Hi all, Elizabeth here. As a Licensed Midwife in California, my medical board uses the term, “normal childbirth” as the kind of birth I can attend. Personally, I do not like this phrasing because “normal” is subjective. I prefer the words “low-risk” or “high-risk” as they become objective descriptors that can be quantified, take the shame and guesswork out of the many available choices.
When your pregnancy, labor, and postpartum recovery are considered a low risk, you have lots of choices available to you in terms of WHERE and HOW you can birth. Your WHERE could be a hospital, a free-standing birthing center, and/or your home. Your HOW could be medicated, un-medicated, surgical, assisted, or vaginal.
The low-risk designation is determined during prenatal, labor, birth, and postpartum time. The assessment can vary from different communities, towns, state-to-state, and countries. A low-risk standard of care guideline can be used to monitor low-risk mothers and babies during labor.
If you are at high risk, your choices are more limited. For the safety of you and your child, you must birth in a hospital where there is an operating room across the hall and a NICU (Neonatal Intensive Care Unit) on site. Doesn’t that seem safe and reasonable to you?
Let’s get specific with a well-known example. Have you ever wondered why Kate Middleton, the Duchess of Cambridge, left the hospital ten hours after she gave birth? Well, she was considered a low risk when she went into the hospital, had a low-risk labor and childbirth, and was considered a low risk for the postpartum time. Because Kate had vaginal births with midwives in a hospital, her birth was regarded as low risk by U.K. standards. Therefore, she was able to go home soon after birth, to recover in her own bed, surrounded by both her family and the familiar comforts of home to bond with her new bubba. She also had midwives come to her home to check in on her — not because she is royalty, but because this is what U.K. midwives do for all their low-risk mamas after they give birth.
Unlike the U.S., did you know European countries do not have private insurance paying for birth? Low-risk care is, therefore, supported by midwives who will transfer a mom into obstetrical care with a trained Obstetrical Surgeon (OB) if she becomes a high risk and needs the support of western medication and/or surgery. Ultimately, this saves the country money and provides better outcomes. In Europe, midwives and free-standing birth centers that specialize in low-risk childbirth have little or no conflict with hospitals. They work collaboratively in the event of a high-risk birth.
This is not the case with health insurance in the United States. Instead of a system that keeps healthy people healthy, it is designed to fix problems. Insurance companies have defined pregnancy in our culture as a problem. This is because they are only set up to treat problems and have no system or funding in place to support low-risk pregnancy.
Contrary to what the system says, we want to reiterate that low-risk pregnancy IS NOT a problem.
For this reason, private doctors and private hospitals rarely learn to differentiate between high-risk and low-risk childbirth. Subsequently, they manage low-risk childbirth the same way they would manage high-risk delivery. They treat it like a problem.
How this affects you:
This drives up the cost of childbirth and the cost of our insurance premiums. Furthermore, it contributes to United States’ maternal mortality rates, which is one of the highest rates globally. t is undoubtedly important to note here that people of color make up 3 to 4 times more of those maternal deaths than Caucasians people. That’s a whole other story, which you’ll hear more about from me in another forum. Health insurance is basically running American obstetrical care. I’ve come to understand that their rules and regulations, particularly as they apply to language, are at the root of all the many challenges you will read in this series. If you have questions, ask away.
We want you to educate yourself as we navigate these times. Realize that you have choices and ask for support. At GraceFull, we are Los Angeles’ First Accredited Birth Center. We have an in-house concierge to help you with billing and insurance. Give us a call to find out more.
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