Hospital Birth Practices Are Not Evidence-Based

Does Anyone Care About Birth Trauma?

There are many traumatic so-called “ends to a pregnancy” — abortion, stillbirth, and maternal death, to name a few. At their best, hospitals exist to decrease the incidence of these negative outcomes. But often, despite the good intentions of health practitioners, malice can enter into the delivery room.

For example, 68 percent of American women who undergo a vaginal birth in the hospital give birth on their back, despite scientific research indicating that this position is more likely to prolong the pushing phase and increase the chance of vaginal tearing or vacuum use. However, this position is preferred by medical staff in the hospital, in part because it gives them easy lines of sight to catch the baby.

When hospital staff complain about a laboring woman’s “failure to progress” and rush her into a Cesarean, they may be citing outdated research by Dr. Friedman, whose eponymous Friedman’s curve has been used since the 1950s to determine the normal length of labor. However, Friedman’s estimation that women’s cervixes begin to rapidly dilate after reaching four centimeters was falsified in a more recent study which indicated that six centimeters was the golden number. This list goes on and on (yes, you can have a vaginal birth after a C-section and probably should).

In addition to pervasive bad science, mothers often have their choices made for them, sometimes with devastating results. Take the harrowing case of Caroline Malatesta. After three traumatic hospital births replete with laboring on her back, epidurals, and episiotomies, she wanted to make a change. Pregnant with her fourth child, she saw an ad for a hospital that trumpeted its honoring of a personalized birth plan, its birthing tub, and its nice birthing suites. She expected a more peaceful experience where she could labor in the manner of her choosing. Instead, she entered into a waking nightmare.

The night her son was born, she was hooked up to continuous monitoring, instead of the wireless kind she requested that would give her freedom of movement. Her request for the promised birthing tub was denied. When labor began to pick up and Caroline disobeyed the nurse’s strict orders to remain on her back, a group of them burst into her room and pushed her down into her previous position. Most despicably, they forced her baby’s head back into the birth canal to delay delivery for six long minutes, giving Caroline a permanent nerve injury. She was later diagnosed with PTSD.

I wish I could say these stories were uncommon. However, one of my favorite podcasts, “The Birth Hour,” recounts countless horrific tales of women who were given unwanted episiotomies, sedatives, Caesareans, and more. Some of the women recount their experiences with nurses who shamed them for not progressing fast enough or for refusing optional medical care for their children. Other mothers were separated from their children without medical need, denying them the important benefits of skin-to-skin contact after birth. Others were told they couldn’t drink water or eat due to fears of a phenomenon called aspiration, which recent science has, again, assuaged. Others had horrible C-section experiences — some after failed, doctor-recommended inductions — where nurses and doctors did not acknowledge the mother’s existence. Still others were threatened with the use of a vacuum if they didn’t push out their baby fast enough.

It is no wonder then, that America has an astronomical C-section rate compared to other countries — 32 percent out of every 1,000 births are Cesareans. The rise of C-sections since the 1990s is not coinciding with better health outcomes for mothers. In fact, the rate of maternal mortality has more than doubled from 1999 to 2019. While some providers like to shift the blame for negative outcomes onto the mother’s age or obesity, we need to call this phenomenon what it is — mass medical malpractice. No wonder women from all walks of life are paying out-of-pocket for doulas and going underground to find midwives.

I am not trying to demonize all medical professionals. Oftentimes, they are doing what they were taught, what they are told, or what insurance companies cover. Additionally, there is no place I would rather be for a truly high-risk pregnancy than in a hospital. However, the underlying incentives on a labor and delivery floor do not lead to good behavior. Doctors get paid more for C-sections and insurance companies reimburse the expensive procedure at a higher rate than they do for vaginal deliveries. As an added bonus, it’s a 45-minute surgery that can be done on the doctor’s timeline, much quicker than non-surgical labors which may last for days. 

For the women who are getting chewed up and spit out by this over-masculinized, brute force, efficiency-based Machine, they are told at the end of their trial that they should be happy — they have a baby, at least. But this is an unacceptable standard of care. Women are not widgets and pregnancy is not a disease. Thankfully, there are ways to make hospital care better, if only we have the will to change.