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No Place Like Home No Place Like Home The Rhetoric of Fetal Rights in the American Homebirth Debate Suzan Steeman (5777038) Thesis Advisor: Manon Parry American Studies – University of Amsterdam [email protected] [ CONTENTS ] Introduction The Reduced Role of the Mother in Pregnancy and Birth 1 [ 1 ] ‘By Women for Women’ The Origins of the Homebirth Movement in America 6 [ 2 ] ‘Visualizing the Fetus’ The Rhetoric of Fetal Rights in the American Abortion Debate 19 2.1 Who Killed Junior 21 2.2 The Silent Scream 33 2.3 Too Many Aborted 39 [ 3 ] ‘Improving Birth’ The Rhetoric of Rights and the Current Homebirth Debate 46 Conclusion 63 Bibliography 66 No Place Like Home? Suzan Steeman (5777038) [ Introduction ] The Reduced Role of the Mother in Pregnancy and Birth In 2012, the World Health Organization (WHO) published a report on trends in maternal mortality between 1990 and 2010. The maternal mortality rate in the United States of 12 per 100 000 live births is higher than the rates in other Western countries like Australia (7), Japan (5), the Netherlands (6), and Spain (6). Additionally, in contrast to many other countries, the maternal mortality rate in the US has increased between 1990 and 2010.1 The American Centers for Disease Control and Prevention (CDC) has also published some shocking conclusions on the pregnancy mortality rate in America. These show that black women in America are more likely to die from pregnancy-related causes than white women, with the pregnancy-related mortality rate for black women at 34.8 deaths per 100 000 live births.2 According to the CDC approximately half of the maternal deaths are preventable.3 Why is America lagging behind so many other Western countries? What is causing these high rates of maternal mortality and complications? A major factor is the increasing medicalization of both pregnancy and birth. The sociological concept of medicalization was developed in the 1970s to critique how the medical profession takes control of behaviors that are not abnormal or necessarily limited to medical factors.4 Critics of medicalization see the high cesarean rate, and the high rates of induction and other medical interventions, as proof of unnecessary medicalization.5 Scholars have argued that the medical world has wrongfully interfered with the natural process of pregnancy and birth and that because of that, a technocratic model of birth now prevails. In this technocratic model, medical viewpoints have the most authority.6 This model is opposed to the holistic model of birth, 1 World Health Organization, UNICEF, UNFPA and The World Bank ‘Trends in maternal mortality: 1990 to 2010,’ published by the World Health Organization (2012) pp.32-36 2 Centers for Disease Control and Prevention ‘Pregnancy Mortality Surveillance System,’ page last reviewe on March 7, 2013 at: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html#5 3 Amnesty International ‘Deadly Delivery – The Maternal Health Care Crisis In The USA,’ London: Amnesty International Secretariat (2010) p.3 4 White, K. ‘An Introduction to the Sociology of Health and Illness,’ London: Sage (2003) p.42 5 Kukla, R. and Wayne, K. ‘Pregnancy, Birth, and Medicine,’ in: The Stanford Encyclopedia of Philosophy (Spring 2011 Edition), Edward N. Zalta (ed.) p.2; Katz Rothman B, (1978) ‘Childbirth As Negotiated Reality’. In: Symbolic Interaction, Vol. 1, No. 2, pp. 126-129; Johanson R., Newburn M. and MacFarlane, A. ‘Has The Medicalisation Of Childbirth Gone Too Far?’ In: British Medical Journal, Vol. 324, No. 7342 (2002) pp. 892-893. 6 Davis-Floyd, R.E. ‘The technocratic body: American childbirth as cultural expression,’ in: Social Science & Medicine Volume 38, Issue 8 (1994) p.1126-1128 1 No Place Like Home? Suzan Steeman (5777038) which is often connected to homebirth, and in which the mother and fetus are conceptualized as one and the mother’s intuition controls the process.7 An indication for the over-medicalization of birth is the high rate of hospital delivery. In 2010, 98.8 percent of all births in America occurred in a hospital.8 This figure has remained high since the 1960s, when the proportion of hospital births first reached 96 percent.9 Around the same time that the hospital delivery rate rose to its highest point, critics called for a more natural birth with less medical interventions. Some of these critics came together in the homebirth movement.10 Although the number of hospital births has been very high for the last fifty years, homebirths are on the rise, and in 2009 were at the highest level since 1989. Between 2004 and 2009, the amount of homebirths increased from 0.56 percent to 0.72 percent (29,650 births).11 This increase was mostly driven by non-Hispanic, married, white women above 35. Midwives attended 62 percent of these homebirths.12 Critics of the medicalization of pregnancy and birth argue that continual, technological intervention in pregnancy is often based on no established medical grounds, and that these interventions often go against the findings of major WHO research and guidelines for best practices.13 Two technological interventions that are commonly used in the US although they are not always necessary are labor induction and cesarean section (C-section). According to the American College of Obstetricians and Gynecologists (ACOG) labor induction is recommended when the health of the fetus or mother is at risk and they define it as “the use of medications or other methods to bring on (induce) labor.”14 According to data from the U.S. Census Bureau, the induction rate of births of all gestational ages in America has more than doubled in less than twenty years’ time, the amount of induced birth rose from 9.6 percent in 1990 to 23.1 percent in 2008.15 A study showed that often times induction cases are categorized as elective and therefore not necessary. 7 Davis-Floyd (1994) p.1136 8 MacDorman, M.F., Mathews, M.S., Declercq, E. ‘Homebirths in the United States, 1990–2009,’ NCHS Data Brief, Number 84 (2012) p.2 9 Devitt, N. ‘The Transition from Home to Hospital Birth in the United States, 1930-1960,’ In: Birth and the Family Journal, Volume 4, Issue 2 (1977) p. 47 10 Martin, J.A., Hamilton, B.E., Ventura, S.J., Osterman, M.J.K., Kirmeyer, S., Wilson, E.C. and T.J. Mathews ‘Births: Final Data for 2010,’ in: National Vital Statistics Reports, Volume 60, Number 1 (2011) p. 9 11 MacDorman et al. p.1 12 MacDorman et al. p.2 13 White p.142. For instance, the WHO advices a cesarean rate of 15 per cent, while in America one third of all births are cesareans. From: Grady, D. ‘Caesarean Births Are at a High in U.S.,’ New York Times, originally published on March 23, 2010 at: http://www.nytimes.com/2010/03/24/health/24birth.html?_r=0 14 ACOG Frequently Asked Questions ‘Labor Induction,’ originally accessed on June 14, 2013 at: http://www.acog.org/~/media/For%20Patients/faq154.pdf?dmc=1&ts=20130616T0925383120 15 U.S. National Center for Health Statistics, ‘VitalStats,’ August 2010 2 No Place Like Home? Suzan Steeman (5777038) Researchers explain these elective inductions by pointing to “health care providers' and new parents' desire to control the timing of delivery.”16 Between 1996 and 2009 the rate of C-sections increased 60 percent, and by 2010, 32.8 percent of all births in America were cesarean deliveries.17 This means that America has one of the highest C-section rates of the industrialized world.18 Obviously, the increase in maternal mortality shows that the high cesarean rate has not improved the outcomes of maternal health, while it has also not resulted in significant improvement in neonatal morbidity and mortality.19 Instead, experts say that with each subsequent cesarean, the risks to the mother increase and that cesarean delivery involves major abdominal surgery, which is associated with higher rates of surgical complications and re-hospitalization for both the mother and the newborn.20 Medical professionals have for a long time denied that this rise in induction and C-section was due to medicalization. They provided other causes such as the rising rate of multiple births, more obesity in pregnant women, and the older age of women giving birth.21 However, both the number of multiple births and the average age of birthing women stopped rising around 2003 while the cesarean rate kept increasing. This means that both of these cannot be the cause for the high rate. The same point has been made for obesity in pregnant women since research has shown that the relationship between maternal weight and cesarean rate cannot be ascertained directly.22 Additionally, mothers have been blamed for requesting elective C-sections. For example, a spokesperson of the American College of Obstetricians and Gynecologists (ACOG) claimed this was the case.23 The idea existed that pregnant women were not willing to attend natural-childbirth classes and therefore chose to request a C-section. Another ACOG spokesperson claimed that he had performed elective cesareans because women were too afraid of the labor-pains.24 However, the idea that mothers are asking for C-sections has also been debunked. The ACOG indicates that only 2,5 percent of all births in the US are cesarean delivery at maternal request, which means it is an 16 O’Callaghan, T. ‘Too Many C-sections: Docs Rethink Induced Labor,’ in: Time Magazine, originally published on August 2, 2010 at: http://www.time.com/time/health/article/0,8599,2007754,00.html#ixzz2WC13RsL8 17 Martin et al. p.2 18 Grady 19 Blanchette, H. ‘The Rising Cesarean Delivery Rate in America What Are the Consequences?’ in: Obstetrics & Gynecology, Vol.118, No.3 (2011) p.1 20 Menacker, F., Hamilton, B.E.
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