1. Medicalization of Childbirth
Created by: Caitlin Richman, Akilah Patterson, Allyssa Pena, Jessica Trygier, Erika Henry, Ellie Mendelsohn

2. What is the medicalization of childbirth?
Medicalization of childbirth: when medical professionals use technological medical interventions at any stage from pre-pregnancy to post-birth
What are ways this process has become so medically focused?
pre pregnancy care- in vitro fertilization
pregnancy care- electronic fetal monitoring, ultrasounds, pre natal testing
childbirth- epidurals, labor inducing drugs, fetal monitoring, cesarean section
post pregnancy- episiotomies, eye treatments, shots
The Business of Being Born
The medicalization of childbirth refers to when the pre-pregnancy, pregnancy, childbirth and post- pregnancy care is managed by medical professionals and usually involves a high degree of technological medical intervention throughout each stage

3. Why is it an Issue?

4. Why is it an issue? Childbirth is a natural process… However,
Over time, more physicians view the process as a disruption to health
This causes pregnancy to be thought of more as an illness and nothing else
Not all mothers wish to have medical practices intervene with their pregnancy… However,
Doctors use their expertise and authority to sway mothers during birthing process, can often lead to unwanted use of drugs or even a C-Section
Currently, doctors are seen as the primary managers of reproduction
This frequently restricts women from playing an active role in their own pregnancies and childbirth
The medicalization of childbirth has become an issue because most people would like to consider childbirth as a natural process. However the medicalization of childbirth basically interprets pregnancy as a disruption to health that needs medical intervention to have positive outcomes, which in turn makes thinking of pregnancy as primarily about health and illness and nothing else.
Hopkins did research on this topic and discovered that doctors were active participants in the decision making of the mothers actual birthing process and they used their expertise and authority to convince women to choose to have a Cesarean Section

5. History
These are some instruments used during labor in the 1880s: often times cracking babies skulls

6. History of the Medicalization of Childbirth
Until the 17th century: Births in most parts of the world were exclusively in the home and prenatal care was little to non-existent
19th and 20th century: Stronger medical influence set in
Development of new forms of anesthesia
Cesarean sections
Safe blood transfusions
20th century: Hospital births became more common
Forceps introduced in the birthing process
In the past, hospitals were only used if a problem occurred
Monitoring, managing and potentially intervening in childbirth
Now, medicalization of childbirth is commonplace for what once developed as a last resort

7. Current Status

8. Current Status
The vast majority of births in the U.S. are delivered in hospitals.
In 2012, 98.6% of all U.S. births occurred in hospitals.
Doctors of medicine attended 85.8% of all hospital births, certified nurse midwives (CNMs) attended 7.6%, and doctors of osteopathy 6.0%.

9. After a gradual decline from 1990–2004, the percentage of out-of-hospital births increased from 0.87% of U.S. births in 2004 to 1.36% of U.S. births in 2012, its highest level since In 2012, 53,635 births in the United States occurred out of a hospital, including 35,184 home births and 15,577 birthing center births.

10. Out-of-hospital births generally had a lower risk profile than hospital births.
About 4.4% of out-of-hospital births were born preterm (less than 37 completed weeks of gestation), compared with 11.6% of hospital births. Similarly, 3.2% of out-of-hospital births were low birthweight in 2012, compared with 8.1% of hospital births. Multiple births comprised 0.8% of out-of-hospital births and 3.5% of hospital births

11. Cesarean Section (C-section)
In 1965, a little over 4% of all babies were born surgically
Today, 1 out of every 3 births (33%)
In a study of 15,500 women who received care from midwives:
1 in 16 (6 percent) of participants required a cesarean birth
Compared to nearly 1 in 4 (24 percent ) similarly low-risk women cared for in a hospital setting
A study, which included more than 15,500 women who received care in 79 midwife-led birth centers in 33 US states from , found that fewer than 1 in 16 (6 percent) of participants required a cesarean birth compared to nearly 1 in 4 (24 percent ) similarly low-risk women cared for in a hospital setting.

12. Costs
According to the WHO analysis, the United States had the third highest number of unnecessary Cesarean sections in the year 2008, costing the country an estimated $687 million.
Average total cost for hospital birth for a woman with 80/20 insurance, a $500 deductible, and one baby in the United States is:
Natural birth at hospital: $10, Cost to patient = $500 + $1900 = $
C-Section birth at hospital: $25, Cost to patient = $500 + $5100 = $
Conclusion: Birth Center or home birth are extremely cost effective.

