By Judy Slome Cohain

The faith of worldwide Jewish community leaders in the medical profession may be misplaced when it comes to pregnancy and birth. While obstetricians are unequivocally the experts at complicated pregnancy, there is compelling evidence that pregnancy outcomes would improve if expert midwives presided over uncomplicated pregnancies. Given their leadership role in the Jewish community, rabbis could perform a remarkable community service by educating women and referring them to midwives as appropriate. Jews should be concerned with finding the best options for women giving birth, since we as a religion value women and children so highly. It seems to me that rabbis who are leaders of communities have a special role to play in bringing to light the facts presented here and lead their communities in a change of attitude by exposing the work of professional midwives rather than suppressing it.

Pregnancy is not a disease. 90% of Jewish pregnancies are uncomplicated¹. Nevertheless more than 1 out of every 10 of these uncomplicated pregnancies end up with a cesarean when doctors are in charge, whereas when professionally trained midwives are in charge, only 1 to 4 per 100 uncomplicated pregnancies end in a cesarean. High cesarean rates offer no improvement in the health of the newborn in uncomplicated pregnancies. On the contrary, they cause more harm than good².

Cesareans were once thought to be able to prevent cerebral palsy. Despite the high rate of cesarean birth³, the rate of cerebral palsy has not decreased at all. Children born by cesarean have an increased risk of allergies and asthma. An extra 1 in 10,000 women die from cesarean surgery from bleeding or anesthesia complications. Research from 2003 shows that a woman who has a cesarean doubles the chances that her next pregnancy will end in an unexplained stillbirth at full term. Unnecessary cesareans endanger not only future fetuses, but future pregnancies. A woman who has a cesarean also greatly increases her risk of hysterectomy on her next pregnancy.

“Too Posh to Push” is marketed by the media as glamorous instead of the highly risky surgery that it is. Over 1.1 million American women last year signed a consent form for a cesarean. Newspapers should publish the cesarean consent form, which lists many of the risks, so that women can read it at leisure and not when they are lying on the stretcher about to have surgery. If newspapers refuse to publish it, then it should appear in all the temple bulletins as a simple way to inform mothers of the risks of cesarean surgery and counter the media hype.

Today, not only do over 10% of healthy women with healthy pregnancies deliver by major abdominal surgery, but thousands of women per year “request” it. A majority of obstetricians tell women that cesarean is as safe as vaginal birth if not safer despite the fact that the National Institute of Health (NIH) says that is not true⁴. When women who have “requested” cesarean delivery are properly informed of all the risks, the majority of them decide against it. Therefore, it seems that using the term “request” for cesarean is a misnomer. It seems her decision very much reflects the advice she is getting.

It should be up to the expert midwife to recognize complicated pregnancies and labors and refer them to the surgical experts for treatment as needed. No one is saying that all midwives are safe and all obstetricians dangerous. That’s where the rabbis come in. Rabbis classically refer people to the experts in the field who have good results. Until now, the experts were all doctors. That isn’t right. Can one rabbi speak out for midwives?

To find out more about how a midwife is trained: mymidwife.org

fn1.Cesareans and Low Risk Women In Israel. The Practising Midwife. 2004.7:7:28-31. Complicated Jewish pregnancies= 3% breech, 2.5% prematurity, 1% twins 3.5% all other problems.

fn2.Detailed tables comparing risks of elective Cesarean with vaginal birth can be found at www.maternitywise.org/cesareanbooklet

fn3.30% is the overall Cesarean rate for all pregnancies in US, 20% in Israel.

fn4.National Institute of Health statement:
http://pregnancy.about.com/gi/dynamic/offsite.htm?site=http://consensus.nih.gov/2006/2006CSectionSOS027html.htm

« Previous article  |   Next article »