The author of “Pushed” on Early Elective Births

Following up on last week’s post on the Booby Trap of an early elective birth, we asked Jennifer Block, author of Pushed: The Painful Truth about Childbirth and Modern Maternity Care, to answer some questions on this topic.

Pushed shines a bright light on the state of birth in the U.S., from the record-high cesarean birth rate to the legal obstacles to midwifery.  It moves seamlessly from individual experience to research and policy, making the truth about birth accessible without sacrificing any rigor.  I was particularly amazed at some of the revealing quotes Jennifer Block was able to get.  Whether you’re planning a birth or want to change the health care system, you’ll find this a gripping read.

What’s driving the increase in early elective births?  What incentives are at play that make it increasingly likely that doctors will push an early birth without medical reason?

It’s so easy to blame women. A couple years ago a study came out showing the detrimental effects of late preterm birth on infants, and the headlines went something like, “women needlessly put babies at risk by demanding earlier delivery.”  But I would argue that women are not driving medical trends. It is physicians’ and midwives’ responsibility to practice good, evidence-based medicine and to educate their patients. Our system unfortunately does not provide incentives for practicing this way. The system rewards intervention, scheduled inductions and scheduled cesareans (less time for the same insurance reimbursement, less malpractice liablity, less unpredictability). If a woman comes in near her due date complaining that she’s uncomfortable, asking “can’t you just induce me?” and the provider “gives the customer what she wants” rather than taking the time to educate her about why it’s better for both her and her baby if they wait for labor to begin on its own, then the provider has the cover of “patient request” but the intervention is ultimately his responsibility.

What, in your view, are the top three things moms can do to avoid an early elective birth?

Women can be fully educated and know intellectually that 97% of the time, their body knows best (97% of women will go into labor by 42 weeks gestation), but it’s still really difficult for women to argue with a provider who’s telling them their baby might be getting too big, or their amniotic fluid looks low, or they’re past 41 weeks, or whatever the reason. So I think the best thing a woman can do is to choose a provider whose values line up with hers, who values spontaneous labor and will only suggest an induction for very solid, evidence-based reasons (the above are not). And women who have had previous cesarean sections should find a provider willing to support a vaginal birth after cesarean with the above criteria.

If a mom is being “pushed” into an early elective birth by her provider, what can she do?

Women, like all adult patients, always have the right to take part in their health care decisions, and to disagree with their providers, and even to refuse treatment. Women can ask questions like, “Am I OK? Is my baby OK? If so, then I’d like to…” This isn’t easy, and there have been scary cases where women are threatened with court orders and losing custody of their children for not following medical orders. That’s totally wrong and unconstitutional, but it does happen. Which is why it’s so so important that women really listen to their gut during pregnancy and find a provider they trust, who they know will suggest what’s best and safest for them and their babies, not what’s best and safest for the hospital, the malpractice insurer or anyone else.

Brought to you by Hadley Stilwell & A Mother’s Boutique!

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6 Comments | Last revised on 06/21/2011

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