13. Pre-Natal Care

14. Pre-Natal Testing What is it? Carrier Tests Screening Tests
Maternal blood tests
Screening Tests
Diagnostic Tests
Amniocentesis
Chorionic Villus Sampling
Fetal blood sampling

15. Controversy Procedure is very invasive to the fetus
Miscarriage is a risk 1.9% rate after CVS and 1.4% after amniocentesis
Can be risky for both mother and baby
Tests do not always yield accurate results
Non-Invasive Prenatal Testing
DNA from the fetus circulates in maternal blood
Indicates genetic mutations mainly trisomy 21 (Down Syndrome)
Blood is drawn from only the mother and is not invasive on the pregnancy
Pregnancy is not at risk during this procedure

16. Labor

17. “There is no other circumstance in which it is considered acceptable for a person to experience untreated severe pain, amenable to safe intervention, while under a physician’s care.” -American College of Obstetrics and Gynecology (ACOG)
“Unnecessary intervention poses unnecessary risks” –NIH

18. Inducing Labor Inducing Labor Reducing Pain During Labor
Pitocin: A synthetic form of oxytocin, a naturally occurring hormone, which causes uterine contractions
Reducing Pain During Labor
Epidural: A regional anesthesia that offers pain relief in lower body region during child birth, usually given when mother is 4-5cm dilated
Why inducing labor might be necessary
Past due date (2 weeks): more labor complications can come with bigger babies
Water has broken, but contractions have not started: puts baby at risk for infections
Mother’s preference: lifestyle accommodations
Negatives that come along with Pitocin
Cause longer, stronger contractions
Sometimes cause double peek contractions
Sometimes doctors increase pain medication because the contractions are so painful and exhausting
May lower baby’s oxygen supply and decrease heart rate
May increase bleeding after delivery: uterine muscles may not properly contract
Benefits of Epidurals
May increase birthing experience for some women with decreased pain
Usually mothers can be alert during delivery
Speeds up C-Section preparation if needed
Allows for relaxation
Disadvantages of Epidurals
Blood pressure may suddenly drop: usually a medication is given to prevent this
Headache due to spinal fluid leaking: <1% of women experience this
May make pushing difficult: forceps or other medications may be needed
Babies may become lethargic and not position themselves for delivery: increasing risk for C-Sections
Some research suggests babies may have an increased difficulty in latching on for breastfeeding

19. Caesarean Section
When baby is surgically removed from mother’s abdomen
1 in 3 (about 33%) babies are born this way in the U.S.
18% is the average C-Section rate for low-risk deliveries
Major surgery, but relatively safe for both mother and baby
Longer recovery period
May be unable to have vaginal birth in future
WHO recommends C-Section rates between 5%-10%
Why and when is it used?
Any unexpected problems
Health problems in mother
Baby’s position*
Baby is too large to fit through vagina*
Possibly for mothers with more than one baby*
Inducing labor increases the risk for C-Sections
2 Common myths surrounding the increase in C-Sections
Women are asking for them: only about 1% of women who get C-Sections requested them
More older women are having babies: C-Sections are actually increasing for all age groups
-1 in 4 women stated they felt pressure from their physician to have a C-Section

20. Why the increase?
Increasing labor interventions: Pitocin and Epidurals
Physicians not offering vaginal delivery as a method
Professionals casual attitude of surgery
Time constraints and efficiency for health care providers
Not enhancing women’s ability to give vaginal birth

21. Post Birth Medicalization

22. Newborn Eye Treatments
What is it?
Eythromyacin as a prophylactic treatment for opthalmia neonatorum
Caused by the STD’s gonorrhea or Chlamydia
Benefits
Can prevent newborn blindness
Why it’s unnecessary
Can cause severe irritation to the newborn
Can be treated after an infant develops the infection
Source: Evidence Based Birth

23. Current Status Erythromycin prophylactic treatment is RECOMMENDED by
U.S. Preventative Task Force
American Association of Family Physicians
American Academy of Pediatrics
Erythromycin prophylactic treatment is MANDATED by
32 U.S. States (Standler 2006)
Source: Evidence Based Birth

