Does the American health system over medicalise birth?

[Schooldil3ma]

A friend of mine is giving birth in America. She had an easy pregnancy in her country of residence, and arrived in USA at about 32 weeks. Jeez, she has had every test, multiple appointments, it's been almost all consuming. She's now in hospital ready to start labour, again so many interventions, she's been in about 3 days already.

Do you think she's just unlucky, or is the way it goes, especially as she's obviously paying?

Frankly I think if you or your insurer is paying, doctors will tend towards more rather than less intervention on most things.

My only knowledge about maternity care is America is from watching ,sixteen and pregnant/ teen mom
So I have no idea if childbirth is portrayed as realistic, however they do seem to go for induction an awful lot and seem to jump straight to epidural rather than other analgesic options.

Yes, and there's a really worrying backlash against it called "free birth", which is a rejection of all medical interventions including scans. Mothers and babies have died as a result, or been severely harmed.

Yes, unfortunately, birth is generally speaking handled very differently in the US. It's one of the reasons I wanted to move away before dh and I decided to have dc (I'm a dual citizen and grew up in the US). Medical care is geared towards profit making, so the more interventions, the better. The practice of medicine is also quite risk averse in the sense of wanting to prevent litigation for malpractice. So more interventions are seen as 'better' from the standpoint of having patients perceive that they are getting the best possible care (and therefore, will be less likely to sue if something goes wrong).

There also isn't the same sort of national guidance and best practice around clinical care in the way that we have in the UK (eg, NICE). It's much more variable (also very dependent on what your insurance will pre-authorise, which is incredibly variable), and there is no national regulation of costs for procedures or medicines, which means that the providers of those services can pretty much charge what they want. It's hard to shop around though for the best deals as most people don't ask about the cost of gauze or one specific type of antibiotic when they are looking for the hospital to give birth in because who thinks of that?

It also doesn't help that in some states midwives as we would know them here can't provide birth care, so right from the start, it's so much more expensive and medicalised because consultant obstetricians cost more and are experts in medical intervention as that's what they're trained to do.

It's an incredibly litigious society, insurance for obs and midwives is crazy - I had to sign so many wavers to have a midwife led birth (almost identical to my U.K. birth) stating I understood the risks of not having a doctor deliver my baby! They ran every test under the sun

@UWhatNow

I had to fight not to have an epidural in the USA- I delivered both mine without pain relief, was absolutely fine, no heroics needed. Tooth pain is far worse

Natural childbirth is risky.

C-Sections are much safer option but much more expensive hence why not the norm in the UK. If we paid for our healthcare we would be offered the safer option like in USA.

The standard of care is poor here compared to what she will be getting.

Most births are doctor led in hospital rather than midwife lead. I saw an obstetrician for all my pre natal and post natal appointments and she was also at the birth. They are definitely more cautious as there is such a “Sue” culture. With my DS2 he was measuring big so I was given the choice of either a planned induction at 38 weeks or a C-section, they would not have allowed me to go longer and try a natural birth. I did like the continuity of care, I felt like I was always taken care of, rooms were all private etc.

Medicine is a business in US. There is a tendency to sue for anything so you'll get all sorts of tests just in case.

I remember someone saying they even charged for the nurse handing you your baby ($30+)

Watch Aftershock on Disney plus. It’s about the mortality rate in black women and women of colour during/following birth. It’s horrific and shows that high intervention does not necessarily lead to good outcomes.

I don’t think that was the case? C-sections are statistically more risky than natural birth. That’s not to say there are not risks. Giving birth is risky.

There’s a Ricky Lake documentary about this - I think it’s called The Business of Being Born. It’s really interesting! It was available on YouTube 11 years ago when I was waiting to go into labour with DD.

And obviously the risks go up in poor care environments, like an understaffed NHS mat ward

Thanks for all the replies. I really feel for her, she's been forced in to the role of "patient" rather than pregnant woman.

I'm probably naive as I had two wonderfully uncomplicated births and spent less than 18 hours in hospital both times from start to finish. Of course it was absolute agony and I was sore for days afterwards, but I mostly felt in control and that it was manageable. It seems like all my friends autonomy has been taken away and she's become a baby delivery vessel.

I did end up with an epidural but I was also give gas and air and diamorphine ,here in the UK.

I think because it’s not always a painful option and it seems nuts to jump in straight to an over medicalised birth. I managed without an epidural and was glad to have the option to see how it was all going without having to fight for it. Definitely would have taken it if it had been too much though!

It's not just there, it's happening over here too.
Starting with a sweep, leading to a cascade of interventions ending in a CSection which would have been unnecessary if we'd just leave well enough alone. Who'd have thought women strapped to a bed with monitoring wouldn't labour effectively, or that sterile hospital rooms aren't effective places to produce oxytocin yourself.

I've had all 4 of mine at home, despite objections at some point with them all, for the most trivial of things. I distinctly remembering the doctor telling me with no3 that I'd be holding a dead baby in my arms and it would all be my fault. They wanted to induce me at 37 weeks because 'I'd not don't this in a few years and my body would have forgotten how'.

It's rarely how it's sold though is it.

Ive been offered an induction with all mine and refused. They told me things like 'just think, you'll be so prepared and know the birthday in advance'. 'If I book you in for X day I can be your midwife.' 'It's only the same as going into labour, just a little push to help things along'.

Thankfully I knew better.

Well good for you but I for one am grateful for the medical intervention i had when giving birth ,ds1 was born with the cord wrapped around his neck three times and he wasn't breathing, thankfully he was rushed off and given oxygen, and he was fine ,
Ds2 was back to back and was born via ventouse neither might have survived without medical intervention ,birth is different for all women some have very easy births and some need lots of intervention,
The main thing is that the babies are delivered safely .

Gave birth twice. Once in USA and once in UK. In the USA there was more intervention than I would have liked. Went from no pain relief to epidural, with no option of anything less. (Second child in UK, no pain relief at all!)

It's not that long since women in USA were effectively knocked out for the birth, or attached to the bed so they couldn't move around.

The answer to your question is yes. It is over medicalised now, as the health insurance and medical companies all make money. A non intervention birth doesn't make them much money.

Your first paragraph is exactly what happened to me. I refused the sweep which my midwife offered. She did make it clear that it was entirely my decision and she was very supportive either way. The doctor on the other hand put the fear of God in me, telling me that as an over 35 year old my chance of still birth if I went over my due date was something like 7%.

I did do my own research but by that point, I was so anxious, I just went along with the doctors advice. After refusing the first sweep, I had one, along with a balloon, 2 pessaries and eventually, after nothing happening, a c section. I wish I'd just left well alone.

Did you read about the recent scandal in the UK for the glorification of natural birth to the detriment (and deaths) of mothers and babies.

I don't understand the backlash against medicalisation...death in childbirth and stillbirths were just par for the course not that many years ago. I'll take the science, thanks.