Debra Bingham, DrPH, RN, is the Executive Director of the California Maternal Quality Care Collaborative (www.cmqcc.org) at Stanford University School of Medicine. CMQCC is a state-wide California initiative to support physicians and nurses to improve maternity care. She was formerly the director of Maternal Child Health Nursing at two hospitals in New York City. Throughout her career, Debra worked to support safe and healthy births for both mothers and infants. She is the mother/stepmother of 4 children, grandmother of 7.
I am a nurse with over 30 years of high-risk perinatal experience. I became a high-risk perinatal nurse because I find it an honor to support families through the miracle of bringing new life into the world. I never tire of learning and discovering as much as I can about the 'simplexity' of such a universal yet personal life-transforming event.
Lately there are many troubling trends. Rates of maternal deaths and maternal childbirth-related injuries are rising in the United States. In fact, we have not seen maternal mortality rates this high since the early 1970’s. In addition, in 2007 the United States was ranked 41st among developed countries for maternal mortality rates. These negative trends and worsening outcomes do not make sense in a country with so many resources. (Click on this link to hear Debra elaborate). The key questions behind this statistics are:
Why has maternity care become less mother and newborn-centric, and more hospital, nurse and physician- centric?
Why is maternity care costing so much and yet bringing about such poor outcomes?
Last night when I vegged out and watched Father of the Bride, Part II the movie helped me see the answers to the questions more clearly. It stars Steve Martin as the father and husband – so you know that the movie is meant to be fun and over the top. However, in watching Hollywood's caricature of both mother and daughter going through a pregnancy and giving birth together reminded me how ingrained certain cultural rituals around childbirth have become.
This movie and most every sitcom or movie in the general cultural landscape unquestioningly portrays what are common, but often not scientifically based maternity practices. For example, (and this is just one of many possible examples), it is now common for a laboring woman to expect to be in bed tethered to an electronic fetal monitor when in labor.
While there is no evidence to suggest that constant fetal monitoring improves the health of the baby, there is a negative consequence to women being in a bed -- a seemingly innocuous change in how women had previously given birth for centuries. Being in bed has been shown to slow labor down, lead to more pain in labor, and to more dysfunctional labors – all of which cause more harm to both unborn babies and their mothers and increase the pain of labor. (For more information, I recommend Evidence-Based Maternity Care.)
Cultural norms affect beliefs and expectations. Beliefs and expectations affect cultural norms. It is a difficult cycle to alter. You have probably heard of the placebo effect, where someone thinks they are getting medicine, but they are not, but they get better anyway. There is also a nocebo effect that is not as commonly discussed. The nocebo effect is how negative expectations can also affect our physiologic responses by making us sicker. Indeed, it is a known fact that beliefs and expectations affect the cellular function of our bodies, our very biology. (see The Biology of Belief by Dr. Bruce Lipton for further reading.)
What does this have to do with maternity care?
Since beliefs affect physiologic functions, how women and men discuss the process of pregnancy and birth can have a negative or positive effect on the women that are involved in the discussion. Our words are powerful and either reinforce or undermine the power of women and their bodies. The next time you talk about pregnancy or birth, think about how your basic assumptions affect your discourse.
- Does your discourse include stories about the power of women?
- Or do the stories shift the locus of control away from women and their bodies to other authority figures such as nurses, physicians, or machines?
- Does your discourse assume that women are physiologically capable of giving birth and nourishing their own children?
- Or does your discourse assume that women’s bodies are fundamentally flawed and in need of medical attention and intervention?
In order for women to fully grasp the power of our bodies, we will need to become better informed. Great options for finding out more information are on the Lamaze International website. In particular, there is a blog led by my colleague, Amy Romano, CNM. There are also pregnancy emails that send weekly empowering messages to pregnant women and there are six evidence-based steps to having a healthy and safe birth.
There are also films that provide a contrast to commonly seen Hollywood images of childbearing and are helpful steps in moving us toward more meaningful discourse about maternity care practices in the U.S. I recommend them, not as depicting the ultimate solution to improving maternity care, but to provide another point of view:
Some of the action in the movie takes place at Roosevelt Hospital where I was the Director of Maternity Care Nursing. I either supervised or was a colleague with the clinicians interviewed or shown in this movie at this hospital. I also worked closely with Cara, the midwife in Ricki Lake's movie, before she became a midwife.
2) A movie by a colleague of mine, Debra Pascali-Bonaro entitled Orgasmic Birth. Debra's movie title is a bit provocative, but if you go to her link and hear her speak about her movie you will learn more about why she chose the title she did. It is worth checking out.
Both movies raise important issues about how maternity care is practiced in the United States and explore these issues in different, interesting, and provocative ways.
What are your thoughts?
How do we shift the public discourse around maternity care?
It would be fascinating to catalog stories around the birth of our children, or hear our mothers' tell of stories around our own birth. Would they illustrate the power of women? Or shift the locus of control away from us or our mothers?
Author Diane Setterfield wrote "All children mythologize their birth. It is a universal trait. You want to know someone? Heart, mind and soul? Ask [her] to tell you about when she was born". What is the story around your birth? Your children's birth?
And our dreams -- do they illustrate our power? Or do we give away all our dreams -- and their fulfillment to others, whether husbands, children, colleagues?
What of policy shifts? How would you move the conversation forward?