This is a movie. This is television. This is the formula:
Jane is going about her business when her water breaks. The time has come! Ready the troops! Jane calls husband or big sister or mom or best friend. "We'll meet you at the hospital! Go Go Go!" If husband is present: "Where are the bags?! WE FORGOT TO PACK THE BAGS!"
Cut scene. Arrival at hospital. Frantic. "My wife/partner/friend/daughter is having a baby, pay attention to us NOW!" Cut scene. Delivery. Woman is screaming, sweating, screaming some more—but still looking relatively good. If family and friends are present, they're worried and distressed in the waiting room. They hear her screams. Cut back to woman. She hurls obscenities at doctor or father. She screams about the pain. She demands an epidural. If this is a sitcom, some joke will be made about her anger with the dad, who looks terrified and might faint. Cut scene. Beaming mom/family cuddles baby.
Deviations exist, of course, but this is the norm. (It's even apparent when interspersed with a musical scene, as below on Glee:)
(Is it wrong that this scene made me tear up?)
We must be sensitive about portrayals of childbirth in the media because the United States is in the midst of a maternal health care crisis. Last year, Amnesty International published "Deadly Delivery: The Maternal Health Care Crisis in the USA," a report that categorically condemned our maternal healthcare system. Key information: In 2011, the U.S. ranked 50th worldwide in maternal mortality rates, tying with Saudi Arabia and dropping rank from 44th in 2010. Yet the U.S. spends more money on maternal healthcare than any other country. African-American women are three to four times more likely to die from pregnancy-related complications, yet unusually high death and illness rates cross racial and socioeconomic boundaries. 42 percent of American births are covered by Medicaid.
The reasons for this crisis are systemic and have a lot to do with health insurance, access to care, and malpractice insurance. They also have a lot to do with how obstetrics is practiced. In this post (one of a three-part series) I will focus on the issue of time.
Re-read the formula. You'll notice the pervasive theme is a sense of urgency and emergency. The sense of urgency is portrayed as deriving from the mother's hysteria and the inherent trauma of childbirth. The urgency is legitimized later in the scene, when the birth is shown to occur immediately and with great pain and drama.
(The Look Who's Talking clip is in French and an absolute must-watch.)
But... Why the urgency? Labor can actually take quite a long time, and if anything, women usually arrive at a hospital too early, not too late. (That doesn't make for great drama though, does it?) When women arrive too early, the doctor often breaks their water manually with a hook and then orders Pitocin, a labor-inducing drug. These types of drugs are used in at least 24 percent of American births, and they make contractions more painful and increase the likelihood of an emergency C-section and other complications. On average, women are three times more likely to die following a cesarean (the danger of a C-section depends very much on the specific situation) than following a vaginal birth, yet cesarean rates in the U.S. are now at 33 percent, an all-time high.
In most U.S. hospitals, an obstetrician must be present during the birth of a baby. This differs from policy in other countries, where doctors are present when surgery is required. Our unique policy transforms childbirth into a feat of time management: so many women, so few doctors. It's common today for an OB to place a time limit on a woman's pregnancy; if she doesn't go into labor by a specific date, she is deemed "post-term" and scheduled for an induction or a C-section. The definition of "post-term" has narrowed over time and varies from hospital to hospital. Meanwhile, "failure to progress" places a time limit on how long a woman can labor before her labor is "augmented" with labor-inducing drugs. The definition of "failure to progress" has narrowed as well, from 36 hours in the 1950s to 12-24 hours today. And finally, the episiotomy—cutting the vagina and perineum—is a common part of labor and delivery in many hospitals, yet conspicuously absent from "the formula."
And so "the formula," the urgent scenario that begins with the water breaking and quickly moves to screaming and immediate delivery, legitimizes the urgency of childbirth and firmly places the source of all urgency on the mother. We rarely see women scheduled for a C-section or threatened with impending induction. The homogeneity of birth scenes lulls us into a state of complacency and misguided expectations. It limits the type of questions that women are asking. Scheduling cesareans or inductions for "post-term" babies is now very common, yet the women I interview for my research are always surprised when it happens to them. Emergency cesareans are common as well, yet these scenarios fall outside our cultural expectations of birthing, and therefore are more upsetting when they occur. We don't anticipate that the circumstances of labor and delivery might be outside of our control. Indeed, on TV and in the movies, the demands come from the woman. Usually that she be given an epidural, stat.
What do you think about "the formula" and portrayals of childbirth in the media? Did I get it wrong or miss an important component? Stay tuned for Wednesday, when I break down the birth scene in this week's Parenthood.