Consumer Reports: high-tech births=poor outcomes

Consumer Reports isn’t just for researching your next car purchase or washing machine anymore. That’s right, that longtime resource for product reviews has broadened its scope to include health and wellness. In a recent article Consumer Reports tackles the topic of childbirth, concluding that "Too many doctors and hospitals are overusing high-tech procedures."

Consumer Reports cites a new report, Evidenced-based Maternity Care by the nonprofit Childbirth Connection, which found that "in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies." Some of those interventions include:

  • Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005
  • Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
  • Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization’s recommended national rate of 5 to 10 percent
  • Electronic fetal monitoring, unnecessarily adding to delivery costs
  • Rupturing membranes ("breaking the waters"), intending to hasten onset of labor
  • Episiotomy, which is often unnecessary

The study suggests that high-touch, low-cost, noninvasive measures are underused in today’s maternity care for healthy low-risk women. These include:

  • Prenatal vitamins
  • Use of midwife or family physician
  • Continuous presence of a companion for the mother during labor
  • Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one’s back
  • Vaginal birth (VBAC) for most women who have had a previous Caesarean section
  • Early mother-baby skin-to-skin contact

They’ve also included a quiz to test the consumer’s knowledge about maternity care and debunk several misconceptions. Here are a few examples from the quiz.

An obstetrician will deliver better maternity care, overall, than a midwife or family doctor.

False. Studies show that the 8 percent to 9 percent of U.S. women who use midwives and the 6 to 7 percent who choose family physicians generally experienced just-as-good results as those who go to obstetricians. Those who used midwives also ended up with fewer technological interventions. For example, women who received midwifery care were less likely to experience induced labor, have their water broken for them, episiotomies, pain medications, intravenous fluids, and electronic fetal monitoring, and were more likely to give birth vaginally with no vacuum extraction or forceps, than similar women receiving medical care. Note that an obstetric specialist is best for the small proportion of women with serious health concerns.

Once you’ve had a C-section, it’s best to do it again.

False. Studies show that, as the number of a woman’s previous C-sections increased, so did the likelihood of harmful conditions, including: trouble getting pregnant again, problems delivering the placenta (placenta accreta), longer hospital stays, intensive-care (ICU) admission, hysterectomy, and blood transfusion.

Labor itself can benefit a newborn’s immunity.

True. When babies do not experience labor (if the mother has a C-section before entering into labor, for example), they fail to benefit from changes that help to clear fluid from their lungs. That clearance can protect against serious breathing problems outside the womb. Passage through the vagina might also increase the likelihood that the newborn’s intestines will be colonized with “good” bacteria after the sterile womb environment.

The buzz in the blogosphere about this is mostly positive. Critics of the current state of birth in the United States are happy to see Consumer Reports raising awareness about the need for change and bringing this information to mainstream society.

The blogger at Rain Garden says, "I feel encouraged that a non-profit organization like Consumer Reports is picking this up on their radar – it is just one more spark that may ignite change."

Susan at Hug the Monkey agrees and says, "It’s kind of amazing that a mainstream and respected organization like Consumer Reports has gotten behind natural childbirth. This must signal a shift in our society’s ideas."

Shay at Augeries of Innocence says, "This just goes to prove pretty much everything that is in The Business of Being Born. If you haven’t seen the DVD, I highly suggest you watch it, rent it or buy it. Even if you’re not wanting to go completely natural for your birth, it has a lot of helpful information on it and really lets you see how wonderful the childbirth process can be."

Yogi Barrett, a prenatal class instructor who blogs at Five Points Yoga, says,

Though women and their partners shouldn’t have to become “experts” on maternal and fetal care when they’re pregnant, it’s very helpful to remember that you are a paying consumer. I recommend finding a doctor or midwife who will take the time to answer the questions you have, and who will talk to you about your choices, options and alternatives. Too often, women come to my class and say something like, “My doctor won’t let me go past my due date. She’ll induce me if I do.” We have to remember that we have a responsibility in all of this to ask questions, and know that it’s *our* decision whether we have that test or procedure. We cannot abdicate responsibility for our bodies and our babies, even if a doctor/midwife presents a procedure as non-optional. The time to set up this dynamic is before you’re in labor – it’s difficult to have rational conversation and decision-making in the midst of active labor!

If you’re pregnant, remember that you need to have confidence in your provider. It’s never too late to switch providers if you’re unhappy. I’ve had students switch providers mere days before giving birth! But also remember, the most important person to trust is yourself, and your baby.

I couldn’t agree more. As a natural birth advocate myself, I think the fact that Consumer Reports posted this study is huge and another step in the right direction. Women want to be informed, they want to make conscious choices regarding their prenatal care and their birthing care for their sake and the sake of their babies. The more information women and their partners easily have access to, the more empowered they will be to make choices that are best for themselves and their babies.

