This issue of “Her” is a salute to women. The definition of “salute” is as follows:
salute (noun); a gesture of respect, homage, recognition or acknowledgment
I have so much respect for women – doing the work I do, I have a front-row seat to the ups and downs, the beauty and the challenge surrounding one of the most amazing things women are uniquely able to do – give birth. I could go on and on about the strength, wisdom, and resilience I witness as mothers bring their babies into the world. My mind fills with all the images of mothers in labor, mothers putting in the work to become educated about birth, mothers caring for their bodies and babies through the practice of prenatal yoga, mothers’ perseverance in feeding their babies, and mothers supporting other mothers along their journey. Those parts are the beautiful parts, and it is such an honor to witness them.
The honor of witnessing those beautiful parts cannot be separated from the responsibility that comes with seeing and hearing the not-so-beautiful parts – the images and stories of those who experienced firsthand some of the ways the current birth culture in our country fails women. I acknowledge this unfortunate reality, and as a gesture of respect for women, feel responsible to not remain silent.
Have you ever heard of the evidence-to-practice gap in medical care? This term refers to the fact that research says from the time something is shown to be a best practice from research evidence, it takes an average of 17 years before that practice becomes standard in the healthcare setting. In the meantime, families may receive outdated information or be subjected to outdated practices that are based on “the way we’ve always done it” rather than on what we currently know to be best for moms and babies.
We MUST do better.
I have a lengthy wishlist for improvement in maternal healthcare, including many ways to close the evidence-practice gap. This list includes greater access to true midwifery-led care and fewer barriers to the creation of freestanding birth centers. We also need publicly accessible data on measures of evidence-based care including hospital and provider-specific rates of cesarean, elective induction, 3rd and 4th- degree tears, and Vaginal Birth After Cesarean (VBAC), as transparency has been shown to result in higher quality care. We need greater adherence to The American College of Obstetricians and Gynecologists (ACOG) own recommendations for preventing unnecessary cesareans.
When there is so much change needed, it can be overwhelming to think how we might make a difference. And let me be clear: it is NOT the responsibility of mothers to make these changes. BUT I have also had a front-row seat to the amazing ways women are paving the way for future birthers. Our birth culture begins to heal each time women seek out a quality birth class independent of the hospital, each time they set the expectation of true informed consent, each time they bravely “fire” a provider who is not providing quality care, and each time they say “no” to outdated practices or procedures. Women pave the way each time they bravely give birth in the way that is best for them and for their baby even when they’ve been pushed to adhere to strict time constraints, been exposed to scare tactics, or just generally been given disrespectful care.
So mothers - I acknowledge you and the challenges you face. I respect you and your right to informed consent and refusal. As my salute to you, I will continue doing what I can to improve maternal healthcare, speaking up for and with birthing mothers and their babies, and chipping away at the current culture by educating and empowering families to advocate for better care.
~Lacy Knipper, Certified Birth Educator, Certified Prenatal Yoga Instructor
Sources:
Rosenstein MG, Chang S, Sakowski C, et al. Hospital Quality Improvement Interventions, Statewide Policy Initiatives, and Rates of Cesarean Delivery for Nulliparous, Term, Singleton, Vertex Births in California. JAMA. 2021;325(16):1631 1639.doi:10.1001/jama.2021.3816
Stanford University School of Medicine. “California Campaign Lowers Statewide C section Rate”. April 27, 2021. https://www.stanfordchildrens.org/en/about/news/releases/2021/california campaign-lowers-c-section-rate
The American College of Obstetricians and Gynecologists. “Safe Prevention of the Primary Cesarean Delivery”. Obstetric Care Consensus. Reaffirmed 2023; https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2014/03/safe-prevention-of-the-primary-cesarean-delivery
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