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?

Am I right in thinking that gas and air isn't really offered in the USA? Is there a specific reason for that? Maybe fewer other pain relief options means that more women have an epidural?

Gas and air is only really available in the UK. Rest of the world thinks we are slightly bonkers with gas & air. They all have epidurals or nothing.

I think it's a great mid way, non interventionist pain relief for the mother's body, doesn't affect baby and it stops the instant you stop breathing it.

Friend in the US may have had room service and a plush room but she was also given an epidural as soon as she walked through the door and made to give birth on her back with feet in stirrups.

The c section rate is over 30% and majority of babies are born during regular working hours. Yes c sections can be risky and much harder on the mother than a straightforward natural birth but the risks are I suppose known upfront. Besides, doctors get paid more to do c sections and it gets the mother out of the labour ward quicker than waiting for labour to progress naturally.

Midwives vary from state to state. Some states they are illegal, other states the qualifications are questionable. Although there are states that have midwives that are degree qualified nurses like here. But birth options are pretty extreme I think. Either a heavily medicated hospital birth with a high chance of intervention or winging it at home with a doula and hoping nothing goes wrong and hope a hospital accepts you if it does.

Evidently not. Maternal mortality rates in the US are amongst the highest in the world at 17 per 100,000 compared to 6.5 in the UK
www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries

@x2boys
I agree, babies need to be born safely, medical intervention is important and does have its place.

If there was a medical reason that I needed an induction I'd be the first in the queue, if it honestly would have made one jot of a difference I'd have begged for one, It being a couple of years more than they'd like between pregnancies isn't one, there also isn't any proof to show that after a gap me or my baby was more at risk. So much was over medicalisation of something that didn't need to be medicalised.

Look into the big baby trial. They recruited hundreds of women without fully informing them of the risks, they told them they needed an early induction for 'big baby' outcomes were no better if not worse than waiting to let women go into labour naturally.

Look at the new NICE guidelines, inducing people based on skin colour, not because it makes a difference medically, but because black women in labour simply aren't listened to and their outcomes are shocking. Instead of doing anything that matters they induce them early.

@Indoctro

I hope to god you're not an actual medical professional.

For a healthy woman having a healthy pregnancy a home birth is significantly safer than any other birth (obviously not everyone's cup of tea) and provides the best results for breastfeeding and maternal mental health. A Csection is the riskiest.

There's obviously situations where a C Section is the safest option. But it isn't and shouldn't be the first port of call for all women.

@CbaThinkingOfAUsername

It's a common story, and one which I believe is what leads to so many women having terrible birth trauma.

My husband is a GP, one consultant told him to 'talk some sense into her (me)' when I refused an induction at 37 weeks for a child measuring less than one I'd delivered hanging onto the kitchen table when the hospital said I didn't sound like I was struggling enough to be in labour 14 months earlier. A midwife wanted me to book in at 40 weeks for an induction advised I google images of stillborn babies to encourage me to make the right decision.

I home birthed my first at home when nobody believed I was in labour, I had to take him in for checks to the postnatal ward, the midwife who I'd spoken to on the phone came to see me and told me off for not coming in sooner. There was no way I was going in with the others unless medically it was required.

I think I'd prefer the option of pain relief when I want it and to be believed when I say I'm in pain. If that's over medicalised then so be it.

gas and air is disastrous for the environment and not a great drug to be exposed to long term (not a prob for individual women in labour, but it is a potential problem for midwives/obstetricians who are exposed to it regularly). Wouldn’t be surprised if it disappears from labour ward here too in the future.

*Natural childbirth is risky.

C-Sections are much safer option but much more expensive hence why not the norm in the UK*

could you post links to back that up please?

@MrsPelligrinoPetrichor

Less medicalised shouldn't mean not being listened to or not receiving what pain relief you want.

You can have a CSection and it not be an over medicalised birth.

The idea is medicalising things for the sake of it. Instead of seeing a midwife every few weeks, seeing an OBGYN weekly.
Instead of going into labour naturally, booking an induction for a date that suits your OBGYN's schedule.
Having continuous monitoring as standard throughout labour.

Yep you are spot on there.

