by Diana Korte and Roberta Scaer

Trends in Childbirth

Eight years ago, when the first edition of this book was published, we told you that the two trends in childbirth were moving in opposing directions. They still are.

One trend is the growing number of hospitals providing homelike accommodations, including Jacuzzis and microwaves, plus the more than 140 out-of-hospital birth centers (with more than 40 in the works), which numbered in the dozens only a few years ago.

The other trend is high-tech childbirth. We've had routine IVs, labor induction, and cesareans for years. Now there's a growing emphasis on tests and procedures of all kinds. It starts early in many parts of the country, with pregnant women of all ages being encouraged to undergo prenatal testing. It continues with the use of the electronic fetal monitor (EFM) during labor for 75 percent of women (and before labor for some), as well as the ubiquitous ultrasound offered routinely in at least three ways (scans, Dopplers, and external EFMs).

And in the last eight years, the cesarean rate has increased from one in five births to nearly one in four. However, the good news about cesareans is that the rate has begun to drop, due primarily to the increase in the number of vaginal births after previous cesareans (VBAC).

What about home births, the defenders of all-natural, no-interference pregnancies? They have shrunk even more in the last eight years from 2 to 3 percent of all births to less than one percent today, according to a 1991 report from the National Center for Health Statistics. However, high tech is present in some home births, too, with the use of the Doppler instead of the traditional low-tech fetoscope. (Both are hand-held devices used to listen to the fetal heart tones, but the fetoscope doesn't use ultrasound.)

Which trend is growing the fastest? No doubt about it: Despite the leveling off of our cesarean rate and the upswing in the number of VBACs, high tech continues to dominate childbirth. If you're like most pregnant women, it's as much a part of your pregnancy and birth today as is your big belly. For most of you, your decision making about high tech is likely to be when and for how long you will use which of these pregnancy and birth tools, not whether you'll use them at all. The issue now is to use birth technology wisely and not be seduced by it.

Childbirth in the USA

Though there are more choices in the United States for birth attendant and place of birth than probably anywhere else on this planet, women mostly give birth one way here -- with a doctor in a hospital. And over the last eight years, despite the availability of these choices and with the exception of an increase in the use of midwives and VBACs, options in the birth process have become less -- not more -- flexible.

Birth plans, for instance, with their list of mothers' preferences during labor, birth, and hospital stay, were designed to help women get what they want. But today birth plans often carry little punch except for those women whose requests match their physicians' usual obstetrical routine. And the change in insurance coverage for those of you who have prepaid plans (with their limited choice of health-care providers and hospitals) can curtail your options even more -- unless you're willing to pay additional cash out of pocket.

Each nation's culture is reflected in how women experience birth, and that' s true here as well. Most American women expect labor to be painful and anticipate using a variety of drugs. And both expectations are met. However, women always vary widely -- no matter where they live -- about the "normal" amount of pain they experience, just as the "normal" length of labor and the "normal" number of days vary widely in pregnancies.

A 1988 study comparing labor pain experienced by women in teaching hospitals in the Netherlands and the United States found that the Dutch women did not expect to experience as much pain and used far fewer drugs for pain relief than American women. "There is in Dutch birth participants a deep-seated conviction that the woman's body knows best and that, given enough time, nature will take its course, whereas birth in America was characterized as much more of a 'medical event," noted one of the study's authors. In the Netherlands most women are cared for by midwives, which suggests that women are helped and encouraged in a variety of nondrug pain relief methods; 35 percent of Dutch births still occur at home. As old-fashioned and unscientific as that sounds to many of you, nearly twice as many Dutch babies survive per capita (even after allowing for racial differences) than in the United States.

But we don't live in the Netherlands; we live in medically oriented North America, where birth conjures up much fear and anxiety. And too many laboring women have been told we are going to give you Pitocin (or a cesarean)," which can increase their discomfort and pain, sometimes leading to panic and a body's total shutdown of labor.

Due no doubt in part to stories like this, we found that many of the original 2,000 survey mothers weren't satisfied with their birth experiences. According to the questionnaire responses we've received from readers, most women giving birth in traditional hospitals with obstetricians today still aren't satisfied. (See Chapter 3 for an entirely different reaction from those women who gave birth elsewhere with midwives.)