Disturbing direction

To the Editor:

After 23 years, I left my job as the nurse-midwife in Bar Harbor. I loved my work and the women I cared for. I was not ready to retire, but can’t accept the direction women’s health is heading.

Maternity services are being eliminated, especially in rural areas. Disadvantaged women, often poor with multiple problems, must travel long distances for basic maternity and gynecological care. Citing that “maternity care is expensive” as the rationale for this is gender discrimination.

Bad roads, weather, traffic, poverty and lack of transportation are forcing women to travel sometimes two hours for a prenatal appointment.

When I arrived in Maine, our profession was misunderstood. Work was required to demonstrate that nurse-midwives were safe and skilled providers. We are advanced-practice nurses with graduate degrees in midwifery and women’s health, not uneducated grannies doing home births. While home birth may be incorporated into our practice, the majority of us attend births in hospitals. We are independent providers caring for women throughout the lifespan, not only during pregnancy and childbirth.

Medicine is rapidly changing, and women are affected disproportionately to men. The U.S. is one of seven countries where the maternal mortality rate is increasing and is currently three times higher than in 1980. The c-section rate in this country is astronomical, and many are unnecessary. Surgery can save the lives of mothers and babies, but it is by no means the safest mode of delivery.

Obstetrics requires long and unpredictable hours. There is temptation to expedite births with intervention, creating risk and consequences. For many years, vaginal birth after cesarean (VBAC) was standard of care. Women with a prior c-section were given a trial of labor, and the success rate was as high as 88 percent. Over the past decade, the economics of allowing a trial labor has made it unfeasible for small rural hospitals. While it is well documented that vaginal birth is the safest mode of delivery, the recommendation for VBAC is that the surgical team be available during labor. This increases costs dramatically. Many small hospitals cannot provide this service. Women are forced to succumb to surgery they don’t want or need, exposing them to increased risks.

How did the opinion about safety get so misconstrued? Money and convenience. Surgery is more profitable than sitting and waiting. It is more convenient to schedule surgery during the day than call a surgical team at night.

I used to refer to this as unnecessary surgery, but now call it what it really is, mutilation. We are mutilating women for convenience and profit, and those women often suffer long-term complications and sometimes death.

In the midst of health care reform, it is imperative that our directives not discriminate against women. A lack of accessible maternity services, and the alarming increase in maternal mortality raise a clarion call to reorder our priorities for women’s health.

Midwives are a solution to this problem. We give safe care, advocate for women and teach them to advocate for themselves. As I leave my beloved practice, I am looking ahead to a bigger picture of improving the care that all women in this state need and deserve.

Linda Robinson

Bar Harbor

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