Wednesday, August 3, 2016

UnBreaking Birth

I recently watched this video "UnBreaking Birth" - a lecture by Ryan McAllister. It is basically a version of the lecture I have given a couple of times as a guest lecturer undergraduate women's/sexual health classes.

"How you're born affects the rest of your life, and can affect the rest of your mother's life, too"

"There are a host of values at play beyond safety"

He says our birth care system is broken for at least 4 reasons:
  1. There isn't a sufficient amount of space and time to build an adequate relationship between the mother and the caregivers
  2. Our interventions have become routine, instead of based on the mom and baby's best interests
  3. Those interventions are often opinion-based
  4. There are conflicts of obligation within the hospital that systematically cause behavior that is out of alignment with the mom and baby's best needs

"Even when they know that practicing a different way would be better for their clients, they have some reason to practice differently. That means that there are conflicts of obligation in the hospital. At times, when the hospital's best interest is over here, and the patient's best interest would mean you behave this way, the hospital's best interest wins."



"Obstetrics has been organized around handling high-risk, emergency surgical births. and they may do this well. But treating all births this way actually derails well-birth, which is the vast majority of births. So I think we need to keep the good of this system and pair it with another approach that doesn't break well-birth."
"How could we possibly find or create highly trained experienced professionals who have evidence based practices, who work within a strong relationship wit h the mother, compassion for newborns, and don't experience conflicts of obligation with a large institution?... Those practitioners already exist. They are independent midwives."

The video does not have ALL of the information on the topic, but is a nice overview for consumers. It covers:
  • Why birth is broken (evidence that we spend more on maternity care in the U.S. but have worse outcomes; evidence that c-sections are too high and it is not caused by women being in worse health)
  • The 4 reasons he believes our maternity care system is broken 
  • A system that would work better for well-birth (certified professional midwives, birth centers)
  • What YOU can do to help improve the system
This would be a great video to share in a class, because it is only 32 minutes long.

"Being aware of and making available these other options, especially independent midwives, but also including other birth assistants such as doulas, is key to unbreaking birth in the U.S."


I like the way the UnBreaking Birth says about the indicators that we have a serious problem. It is basically a run-down of why I do what I do as a public health professional and a doula/childbirth educator:
  • there are terrible health disparities by race and socioeconomic status
  • infant and maternal mortality rates are higher than in 45 other nations
  • the maternal mortality rate has risen every year since 1995 while in most other countries it has decreased
  • only 25% of obstetric practice guidelines are based on good scientific evidence, many are overtly contra-indicated
  • common hospital policies are not in the best interest of moms and babies
  • and we spend more than any other nation on healthcare
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