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Rhonda Arthur

Arthur, of Floyd, is a certified nurse midwife, a women's health nurse practitioner and a family nurse practitioner. She works as a family nurse practitioner and teaches by distance learning for the Frontier School of Midwifery and Family Nursing in Kentucky.

I am saddened by the realization that even though the United States spends more money and routinely practices intensive medical management of childbirth, we continue to rank near the bottom of industrialized countries in infant and maternal mortality rates, and are experiencing rising preterm births. With all the money we spend and intensive medical management, there is a big problem with our outcomes. Why do we have such dismal statistics? Statistics in this case are in fact the lives and well- being of women and infants.

I believe our outcomes are related to our attitudes and current system of medical management of pregnancy and childbirth. More than half of the labors in the United States are chemically induced; even more frequently, artificial rupture of membranes occurs. Women frequently spend their labor lying in bed strapped to continuous fetal monitors, have food and water restricted and IV tubes in their arms. None of this is physiologic and does not promote normal, healthy labor and birth.

The overuse of induced labor and Cesarean section without true medical indications is in part responsible for our poor outcomes. In America, about 30 percent of women give birth by Cesarean section. This procedure is a major abdominal surgery that carries about three times the maternal death rate as vaginal birth. After Cesarean section, women are twice as likely to have stillbirths in subsequent pregnancies and have more frequent incidence of life-threatening problems for themselves and their infants. The Cesarean scar makes it more difficult for the placenta to attach and has resulted in situations where the placenta grows through the uterine wall, leading to maternal hemorrhage and at times resulting in the uterus and even the bladder being removed. Any subsequent abdominal surgery is more difficult and carries more risk due to scarring and adhesions.

Potential complications of inductions and elective Cesarean sections include premature birth. Premature birth carries many additional risk factors such as breathing, feeding and developmental problems for the infant. Premature infants often have to spend more time separated from their families, have frequent painful medical tests and treatments and are hospitalized longer than term infants.

Our current system of care for mothers and infants needs urgent change. These changes include full disclosure by doctors of the risks of the medical care being given. Doctors often suggest the rising induction and elective Cesarean section rate is due to women's choice. If mothers were given complete and accurate information, fewer women would choose induction and Caesarean delivery. They also should be presented with the evidence that vaginal birth results in babies with less asthma and chronic lung disease and fewer learning disabilities. Additionally, mothers need to be informed that there is no evidence that Caesarean section prevents future urinary incontinence.

If doctors, hospital administrators and Virginia lawmakers are truly concerned over women and infant outcomes, they should look at successful models of care with the best maternal infant outcomes such as those in the Netherlands, Sweden and Denmark. These countries promote physiologic childbirth and have midwives provide the care to normal, healthy women. Care provided by midwives has been shown to reduce the Cesarean section rate. Midwives spend time with women, offering the woman and her family education and support, and are experts at normal pregnancy and childbirth.

Currently in Southwestern Virginia, it is very difficult for Certified Nurse Midwives to provide care to women. Despite the fact that many women request this care, local hospitals have failed to provide the additional choice of nurse midwives to the mothers of the area. Certified nurse midwives are legal in Virginia, but must have an agreement with a collaborating physician. Currently, nurse midwives have been refused such agreements in the Roanoke area. When individual physicians have agreed to work with certified nurse midwives, their employer hospitals have not allowed this collaboration. Certified nurse midwives work in all states and in other parts of Virginia, but have unfortunately met barriers in Roanoke.

I encourage readers to call local hospital administrators and request additional choices of care for our mothers and infants. Request that all women be given complete informed consent in their care and that women have the option of nurse midwifery care. Even if you are not expecting a baby now, you know others who are or will become pregnant.

It is simply not acceptable that American women are 70 percent more likely to die in childbirth than European women. It is time we take a serious look at a superior model of health care and demand change. A movement to support women in more physiologic birth, supported by certified nurse midwives, will not only decrease the cost of health care, but also reduce infant and maternal morbidity and mortality. How can doctors, hospital administrators and lawmakers argue with those outcomes?