Monday, July 02, 2012

Why Fear Mongering is Costing Maternity Care $$

Just counting the articles about fear in childbirth and the increase in time in labor and increase in complications of labor, one would think this is a new concept.  However, it is not.

In a recent Time Magazine article, WhyWomen Who Fear Childbirth Spend More Time in Labor, author Alexandra Sifferlin points out “Women who fear childbirth just got something else to worry about: a recent Norwegian study found that women who were scared of giving birth ended up spending more time in labor, about 8 hours versus 6.5 for women who weren’t afraid.
According to the study’s authors, 5% to 20% of pregnant women fear giving birth. The reasons vary, from the mothers being young or never having given birth before to their having pre-existing psychological problems, a lack social support or a history of abuse or bad obstetric experiences.
The study also found that mothers who feared childbirth were also more likely than unafraid women to need an emergency C-section (11% versus 7%) or assistance with instruments such as forceps for vaginal delivery (17.0% versus 11%). Overall, about a quarter of women who feared childbirth delivered without any obstetric interventions, compared with nearly 45% of women who were not afraid.”
“There are a number of reasons why women may develop a fear of childbirth,” said John Thorp, editor-in-chief of BJOG: An International Journal of Obstetrics and Gynaecology, the journal in which the new study is published, in a statement. This research shows that women with fear of childbirth are more likely to need obstetric intervention and this needs to be explored further so that obstetricians and midwives can provide the appropriate support and advice.”
Let me first be very clear, as a nurse of 36 years and a Lamaze Certified Childbirth Educator of 32 years, I believe there is a time and place for obstetrical intervention.  We are blessed and fortunate to have the technology to save lives.  However, when fear is the catalyst for an increase in medical intervention including major abdominal surgery (yes, a cesarean is major abdominal surgery), then we need to stop bantering back and forth about how tragic this all is and DO something.
From all over this country (US), I am hearing stories of how obstetricans and medwives are discouraging expectant mothers from attending childbirth education classes.  While childbirth education is not the panacea for an epidemic of fear/intervention, I have been practicing long enough to know that when comprehensive, evidence-based childbirth education is incorporated into prenatal care, intervention rates go down and women’s satisfaction with care providers/hospitals as well as their birth experiences go up.
Remembering too that hospitals are a business.  A company.  And businesses and companies exist to make money.  This unfortunately is where the water gets very, very murky. 
And it begs the question.  “If comprehensive, evidence-based childbirth education would decrease fear, interventions and revenue for a hospital, is it any wonder why this education is discouraged?”

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