Cross-posted at BlogHer.

17 thoughts on “Consumer Reports: high-tech births=poor outcomes”

  1. I’m not sure if an epidural and epidural painkillers are the same thing, but I had an epidural with my first. It ended up being a good thing, because I’d be in labor for ages, my labor stalled and I was in considerable pain and distress. The epidural masked the contractions caused by the pitocin they gave me, and I was able to get some sleep.

    However, the doctor botched my epidural the second time around, causing some severe side effects in me (baby was fine) and the OB that delivered me wouldn’t let me get off my back, even though I begged him!

    Great post!

  2. I’m an insider. I’m a RN and have been a L&D nurse and a midwife. I’m all for interventions when they are appropriate. There is a balance between using technology for the good of infant and mother and high interventions to raise costs.

    I get a little tired of the “natural” birth vs. what, unnatural birth? A C-section is an unnatural birth (and the rise in their rates is both due to mother vanity–getting a C-tuck at the same time and to increase in malpractice law suits and of course, the requisite insurance), but if it comes out of your Vajayjay (!!) it’s a natural birth, whether your medicated or not.

    Have the birth you want. Communication is key with your birth attendant. If you have an epidural or any medication for pain control, you didn’t do it unnaturally, you just chose a different route.

    I’ve been on the receiving end of several home births gone bad. Three resulted in infant death, for easily managed conditions in the hospital, one resulted in a cerebral palsy kiddo, and one, we lost the mother. For these reasons, I gave birth in a hospital with a highly rated neonatal ICU. I also enjoyed a fantastic epidural, which in no way affected my son. In fact, I see the quiet, easy, peaceful way of a child arriving with pain control in many ways superior to tramatic, painful delivery.

    Some of the quotes in the article are a little outdated and not completely accurate (just an insiders view here.) Sometimes birth plans go out the window when a mother or infant’s life is at risk. I would tend to side on caution vs. allowing a woman to choose her birth position. For example, a hemorrhaging woman would not be aware of it, a change in position could threaten her life or uterus.

    Our grandmothers prayed for less infant death and pain control. Interventions are not evil, bad, whatever. I think overuse of interventions has a lot to do with insurance companies and hospitals profiting easily, and without question by such procedures. It’s good to see that people are beginning to question them more.

    When necessary, though, I side with as much intervention as possible if it means just one life is saved or kept from debilitating handicap.

  3. I think it’s awesome that Consumer Reports is stepping up to the plate on this issue. Especially, since the audience for that magazine is HUGE. Natural birth is so controversial that by spreading the information on why it doesn’t have to be…and why it should be less envasive may help people understand their options. Without riding my the high horse here- I’ll just say KUDOS to Consumer Reports- I hope that more woman make the informed decision.

  4. I think that frequently there is too much intervention for pregnancies and births that are not complicated. One thing I did was write a birth plan and had my doctor sign it and then waved it everyone’s face while at the hospital. I kind of had to be a bitch about it.

    Of course, things don’t always go as planned and I did have to deviate from my plan but ultimately ended up with a healthy baby.

    I think sometimes we divide into camps as to what is right and what is wrong, what is natural and what isn’t. I think what we need to keep in mind is that childbirth still kills about 600,000 women per year worldwide. I think invasive procedures that err on the side of caution are a fair trade-off. More choice is good but it wasn’t that long ago where having a child was the most dangerous thing that any of us could do.

  5. I just wanted to point out to previous commenter that sometimes the hospitals don’t give the mom a choice when it comes to interventions. When I had my first, the nurse injected me with a pain killer without telling me what it was or asking if I wanted it. I had a reaction to it and it made me retch so violently, I couldn’t hold my baby for hours. With my second, I was told I had to lie flat on my back because another position would disturb the monitoring device, but I didn’t want the monitoring, I wanted to try a different position to aleviate my pain. I wasn’t given a choice, and I think that sucks.

  6. Lilbet, I respect you as a professional with work geared towards helping parents and babies at a very wonderful time in their lives. I agree with some of what you said but also want to remind CDG’s readers that while babies do die at home while being birthed, they still die in hospitals too. It’s a unfortunate part of life and I am so sorry for anyone who has had to experience it. I am fortunate that I had a fairly trauma free unmedicated hospital birth with our first and a trauma free homebirth with our second. We, as women, have to accept that we cannot control an experience that truly isn’t ours. We all have one birth experience and when we are considering the birth “we” want to have, we should really be considering the birth that is best for our baby. Does this mean for some that they end up with a medicated experience because they are so scared and terrified that they can’t joyfully welcome their child? Yes, it seems so. Does it mean that for others they would be quite the opposite if allowed to birth in comfortable surroundings such as their homes? Most women who choose to give birth at home have such a different view of birth (mind you I said “different” and am not placing value on the views here) which leads them to their decision. Same with hospital births.

