Judy Norsigian: Pregnancy and Birth

Judy Norsigian is co-founder of the Boston Women’s Health Book Collective and co-author of the ground breaking Our Bodies, Ourselves published in 1970. Since its publication, women’s groups around the world have developed cultural adaptations of, or other publications inspired by, Our Bodies, Ourselves. Most recently, women’s groups in Albania, Russia, South Korea, and Tibet have produced new publications in book and other formats. Judy is also the co-author of Our Bodies, Ourselves: Menopause and most recently, Our Bodies, Ourselves: Pregnancy and Birth. Check out the Our Bodies, Ourselves blog when you can: http://ourbodiesourblog.org/
Judy speaks and writes frequently on a wide range of women’s health concerns, including abortion and contraception, sexually transmitted infections, genetics and reproductive technologies, tobacco and women, women and health care reform, and midwifery advocacy.
Here’s Judy…

The U.S. cesarean section rate hit a record high of more than 31% in 2006. What do you attribute to this all-time high?
There are multiple reasons for this worrisome trend. One is the constant concern about medical liability on the part of obstetricians (this concern often does not serve the mother’s best interests when doctors use interventions that increase the likelihood of a cesarean). Another is the perverse set of reimbursement mechanisms that now favor doing more rather than fewer interventions. Another is the growing number of hospitals and doctors that refuse to allow vbacs (vaginal births after a cesarean). The vast majority of women who previously had a csec (cesarean) can have a successful subsequent vaginal birth, so denying women this option will definitely increase the overall csec rate.
Another reason is what I see as the growing fear and doubt among younger childbearing women, probably fueled by distortions and misleading information in the media (TV shows, movies, articles). For example, some women mistakenly fear that they will more likely have future incontinence if they have a vaginal birth rather than a cesarean. Others have a deep conviction that they could not possibly “handle� a vaginal birth and thus must “choose� a cesarean. In some cases, doctors misleadingly suggest that cesareans are just as safe as vaginal births. This is certainly not true in terms of risks to the mother’s health, and in terms of the baby’s health, depending upon the circumstances it can also be better for the baby to be born vaginally.
And how are women generally informed of their delivery options?
Mostly by the doctors and hospitals that they first approach. Relatively few women know very much about the substantial advantages of the midwifery model and thus never consider this option seriously.
You also mention that the rise in cesareans coincides with the first rise of the maternal death rate in decades. Can you talk more about this? Is there a strong correlation between this rise and the rise of cesareans?
It is too soon to say that the rise in maternal deaths is definitely related to the rising csec rate, but it is likely the case. The risks of repeat cesareans are known to be greater than those associated with first-time cesareans, so that the growing lack of access to vbacs might well lead to more maternal deaths overall.
And are women informed of these statistics when receiving counsel from their doctors?
My sense is that most women are poorly informed about the latest studies. And the childbirth connection’s survey conducted by Harris Interactive showed this to be true as well for many routine medical interventions during childbirth.
How does the U.S. compare to other countries when it comes to pregnancy and delivery care?
Not that well. The World Health Organization (WHO), for example, noted that 30 other countries had lower maternal mortality rates than the U.S. in 2005.
Are midwives and doulas more common in certain parts of the world, and what are the results?
Almost all other industrialized countries that have lower perinatal and maternal mortality rates utilize midwives much more than in the United States. In many countries, midwives attend 85% or more of the births, while in the U.S., midwives attend less than 10% of the births.
How does pregnancy and delivery care vary across the country? Do you know of any states, counties or districts that are working to maintain high quality pregnancy and delivery care?
That’s a long answer. The short answer is some cities do have strong nurse-midwifery services in their hospitals, and these services have excellent outcomes while maintaining lower rates of intervention. Some hospitals have obstetricians, family practice physicians, and nurse-midwives all train together, and this tends to improve working relationships and the ability to offer most women the choices that they seek.

You’ve been traveling across the country with Our Bodies, Ourselves: Pregnancy and Birth. How is it being received in different parts of the country?
Most people – including midwives, doctors, educators, and new moms – love the book. It is clearly written, evidence-based, and includes the stories of women from varied backgrounds. The chief of obstetrics at the University of Michigan Medical System in Ann Arbor has purchased 4,000 copies to give to all women seeking prenatal care there in the coming year. He thinks it is now the best resource of its kind.
The book is well-received, but there definitely are varying degrees of frustration with the status quo. In regions where the option of a vbac is disappearing quite quickly (Houston, for example), some caregivers are deeply concerned about the increased risks for mothers as well as the ethics of forcing women to undergo major abdominal surgery when they do not want to and when it is clearly less safe for them.
And what’s the recurring feedback you’ve been hearing from women and couples?
It is still early, as the book has been out only two months or so. But so far, the feedback is largely positive. Of course, it would have been great to have more space to devote to the specific concerns of women with disabilities, or lesbian mothers, or immigrant women, but space constraints precluded that. We are using our website to expand content, as we have done with all our books.

What advice do you have for women who just found out that they are pregnant and want to carry to term?
Read this book and similar resources. Become well-informed and try to ignore the fear-mongering about birth that has pervaded this culture. These distortions take away from a full appreciation of the extraordinary experience that pregnancy and birth can be.
What are some things they should take into consideration when pursuing prenatal and delivery care?
• Find a doctor or midwife with low rates of intervention.
• Choose a birth setting with low overall rates of intervention.
• Try to find caregivers who support your philosophy and preferences regarding birth.
• Arrange for continuous labor support from someone with experience.
• Explore all options for pain relief and choose them as needed.
• Avoid continuous electronic fetal monitoring when possible.
• Avoid routine use of other medical interventions when possible.
What other projects are you and the Boston Women’s Health Book Collective are up to?
We are trying to reach women with more balanced information about many drugs and devices that are misleadingly advertised (for example, silicone gel breast implants). We are working with women’s groups in other countries who have approached us for assistance to produce their own translations and adaptations of Our Bodies, Ourselves. We are now seeking funds to produce a new revision of the cultural adaptation of Our Bodies, Ourselves–Nuestros Cuerpos, Nuestras Vidas (last published in 2000). And we continue, with hundreds of other organizations, to work in the area of reproductive rights and justice.
You’ve been doing this kind of work for so many decades. How do you keep your spirit and your energy up?
Seeing the effects of our work is tremendously rewarding and energizing. Also, working with younger women who are now assuming leadership roles in the women’s health movement is inspiring. I love to learn in an inter-generational setting.
Is their a presidential candidate you feel has a strong handle on the health care needs of the U.S., especially women’s health, and why?
Both Clinton and Obama have pretty good understandings of women’s health care issues, but I am disappointed that neither is so far willing to challenge the pharmaceutical or insurance industries in ways that I believe to be essential. Hopefully, that will change.