Coped to fg.org as draft
TOPIC-3 pages 12 &13
Chapter 1. The motives behind the obstetrical profession’s 1910 decision to define normal childbirth in healthy upper-class (white) women to be inherently pathological and its far-reaching consequences
When I was first introduced to the highly obstetricalized childbirth practice of American obstetrics in the 1960s, the unquestioned policies and protocols that defined the care of healthy hospitalized childbearing women were already more than a half century old.
When I retired from L&D nursing 13 years later, the obstetrical protocols at a different Florida hospital still included drugging every new labor patient, whether she consented or not, with large doses of narcotics. Our docs were no longer giving the generic drug scopolamine, but only because a herd of aggressive pharmaceutical sale reps convinced them that newer and more expensive psychotropic drugs were ‘so much better’. All the other interventions and invasive procedures, from general anesthesia (the safer but still explosive gas Cyclopropane), forceps and manually extracting placentas, all continued on as if the 1910 version of interventive obstetrics were the law of the land.
Our OBs still believed they were doing the mother a big favor by cutting a ‘generous’ episiotomy to prevent “women’s troubles such as incontinence and uterine prolapse. When suturing the episiotomy afterwards they paid particular attention to “the husband stitch”. Obstetricians claimed these last few tights stitches would restore “virginal tightness” to the newly-delivered mother’s vaginia, the purpose being to keep her husband happy in the marriage bed.
Thankfully this specific historical period organized around racial discrimination and routine use of Twilight Sleeps drugs and general anesthesia for all its white labor patients is long gone. But unfortunately, the dysfunctional nature of interventionist obstetric for health women remains generally unchanged. This is the result of American obstetrical profession century-long refusal to acknowledge the important functional difference between healthy childbirth women with normal pregnancies, who don’t benefit from the routine use of obstetrical interventions, and pregnant women with serious medical conditions, high-risk pregnancies or who develop complications and quit obviously benefit from intensive obstetrical management.
The appropriate and cost-effective model of care for healthy childbearing women with normal pregnancies is physiologically-based (i.e. non-medical) care provided by family practice physicians and professional midwives. That is the system that has been successfully used in most Western European countries for the past 2 centuries but is decidedly not what happened in the United States, starting in 1910!
The lop-sided power dynamics between the obstetrical profession, the nursing staff as hospital employees specifically hired to carry out “Doctor’s Orders”, and the endless stream of laboring women has changed very little over the last half century. The obstetrical profession as a national system continues to treat normal labor in healthy women as potential emergency and childbirth as a surgical procedure. For the last half century, all the efforts of individuals, consumer organizations, professional groups, and hospital nursing staff to end these “business as usual” interventive practices have so far been futile. Unfortunately, obstetrics is about obstetricians, thus it is organized around the needs and wellbeing of obstetricians instead of healthy childbearing women.
Healthy childbearing women are still being constrained by harmful policies that result in them being talked into or scared into routine interventions such as elective induction, use of continuous electronic fetal monitoring and medically-unnecessary operative deliveries or Cesarean surgeries. Rather than a focus on meeting the biological and psychological needs typical for the majority of healthy labor patients, obstetricians order interventions that speed up or slow down labor or schedule elective and “repeat” C-sections. many obstetrician also believe these interventions help to protect them and their hospital from malpractice suits, but particularly a repeat C-section (i.e. to prevent a vaginal birth after a previous Cesarean). Other find these interventions to be economically advantages, as it allows them to attend more deliveries, and gyn surgeries.
However, L&D nurses who carrying out these interventions know full well that much of what they are being told to do to labor women is both unnecessary and harmful. Unfortunately, this charade – the idea that the pre-emptive use of obstetrical interventions makes childbirth safer for healthy women – goes on unabated every hour of every day in every hospital obstetrical department all across America.