@Indoctro

C sections are not safer for the mother and come with risks too. Everyone wants a safe delivery but a surgeons knife doesn't mean better - also proven that babies do better after vaginal delivery, something to do with bacteria in the birth canal

Strange if the US standard of care is soooo much better & safer, then why do more mums and babies DIE in childbirth in the US than in the U.K.?

I think the arguments between natural and c section birth is pointless. I know this because I spent a very long time researching the stats on both. There’s only about 2 or 3 studies in the whole world which actually compare low risk maternal request c’s vs low risk natural births and they were very small studies. Most research compares all c sections (most being emergency or medically indicated elective) with natural birth. Obviously that’s going to skew stats majorly when the people in one group are the people having issues anyway - and the natural birth group are also ending up a quarter of the time in the c section group - just those who are having issues switch sides and so that skews it too and high risk situations end up in the other group. They really need to improve research in this area so women can make informed choice. .

There’s also the point of who is the priority. I am not sure if the following is true because of the shit data - but for arguments sake say if natural birth is safer for a mother and less safe for a babe or vice versa - then how are we designating which is safest?

Basically I went round in circles with all of this. The data isn’t clear and even if it was you are weighing impossibly difficult outcomes against one another.

On the America thing - it’s not right that it’s automatically over medicalised. If a woman wants or needs that fine - if not they should have less intense options available.

America’s population is extremely unhealthy. 30% are overweight, 30% obese and 10% severely obese. That leaves only 3/10 people who are a healthy weight.

So I don’t think their outcomes vs U.K. outcomes are necessarily comparable.

I’ve given birth in both systems.
gas and air was completely useless and didn’t help one bit when I was in the socialised system. Waste of time. Then I had to wait hours for an epidural. My recovery was terrible. Sharing a room meant I couldn’t rest.
In the US, I had to be induced as I was already 12 days past my due date and the movements had slowed down. Because I was given pitocin I had to be attached to a monitor. As soon as I requested an epidural the anaesthesiologist came - no waiting.
post birth, I recovered in my own room. I was brought iced condoms every couple of hours, food, snacks. I really had some time to recover.
no competition for me really.

I thought the safest method of delivery for mother and child was elective c-section?

Data on c sections obviously included emergencies so is not reliable.

I only need to glance at the birth injury boards to know that pursuing a natural birth at all costs is not for me (and having had a forceps birth myself).

Why would we not medicalise one of the most significant things to ever happen to our bodies and one with so many extreme possible outcomes.

@completelyunderwhelmed

Medicalised and over medicalised are different.

Would you want an MRI every time you had a mild headache? Or an endoscopy everytime you had heartburn? Antivirals everytime you had a sniffle?

I think there's a midway point to be had between no interventions at the risk to mother and baby and overmedicalising to bump up cost, however for people saying outcomes here are poor, they're certainly not comparatively to the US.

I err slightly on the more medicalised side, but that's personal preference for me.

I've given birth to two babies in the US. They get you in and out as soon as possible. The care I had was fantastic. There are no post natal wards full of people/babies and other women's husbands talking, eating and using the bathrooms. I had a private room with my own bathroom. Even shared rooms are only two or three bed and you can asked to be moved if you are not getting along with your room mate.

They do not do a lot of unnecessary procedures to run up the bill because they have to go through your insurance company, the insurers can refuse cover. Also if a doctor or hospital were overcharging or doing unnecessary tests etc, they wouldn't be on the insurers list of 'preferred providers'.

It's to bump up the medical bills as insurance pays and increase their salaries and to mitigate any risk of a medical negligence suit being filed against them. Not a bad system if you can afford it. Very risk averse. The nhs could learn from it

I was brought iced condoms every couple of hours, food, snacks. I really had some time to recover.

Eh?

We have it here in Ireland as well. I personally found it absolutely useless. It made me puke my guts up.
I'd hate to have the US system with no community nursing. No public health nurses (our equivalent to health visitors) . My friends sister had a baby recently in the US and once you were discharged from hospital then that was it. All fine if you have amazing health insurance but what about poorer mothers. At least we have a place to call just to get the baby weighed or small things that you may not need the gp for.