MDWF 1010

Sect. 1 Reflection Paper

Katlyn Carter

Our System is Broken

As I began attending births in a large county in NW Washington, I knew some of the

local homebirth midwives but wasnt very familiar with the hospital scene. Over the last year, I

began taking doula clients in all settings and made it a goal to get my foot in the door of all the

hospitals in my surrounding area. Heading in, I only knew what I had heard second hand. My

first solo birth, unfortunately and fortunately, transferred (at 37 weeks) from a birth center to a

hospital that would usually be outside my area, but I transferred with them. I was able to witness

a relatively nice 4-day induction with an OB known in the area for accepting the VBACs,

breeches, and more high-risk cases. It was great! He was on his knees catching this baby that the

mom pushed out, unmedicated, on her hands and knees. Afterwards, he announced to the room

with a big ole smile, And, THATS how the midwives do it! I laughed when I read Born in

the USA, midwives are not second-class obstetricians, but rather obstetricians are second

class midwives (pg. 103). What a great experience that was, unfortunately, the rest of my

hospital births that year would go steadily downhill from there

I have attended births at our local Naval hospital. I saw things, both good and bad there,

but definitely began to see some broken pieces in this particular maternity system. After reading

Born In the USA (Wagner 2008), I see things a little differently in a Navy-run hospital. The

White Coats in Navy hospitals not only wear white coats, but big, high-ranking titles like

Commander. To a young sailor (whether the birthing person is active-duty military or shes
married to one), that White Coat with Brass is the Boss. The Boss knows what is best, and The

Boss makes the decisions. The legal rights of women discussed in Chapter 7 on Born In the USA

seem to be more of a suggestion, at times.

Fast-forward a few months, and I had a few clients at the local civilian hospital. While

conveniently located, big and shiny, and proclaiming to be family centered, I found the exact

picture Wagner painted. Some of the words he used to describe obstetricians were hard,

competitive, elitest, aggressive, and a mans world(107). Even the female obstetrician I observed

appeared to be trying to fit that description. Though met with smiles and kind words, these

laboring mothers arent being told all the options or given the opportunity to let their bodies do

their job. Wagner talks about The Malpractice Crisis. I have seen that evident in cases where

the doctor directly askes the laboring mom, So, you ARE declining a c-section? A procedure I

recommend, at this time?! This was asked as baby was nearly crowning and was born a few

minutes later. I have had 2 clients confide that they think they have PTSD, not from their birth

directly, but because of the hospital stay and how they were treated when they were so

emotionally vulnerable. Its awful. Our system is broken.

Why are we having these systemic failures? In Deadly Deliveries (produced by Amnesty

International), they talk about the shortage of health care professionals, the lack of availability of

specialist care, inadequate staffing levels, the lack of standards among hospitals, the lack of

information, and the lack of adequate postpartum care. There just arent enough staff to go

around in big hospitals. A quote from a woman on the Red Cliff Indian Reservation in Wisconsin

broke my heart. She said, A car wash takes about 5-8 minutes. And thats how long the typical

prenatal appointment with a doctor takes. Thats how I felt when Id leave my prenatal
appointments, disappointed because I didnt have the time I wanted or deserved for an

appointment (p. 73). No woman should be made to feel like this.

Chapter 3 of Deadly Delivery talks about the discrimination were seeing in maternal

health. Black women are 4 times more likely to die than white women in pregnancy-related

causes. The numbers reported in Womens Health USA 2010 were horrifying. I was aware that

maternal mortality rates were higher in Non-Hispanic Black communities, but to see the actual

data How has this happened? This is very literally a life and death situation. People are dying.

Needless to say, these readings were entirely depressing. There is so much death,

discrimination, and expense in our system. How can we spend so much on health care and have

such poor outcomes? How can we be spending so much and have families without insurance,

adequate care, or even access to family planning? An example that I, personally, have dealt with

was addressed on pg. 60 of Deadly Delivery when a health advocate said, My daughter chose to

have a midwife deliver her baby at home, for a cost of $2500. In the hospital system it would

have cost us $12,000, but because it was at home, insurance wouldnt pay for it. How is that

logical, even a little bit? A better service for a fraction of the cost. Seems like a better situation

for everyone, but it doesnt happen. Our system is broken.

I truly believe that the midwifery model of care is the answer to all of these problems. In

Born in the USA, Wagner describes the different paradigms between the medical model and the

midwifery model, Doctors deliver babies and believe that having a baby is something that

happens to a woman. Midwives assist at birth and believe that giving birth is something that a

woman does (pg 105). Lets greet our mamas with a hug, chat for an hour over a hot cup of tea,

and let our bodies do the work of birth.