With Freedom Comes Responsibility

I saw a commercial on TV last night that made me stop short. It aired about 3 times during the course of evening programming. Each showed 3 brief cameos of educated, well dressed women stating what they wanted in birthcare, and then at the end the logo of a local hospital where they can find such stellar care. Dare I suggest, that women have been taught to ask for care options only within very defined boundaries. Sure its okay to ask for midwifery care, good nurses, or qualified doctors, but who would aire a commercial with women asking for water birth, a massage therapist, or intermittent monitoring? I'm afraid so-called childbirth education has become a tool for manipulating women with precise and limited knowledge. I've been amazed by how tightly regulated it is by doctors. They now own most of what is known as childbirth ed. It should be called "Childbirth Indoctrination." What is needed is a new way to educate women about birth- but of course they have to want to know more than what they are currently being spoon-fed. Which brings me to my next rant.
Did anyone happen to read the latest issue of US News and World Report (June 12, 2006)? If so you might have caught Dr. Bernadine Healy's, On Health column, titled, "Birthing by Appointment" that starts out "Cesareans are in; pushing is out." Dr.Healy goes on to outlay the National Institute of Health's report on rising c/s rates caused by maternal choice, not medical necessity. She doesn't quote a percentage but states that "close to a third" of babies are born this way. She gives a nice quick overview of the past century and ends with an acknowledgement of the baby-boomer led natural birth movement that has ended with our daughters seeking the most medicalized births of all. Reading this made me recall a comment from my midwife friend Sandy who bemoaned to me last year that "All the midwives daughters are having cesareans." Dr. Healy attributes a lot of this, oddly enough, to consumer-directed healthcare. (What was I just saying about choice and control and how we can be free to make bad choices?) Of course my theory is that healthcare has created its own Frankenstein when it comes to women opting for nonmedically necessary cesareans. The same fear laden messages women are given about birth, have made them not only subsurvient to the healthcare system, but have pushed them beyond mere complience to requesting a procedure they think gets them out of "doing" the birth. There is also the issue of convenience which benefits both care providers and consumers.
So what was the NIH's take on all this? They don't know. Thats right, that bastion of learned medical wisdom, that flagship of research authority that others look to, couldn't figure it out. They could not conclusively say which was safer for a low risk pregnancy, an elective cesarean or a vaginal birth. But they could conclude this; more research needs to be done.
Dr. Healy ends the article with a quote from a physician willing to go on record as saying that vaginal birth is better, and even that providing elective cesareans presents an ethical conflict. (Wow, what is this guy, some kind of heretic?) However, he also admits that a woman's autonomy must be respected, as well as her informed and thought out decision making process. (Okay, this one leaves me scratching my head, but I knew yesterday when I was writing that a woman could take my same argument for homebirth on the basis of control and power and use it for elective cesarean. It's here that my logic gets stuck, I admit.)
The article on the whole was balanced and appealing except for the last sentence. She writes, "Welcome to the world of consumer-directed healthcare." She seems to be indicting that very freedom of choice as the crux of the problem. But again I state, women did not get to this place on their own. The culture of fear that surrounds birth and that is passed on in doctors offices and childbirth classes, at the office water cooler and around the dinner table has brought women to this place. I've gone round and round about this in my head and the conclusion is always the same; with the freedom of making choices comes the responsibility to be well-informed.