Navajo Births Look Suspiciously Like Israeli Births

There's an article in today's NYT about the low C-section and high VBAC rate at a small Navajo hospital in Arizona. The article describes how:
Nurse-midwives at these hospitals deliver most of the babies born vaginally, with obstetricians available in case problems occur. Midwives staff the labor ward around the clock, a model of care thought to minimize Caesareans because midwives specialize in coaching women through labor and will often wait longer than obstetricians before recommending a Caesarean. They are also less likely to try to induce labor before a woman’s due date, something that increases the odds of a Caesarean.
This is an almost exact description of Israeli hospitals. Women don't bring their own doctors to the hospital to give birth, unless they pay privately. I did for my first birth, because everyone in my family and my husband's family was nervous and wanted trusted MD backup. It was nice to have her there, but all she really did was kind of speed things up a bit by doing a amniotomy and  adjusting my daughter's head while she was in the birth canal. Most of my labor was supported by my husband and birth coach and I don't think I would have managed as well as I did (no epidural and a smooth birth) without them. The nurse-midwives at Hadassah came to check up once and a while, but basically they left me alone, until the pushing, when I seem to recall a whole cheering section (one midwife held up and waved around the little stretchy I brought to bring my daughter home in as inspiration for the home stretch)

The article has a beautiful description of the effects of Navajo culture on childbirth and attitudes towards children in general:
Birth is a joyous affair here, and the entire family — from children to great-grandparents — often go to the delivery room.
“I’ve had 12 family members in the room,” said Michelle Cullison, a nurse-midwife. “I’ve frankly never seen a place like this. Whoever that woman wants to be there is there. It’s something I would take out to the community.”
What I found most amusing is the following quote from a doctor:
Can the rest of the country learn from Tuba City? Doctors say they are intrigued by the model but not sure how transferable it is.
Hello, we have a whole country that approaches birth the way this dusty little hospital does. And I don't think Israel is alone, most of Europe approaches birth this way as well. It's frustrating (and ironic) how provincial the US can be when it comes to healthcare, despite all of its technological advances.

4 comments:

LeahGG said...

eep. I just read what an amniotomy is.. I had the freakiest thing with Ephraim - the water never broke. It's called being "born with the caul" and means he's destined for greatness. :)

Anyway, the reason America couldn't easily transition to this system is 1. liability. 2. what women are used to. 3. there probably aren't enough trained nurse-midwives to take over whole departments.

Personally, I don't know how the US system works... but the Israeli system seems to do pretty well. Except that I'm still waiting for my epidural... (asked for one immediately upon arrival at the hospital. Current stats: births:2 epidurals: 0)

mother in israel said...

Shoot. What happened to my comment? Lost in cyberspace I guess.

My experience is that if you don't want an epidural you're seen as a neanderthal. Also, the c/s rate is way up here. I don't have numbers but one reason is that breech babies are all born by c/s.

Commenter Abbi said...

Leah- I've heard of that before, but i'm sure it's freaky when it actually happens to you.

MII: Nobody has ever really commented on my desire not to have an epi. I think the c/s numbers might be up, but I don't think they can match America's.

tanya said...

Abbi-in the Uk it is all midwife lead. In fact the care throughout pregnancy is with a midwife and you would only see an ob/gyn if you had a complicated case (or as in the case of my mom, she got one privately because she was too old to be having a baby at 32!).

Also in the UK, they really really don't push epidurals.the opposite. Most people get by on pethidine and gas and air. I am still very angry about my last birth experience where I was induced and didn't get an epidural and wasn't offered any other pain relief. I don't know how you do it without an epidural Abbi...maybe without the induction it wouldn;t have been so bad?? Generally having experienced an induction, it is definitely something to be avoided!

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