Women from around Michigan will celebrate labor of a different kind Monday when they gather at the Capitol to rally for improved maternity care in the state.
The Improving Birth rally is one of more than 100 planned throughout the country on Labor Day as part of a national effort to reduce the nation's rate of Cesarean sections and return to a less-medical approach to childbirth.
With organizers calling it the next wave in the women's movement, the rallies stem from the rising practice of natural birth -- that is, births without painkillers, medical technology and, sometimes, even a hospital.
Organizers say they want to take back birth from a medical system that casts pregnancy as a disease that needs to be cured; they want the birth process returned to women as something empowering.
"We're asking for evidence-based maternity care, which means care that is based on reliable research," said local organizer Jessica Warren, an Okemos woman who is in training to become a type of birth assistant called a doula. "It needs to be beneficial to moms and babies by reducing incidents of complication, injury and death."
The issue arises from a larger concern that the United States compares dismally to other industrialized nations in several indicators of maternal health.
A report by Amnesty International states that American woman are more likely to die in childbirth in the United States than women in 40 other countries, including Iceland, Slovakia and Bosnia. Greece reports the lowest maternal death rate with just two deaths per 100,000 live births, according to the World Health Organization.
The U.S., by comparison, has a pregnancy-related death rate of 15 per 100,000 births, according to the Centers for Disease Control and Prevention. When broken down by ethnic and racial groups, U.S. women face alarming disparities. African-American women are three times more likely to die in childbirth than white women.
"It's clear that we have to do something different in order to improve outcomes," said Cynthia Gabriel of Ann Arbor, author of a new book advocating for natural births in hospital settings. "If you keep doing more of the same, just throwing more technology at these births, there will be a point of diminishing returns, and we hit it a long time ago."
Causes are wide-ranging
Many factors are suspected in the high U.S. maternal mortality rate, including the nation's obesity crisis, worsening economic conditions and lack of insurance for at-risk women, and even data-collection changes over the past several decades.
But natural birth advocates also point to the nation's C-section rate as one of the causes. Nearly one in three American moms now deliver via C-section, according to the CDC. In Michigan, the C-section rate is more than 37 percent, according to the Michigan Department of Community Health.
"C-sections are major abdominal surgery," said Warren. "They carry both short-term and long-term risks to moms and babies. (C-sections) have become so common that they are perceived as normal, but they carry risks."
Definitive data elusive
C-section death rates are hard to measure, however, because many are caused by infection or other complications that develop later.
C-section rates for local hospitals were not available. Sparrow Hospital and McLaren Greater Lansing have refused several requests by the Lansing State Journal to provide their rates. The Michigan Department of Community Health also said it could not provide individual hospital rates, only county-by-county numbers.
However, Sparrow and McLaren officials have said they are willing to listen to the needs and demands of moms in the area.
"We recognize that some women would like to have natural childbirth options within a hospital environment," said Sparrow spokesman John Foren. "We're in the process of exploring the opportunity to be able to provide this option to expectant mothers. However, there are a number of issues that we want to be sure we have a full understanding of in terms of quality of care, staffing, etc. It is too early in our research to communicate more on this potential service."
Advocates point to the new Von Voigtlander Women's Hospital at the University of Michigan as a good example of a hospital that encourages natural birth. There, rooms are designed to help moms labor naturally and avoid so-called interventions, such as epidurals or drugs to speed labor along. Rooms feature laboring tubs, hanging bars for upright laboring and labor balls.
The hospital also has nearly 20 nurse midwives available for patients.
McLaren is the only hospital locally with a nurse midwife on staff. Studies have shown that mothers who receive care through a midwife instead of an obstetrician are less likely to undergo a C-section.
Sameerah Shareef, the McLaren midwife, said a large reason for that, however, is that women who qualify for midwifery care have to already be low-risk, meaning they don't suffer from conditions that carry a higher risk for pregnancy complication.
Some women, she said, can't avoid a C-section because certain conditions and emergencies require them.
"Education is the most important piece," she said.
"Women need to take a position of self-empowerment. You have to be in good health. You have to be willing to do what you need to do to have a healthy pregnancy, and those things are going to help you lower your chance of having a C-section."
Shareef also said the C-section numbers for individual hospitals can be misleading. Hospitals like Sparrow are going to be higher than others because they have the region's only neo-natal intensive care unit, which means they are more likely to serve mothers with high risk factors.
Bills could affect practice
Natural birth advocates in Michigan are perhaps more galvanized than in other states, motivated by two controversial bills pending in the Legislature that could drastically affect who is allowed to practice as a midwife -- the chief practitioners and promoters of natural birth and home birth.
One bill, by Rep. Ed McBroom, an Upper Peninsula Republican, would allow certified professional midwives -- or CPMs -- to become licensed as health professionals in Michigan.
That would allow them, among other things, to eventually receive Medicaid payments for home births.
CPMs have two to three years of training and must pass a national certification exam, but they have been criticized because they aren't required to have a college degree.
McBroom's bill is being pushed by the Friends of Michigan Midwives, which largely represents home-birth and CPM midwives.
The bill also would require home-birth midwives to carry medical malpractice insurance.
Whitmer has been under intense criticism from midwifery advocates since she introduced the measure, with some using her Facebook page to accuse her of betraying women and limiting health care choices.
Whitmer did not return a call seeking comment.
Her bill was written in response to the death of a DeWitt infant named Magnus Snyder following his delivery at the Greenhouse Birth Center in Okemos, a non-hospital-affiliated center that offers a home-birth-like experience using midwives. Magnus' parents, Sara and Jarad Snyder, sued Greenhouse because they say their midwives assured them it was safe to deliver him outside of a hospital even though they knew he was breech. He suffered brain and organ damage and died 13 days after birth.
The lawsuit still is pending, but Greenhouse midwives are closing the center on Sept. 30, citing "legal and emotional stress" in a letter to supporters and clients.