The Road to Better Obstetric Care?

05.12.11: Take the middle path


My friends and I watched Christy Turlington's documentary, No Woman No Cry (about global maternal health conditions) with our plates loaded with olives and cheeses, macaroni and salads, cookies and berries. We had so many choices it was almost impossible not to choose everything. Then, we watched as Janet, (a Tanzanian woman filmed in the documentary) endured days of labor. She'd walked for miles to a barebones, rural clinic that had no food to offer her, so Janet went hungry. The contrast between our feast and Janet's hunger was as extreme as the contrast between the medical world America represents and the very different ones the women in Christy's film had access too.

When we talk about the obstetrics today and how to deliver the best outcomes, it's clear there are too many contributing factors in each individual birth to pick one "best" way to deliver babies. Yet the loudest conversations tend to revolve around extreme perspectives as if there's only one correct choice between, for example: natural or epidural births, home or hospital deliveries, doing more or less c-sections. What works for one mother, culture or country may be too extreme in another situation. If America represents excess and Tanzania represents famine, maybe we should be looking for a healthcare model that's somewhere in between.

Christy and I talked last week about the extreme differences we see between various countries, birth philosophies and practices. As both a yoga and maternal health expert, Christy agrees the road to achieving the best maternal health for women everywhere probably travels the middle path. Take for example, a few of the noisy conversations currently taking place about American childbirth philosophies.

Home versus hospital birth

Christy said, "You hear people say, 'you should only have a natural birth or a homebirth because hospitals use too many risky interventions,' but that doesn't work for everyone. Some mothers die because they can't get to the hospital in time. Other people say, 'Nobody should ever deliver at home because it's not safe enough.' Yet, statistics show, most deaths happen in hospitals, not at home births. I'm not judging how anyone chooses to deliver. We need lots of education and plenty of resources to make the best choices. For me, that was a midwife and birth center, but located in a hospital." Christy's middle path option provided the natural home-like environment she wanted, but connected to all the medical help she ended up needing.

Natural or Medicated Births?

I've been in countless labors where women (and doctors) insisted on epidurals way too early before labor was really established. That led to complications and interventions that mother and baby didn't need. I've also been in deliveries where epidurals made the difference between a birth that was torture and a birth that was peaceful. I've been in all-natural deliveries that were as Zen as a monastery and ones that were like scenes out of Pulp Fiction.

What's the middle path? Maybe it looks something like this: We approach labor as naturally as possible for as long as possible. Then, we work with the experience and tools in front of us, but only the ones we need. Sometimes that means taking another deep breath or getting in a bathtub; sometimes, it means getting an epidural. There are a lot of steps to take between those two choices.

More C-Sections or Fewer C-Sections?

Women's health experts agree the current US model of obstetric care results in way too many c-sections. We should do fewer. However, the one c-section you didn't do, but should have, is a tragedy we know how to prevent. In other parts of the world, lack of trained health care workers and hospitals means too many women and babies die when a simple c-section would save them. They should do more.

What's the middle path? Let's look at how Norway and Ireland are leading the pack with the world's best maternal health statistics. Hint – They have more midwives, affordable (or free) healthcare, use fewer interventions, do fewer c-sections, and provide longer maternity leaves.

Pregnant women today are in a powerful position to blaze new trails for obstetric care. You can improve maternal mortality statistics by making sure your pregnancy is as healthy as possible. That means:

- Choose the right foods that allow great nutrition and adequate weight gain without packing on too many pounds. You don't have to be vegan and the occasional peanut butter cup won't kill you, but, don't over do it. Obesity leads to killer complications.

- Exercise regularly to keep your weight under control, your heart and lungs healthy and your mind and spirit humming. Don't worry about getting into the best shape of your life. Just take a walk or a class and do some yoga on most days.

- Excellent prenatal care - Choose providers who evaluate your health individually and prescribe customized prenatal care, but don't confuse "excellent health care" with "excess health care." Some doctors order everything off the menu from an endless array of tests and interventions, to cover all the bases (and ward off potential lawsuits). Most pregnancies are healthy and don't need to be treated like a potential disease.

Pick doctors and midwives with the experience to handle any potential emergency, but who don't think every patient should be treated like one.

- Support Other Mothers:

- Learn more about maternal health issues around the world at Every Mother Counts

- Check out and donate to CARE's work in developing countries

- Support mothers in your family and community to make healthy daily choices.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.