24. Newborn Vitamin K Shot What is it?
Newborns are at risk for major blood loss through Vitamin K deficiency bleeding (VKDB)
Benefits
Can prevent bleeding out
Why it’s unnecessary
Not “natural” child birth
Source: Center for Disease Control and Prevention

25. Current Status Newborn Vitamin K shot is RECOMMENDED by
American Academy of Pediatrics
State Laws about Neonatal Vitamin K shot vary immensely
20 States have no laws
30 have inconsistent laws
We recommend that all newborns receive the Vitamin K shot and that consistent policies are implemented throughout states
Source: Center for Disease Control and Prevention

26. Recommendations for Health Educators

27. Recommendations Always have a plan
Mothers need to have a well written birth plan
Mothers need to write down decisions that might have to be made during the delivery
Have doctor and nurses sign plan
C-Sections, Pitocin, and Epidurals all have purposes, but health care providers need to treat labor and delivery as a natural process vs. a medical procedure
Health educators can encourage expecting mothers and fathers to choose a like minded practitioner.

28. Recommendations Continued…
Health educators should be able to serve as a resource for expecting mothers and educate them of different birthing options.
Health educators need to ensure mother’s have the resources they need to thrive before, during, and after birth.
Mothers need to make informed decisions and realize their birth plans may not go as expected.

29. References
A Natural Process? Women, Men and The Medicalization of Childbirth. Retrieved November 5th, 2014, from Exploring the History of Medicine website:
American Association of Birth Centers. (2013, Jan 31). New Study Shows Mid-wife Led Birth Centers Improve Outcomes and Lower Health Care Cost. Retrieved from
Cesarean Section. (2014, October 24). Retrieved November 11, 2014, from MedlinePlus website:
¨Center for Disease Control and Prevention. (2014, June 23). Vitamin K Shot—Essential in Preventing Serious Bleeding in Newborns. Retrieved from
Dekker, R. (2012, November 11). Is Erythromycin Eye Ointment Always Necessary for Newborns? Retrieved from
Epidural Anesthesia. (2014, July). Retrieved November 12, 2014, from American Pregnant Association website:
Hall, H. (2011, February 15). Childbirth Without Pain: Are Epidurals the Answer? Retrieved November 11, 2014, from Science Based Medicine website:
Johanson, R. Newburn M. Macfarlane, A. Has the Medicalization of Childbirth Gone Too Far? (2002, April 13). Retrieved November 5, 2014 from The National Institutes of Health website:
Labor and Deliver, Postpartum Care. (2014, June 20). Retrieved November 11, 2014, from Mayo Clinic website: living/labor-and-delivery/in-depth/inducing-labor/art ?pg=2
Pregnancy, Birth, and Medicine. (2011, February 17). Retrieved November 5, 2014, from Stanford Encyclopedia of Philosophy webstite:    

30. References
MacDorman, M. F., Mathews, T. J., & Declercq, E. (2014, March) Trends in Out-of-Hospital Births in the United States, Retrieved from
¨Martin, J.A, Hamilton, B. E., Osterman, MJ. K., Curtin, S. C., & Mathews, T. J. (2013, Dec 30) Births: Final Data for National Vital Statistics Report, 62, Retrieved from
Non-Invasive Prenatal Testing (NIPT) Factsheet. (2012, August 15). Retrieved November 12, 2014, from
Obstetrics and Gynecology, Retrieved November 12, 2014, from
¨Precious Passage Birth Services. (2014). Hospital vs. Out of Hospital Cost Comparison. Retrieved from
Screening tests for birth defects. (2014, April 1). Retrieved November 12, 2014, from Patients/faq165.pdf?dmc=1&ts= T
¨Standler, R.B. (2006, December 17). Statutory law in the USA: requiring silver nitrate in eyes of newborns. Retrieved from
¨Starr, T. (2014, May 12) Why are Cesarean Sections So Common When Most People Agree They Shouldn’t Be? Retrieved from
What Hospitals Don't Want You to Know About C-Sections. (2014, May). Retrieved November 11, 2014,from Consumerreprots.org website: what-hospitals-do-not-want-you-to-know-about-c-sections/index.htm
What is Pitocin? (n.d.). Retrieved November 11, 2014, from wiseGeek website: