Penny Simkin, renowned Seattle-based childbirth educator, doula, birth counselor and author of several best-selling books. PHOTO BY ANDY ROGERS/redboxpictures.com
Looking Back at the Changing Face of Maternity Care
NOW & THEN
By Penny Simkin
In 1979, when Seattle’s Child was born, my career as a childbirth educator was 11 years old. Now, I have been teaching for 41 years and have supported hundreds through labor. Over Seattle’s Child’s lifetime and my career, we have witnessed massive shifts in maternity care in the U.S. and in Seattle. For the record, I have always felt (a little chauvinistically) that Seattle is the best place in the country to have a baby. I still feel that way today, but with less conviction than I did a decade ago.
One reason that Seattle has long been such a good place to give birth is that we have experts here in both low-tech care for low-risk healthy pregnant women, and high-tech care for those low-risk women who prefer it and for the high-risk women who need it. We have licensed midwives with training and expertise in home and birth center deliveries; nurse-midwives and family practice doctors in most area hospitals who serve low-risk women from diverse populations with sensitivity and skill; obstetricians and perinatologists who can take care of both low-risk and high-risk women and perform cesareans.
Some obstetricians also provide respectful and sensitive backup care for home birth clients who, for safety reasons, transfer to the hospital during labor. We have Seattle Children’s Hospital, where sick newborns can be taken for the best care possible. And, let’s not forget maternity nurses, who can make or break the birth experience for the woman. In Seattle, we are fortunate to have many dedicated and skilled nurses, who appreciate the stress and pain of childbirth and give high priority to individualized care, kindness, and respect toward clients, as well as clinical excellence.
Today in Seattle, many women – regardless of ability to pay – have better birth experiences because doulas are available to them to provide continuous emotional support, physical comfort, guidance, encouragement, and reassurance to women and their partners during labor. Doulas are experts in non-medical ways to ease labor pain. They work with women to increase the woman’s sense of well being and improve labor progress. Scientific trials comparing outcomes of women with and without doulas find that doula care lowers cesarean rates, need for pain medication, and newborn admissions to the intensive care nursery, while increasing women’s satisfaction with their births. Few people knew the word doula 30 years ago – it was not a career as it is today.
Childbirth education remains popular in Seattle, although attendance at classes has decreased over the years, but to a lesser degree than in much of the rest of the country. All this is to say that women in Seattle have many safe choices regarding their care, and an informed woman can obtain the kind of care that she prefers. Unfortunately, Seattle’s supportive birth climate is clouded by the same disturbing trends in maternity care that prevail all over the country. During Seattle’s Child’s lifetime, we have witnessed a doubling in the Cesarean rate from 15 percent to more than 30 percent. Induction of labor has more than doubled to around 40 percent, and much more in some area hospitals. Epidurals, once reserved for abnormally painful labors, are now the most common and most effective form of pain relief, even for normal labors, and are used in 70 percent or more of labors.
We are beginning to realize that as the use of these technologically intensive interventions has become mainstream, many of the usual outcomes that measure quality of maternity care are actually worsening. Prematurity is on the rise. Now, 13 percent of babies in Washington are born prematurely (up from about 9 percent in the 1980s). The March of Dimes recently gave the state of Washington a grade of “C” in prematurity prevention.
Nationwide, infant mortality and even maternal mortality are rising. Racial differences in all these outcomes exist, with African-Americans and Native Americans faring worst. We have also become aware that childbirth is described as traumatic by approximately 25 percent of women, and about one quarter of those actually go on to develop post-traumatic stress disorder. Postpartum depression also afflicts 25 to 30 percent of women, and adequate and appropriate services for women with these mental health problems are seriously lacking.
There are many factors that contribute to the worsening outcomes in maternity care. It is clear that the unchecked rise in high-tech care for low-risk mothers and babies has reached a tipping point and is now doing more harm than good. The irony of all this is that the birth process, itself, remains essentially the same as always. The notable thing that has changed is the way childbirth is managed. I’d love to witness renewed interest and investment in keeping normal birth normal among all the stakeholders: childbearing women and their partners, their caregivers, hospital administrators, health insurers, the obstetric and pediatric professional associations, and our state and national governments. Great advantages would be realized in the form of improved physical and mental health, financial savings, and job satisfaction for maternity professionals.
Penny Simkin is a childbirth educator, doula, birth counselor and author of several best-selling books. This year she released the third edition of her popular guide The Birth Partner (Harvard Common Press). The Simkin School for Allied Birth Vocations at Seattle Midwifery School, which recently celebrated its 30th anniversary, was named after her last year to celebrate her four decades of service.
Editor’s Note: This essay is Part II in an ongoing series that looks back on the 30 years Seattle’s Child has been a resource for local parents. To read April's installment, an interview about the evolution of pediatric care with Dr. Steven Dassel, and other retrospectives, go to our Health and Development page or search for NOW & THEN.
