. I loved the fact that it was a separate space from L&D but the transfer to L&D when needed was easy (my midwife and one birth center nurse came with us, which made a huge difference). We also were able to transfer BACK to the birth center as soon as my epidural wore off, so nobody interferred with the baby and nobody hassled us . . .

  26. Erin Says:

    PS I was just thinking that maybe we could start an informal database of mother and baby friendly hospitals, with information provided by the moms & dads. Does such a thing already exist?

    • nursingbirth Says:

      Erin, I agree, it is much better to have a doula that is on the same wavelength as you are! That is, are you looking for a doula that is passive or more assertive. Sorry to hear your doula wasn’t a good fit but glad to hear you had a positive birth center experience!!! As far as stats go please check out THE BIRTH SURVEY at http://www.thebirthsurvey.com/

      The Birth Survey asks women to provide feedback about their birth experience with a particular doctor or midwife and within a specific birth environment. Responses will be made available online to other women in their community who are deciding where and with whom to birth. Paired with this experiential data will be official statistics from state departments of health listing obstetrical intervention rates at the facility level.

      That is such a great question! Thanks!

  27. Kathy Says:

    Erin — there is already a website like that — The Birth Survey. Definitely go check it out, and if you’ve given birth within the past 3 years, tell your experiences. This is not just for “baby/mother-friendly” hospitals (although the people who run the website are definitely pro-natural-birth), but everyone can use it to give an honest description of what they encountered from their doctor, hospital, nurse, midwife, etc. If a woman was upset that she couldn’t have an epidural as early as she wanted to, then she can write that; if a woman was upset that she was coerced into taking an unwanted epidural, she can write that. And please spread the word as much as you can about this website, because I think it is important to have such a grassroots effort to really shine a light on obstetric care in hospitals.

  28. […] Please also see my post: Super Comment!: Maternal Death in the U.S., or TOP TEN Ways to Reduce Your Risk For Complications in… […]


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