Dr. Marsden Wagner (Courtesy of Dr. Marsden Wagner)
The United States has the second worst newborn mortality rate in the developed world, despite the fact that it's one of the most expensive maternity care systems. Dr. Marsden Wagner is the former director of Women and Children's Health at the World Health Organization and he says the system is broken. Dr. Wagner joins host Bruce Gellerman to discuss his book “Born in the USA – How a Broken Maternity System Must Be Fixed to Put Women and Children First”.
GELLERMAN: For most of his career Dr. Marsden Wagner was your typical American OB/GYN. A baby doctor; delivering his share of the four million babies that are born each year in the United States.
Ninety-nine percent of those births take place in hospitals. That’s the way it should be, thought Dr. Wagner until he became the Director of Women and Children’s Health at the World Health Organization and began to travel to places where midwives do the job.
What he saw changed his life.
WAGNER: And it was an epiphany for me it was a shock beyond belief because that woman when she got near birth she started yelling and she said to the midwife and to me and the family and everybody, “Stand back, I’m gonna have this baby!” And she did. And what I actually witnessed for the first time in my life was a woman in her full power, and it scared me to death.
GELLERMAN: The idea that midwives could do in the home what doctors did in hospitals only cheaper and better in terms of the health of babies and moms led Dr. Marsden Wagner to re-think his profession and write the book “Born in the USA- How a Broken Maternity System Must Be Fixed to Put Women and Children First.”
WAGNER: It's important to know that midwifery is a profession that goes back into antiquity. The word midwife comes from the ancient English for "with the woman." In Danish it is jordemor, which means “earth mother”. And there have always been women at birth. Birth was part of the women's world.
GELLERMAN: I gotta tell you. I'm a little bit um hesitant about this interview because here we are two men talking about women, maternity, and birth.
WAGNER: Well, I think that's a very legitimate concern. And indeed until about 250 years ago there were never any men at the birth. And indeed one of the best known early obstetricians in Great Britain went to birth cross dressed as a woman.
GELLERMAN: Well, I did read your book with great interest and basically what I understand you to be saying is that we've got a broken system. The maternity system in the United States, the way kids are born here is broken. Well, what's the problem?
WAGNER: Well, the problem is that the obstetric profession 100 years ago decided to drive out the midwives because they were taking their patients. And they wanted the field to themselves. So they started campaigns in many states, witch-hunts essentially, to claim that midwives don't know what they're doing. They're killing babies and so forth. And they succeeded in driving midwifery out of our country. They didn't do that in any other country. And in every country in the world, except ours, highly trained midwives catch the vast majority of babies except for the 10 or 15 percent where there's a serious medical problem. But in our country the obstetricians try to catch all the babies and get all the money and all the credit. And this is a very broken way to do things. We have good scientific data showing that doing it this way means many more dead women and many more dead babies.
GELLERMAN: So what you're saying is that they've turned the maternity system into a medical system.
WAGNER: Exactly. It's turning birth into a surgical procedure. And since obstetricians are also gynecologists it means they're also surgeons. So they do it as a surgical procedure. But it is Mickey Mouse and it has nothing to do with the safety of that birth.
GELLERMAN: Well, there have been a dramatic increase in the number of surgical procedures during birth, c-section. But you write basically it stands for convenience. It’s for the convenience of the doctors.
WAGNER: Well you see the problem for the busy gynecologist obstetrician is, that he or she has far too much to do. In catching all the babies, and doing all the family planning, and doing all of the gynecological surgery; their plate is over flowing. And the worst thing on their plate is normal birth because it takes, on average 12 or more hours, and it happens 24/7. So it is a nightmare yet it is their primary source of income. So they're not gonna give it up. So what they've got to do is bring it under control. Now there are two ways that, ah, the obstetrician can bring control into childbirth.
One is to artificially start the labor at a time that is convenient to the doctor and the hospital. And this is done through induction of labor with very powerful drugs. Now the second way that you can bring control into this is to do a cesarean section instead of a normal birth because a cesarean section takes 20 minutes not 12 hours and I can schedule it. And, as a matter of fact, we do twice as many caesarians in this country as should be done. It is more dangerous for the woman and it is more dangerous for the baby.
GELLERMAN: One of the drugs that is used to induce labor is something called cytotec and you talk about it in the book.
WAGNER: The amazing thing about cytotec is that it is on the market only to treat stomach ulcers in adults. And it says on the bottle that this should never be used on pregnant and birthing women. And in fact there's a picture on the bottle of a silhouette of a pregnant woman with a line through it. And yet they use this to induce labor. And the, the result is that this drug causes such violent contractions of the uterus that the baby can't get enough oxygen because the only time a baby gets oxygen during labor is in between contractions.
GELLERMAN: But if you go to the website of the American College of Obstetricians and Gynecologists, which I did, they say, "Yes we have a crisis in the United States in terms of OB/GYN and birthing. The fact is we don't have enough OB/GYNs and that docs are starting to get out of the business because they're afraid of being sued because it's the riskiest of all the specialties in terms of law suits.
WAGNER: Well, there is a great deal of litigation against obstetricians in our country and the obstetricians are screaming and screaming, "no, no, no" and yet why is there all of this litigation? It's because when the woman, pregnant woman, comes to the obstetrician basically the obstetrician is saying, "You come to me and all my expertise and the beautiful hospital with all their machinery and we will guarantee you a beautiful perfect baby." Well, if you play God you get blamed for the natural disasters.
GELLERMAN: You're very passionate Dr. Wagner. Um, are you optimistic?
WAGNER: Yes, I am optimistic. And I'm optimistic because I believe Abe Lincoln was right you can't fool all the people all the time. The American public is going to wake up and discover, for example that the obstetricians are absent, and discover that we're not number one in the world when it comes to maternity care. And discover that we're paying twice as much as we need to for the maternity care. And discover that they are being deprived of this wonderful professional called a midwife and so forth. And they are going to wake up.
GELLERMAN: Well, Dr. Wagner thank you very much. It's been a pleasure talking with you.
WAGNER: Thank you very much sir.
GELLERMAN: Dr. Marsden Wagner's new book is called "Born in the USA: How a Broken Maternity System Must be Fixed to Put Women and Children First."
[MUSIC: Happy Baby “Rock-A-Bye-Baby” from ‘Happy Baby: Good Night’ (Valley Entertainment – 1999)]
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