The Jewish Attitude on Midwives
By Judy Slome Cohain, CNM, MSN
The recent faith of worldwide Jewish community leaders in obstetricians 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.
Jews should be concerned with finding the best options for women giving birth, since our religion values women and children so highly. Given their leadership role in the Jewish community, rabbis and their wives, and women Torah scholars could perform a remarkable community service by educating women and referring them to midwives as appropriate.
Pregnancy is not a disease. 90% of Jewish pregnancies are uncomplicated. 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 good in uncomplicated cases. Cesareans were once thought to be able to prevent cerebral palsy. Despite the high rate of cesarean birth, 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 showed that a woman who has a cesarean rather than a normal birth and gets pregnant again 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 and gets pregnant again, greatly increases her risk of hysterectomy.
"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.
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 true. When women who have "requested "cesarean delivery are properly informed of all the risks, the majority of them decide against it. Therefore, it seems the phrase that "request" cesarean is a misnomer. It seems her decision very much reflects the advice she is getting.
It could 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. For the past 50 years, the experts were all doctors. With the cesarean rate spiraling out of control, one way to bring it down would be to return childbirth to professional midwives.
Judy Cohain is an Independent Researcher with 22 first-author research articles in the medical and midwifery literature and lives in Alon Shvut, Israel.
from the June 2006 Edition of the Jewish Magazine