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Childbirth in America: Is There a Human Rights Failure?

american childbirthThe article American Childbirth: Human Rights Failure? talks about the fear American women face while pregnant. The author said most of the pregnant women she spoke to are, “scared to death” of childbirth. She wrote about the dire state of labor and birth practices in American hospitals. About the real and terrible statistics of birth in the United States compared to other developed nations as cited by the World Health Organization and Amnesty International.

The same day I read this article I heard stories of four women and three babies here in Djibouti who died in childbirth. Each woman was the relative or friend of close friends of mine. Fadouma squeezed her healthy, laboring sister-in-law’s hand and wished her peace as she was wheeled away for a c-section. Minutes later a nurse burst from the room with a dead baby in her arms. Fadouma watched through the door as another nurse checked the vitals of her brother’s wife and declared her dead. She spent the weekend washing and burying bodies, comforting her brother and his firstborn, still a toddler.

Aisha’s next door neighbor died during a c-section delivery of her fourth child. She said it was the mercy of God that took the baby with the mother. She said fathers can’t care for children alone, he would take another wife, the new wife would neglect the dead woman’s children. How else could she respond when the chances of dying are so high? How else but with an utter, almost helpless insistence that it was a mercy?

These women, and the other two, delivered in hospitals. Three of them in a specialized maternity hospital and the fourth at a modern, clean, and upper class facility.

Is there a human rights failure in American childbirth practices?

I understand the author of this article isn’t attempting a wide scale comparison of birth around the world, but she is using words like human rights and scared to death. These are loaded terms that should be used with wisdom and caution and global realities need to be considered when these words are used.

What do American women fear? Episiotomies? Drugs? Having a fetal monitor wrapped around their belly? Or do they, like Djiboutian women, fear someone pressing down on their stomach while the baby is still inside? Being pinched or slapped for vocalizing their pain? Shamed and ordered to shut up when they groan? Do they fear delivering through an opening that has been sealed with circumcision scar tissue? Coma from an unregulated medicine dosage? Do they fear death?

Maybe they do fear these things and that’s okay, childbirth is intense and painful and carries inherent risk. I have been a pregnant and delivering woman in the US and in a developing, third world country and both times I experienced various fears. More questions must be asked though: how realistic are these fears? What are their chances of delivering a dead baby or of dying themselves?

I’m not a doctor, not an expert in public health or policy. I just live here, in the middle of all this. So I think it is valuable to give voice to another perspective in this discussion, from an American obstetrician. In response to this essay she (who requested anonymity) wrote:

“I think some of what the article is saying regarding human rights is related to a woman’s ability to make choices and how evidence-based or non-evidence based we practice. The US practices obstetrics much in a way to avoid litigation rather than optimal care, which has lead to poor outcomes in my opinion. In that way many women feel that their rights are violated when it is “strongly recommended” that they have a C/S. In this regard, I do think that physicians at times take away the rights of the patient or direct them to have a certain procedure performed. For a country that spends so much money on pregnancy, delivery and postpartum, you would think the numbers would be better than they are-even if significantly different than eastern Africa.”

Her point, I believe, is that yes, the American childbirth experience is better than in high risk nations. But for the amount of money spent on it, it should be much better. We should be doing a better job caring for mothers and babies. I agree. And I think it is important and valuable to look beyond the border of the United States for perspective.

So, what are those numbers outside our borders?

In the United States, where I was raised, the maternal mortality risk is: 21 out of 100,000.

In Djibouti, where I currently live, this risk is: 200 out of 100,000.

In Somalia, where I used to live, this risk is 1,000 out of 100,000.

Source: CIA Factbook 

Infant mortality rates are as follows:

In the United States: 6 out of 1,000

In Djibouti: 72 out of 1,000

In Somalia 100 out of 1,000

Source: UNICEF

It is natural to feel afraid about something as physically intense and painful and unknown as childbirth. I’m not saying American women have no right to be afraid. They do. But this fear is not in the same category as the fear women in the developing world face about childbirth and calling these statistics a ‘human rights failure’ speaks to how far from the rest of the world Americans live.

Phrases like ‘human rights failure,’ if we start using them to describe an American woman’s risk of having a c-section or a fetal monitor, risk losing their potency. When an American woman’s experience is given the same words as a Djiboutian woman’s, I see a problem.

Yes, American women should have healthy deliveries. Yes, they should be able to deliver free from fear.

But Djiboutian women should have healthy deliveries and be free from fear as well. Djiboutian women need the words ‘human rights failure’ to matter. They need those words to mean people will fight for their right to give birth to life and to live to enjoy that life. So while those in America fight for better health practices for women and infants, let them do so without trumping the realities of others, without usurping the words other women desperately need.

*image via Flickr

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