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Brittany Ashinhurst
Professor Holloway
English 2010
18 February 2015
Pregnancy Care in America
For many, if not for most people, having a baby is an exciting, life changing experience.
For the next 9 months or so parents are making important decisions that not only affect them but
their child/children as well. In America the most common practice is once a woman finds out
shes pregnant she quickly finds an Obstetrician/Gynecologist Doctor (OBGYN) usually referred
to by friends or family and starts planning what hospital she can deliver at and who she should
she pick to do the photo shoot of her new born baby. The parents usually then start discussing
baby names and what the nursery would look like and start saving up for the latest fashionable
needs and accessories for a new born baby for which he/she will quickly outgrow and joining
groups and classes to try and learn everything they can about what their OB/GYN suggested.
But are we as a nation focusing on the wrong parts of having a baby? Yes having a baby is
exciting as well as everything else that goes along with it but again why is those topics our main
focus? Why are we as a nation not educating ourselves on the topics that really matter? For
example, why is it that for America our first choice to take care of women during pregnancy an
OB/GYN who specialty is high risk and surgery instead of midwife? Why are cesarean (Csections) rates so high in America? And why are all these drugs that are pushed at the hospital
considered necessary in order to have a baby? It seems like our standards for maternal care and
giving birth have declined dramatically and we just sit back and let it happen.
OB/GYN vs Midwives: An OB/GYN is a medical doctor who can specialize in several
areas concerning the health of woman. Most think they are the baby doctors but they can also
specialize in several different areas such as gynecologic oncology, infertility, and even
reconstructive pelvic surgeries. They usually have their own private practices as well as working
with several different hospitals. When it comes to maternal/fetal medicine they are specialized

and concerned with the care and consultation of patients with complications of pregnancy and
are required to have the knowledge of obstetrics, medical and surgical complications of mother
and fetus, current approaches to diagnosis and treatment, and newborn adaptation.
(Obgyn.com).
A Certified Midwife (CM) or a Certified Nurse Midwife (CNM) on the other hand offer many
service concerning womens health but they mainly focus on normal, healthy pregnancies. Most
work with physicians and go more the natural, intervention free route. Though midwives are the
primary caregivers for pregnancy for the majority of the rest of the world, less than 1% of
women use midwives here in America.
Cesarean rates in America: Part of the problem with pregnancy care here in America is
that most of the health care providers view normal, healthy pregnancies as health issues. In the
United States, if you define all births as 'potentially dangerous', then you would make the
argument that you need a specialist for every birth. That perspective has persisted, and, given
that, we've got a problem. (Declercq, Eugene). In 2013 the American C-section rate was
32.7%
(Births - Method of Delivery) with a maternal death rate of 28 woman per 1,000 births,
compared to Swedens C-section rate of 17.2% and a maternal death rate of 4 woman per 1,000
births (Maternal Mortality Ratio). So why is it that America who is advancing in medical field
ranked 50th in the world (Sweden is 4th) for maternal care? A few possible reasons could be the
ratio of OB/GYNs to patients? C-sections are far more expensive than a normal vaginal birth so
money could be a big reason, convenience of knowing exactly when your patients are going to
have their babies so it doesnt mess with your weekend could be one and our health care system.
Many of our lower economic women who are uninsured do qualify for Medicare but there are far
less tests and procedures covered with Medicare. Now dont get me wrong. OB/GYN are

important BUT they should be working with the high risk pregnancies. Those are the patients
that should be getting their undivided attention. And C-sections should only be happening when
its a true emergency for the mother or baby and not used as a convenience for your job. In
Sweden if you are not high risk you work with a midwife and they must be doing something
right because their C-section rate is about half of Americas with a much lower maternal/fetal
death rate.
Interventions: Intervention is a term used by the medical field when they want to speed
up the birthing process, or if there is an emergency. The most common intervention is the use of
synthetic oxytocin AKA Pitocin. Pitocin is used for mainly two reasons. The first one is to help
the mother dilate by making her contractions more constant and more intense and the second
way is to induce contractions after the baby has been born to help stop bleeding if the mother has
started to hemorrhage. But The following adverse reactions have been reported in the mother:
Anaphylactic reaction, postpartum hemorrhage, cardiac arrhythmia, fatal afibrinogenemia,
nausea, vomiting, premature ventricular contractions, pelvic hematoma, subarachnoid
hemorrhage, , Hypertensive episodes, and rupture of the uterus (Pitocin - FDA Prescribing
Information). What the funny thing is, is that the doctor will give the laboring woman Pitocin to
help speed up her labor which has a high side effect of making her hemorrhage postpartum
and then to give her another dose to stop the hemorrhaging that could have been caused by the
first dose? And rupture of the uterus? A womans uterus if you dont know is made of very
strong muscles. So to give her a drug that could make her uterus pop like balloon does not seem
like a drug should be handed out like candy. Right now in America Pitocin is now a standard
drug to give a woman in a hospital unless the women specifically tells the hospital no. The next
common intervention is the famous epidural. An epidural is a drug they put into your spinal cord
to numb the lower half of your body so a woman doesnt feel the contractions. When given

during childbirth, epidural anesthesia may cause labor progress to decrease, leading to an
extended labor time and, in some cases, a Cesarean section. (Kresser, Chris). So when a
laboring woman walks into the hospital she is most likely in pain and will want an epidural
which in turn slows down her labor. She is then given Pitocin because her labor has stalled and
the process goes back and forward between 2 drugs that in a way contradict each other and the
end result is a mother and baby in distress and they are heading to the ER for a C-section. Which
could have been avoided if these drugs werent so heavily pushed. In Sweden because the
majority of the care is provided by midwives interventions such as Pitocin and Epidurals are
rarely used with the exception of the higher risk pregnancies.
In conclusion we can see that our healthcare system is in need of much improvement. The
first and foremost important thing we could do to change our maternity care is for more women
and men taking control and doing more and more research about pregnancy, about certain tests,
and the drugs that a OB/GYN wants to prescribe, etc. If you do happen to have a high risk
pregnancy then sticking to an OB/GYN is a very smart thing to do. But if you are the majority
who have normal, healthy pregnancies and OB/GYN might not be in your best interest and you
can look into what a midwife will provide. Second, many woman here in America are not
comfortable with the idea of having a home birth unlike Sweden where it is the normal to have a
home birth. Here in America we are slowly starting to have midwives who do deliver at hospitals
or birthing centers but depending on where you live one might not be available to you. If we
could start collaborating more midwives and OB/GYNs and meet in the middle hopefully we
could improve our system and lower our numbers with C-sections and maternal/fetal mortality.

Figure 1. The national U.S. cesarean rate in 2012 was 32.8%.The national cesarean rate has not changed since
2010 when it declined slightly from 32.9% in 2009, the only dip since 1996. Cesarean section is the most common
operating room procedure in U.S. hospitals. Overuse of this procedure is associated with excess morbidity in women
and babies. For both commercial and Medicaid payers, total maternal-newborn costs are about 50% higher for
cesarean compared with vaginal births. (U.S National Cesarean Rates)

Figure 2. Percentage of births occurring out-of-hospital: United States, 19902012

NOTE: Out-of-hospital births include those occurring in a home, birthing center, clinic or doctor's office, or other
location.
SOURCE: CDC/NCHS, National Vital Statistics System, birth certificate data.

In 2012, two-thirds (66%) of out-of-hospital births occurred at home, and another 29% occurred in a
freestanding birthing center. (The remaining 5% of out-of-hospital births occurred in a clinic or doctor's
office or other location.)

The percentage of home births increased from 0.84% in 2011 to 0.89% in 2012. This percentage has been
increasing since 2004 (0.56%).

The percentage of birthing center births increased from 0.36% in 2011 to 0.39% in 2012. This percentage
has been increasing since 2004 (0.23%). (Out-of-Hospital Births)

Figure 3. CNMs/CMs practice wherever women give birth. In 2012, the majority of CNM/CM-attended births
occurred in hospitals (94.9%), while 2.6% occurred in freestanding birth centers, and 2.5% occurred in homes.
(CNM/CM-attended Birth Statistics.)

Works Cited
"Births - Method of Delivery." Centers for Disease Control and Prevention. Centers for Disease
Control and Prevention, 22 Jan. 2015. Web. 18 Feb. 2015.
<http://www.cdc.gov/nchs/fastats/delivery.htm>.
"CNM/CM-attended Birth Statistics." ACNM. Web. 23 Feb. 2015.
<http://www.midwife.org/CNM/CM-attended-Birth-Statistics>.
Declercq, Eugene. "Eugene Declercq | SPH | Boston University." SPH RSS. Web. 18 Feb. 2015.
<http://www.bu.edu/sph/profile/eugene-declercq/>.
Kresser, Chris. "Epidural Side Effects - Pharmacy Drug Guide." Epidural Side Effects Pharmacy Drug Guide. Web. 18 Feb. 2015.
<http://www.pharmacydrugguide.com/Epidural_Side_Effects>.
"Maternal Mortality Ratio (modeled Estimate, per 100,000 Live Births)." Maternal Mortality
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