    Quite honestly, I think that a HUGE problem for American women is that we make a lot of our birthing choices based on fear and not empowerment. For a variety of reasons we have been stripped of our dignity and pride for being the portion of our species that •gets• to bring another living, breathing human being in to this world. There’s no denying that there is supreme feminine power in that ability and that there is absolutely nothing, in my mind, that compares to it. We are constantly given information that feeds our fear and scares us to death. It keeps people in the hospital, monitored, drugged, etc. There are certainly care providers and hospitals that use interventions on an as needed basis but am shocked that there are so many that use them routinely for perfectly healthy, routine labors. That’s the problem and that’s where parents need to be educated more. They don’t need to hear all about what can go wrong (talk about planting seeds!!) but they need to hear more about what will go right. What is considered naturally routine (please see definitions of “natural” below) and what the limitations are for that routine.

    It sounds to me as though Consumer Reports will empower women with more knowledge so that they can be truly educated. Interventions used when there are dire circumstances can’t be replaced by any means!! We are so very fortunate for that. I’d venture a guess that my great grandmother would have hoped for interventions that could have saved her twin infants (back in the 30’s) but I’m sure that she wouldn’t have hoped for interventions that would have led to abdominal surgery if the labor and birth was “normal.”

    They wanted pain controlling methods because they were strapped to the table, w/o their spouse, mother, etc. and were left to labor on their own. The pain alone caused by lying down, nevertheless with your wrists and ankles strapped down, would have been unbearable. Add to that no emotional support, no opportunity to rub your big sweet belly and encourage the baby…well, I’d be hollering for pain meds too. We are very fortunate that we get to move around (depending on whether you are “strapped down” to the bed by monitors w/o real cause) and have our partners or family in the room with us. We are fortunate in quite a few states that we can labor and birth however we want at home with the whole dang neighborhood if that’s what made us feel most comfortable.

    Birth should be about choices and women need to have the most choices given to them as possible. It first starts with them informing themselves with good, balanced information and with us quieting ourselves when it comes to horror stories and shouting the news when it comes to the goodness of birth.

    Note: I’m including some definitions of “natural” thanks to I do so because “natural” can certainly be applied to birth. However, I tend to use “medicated”, “unmedicated”, or “intervention free” these days simply because “natural” seems to ruffle quite a few feathers.

    •existing in or formed by nature

    •growing spontaneously, without being planted or tended by human hand, as vegetation

  7. Great post! I would add that having a birth plan and a doula are great ways to reduce your risk of interventions. I couldn’t have a midwife (couldn’t get one that would take me), but did have a doula and it was great!

    @kayris – I also had an epidural with my first birth and I am convinced that it is the reason that my labour stalled and took so long. Second time I went natural and my body was able to fully engage in moving things along, I could use gravity by walking around, etc. MUCH better experience.

  8. I think that it’s important to empower ALL patients, no matter what the procedure they’re going through. I’ve seen such strong feelings when it comes to “MY ideal birth”, “My birth plan” etc.

    There is NO birth plan that is followed completely. No birth is what any mother thinks it will be, intends it to be.

    I think you would be surprised at how many birth plans are NOT read by labor and delivery staff. Quite honestly, we rarely have the time, but in a good patient/nurse relationship, there will be communication. And our best intentions are to provide what you want. Your birth plan, if you are fit to discuss it at that time and if your doctor/midwife or his/her partners are familiar with it, will be attempted to be followed. There are things, though, that you may not understand that are going on in addition to what you think you are experiencing.

    That said, if a fetus is in any way in jeopardy, we will err on the side of caution. And that may mean you don’t get to position the way you want to. Sorry, moms, but if your baby’s heart rate is dropping, I need to make sure it doesn’t die. My objective at the end of the birth is a healthy baby and healthy mom. That doesn’t always equate to a satisfied mom when it comes to the “experience”. It saddens me, though, when moms don’t judge the experience by the outcome, but the fact that they didn’t get what they wanted in an experience that is spontaneous and fragile in its predictability.

    I think birth is the beginning of realizing that raising a child is NEVER going to be as you expect it. You will never control your birth. Being in communication the best you can is utmost. BUT, that isn’t an issue just delegated to a birth experience.

    I’ve seen people make such uninformed choices for surgeons, medical procedures, medications, etc. With a little education, communication, AND most importantly TREATING YOUR HEALTH CARE AS YOU WOULD ANY OTHER CONSUMER GOOD. Pick and choose the right provider for you and then make sure you make educated choices.

