Thursday, November 10, 2011

A Clear Destination for the Canadian Maternity System

Often times it feels as though when it comes to maternity care in Canada - the system is being pulled in all directions without any true sense of destination.

There are those who would like to see the role of intervention limited (Dr. Klein, Ricki Lake, Ina May Gaskin, NCB advocates, etc.) as they see intervention as being costly and frequently unneccessary. They perceive the benefits of ready access to drugs and epidurals in labour as being outweighed by the risks of longer second stages of labour, increased risk of instrumental deliveries, increased risk of resuscitation. They may argue that medicalized birth is expensive birth, that on a whole does not yield better outcomes for low risk women than medicalized birth with it's "cascade of interventions". The claim is that women have been giving birth for thousands of years, our bodies are made to birth, and that there is no valid reason for c-section rates to exceed 15 percent. They also bemoan the impact that interventionist birth may have on breastfeeding. Birth to them is something that needs to "be reclaimed as a natural process". Home-birth and unassisted birth is viewed as a reasonable and inherently 'safe' option by many in this group.

On the flip side, is a small minority that has only recently found it's voice (Dr. Amy Tutuer, Mrs. Pauline McDonough-Hull, Mrs. Eckler, etc.) who argue that the medicalization of birth is a good thing that prevents morbidity and mortality and unneccessary pain and suffering. For the most part these women (as they are mostly women) argue for 'informed consent' and unbiased information as it pertains to birth. They see the benefits of intervention as frequently outweighing the risks. Birth is seen by this group as a biological process that has inherent risks and those risks can and should be proactively managed. C-section on demand is seen by many in this group as reasonable and a comparably 'safe' option.

There is no universal 'right' way to birth a child, just as there is no universal 'right' way to parent a child. To believe that there is, is the hight of sanctimommyness.

As such, there can be only one clear destination that would allow both viewpoints and all viewpoints in-between to exist and that is:

"A system that seeks to achieve the best health outcomes for moms and babies based on respect, informed consent, and the best available evidence."


  1. I believe in the freedom of choice.

    Freedom of choice entails informed consent and respect, as well as actually having a CHOICE.

    It seems though, that as things stand, most women only have the choice to embrace natural childbirth. How is that a choice? If you cannot also choose to have an elective c-section, then you do not have choice. If in BC you cannot choose to have an epidural, because there are no anesthesiologists at 1 am, then you also, do not have choice. (I'm blown away by the fact that in parts of BC if you need an emergency c-section, the get it out NOW kind, you can't have one because the hospitals which serve patients with high risk pregnancies does not have an ON anesthesiologist on hand 24 hours a day. Blown away.)

  2. Choice, such a simple yet elusive concept.