Science Vs - Childbirth: Are Doctors Messing It Up?

Episode Date: September 23, 2021

Childbirth seems to be getting more and more medicalized, with C-sections and other interventions out the wazoo. But childbirth isn’t a disease! So is all this medical meddling really necessary, or are doctors too trigger-happy with the scalpel? To find out, we talked to obstetrician and gynecologist Dr. Sarah Osmundson, doula Shala Konomi, clinical scientist Dr. Sarah Stock, and obstetrician and gynecologist Dr. Crystal Berry-Roberts. Here’s a link to our transcript: https://bit.ly/3kxPO2j  Check out Shala’s instagram here: Sajeandluna  This episode was produced by Meryl Horn with help from Wendy Zukerman, as well as Nick DelRose, Taylor White, Michelle Dang, Rose Rimler and Ekedi Fausther-Keeys. We’re edited by Blythe Terrell with help from Caitlin Kenney. Fact checking by Angely Mercado and Taylor White. Mix and sound design by Bumi Hidaka. Music written by Peter Leonard, Marcus Bagala, Emma Munger, and Bobby Lord. A huge thanks to all the experts and we got in touch with for this episode, including Tammy Hall, Aza Nedhari, Dr. William Grobman, Dr. Ana Betran, Professor Vincenzo Berghella, Dr. Prabhcharan Gill, Kate Dirk, Carol Burke and Dr. Ellen Mozurkewich. And special thanks to Jack Weinstein, Navani Otero, the Zukerman family and Joseph Lavelle Wilson. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hey, I'm Wendy Zuckerman, and you're listening to Science Versus from Gimlet. And yes, I am back. I was away spending some time with the family. They say hi, by the way. And I am ready to dive into today's episode, which is about childbirth. Are doctors getting it wrong? For decades in the US, doctors have been intervening more and more into childbirth. We're at the point where around a third of people having babies in the US are getting C-sections. Yeah, about one in three are getting surgically cut open to get the baby out.

And a lot of people are saying, childbirth isn't a disease. Is all this medical meddling really necessary? And this is something our editor, Blythe Terrell, has been thinking about ever since she went into labor. It all started in August 2019. She was eight days past her due date. Blythe and her husband got back from having dinner, some pizza, and they were sitting on the couch at their apartment in Brooklyn. At this point, we were like watching TV in the basement and I can't remember what we were watching. Maybe billions, unfortunately. We'll keep that out of the cutting room floor, out of respect. Yes.

Then she starts feeling really uncomfortable. Things were like tightening up and stretching around. And, you know, it was like a storm was brewing or something. It's like the gears grinding on like a really old truck was how it felt. And things started getting more intense. Blythe had started contractions. This happens when the uterus starts squeezing, pushing the baby against the cervix so that it can eventually get out.

This is exactly what's supposed to happen in childbirth, but it can get incredibly painful. It got so bad that Blythe couldn't bear to sit on the couch anymore, and every time the pain hit, she had to get on all fours. But after about four hours, she called up her doula, Sharla Konomi. Sharla's job is to support people through their deliveries. She's helped about 80 births.

She came over right away. And by now, she sees that Blythe is pretty far along. And I'm like, oh, okay, something's going on. I definitely was like, yeah, we need to leave right now. And I was like, oh, okay, something's going on. I definitely was like, yeah, we need to leave right now. And I was like, okay. So Blythe, Charlotte and her husband take a lift through Brooklyn and arrive at the hospital. Blythe's contractions are getting stronger and stronger.

The pain is intense. They put her in a curtained off space, check and see what's happening. And the doctors are like, holy crap, this baby is ready to pop out now. Well, then I was like, this is awesome. This baby's about to come out in like 10 minutes, probably. And then we'll be like out of here. Like, this is amazing. I was so excited. I was like, I've already done the hard part. This is going to be great. But it quickly became clear that things weren't going to be great. Basically, we start going through this like round of like,

okay, contractions come, push, push, push, no baby. Contractions come, push, push, push, no baby. I'm thinking, why? What's going on? Because everything progressed so quickly for her. And to get all the way to pushing and your baby's not coming out, something was going on. This goes on for several hours with no sign of the baby coming out. And the doctor looked at me and was like, listen, if I thought it would happen if you just kept

pushing, I would say, let's do it. But I just don't think this baby is coming out. And I think you need a C-section. A C-section. This is exactly what Blythe didn't want. She'd heard that it might be bad for your baby in the long term. And the doctors in the U.S. have a reputation for giving C-sections, even if you don't really need one. I mean, I'd come in and it felt like I was so close just a few hours before. And it felt like I wasn't sure if a few hours before. And it felt like

I wasn't sure if I'd given the baby like enough chances to come out of the vagina. It felt like I was like, am I throwing in the towel too early? And do I really need this? Blythe trusts her doctors, though. She has a C-section and her baby comes out healthy in the end. But this birth felt like it went off the rails the moment the doctors got involved. And two years later, Blight's still thinking about what happened to her. And what do you feel like you missed out on? I guess I had this image in my head of I did it. I have this sense of relief.

