[Johnson]  The Miracle Machine

by Brian Johnson
May 20, 2009

The season of the Obama baby has arrived. Like many members of our generation, my beloved and I found the Bush years distinctly unarousing. Even today, I worry that newborns who catch word of Dick Cheney’s media blitz will cry foul and make a run back for the womb.

We were lucky enough to celebrate Barack Obama’s victory in Chicago’s Grant Park, where black toddlers were hoisted on white shoulders to see our new president-elect. We went home and celebrated some more. Now, we await the arrival of our first child.

By all accounts, we will have plenty of company this summer. In delivery rooms across the nation, nurses will pump synthetic hormones into IV lines. Mothers will gaze up at the ceiling, dead below the waist, as doctors attach vacuum extractors to babies’ heads. For a third of mothers, the miracle of childbirth will end in surgery, with doctors cutting open bellies to remove startled babies.

This American style of birth is now taken for granted by most parents, who regard modern medicine as their only salvation from certain doom. And while there is no question that certain situations require the intervention of a surgeon, many of the crises our medical system rushes to resolve were caused by that system in the first place.

Today, doctors often intervene in labor before it has even begun. Only 5 percent of women give birth on their actual due date, but once a woman is a couple days overdue, many doctors recommend inducing labor. Doctors induce labor using a synthetic hormone called pitocin. The hormone causes intense, painful contractions, so it’s usually only a matter of time before doctors urge women to get an epidural, an anesthetic injection into the spine. “Don’t be a hero,” they say. The epidural robs the mother of feeling below the waist, prolonging labor. With the uterus contracting like mad, and the woman too numbed to push, the baby may go into distress. Then, the surgeons finally do what they do best, which is cut. They will chalk up the Caesarean section as another triumph of medical science: another baby saved.

The truth is that the Caesarean section might not have been necessary if doctors had left the mother alone.

Since the 1960s, the Caesarean section rate in the United States has risen from about 5 percent to more than 30 percent today. Doctors offer many explanations for this medical embarrassment. Often, they suggest that Americans’ poor health is to blame, but why then don’t the pasty, chain-smoking British have rates as high?

In fact, even with so many Caesarean sections, our infant mortality rate is a national disgrace. Central Intelligence Agency data shows that the United States ranks No. 42 in the world in infant mortality. (Hats off to an agency that takes time off from waterboarding to collect infant mortality stats.) As usual, Cuba beats us, damn it. However, most of the 41 countries where it’s better to be a baby are in Europe, including the Netherlands, which has the highest home delivery rate in the world. Of course, most U.S. OB-GYNs denounce home births as dangerous.

Our maternal mortality rates are better, but they are creeping up as well. Again, technology that saves lives can endanger them as well. One reason maternal mortality is rising is that the risks associated with Caesarean section go up with repeated surgeries. Unfortunately, it’s not unusual for women in our country to have three or more Caesarean sections.

Now, I should make it clear that I am not judging women who get epidurals or Caesarean sections. I know that I will never face the trial of childbirth, natural or otherwise, and I don’t want the authorities to find my bullet-riddled body in a ditch somewhere, my wrists and ankles bound by nursing bras. The problem is with the medical system itself. In countries where natural childbirth is the norm, most women deliver that way. In our country, women face enormous pressure to submit to a medical system that does not serve mothers well. Women may clamor for epidurals, especially when doctors falsely assure them that there are no risks. But has any woman ever demanded an episiotomy?

The episiotomy may best symbolize the failures of modern medicine. No procedure causes mothers more dread, and rightly so. Cutting through the perineum with scissors would give even John Yoo pause. Also, there is no question that women who suffer episiotomies are slower to recover from childbirth. Still, most American women accept episiotomy as a gruesome necessity, possibly because doctors give the procedure to at least 90 percent of American mothers.

Incredibly, the episiotomy is more a matter of tradition than necessity. In European countries, the episiotomy rate in hospitals is only about 12 percent. The rate is even lower for home births attended by certified midwives. A Maternity Center Association study found that out of 5,000 home births, there were only 22 episiotomies, or about .5 percent. Doctors perform episiotomies because they think themselves too important to be bothered with massaging women to prevent tears.

Too often, doctors present women with a false choice between modern medicine and no medicine at all, between science and barbarism. For our part, my beloved and I will have our baby in a birthing center, with the help of a certified midwife. We will be well prepared by birthing classes and labor exercises. If something should go wrong, surgeons will be waiting just down the hall, but intervention will be our last resort rather than our first.

We make this choice not out of some mystical rejection of science, but because there is too little science in the medical model of childbirth. In place of genuine science, doctors offer the arrogance of traditional practice. The system is broken, and we will do what we can to avoid it.

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