    There is so much emotion, nope, that’s the wrong word. There is so much anger when women start speaking out about birth experiences and what is RIGHT. The goal, ultimately, is to do what’s right for you. I do think fear is a healthy motivator for health care. Isn’t it a realistic motivator? If you say no, then I don’t think you’re thinking clearly or your not willing to give a little just for the sake of argument.

    Cerebral palsy occurs at the time of birth from oxygen deprivation. For ME, having a home birth would never be an option, as cerebral palsy could occurred with a delayed delivery. This is a healthy fear, a healthy motivator for ME. Do as you wish.

    I would be curious to know why so much emotion about birth experiences? I have to wonder if the emotions attached to it have other sources. More than anything, it’s the one experience in our lives where we’re not in control. I think THAT is what scares people, what sparks their strong reactions.

    For the record, my grandmother was not strapped down during her deliveries and she would have never wanted her husband with her. At that time, that would have been taboo and she would have died of shame! At that time, we didn’t have immunizations, rudimentary cancer treatment, etc. Medicine is an evolving science as is all of life. With time, we hope, things get better. I often see home birth advocates shun technology, but yet want to use it in other areas of life. I guess I find it hard to understand why. I think you would need to speak to some of my patients who lost children or walk in their shoes to understand. I held too many sobbing moms, who said, “I want to do it over. I made a horrible mistake.”

  9. Wonder if any of this has to do with when the actual OB shows up? I had 2.5 flippin hours of pushing before the OB showed up (I thought she took forever, turns out the nurse had JUST called her). 20 minutes after she showed up — with her coaching my son was born. Sure wish she’d been called earlier!

  10. My first birth I really wish I had pushed for just one more day’s delay. I was 9 days late, and because he was about to go on vacation my OB insisted we go in for an induction. I was in light labor at that point, so I really think one more day would have allowed me to do it on my own.

    And I think I would have been fine with a different OB. He’d already introduced me to the other doctors in the practice just in case.

    My second was a very necessary C-section.
    Would’ve had a late term miscarriage without due to breech position and lack of amniotic fluid. I don’t resent that one at all.

    My current OB wants to do another C-section. I’m working on changing OBs because I want a VBAC! Hubby’s insurance is changing and she’s not on their list, so it should be easy. Found out which hospitals in the area allow VBAC, which was apparently a part of the issue with the current OB.

  11. Hi wonderful post as usual!

    I was a devoted advocate for homeopathic birthing options until I actually experienced a mind-alteringly painful and violent thirty-hour childbirth. Afterwards I heard this wonderful show of John Ashbrook’s on npr talking to the author of the book Sex, Time and Power and it really altered the way I see gender politics and childbirth (news ends at 6 minutes):

    It really brings together a lot of what everyone is talking about.

    For my second childbirth I remained more open-minded. I labored for 7 hours then fell madly in love with the anaesthesiologist. I think I loved my epidural so much that if there was some opportunity for recreational use I would jump at it. My second birth was beautiful and joyous.

    I support and applaud any woman who unlike me is physically capable of going it natural and those options should always be open, but I think we also need to be kind and nurturing to ourselves no matter what path we need to take.

  12. As another L&D RN, I mostly side with Lilbet. While the article made some points that I think are valid, the way that a few things were stated are misleading — for example, stating that midwives use less forceps and vacuums — while that is true, the fact that in many states midwives are not permitted to use those items themselves was not mentioned.

    I fully support being educated about things, and having an idea about how you would ‘ideally’ like things to proceed. And I won’t deny that there are some interventions that might not be necessary. However I think that one person’s definition of unnecessary might not be another’s — I can read a monitor and gather information that someone who is not experienced in OB simply can’t – and just because the intervention doesn’t seem like it’s needed, doesn’t mean that it isn’t. The idea is to step in before something truly bad happens.

    The other thing that I wish had been pointed out in the article is that the patient population is changing, and with that the level of care that many are requiring is also changing. There are people who do not require a change in their level of care, but many do. I have to wonder if some of the rise in interventions is due to the fact that the population in general is not as healthy as it once was.

    Homebirth is not something that I believe in, although I know that other people do. Like Lilbet, I have been on the devastating end of some, and it is something that I won’t ever forget. While I know that many people are able to have very lovely births in their homes, all of the perfect home deliveries in the world will never erase the bad outcomes from my mind.

    The same can be said of hospital deliveries. Most of my patients are blessed with uncomplicated, easy deliveries that meet the expectations that they laid out. But because I have see some that turn so bad so fast, I am ready for things to change at the drop of a hat.

  13. Thank you for this great article and for quoting me! I think the more expectant parents can think of themselves as *consumers* of healthcare, the better off they will be navigating the medical journey of parenting (including birthing).

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