After the birth of her son in 2011, Cristen Pascucci left a career in public affairs to study American maternity care and women’s rights within it. She is an advocate for mothers, vice president of ImprovingBirth.org, and co-founder of a U.S. legal advocacy network related to childbirth. She works closely with leading national advocates, organizations, and birth lawyers to promote better treatment of women in childbirth.
Women in the Birth Monopoly
What I found as a customer in maternity care was that the system didn’t serve me and my baby very well. Many of the messages I received were intended to encourage a compliant patient, not an informed and active participant. As the woman giving birth, I felt more like a passenger than a driver.
I remember asking the nurse teaching my childbirth class what I needed to do to make sure that my baby was given directly to me after birth (barring any medical complications). She said it would depend on who the hospital staff was. There was a very good chance I would get my baby right away, but it wasn’t a guarantee, because some staff “preferred” to do the routine newborn procedures immediately or isolate babies for routine observation.
That was the best answer I got from anyone: I would probably get my baby right away, but it ultimately depended on the preference of who happened to be working at that time.
This told me a couple of things. First, the woman giving birth was not, apparently, at the top of the totem pole in Labor & Delivery. Second, evidence-based care was not a consistent standard — it’s a no-brainer in modern care that healthy babies benefit most from going directly to their healthy moms’ chests after birth. Why did the current medical evidence and my wishes rank below the preferences of random hospital staff ? Answering that question, and others like it, has been a fascinating journey.
Less than a year later, in 2012, I got involved with mothers’ advocacy organization ImprovingBirth.org, and the next thing I knew, I was running a hotline with lawyers from Human Rights in Childbirth trying to keep up with the influx of women experiencing dilemmas in their care: unable to find good providers or hospitals, being pressured into medical procedures they didn’t want or need, and unsure whether they had a right to complain following a bad experience.
As I began talking to more and more women around the U.S., I felt like I was uncovering a massive, silent epidemic: major variations in care, low consumer power and extremely limited options in some places, and very little transparency about any of it, anywhere.
Recently, I wrote an article at ImprovingBirth.org that was meant to illuminate some of the difficult choices women make around the location of giving birth. I expected some negative reactions towards the idea that any would give birth outside a hospital for any reason whatsoever, but that wasn’t what I got.
What most people expressed, instead, were disbelief and surprise (and sympathy) at the handful of stories I used as examples of women who have very limited choices. What seemed so obvious to me – as someone immersed in these stories every day – was not at all obvious to many readers. Most people had absolutely no idea how limited and how poor the options are in some places in the United States.
I thought it would be useful to get some of these stories out of my head, and combine them with what quantitative data there is, to paint a bigger picture of the reality that many families face.
This is my small contribution towards transparency and a little more consumer power in American maternity care.
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