| Chapter 1: | Maternal Expectations in 21st-Century U.S. Birth Culture |
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An additional consideration is that labor induction, labor acceleration, epidurals, and IAP are infrequently delivered in isolation because one intervention often leads to another (Simpson, & Thorman, 2005); this is referred to as the “cascade of interventions” and translates into multiple points of potential deviation from childbirth expectations. For example, labor contractions in a mother whose labor was induced might not become regular, in which case oxytocin might be increased as her deadline for delivery nears. With contractions of increased intensity, the mother might request an epidural, which would slow her labor, increasing the need for more oxytocin, and so on. This use of one procedure to address the shortcomings of another led some of my study mothers to describe their labor experiences “like a rollercoaster” or as involving “being hooked up to all kinds of tubes and wires.”
Perhaps the most dramatic deviation from an expected “normal,” vaginal birth is cesarean delivery. Of the approximate 32% early 21st-century cesarean deliveries (Martin et al., 2010; Meikle, Steiner, Zhang, & Lawrence, 2005; United States National Institutes of Health, 2006), about half are the so-called labored or emergency cesareans performed on women who had been in labor when someone determined that it was time to terminate labor with surgery in the interest of maternal or fetal health. Labored cesareans should be distinguished from the remaining half of cesarean surgeries that are planned—that is, scheduled months or weeks ahead of time to occur around the baby’s due date, allowing mothers to forego labor entirely. For both labored and planned cesareans, uniform guidelines on appropriate medical cause are vague or nonexistent; this and related issues are discussed in chapters 6 and 7.
Both within the medical community and among the public at large, routine practice of procedures such as labor induction, IAP, and cesarean surgery is frequently supported with the argument that such procedures make childbirth safer overall, and that though the procedures carry their own risks, they are preferable to what could happen if the interventions were not used. Consequently, the argument continues, how could a responsible mother trade the known risks of a perhaps unnecessary birth procedure for the unknown risks of proceeding without it, even if this