The five most important dangers of childbearing have much less to do with the biology of normal childbirth, and far more to do with historical age one was born into and the physical, social and political barriers of geography, economics, social prejudice, and mental health problem
- The historic danger of childbearing was to live before the development of scientific medicine.
- The geographical danger of childbearing is to live in parts of the world that don’t have a functional (scientifically-based and effective) healthcare system.
- The economic danger of childbearing is to live in a country with a profit-based medical system that is so expensive the family can’t afford necessary care.
- The social danger of childbearing is to belong to an ethnic or religious culture that rejects the use of modern medicine.
- The personal danger of childbirth is to be a pregnant woman unlucky enough to have a mental or emotional problem that causes her to reject life-preserving maternity services.
While the biological dangers of childbirth for mothers and their unborn/newborn babies are real, risks of death and long-term disabilities become vanishingly small when childbearing women have access to a healthcare system that provides effective maternity services and necessary medical services.
Currently, the most dangerous place in the world to be a childbearing woman has an MMR of 2,000 per 100K live births – that is one death for every 50 births. If you have 7 or more children, your chances of dying in childbirth are as high as 1 out of 8.
In a 21st century world, 99 times out of a hundred the problem is not the biology of pregnancy and childbirth but the inability, for whatever reason, to access to life-sparing maternity care and perinatal services.
Whether that is because a woman can’t afford care, it is geographically unavailable to her, or prejudiced individuals deny care to people of a particular color or ethnicity, or the husband (or mother-in-law) won’t ‘allow’ the pregnant woman to use medical services under any circumstances – childbearing is:
- a potentially deadly condition that
- results in tragic deaths of mothers and babies
- when normal childbearing are
- isolated from the modern maternity care process and
- appropriate use of elective and emergent medical services when indicated.
So the 4-part answer is so simple it may shock or even anger the reader:
it is lack of access to a modern (i.e. scientific and effective) healthcare system that provides maternity care to all childbearing women (regardless of ethnicity or ability to pay) by that is:
- Accessible, affordable and acceptable to the women it services
- provided primarily by non-obstetricians (midwives and GPs)
- includes referral to scientifically appropriate medical services as needed
- these medical, obstetrical & perinatal services are provided in a safe, timely and effective manner
The majority of unexpected problems associated with unattended childbirth can be prevented or successfully managed when licensing laws authorize professionally-trained midwives to:
- Provide regular prenatal care
- Physically examine and evaluate the health status of the pregnant woman and her unborn fetus prior to the onset of active labor (late pregnancy, very early labor), so laboring women with signs of a complication can be prophylactically transferred to medical services
- Be present during the mother’s active labor, the normal spontaneous birth of her baby, the immediate postpartum-neonatal period and the 6-week of follow-up care for both mother and baby.
This universal safety net includes initial and on-going screening for abnormal conditions and complications (with appropriate referral to medical services), routine prenatal care, a train birth attendant (midwife or physician) present throughout active labor, birth and immediate postpartum-neonatal period, with follow-up care routinely provided to new mother and baby and appropriate use of medical services any time a complication develops or the mother requests medical care.
What is vitally important – the core issue — is that modern and comprehensive health care systems exist, that childbearing women have access to it (i.e. no racial, ethnic discrimination and family is able to pay for needed services) and the childbearing family is willing to use such services (i.e. no religious beliefs that preclude medical care or introduce gender-related barriers to receiving such care).
Concepts of “safety” in regard to maternity care must factor in its acceptability to childbearing families it serves. Relative to regulations about the practice of California licensed midwifery, any regulation that leaves pregnant women without the legal options of midwifery care and thus forces them into highly-medicalized but unwanted hospital obstetrics or lay mfry or unattended labor and birth is functionally a denial of services that introduce totally unnecessary risks for both mother and baby. Many of these women have very real, very respectable reasons for declining hospital-based obstetrical care as a ‘risk-reduction strategy that
Many of these women have very real, very respectable reasons for declining hospital-based obstetrical care as a ‘risk-reduction strategy that unfortunately does NOT in their particular case actually reduce the risk to them, or it exchanges one set of risks (ones acceptable to the family) for a set that are may actually higher (ex. unwanted repeat Cesarean) and/or otherwise unacceptable to that particular family. This is particularly an issue for women with PTSD as a result of prior physical or sexual abuse or a previous traumatic birth experience.
Any law or regulation that creates an ipso-facto denial of services represents a one-dimensional definition of ‘safety’. Whether this happens as a result of politics or genuine concern, any law that prevents childbearing women from receiving the care they need is a bad law.
Time for a little Nancy Reagan’s “Just say No”!
