Consider yourself warned.
I JUST got done writing about Maternal Mental Health Awareness Week last week and here goes ACOG, getting me all riled up again.
Over the last two days, amidst speculation and excitement surrounding the new Royal Baby Sussex, articles from a variety of sources have come out talking about how, at the American College of Obstetricians and Gynecologists Annual Conference in Nashville over the weekend, obstetricians were making fun of Meghan Markle’s desire to give birth at home.
Let me say that again for the people in the back.
At an annual convention of obstetricians and gynecologists, a group of doctors poked fun of a woman’s desires for her birth.
What in the actual f*ck. And pardon my bluntness.
Here are some of the headlines:
Women’s Health Magazine- “The World’s Top Ob-Gyns Just Had the Most Savage Response to Meghan Markle’s At-Home Birth Plan”
This is part of the reason why more and more women are opting for non-hospital births.
This is part of the reason why more and more women are choosing midwives over Ob-Gyns.
This is part of the reason why 1 in 5 women experience maternal mental health issues postpartum.
According to wide reporting of the ACOG conference, Meghan Markle was the topic of conversation, or rather, the topic of a joke. Dr Timothy Draycott, envoy of the Royal College of Gynecology and a professor at the University of Bristol, reportedly said to “raucous laughter” from the audience of doctors that “Meghan Markle has decided she’s going t have a doula and a willow tree… let’s see how that goes. She’s 37, first birth… I don’t know.”
A willow tree, if you aren’t aware, is a Celtic symbol of fertility. A doula is a birth coach.
If it matters, last year at the ACOG conference, their suggestion for decreasing maternal mortality was to increase the use of hormonal birth control. If you don’t want to die, don’t get pregnant.
Who is ACOG
The American College of Obstetrics and Gynecology, according to their website, is a leading professional association of physicians specializing in obstetrics and gynecology in the US. The association believes that hospitals and accredited birth centers are the safest settings for birth (despite studies proving otherwise). ACOG hedges their statement that “each woman has the right to make a medically informed decision about delivery.”
ACOG’s position on doulas is as follows: “Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.”
Why Does ACOG Care What Meghan Markle Does
Presumably because home birth is not supported by ACOG in the United States. ACOG’s physicians don’t make money from home births and most insurance does not cover home birth, despite it being about 1/12 the average cost of hospital care. In the 1900s, a campaign was run in the US, wherein midwives were disparaged and the importance of obstetrics was elevated. “We saw a very deliverate approach, with campaigns to move people into hospitals and out of their homes,” said Dr Lisa Kane Low, an associate professor at the University of Michigan’s School of Nursing.
In the United States, home births make up less than 1% of all births (approximately 35,000 per year).
In England, recent studies show no statistical difference in safety between obstetric units and non-obstetric units for low-risk women. For women that have given birth before, planned home births resulted in fewer interventions (forceps/vacuum, induced labor, or antibiotics) with no impact to the baby’s health. Similar findings have been present in Canada and Denmark, where midwife and doula care are highly integrated into the obstetrics medical system.
Even prior to Baby Sussex’s arrival, news sources had been commenting on her rumored birth choices for months. I personally think the Washington Post said it best in its article “Why rumors of a royal home birth were greeted so differently in the U.K. and the U.S.” “…because the United Kingdom has long recognized the importance of home birth and midwives in positive birth outcomes.”
The article further points out- “Not long ago, both countries shared a respect for midwifery and home births. But over the centuries, they went in opposite directions. In the United States, technology and the dominance of obstetrics have served to diminish the status of midwifery and home birth.”
What is beyond fascinating, of course, is that in this obstetrics dominated birth atmosphere in the United States, the US has one of the highest maternal mortality death rates in the entire developed world. The United States is tied with Puerto Rico at 46th with 26.4 deaths per 100,000 live births, behind (among others): Qatar, Saudi Arabia, Kazakhstan, Bosnia, Lithuania, Libya, Estonia, North Macedonia, Belaris, Kuwait, and Montenegro. Approximately 700 women die yearly in the U.S. because of delivery complications and pregnancy, according to the Centers for Disease Control and Prevention (CDC).
In every other country measured in the investigation (over 100), the maternal death rate has stabled or has been falling. In the US, it has dramatically gotten worse, nearly doubling in just 25 years.
The United States is the “most dangerous place to give birth in the developed world,” finds a USA Today investigation. It’s research states that more than 50,000 mothers are severely injured during or after childbirth and 700 die. The USA Today investigation, “Deadly Deliveries,” found that there is very little tracking of hospitals’ maternal safety records – and hospitals are shy to talk about it. There are thousands of maternity hospitals across the country where women don’t know if proper safety measures are taken because hospitals are not required to report that information.
In the UK and Western Europe, fewer than 9.2 per 100,000 die in childbirth. Evidence now suggests that the mortality rate is low in UK due to the popularity of midwives and their patient-centered model of care; eliminating the use of C-Sections (except actual true emergencies), forceps, and doesn’t believe in inducing labor while concentrating on a natural birthing process.
This isn’t about home birth vs hospital birth, this is about respecting women
This is about practitioners using their platform to make fun of a woman’s desires for her birth. It’s estimated that 25% of these births were not planned to take place at home.
I truly believe January Harshe says it best in her book, Birth Without Fear:
I do not care what kind of birth you have… a home birth, a scheduled cesarean, epidural hospital birth, or if you birth alone in the woods next to baby deer. I care that you had options, that you were supported in your choices, and that you were respected.
How absolutely disrespectful is it of this group of professionals, whose sole purpose in their career is to care for women, to treat Meghan Markle this way? First of all, she never came public with her intentions for birth, there was only speculation. Second, why the hell do you care how she gives birth? She’s not your patient. You aren’t going to be held liable if something goes “wrong.” Third, if you talk about someone who isn’t your patient so freely in a public setting, what do you say about your patients behind closed doors when you don’t have the spotlight on you?
To say I’m absolutely disgusted doesn’t begin to touch it. Perhaps I missed my calling in life, I don’t know. I absolutely love birth and think it is the most beautiful and humbling experience in the world. I feel passionately about supporting women through this journey on the way to meeting their babies, and don’t understand how or why the world is so judgmental about things that have absolutely nothing to do with them and don’t remotely put them at risk in any way.
New Jersey Senator Cory Booker and Massachusetts Representative Ayanna Pressley introduced legislation in the Senate and the House just this morning, days before Mother’s Day, aiming to address the maternal mortality crisis in the United States+. The legislation aims to increase doula care access adn create a Maternity Care Home Project that would study a patient-centered model of maternity care (midwifery!!!). Sens Kirsten Gillibrand, Kamala Harris and Elizabeth Warren- all three 2020 Democratic presidential candidates- are co-sponsoring the legislation.