The technological advancement and expansion of biomedical knowledge may assist pregnant women in delivery and may help them avoid multiple birth complications. The medical and obstetric assistance are especially important when a woman’s health condition is unsatisfactory, and there are fewer chances for the positive pregnancy outcomes. However, many women in the USA prefer natural childbirth which implies minimum obstetric and medical assistance.
The choice of a particular birth option can be influenced by the cultural and social backgrounds of a woman, the availability of support resources, and potential health risks. The choice of an appropriate childbirth option is important because it can help to prevent birth complications that may threaten the psychological and physical well-being of a pregnant woman and affect infant development in a negative way.
Hospital birth is a common option for labor and delivery. Traditional hospital birth is associated with medical support and professional supervision during the gestation period. Many hospitals in the USA provide prenatal care practices such as parenting and childbirth training which help women to reduce stress and to feel more secure. Although hospital birthing is commonly perceived in close relation to medical interference and regarded as “unnatural,” many US medical settings give women an opportunity to have more “natural” delivery without medication yet with the assistance of a midwife (Miller & Shriver, 2012).
However, in the emergency situations, technological and obstetric interventions are needed for the maintenance of maternal health and infant survival. Nowadays, about 26% of births in the USA were supported by the surgical interference, and the researchers consider that many of such deliveries were unrelated to the factors of maternal health and child’s survival (Crossley, 2007).
It is observed that the rates of caesarean deliveries have risen dramatically in a few decades, and it is considered that women may prefer medicated hospital childbirth because it is commonly associated with a high level of professional expertise and less painful experience (Miller & Shriver, 2012).
The natural home births became very popular. Many women prefer to reduce medical control and management in labor and delivery. Natural delivery often takes place at home among the family members, and because of the comfortable conditions and psychological support the woman may feel less stressed. Natural home childbirth is often idealized and regarded as the best option, but the lack of pregnancy monitoring may provoke adverse outcomes and birth complications. Therefore, at least a small amount of obstetric supervision is still important to ensure the positive pregnancy outcomes.
Factors of Childbirth Decisions
There are close interrelations between cultural contexts, social organization and influences, personal values and the selection of childbirth options. For example, it is observed that natural unassisted homebirth can be largely influenced by the “religion-centered lifestyle” (Miller & Shriver, 2012, p. 713). Natural delivery and mothering are also frequently preferred by the women who are attached to family and are primarily child-oriented.
At the same time, the women who prefer hospital childbirth associate the availability of midwives and the presence of physicians during delivery with safety (Miller & Shriver, 2012). It this way, cultural contexts, as well as the personal values and beliefs, play a decisive role in childbirth decision making. However, it is possible to say that the role of personal values and preferences in childbirth decision making is significant in case many options are available for a woman, and she does not have any strict financial or social constraints in following the personal interests.
The choice of the childbirth option can be motivated by the socioeconomic position of a pregnant woman. The costs of deliveries in the US hospitals may exceed $6000 (Miller & Shriver, 2012). The preparation training practices, prenatal care and monitoring, courses and other pregnancy management activities may become unavailable for many women from poor families who do not have medical insurance.
In some cases the assisted homebirth may be more expensive than a hospital delivery, and many women who cannot afford to have a homebirth but regard it as an ideal sense of safety are forced to give birth in less comfortable conditions due to the financial situation.
Birth Complications
Although a woman may have no health problems during the pregnancy, the complications during delivery still may arise. For example, the complications may be related to the abnormal position of the fetus in the uterus that may lead to the prolonging of labor, increase of pain and traumatic experience during delivery. The fetal malposition and the consequent prolonged labor often require the surgical intervention, and the severe cases can result in the mother’s morbidity (Senecal, Xiong, & Fraser, 2005). It also increases the risks of the infant morbidity that may include the admission to the neonatal intensive care unit, and multiple traumas.
There is the risk of umbilical cord prolapse and umbilical cord compression as well. Umbilical cord provides the flow of blood to the fetus and its disposition during delivery provokes the emergency situations. Umbilical cord compression decreases the blood flow and may provoke the fetal heart rate drops (Ashington, 2009). The severe consequences of umbilical cord compression are uncommon and they usually require the caesarean section.
Umbilical cord prolapse is also a rare phenomenon, but the respond to this critical situation should be urgent. It occurs when the umbilical cord precedes the baby in the birth canal during the delivery (Maher & Heavey, 2015). When the fetal cord can be felt or seen on the perineum after the rupture of membranes it is defined as the overt prolapse, or when it is not seen but it moves alongside the fetus’ body, it is defined as the occult prolapse (Gabbay-Benziv et al., 2014). Cord prolapse may be spontaneous, or it can be developed as a consequence of the artificial and premature rupture of membranes (Maher & Heavey, 2015).