I pushed this baby out. There's this feeling of this big push and then it comes out and you're like, there it is. And there's like coursing through your whole body is just this magical feeling of hormones and, you know, like joy. And then they hand you the baby and you're crying and you're like, I did it. We did it. We're here together now. We're a family're a family and um that just wasn't the experience I had and I'm and I want to know if I should be sad about that and Charlotte has seen this happen so often where you get to the hospital and it's one intervention after another and the next thing you're being wheeled into an operating room absolutely oh. Oh gosh, you know, I've definitely been to births where interventions

were necessary and it worked and I agreed with it, but I have definitely been to a lot of births where interventions were pushed on the families I worked with for sure. So on the one hand, we have people saying that doctors are screwing up childbirth and that perhaps you'd be better off without them having your baby at home. After all, this is something that people with vaginas have been doing basically ever since people had vaginas. On the other hand, though, you've got doctors saying, hey, we're not meddling willy-nilly.

We're intervening to save the lives of people giving birth and their babies. So who's right here? Are doctors really messing up childbirth? Today on the show, we're zooming in on C-sections to find out if doctors are a bit too trigger-happy with the scalpel. And then we'll look at other arguments for why you might not want a doctor around. Like the idea that they can treat you like crap, particularly if you're black. And bottom line, we are going to find out,

would most of us be better off giving birth without a doctor? When it comes to childbirth, there's a lot of... Do I really need this? And then there's science. Science Versus is coming up just after the break. Bumble knows it's hard

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New episodes drop every other Thursday, starting February 1st. What does the AI revolution mean for jobs, for getting things done? Who are the people creating this technology? And what do they think? I'm Rana El-Khelyoubi, an AI scientist, entrepreneur, investor, and now host of the new podcast, Pioneers of AI.

Think of it as your guide for all things AI, with the most human issues at the center. Join me every Wednesday for Pioneers of AI. Think of it as your guide for all things AI, with the most human issues at the center. Join me every Wednesday for Pioneers of AI. And don't forget to subscribe wherever you tune in. Welcome back. Today, we're talking about childbirth. And just quickly, we know that not everyone who gives birth is a woman, but a lot of the studies and experts still talk about it this way. We've tried to use inclusive language. Okay, so we are looking at whether doctors are screwing up childbirth, meddling when they don't need to be. And look, obviously there are times when you do need a doctor around during childbirth. Let's zoom in on that procedure

that Blythe was worried about, C-sections. You know, a cesarean can be really a life-saving measure in a lot of women. And if the heart rate of the baby looks bad, if mom starts getting really sick, that is an easy decision for us to make. This is Sarah Osmunson. She's an OB and associate professor at Vanderbilt University.

So yeah, if the baby's heart rate drops and doesn't get better, this can be dangerous for the baby and a doctor is going to step in. But the thing is, sometimes everyone is looking fine and doctors like Sarah are still doing C-sections. So what's going on there? Well, one of the big reasons why doctors give C-sections is because labor is taking forever, and doctors are worried that something is going to turn south. But producer Meryl Horne asked Sarah the big question here.

Like how long is kind of too long for somebody to be in labor for? And the reason Sarah's giving us the old deep sigh is because doctors don't really know. So what they're looking out for is if the cervix is dilating fast enough. The cervix is like the trapdoor to the uterus. That's where the baby's going to come out of. And the door has to open wide enough so the baby can squeeze through. It basically has to stretch open to 10 centimetres. That's where you can start pushing.

And for decades, to know if that door was swinging open fast enough, doctors relied on this idea that was created by a guy called Emanuel Friedman. Back in the 50s, Friedman was like, once your cervix opens to about four centimetres, from there, it should start to dilate fast. And this idea became known as the Friedman curve. The Friedman curve really suggested that once somebody reached like four centimeters of dilation, that they should suddenly take off and deliver quickly. That means like if you're four centimeters and I come back in two hours and check you,

you should be six centimeters. And if you're not, I'm going to start talking to you about needing a C-section. So the idea is that if you get to four centimeters and your cervix isn't opening up fast enough, something is wrong and doctors might give you a C-section.

But it's becoming clear that what is wrong is this idea. So, for example, one big study of 60,000 people found that it was perfectly normal to take six or even seven hours to open from four centimetres to five centimetres. And now the World Health Organisation says, seriously, don't intervene just because someone is going a little slow. But we know that sometimes doctors are still jumping the gun. So much so that several years ago, the American College of OBGYNs,

the top dogs in this space, said that too many C-sections were happening in the U.S. because doctors weren't waiting long enough. We still are not very good at identifying who needs to have a C-section for the right reasons. And so we probably over-call it in a lot of women. And you know what? I will be totally honest. I have been proven wrong. Like I have had people who I think, oh, this person is going to need a C-section. And I've, you know, I've given, I remember one patient, I like, she was like eight centimeters for like four hours. And I said, it's time for a C-section. And there was a problem with the light in the operating room. And so we had to wait

like several hours and everything looked fine with the baby and then she pushed for an hour and had a normal delivery. I mean, I felt terrible, but like I was following what I thought was the right pathway. And the reason that Sarah thought she was doing the right thing is because she was ultimately trying to avoid something really, really bad happening here. Like if you're in labor for a really long time, you're more likely to get an infection or scary bleeding.

