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Do Labor-Support Professionals Advance or Repress Women?

April 11, 1993

Your article "Organized Labor" generated much discussion among my obstetrician colleagues and the labor and delivery nurses at the hospital in which I practice obstetrical anesthesia. Once again it appears that women are being encouraged to return to the days of "natural childbirth" (however that term is defined) accompanied by the "birth experience" complete with death or injury to mothers and/or babies and much unnecessary suffering.

I almost feel as though I have been caught in a time warp. Let me reset my watch 25 years.

The article stated that women preparing for childbirth have begun to turn to "labor assistants" because of the impersonal care and high rates of Cesarean deliveries which modern medicine has allowed to become commonplace. I am sure that many women have been subjected to what they consider a less than optimal birth experience that they attribute to the impersonal care on the part of physicians and nurses.

However, in my experience, this is the exception rather than the rule. At my hospital we take great care to provide physicians, nurses and ancillary staff who are not only highly trained and caring, but are enthusiastic as well.

It is my opinion that much of the dissatisfaction that women experience is related to their high level of expectations for the "perfect delivery of the perfect baby." These high expectations are placed mostly on themselves in terms of how they will perform during the birth event.

When the labor or delivery becomes complicated, requiring intervention, or the woman can't deal with the often severe pain of labor and requests pain relief, they sometimes project the anger and disappointment of their own perceived failure onto the doctors, nurses or occasionally even the hospital food.

In terms of high rates of Cesarean births, obstetricians are often caught in a bind. If they wait too long to intervene when the labor or delivery become complicated and deliver the less than always expected perfect baby, they may face a multimillion-dollar malpractice suit. If they intervene too soon, which can also happen, they are accused of performing another unnecessary Cesarean section.

Many hospitals, including ours, have lowered and continue to strive to further lower our C-section rates. Physicians whose rates are too high are carefully evaluated by the hospital peer review committee, and changes in practice patterns are suggested or sometimes even imposed. A doctor with a high Cesarean birth rate may actually be the best physician and perform more operative deliveries because he/she cares for a greater percentage of high-risk mothers.

I have seen no scientifically performed study that demonstrates that the presence of labor assistants decreases the likelihood of forceps or Cesarean deliveries.

The presence of the labor assistant can potentially improve the birth experience for all concerned if they are present to support the mother in whatever decisions she makes regarding her own care. No woman is a failure if she requests assistance in bearing her child regardless of what that intervention may entail.

In no other area of medicine has more misinformation and disinformation been made available to the public than in the field of obstetrics.

Modern obstetrical care and obstetrical anesthesia have saved many mothers and babies from tragedy. Modern obstetrical anesthesia has allowed mothers to more fully enjoy and participate in the births of their children without increasing the chances of having to undergo a Cesarean section. Many times this means the patient requires virtually no intervention, drugs, etc.

However, not many of my patients have indicated a willingness to experience the same type of childbirth as their mothers.

RAYMOND C. OAKES, M.D.

San Juan Capistrano

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