Sheldon Wasserman, MD Obstetrics/Gynecology Prospect Medical Commons

December 01, 2006

What does politics have to do with birth? Politics is about power; birth is the natural process in which life begins. Yet, the fact that women today give birth in a hospital setting, under the care of medical professionals, raises questions.

Where does the power for making decisions about birth lie — with women or medical professionals?

Some women are concerned that the balance of power has shifted towards the medical profession. Have women given up their power to give birth as they choose? What can be done to restore the balance of power?

At the core of the issue is the fact that birth is a very natural process, something that women have accomplished from time immemorial. In fact, women giving birth in a hospital setting, under the care of medical professionals, is a recent phenomenon, one with benefits and consequences.

Medical professionals often view birth in the context of risk. We approach it by managing what may go wrong instead of what can happen naturally. The fact is that the vast majority of births are classified as normal births. Yet cesarean birth rates and inductions are soaring. In many developed countries, one out of every three babies arrives by C-section. Likewise, induction rates are rising well beyond the medical need for them. Women and doctors alike are increasingly opting for inductions just for the convenience of being able to schedule births. And the use of epidurals is definitely the norm, with more than 90% of women opting for epidurals in some places. At the same time, low numbers of women are opting for natural birth.

Many factors contribute to the pendulum swinging towards more medical intervention. First, in today’s litigious society, the fear of malpractice lawsuits, combined with the fact that many women are having children later in life, consequently making those pregnancies high risk, drive some doctors to push for cesarean births. At the same time, some women prefer to schedule this surgery than to have vaginal births. In Rio de Janeiro, Brazil, many wealthy women prefer to have cesareans with the discreet “bikini cut” than to go through labor and a vaginal delivery.

How can we restore the balance of power so that women can consider, and should they choose, decide to pursue a natural childbirth? We should nurture open dialog and communication between women and health care professionals. The result will be a more educated mother-to-be with an awareness of her choices and their benefits and consequences.

And those educated mothers-to-be should choose medical partners who support women and families decisions regarding their birth experience. Women should actively seek a hospital and doctor who will encourage them to develop a birth plan that articulates their wishes. For their baby’s birthplace, they should seek a supportive atmosphere with an attentive, experienced nursing staff; preferably offering doulas for additional emotional and informational support and comfort.