The frequency of the complication occurrence is low but it may lead to the infant’s death. Cord prolapse decreases the blood flow and leads to the deceleration of the fetal heart rate. The perinatal mortality associated with the cord abnormality is asphyxia, prematurity and low body weight (Gabbay-Benziv et al., 2014). The prolonged umbilical cord prolapse increases the chances of negative outcomes in both preterm and term deliveries. Thus, the quick medical respond to the emergency situation is a necessity.
The prolonged umbilical cord prolapse can result in the development of physical abnormalities in the infant. It is reported that about 15% of all neonates influenced by the prolapsed cord during delivery were referred to the intensive care units due to respiratory problems, such as transient tachypnea or respiratory distress syndrome, or hypoxic brain injury (Gabbay-Benziv et al., 2014). The fetal hypoxic brain injury caused by the reduction of blood flow influences the development of brain structure in a negative way and, as a result, the infant’s cognitive and motor development can be delayed (Macnab, 2012).
The intervention of cognitive and sensorimotor deficits should include the stimulation of the neurocognitive mechanisms in a child. The caregivers need to communicate and actively interact with the infant and create a favourable sociocultural and physical environment to facilitate the sound neonatal development.
The cord abnormality does not usually have a severe physiological negative impact on mother, and the physical distress can be caused only by the medical interventions. However, the critical health condition of a newborn child may create a significant psychological burden for the mother and her family. The post-delivery intervention that may include the admission to the intensive care unit does not guarantee the positive outcomes and implies large financial costs, and it thus can be unaffordable for the low-income families. Based on this, it is recommended to take the preliminary measures to ensure the medical intervention in case of emergency will be rapid.
The factors increasing the risk of cord prolapse include the fetal malpresentation, multiple pregnancy, congenital abnormalities, or prematurity (Maher & Heavey, 2015). These factors can be identified through prenatal screening. The early identification of risk factors allows the physicians and parents to make necessary preparations for a quick intervention. It is recommended for a woman who is at risk of umbilical cord prolapse to choose the supervised hospital as a childbirth option and increase medical control during labor.
The level of medical staff skilfulness and technological advancement in the setting is significant as well. The opportunity to communicate about the medical decisions and procedures included in the labor management can be an important factor for a woman because it can increase her confidence in the positive delivery outcome and develop the sense of safety.
The Role of Culture in Family and Birthing Decisions
Depending on the culture, the decisions individuals make about birthing and family can vary significantly. For example, Brazil is the country where the rate of cesarean sections comprises forty percent; furthermore, if to analyze private hospitals, the rate can even be higher than forty percent. This occurs due to the fact that the majority of women that give birth in private clinics come from high, and middle class thus can afford the procedure.
On the contrary, in Japan, there is a prevailing paternalistic pattern of approach towards childbirth – when the doctor makes all the decisions concerning the health of the mother and the fetus. Such an approach is used in countries like Australia only in specific emergency situations when there is little time for deliberations. Women in labor hospitalization in Ethiopia is acceptable if the cervical opening is more than three centimeters.
If the cervical opening is smaller than three centimeters, a woman is sent home until she surpasses the requirement. Another interesting differentiation in cultural decisions about childbirth can be found in India where it is illegal to determine the sex of the fetus during the prenatal screening tests (Queensland Health Multicultural Services, 2014).
On the other hand, some cultures, especially countries that practice Islam, resort to female genital mutilation (FGM) that has a long-term effect on the health of women and their pregnancy. FGM is usually conducted in childhood to preserve the culture heritage of a particular nation, a supposed initiation into womanhood, or other non-surgical reasons. FGM makes the pelvic examinations during pregnancy almost impossible, create a risk for the mother and the fetus without an opened birth canal, complicate the monitoring of the fetal distress.
Thus, the ability or inability of women to make decisions about family and childbirth are deeply rooted in cultural beliefs and traditions, no matter how specific or inexplicable they may be.
References
Ashington, G. (2009). Umbilical cord anomalies. Ultrasound, 17(2), 106-108.
Crossley, M. L. (2007). Childbirth, complications and the illusion of choice’: A case study. Feminism & Psychology, 17(4), 543-563. Web.
Gabbay-Benziv, R., Maman, M., Wiznitzer, A., Linder, N., & Yogev, Y. (2014). Umbilical cord prolapse during delivery – risk factors and pregnancy outcome: A single center experience. Journal of Maternal-Fetal & Neonatal Medicine, 27(1), 14-17. Web.
Macnab, A. (2012). The etiology and evolution of fetal brain injury. Brain Damage – Bridging Between Basic Research and Clinics. Web.
Maher, M. D., & Heavey, E. (2015). When the cord comes first. Nursing, 45(7), 53-56. Web.
Miller, A. C., & Shriver, T. E. (2012). Women’s childbirth preferences and practices in the United States. Social Science & Medicine, 75(4), 709-716. Web.
Queensland Health Multicultural Services. (2014). Cultural dimensions of pregnancy, birth and post-natal care. Web.
Senecal, J., Xiong, X., & Fraser, W. D. (2005). Effect of fetal position on second-stage duration and labor outcome. Obstetrics & Gynecology, 105(4), 763-772. Web.