| Chapter 1: | Maternal Expectations in 21st-Century U.S. Birth Culture |
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generally focuses on treating things that go wrong rather than things that go right, attended 93% of hospital births as of 2007 (Martin et al., 2010). Midwives attended most of the remaining hospital deliveries, and though they are trained to view childbirth as a normal, healthy process, they are still subject to hospital protocol, which currently translates into rates for common obstetric procedure use of over 50%. This means any hospital-birthing mother has a better than one in two chance of receiving some procedure in a hospital birth—adding up to over two million U.S. women a year who receive hospital obstetric intervention whether they had planned on it or not. With contemporary birth interventions occurring at these rates, mothers who achieve birth experiences consistent with their earlier views, particularly those pursuing intervention-free birth, constitute a true statistical minority.
One of the greatest contributors to current intervention rates is the emphasis on controlling the process, most often by reducing the time women spend in pregnancy, labor, and delivery with medical procedures to manage when labor begins (onset), its duration, and the newborn’s arrival. As but one indication of the contemporary “race to the finish” childbirth orientation, for first-time mothers, U.S. hospital protocols commonly set 12 hours as a safe limit for “normal” first-stage labor (Zhang et al., 2010), whereas the World Health Organization (WHO) grants women 20 hours in a first birth (2006a). To move labor along, labor-acceleration procedures are frequently introduced. For example, in mothers who plan to deliver vaginally, labor typically starts on its own (spontaneously) sometime between the 38th and 41st week of pregnancy, but decreasing numbers of women wait for natural labor because of the growing use of an artificial, hospital-based procedure known as medical labor induction. In 1980, only 1.1% of mothers underwent labor induction (DeFrances, Cullen, & Kozak, 2007); in the early 21st century, hospital records and maternal reports yielded figures ranging from 23–41% (Declercq, Sakala, Corry, & Appelbaum, 2006). (More on labor induction and related controversies appears in chapters 2 and 3).
Additional statistics show how pervasive other labor-acceleration strategies have become. One of the simplest, nearly universal, but often