Fact: the American maternal death rate is rising. Steeply. And although American women may be waiting longer to bear children, and more moms-to-be suffer from obesity, high blood pressure and diabetes, blaming these moms for our birthing system’s failures – an easy explanation even spokespeople from the CDC have leaned toward at times – is off the mark. In fact, many of the complications that occur most often in new moms during, or shortly after, hospital deliveries occur in women whose pregnancies were categorized as low-risk. Thus, some hospitals are beginning to look within, so to speak, for explanations as to why the nation that spends more than any other on prenatal care and delivery now ranks so unfavorably, when compared with other developed nations, on the maternal mortality score.
What are these hospitals seeing when they ‘look within’? High (steeply rising) c-section, and other intervention rates, are of course a part of the picture, but so are inconsistent emergency preparedness procedures. Interestingly, and encouragingly, some hospitals have been able to improve their own mortality statistics by training their delivery teams using life-like (military-style) drills, and by streamlining their emergency procedures. Dr. Peter Johnson, a surgeon at Aurora West Allis Medical Center, near Milwaukee, recently described his team’s management of a case in which a mother began hemorrhaging after her baby was delivered (she ended up needing a massive blood transfusion and an emergency hysterectomy) as significantly improved with this kind of training in place. Instead of running around trying to locate equipment and personnel, "there was a real sense of calm, rather than all this chaos," he says. "Having these [new] protocols in place makes things function seamlessly, and that will save lives."
Just as ‘looking within’ is improving birth practices within the American medical system, looking ‘without’ could likewise initiate some positive self-reflection and life-saving change. Specifically, I think, looking at systems that are working could provide insights into the aspects of our system that are broken – why reinvent the wheel when successful models exist, right? And who better to note the differences between our birthing system and another than American moms living (and having babies) overseas?
This Japan Times article, directed at foreign, expecting moms living in Japan, fascinated me for this very reason. While the piece doesn’t specifically address the problems within the American hospital birthing system, it does provide some inside perspective into what giving birth in Japan is like, and what options are available to moms-to-be living there. Why does this matter? Because Japan boasts some of the best infant and maternal mortality rates in the world. And while some similarities exist between hospital birth there, and here in the States, there are also major differences. Namely, “natural” birth practices are not considered alternative, or even – for the majority of the population – separate from mainstream hospital birth protocol.
In the States, women often must choose between extremes: a natural, midwife-assisted birth at home – which can provide the kind of close, gentle, mama and baby-friendly birth experience many women desire, but includes at least a perceived element of risk in the event of a major emergency – and a hospital birth – which may feel (or be, if a woman has existing complications) safer, but may or may not involve unwanted interventions, their side effects, and less-than-stellar post-delivery circumstances, which can affect mother and baby health, breastfeeding success, and more. In Japan, moms have additional options: “broadly speaking, these options can be divided into three main categories: the OB-GYN department of a large hospital (which may be private or public), a smaller specialized maternity clinic, or a birthing center with midwives.”
Even in the first category, however, midwives “run the show,” as one British mom, who’s given birth to three babies in a Japanese hospital, put it. She labored for 70 hours with her first child, and the hospital’s midwives supported her throughout; "I really don't have the words for how moved I was by their dedication," she says. Personal, midwife-directed care is not something most women associate with hospital birth, at least not in America. In Japan, for the most part, it’s standard operating procedure. Another mom, an American, chose her hospital in Japan for its commitment to baby-friendly breastfeeding support policies according to guidelines from the WHO and UNICEF.
While hospital midwives and baby-friendly breastfeeding policies do exist in the United States, they’re not yet the norm. Neither is gourmet French food during one’s hospital stay after delivery, something foreigners have been pleasantly surprised by in Japan. And although hospital food, obviously, is not crucial to maternal health and has no bearing on emergencies, I think this point is significant in that it reflects the difference between the systems’ approaches to maternal care. I’ve written before about my post-delivery experience at a leading hospital in New York City, during which I did not feel well cared-for, was not provided with adequate breastfeeding support, and, for what it’s worth, was not fed well. I remember a friend, while visiting me there one afternoon, asked, incredulously, when a lone baked potato landed on my bed-side tray, “Is that your dinner?” (I didn’t touch it.) On the upside, I lost all of my baby weight pretty much by the time I arrived home. On the down side, I felt, while I was in the hospital, like I was in prison. It was not the positive start I would have wished for, for myself – or anyone else – after delivering a baby.
Like the American hospital system, however, Japan’s varies from hospital to hospital, and although midwife, mommy and baby-friendly protocol is pretty widespread, some moms cited in the Japan Times article toured hospitals where their questions and birth plans were met with indifference, or outright hostility. One doctor said, point-blank, that every woman giving birth in his hospital received an episiotomy. Another mom recalled being told she would only be able to keep her baby with her throughout her hospital stay if she happened to score one of a limited number of private rooms there. And many foreign mothers are dismayed to discover a pervasive lack of pain relief options, even in the best Japanese hospitals. (One told the Times’ author that the hospital’s childbirth education classes were quite helpful in that respect, though.) The moral of the story is the same as it is here: moms in Japan must do their research and find a doctor and hospital that feels right to them. The difference is that in Japan, moms have more, and better, options, both within hospitals and without, and finding the right match isn’t as much of a mystery or gamble as it is here in the States. And, maternal and infant mortality rates coming out of Japan prove the system, overall, is working. (As far as birth outside of hospitals goes, birthing centers in Japan are described in the article as “serene”, and with very capable midwives – one American mom’s breech baby was delivered vaginally in one of these centers, without problems.)
Lastly, the article’s author tempers foreigners’ expectations with this, lest we get too excited and expatriate in the name of procreation: “Unlike in some countries, prenatal care and childbirth are not free in Japan, but government allowances have become more generous over the last few years… Regardless of where the baby is born, or whether the facility is public or private, the government pays a standard reimbursement of ¥420,000 to mothers enrolled in the country's national health insurance scheme. This amount is actually very close to the average cost for a normal delivery.” Women can also file for reimbursement for expenses like private rooms, or non-standard procedures they may have needed during delivery. If you’re British or Australian, this all might sound unduly complicated, and give you pause before you run out to apply for your Visa. But if you’re American, and thus unfamiliar with national health insurance programs that add up, essentially, to free prenatal care and childbirth, it sounds pretty darn good. (I would have had to pay $5,000, per night, for a private room in NYC, without the prospect of a reimbursement, so, yeah… pretty darn good.)
What do you think of the differences between the Japanese hospital delivery system and the American system? (Or, if you live in another country, how do these systems compare with your own?) Have you ever given birth overseas? Would you want to give birth in a Japanese hospital? Would you feel safer doing so, considering the statistics? If you could change one thing about hospital birth in America, what would it be?