These are small risks, but they do go up. It could also be bad news for the baby. There are risks with labor that goes on too long. You know, someone could be, someone who is laboring for hours and hours on end, the baby could die. So what Sarah is balancing is these really small and horrible risks against the risk of doing an unnecessary C-section. So our next question is, what's so bad about C-sections? If you've spent any time on parenting blogs, you've probably seen chatter that kids born via C-section are worse off than kids born vaginally, and they're at a higher risk of a whole range of conditions, especially asthma and obesity. But is that true? Well, for this, we talked to Dr. Sarah Stock. She's at the University of Edinburgh, and Sarah just did this huge analysis of all these studies on this topic. Oh, my goodness.

We brought together 80 studies near 30 million participants. Yeah, 30 million people, including mums who gave birth all sorts of ways, upside down, on a roller coaster, in space. No, no, it was people who gave birth either vaginally or via C-section. And a bunch of the studies asked, how are the kids doing? And it turned out that yes, C-sections do increase your kids' risk of both asthma and obesity. But by how much?

Well, here's how Sarah explained it. If you took 1,000 C-section babies and compared them to 1,000 vagina babies, how many more of the C-section bubs would end up with, say, asthma? So six more cases of asthma if you had a caesarean birth. Six more from 1,000 babies. OK, so is that a lot to you or a little? What do you make of those numbers? I think when you put that at population level, it's significant

and asthma can be a really serious problem. But I think that it's it you know we've it's hard right i don't know what to make of it what do you yeah well i think this is you know this is people interpret the risks really differently you know if you know somebody with really brittle asthma then six more cases of asthma is a really huge risk for you if you um if you know if you sort of think, well, it's a little bit of mild breathing problems and it's only six cases, I'm not so bothered. The risk is higher for obesity. So if you take those thousand C-section kids,

now roughly 40 more of them would be obese as kids. Scientists aren't exactly sure why this is happening. It might have something to do with your baby missing out on the good bacteria in your vaginal juices. But some academics argue that this actually might not have anything to do with C-sections. In other words, it's just a correlation. As for the risks to the person getting a C-section, Well, the biggest thing that Sarah found was that people who had c-sections had the small chance of running into problems with their next pregnancy. We also really went down the rabbit hole on this idea that it's harder for people to bond with their babies if they've had a c-section. The best study we could find on this didn't show that was the case.

And so what does all this mean for a doctor who's helping someone through labour and trying to decide what to do? Well, for Sarah, it means that C-sections aren't the villain they're sometimes made out to be, particularly if you're comparing it to the risk of a mum or baby dying. That's going to blow anything else out the water for that. If you need to have a caesarean section, that's really important. The benefits can far outweigh the risks, and the risks are relatively low. So that's how some doctors are thinking about this whole thing.

They often don't know exactly when is the right time to step in, but generally they don't see C-sections as that troubling and so might end up doing one when they don't really need to. And this plays out with some other interventions too, like inductions. This is where a doctor jumpstarts labor artificially. They're also getting more and more common in the US. And again, you see that doctors are weighing up this super small risk of something bad happening if the baby is cooking in the uterus for too long, against doing an intervention that ultimately might not be necessary.

So what does all this look like when you're at the hospital? Well, let's go back to Blythe. When she was told that she needed to get a C-section, it was really unclear that she actually needed one. The baby was fine. Blythe was exhausted but healthy. And even her doctors weren't saying, you need this now.

They were like, we think you probably should do it. But once she was wheeled into the operating room, things changed, and it became clear that she did need it. Her husband Jack was there too, and the doctor told them that the baby's heart rate is dropping. I knew the baby was in distress, so I knew that they needed to get the baby out fast and I didn't know what was going to happen. From there, things start moving really fast.

They put up a blue curtain to separate Blythe's face from her stomach. She's wide awake, but her lower half is numbed up. And then they start the surgery. And at one point we start hearing like everyone's voice gets a little more strained they're like you know okay give me that okay do this okay do this okay okay like do this do this and they're like jerking my body around back and forth the top of you was like kind of moving and jerking as they like pull you back and forth to like try to get the baby out and I was like oh my god what's happening now like is everything gonna be okay and so I was lying there like waiting to know something and waiting to hear something um and just waiting you know it was

like just waiting it was like horrific um because the only information you have is like the baby's heart rate wasn't good. And they were super stressed out about what was happening. And you don't know. You can't hear the baby. You don't know if the baby's still in there. You just don't know. And just didn't know in that moment if things were going to be okay or not. Finally, the doctors

rush to another part of the room. It looks like they've got the baby out, but they're still not saying anything. Blythe and her husband are just waiting. I'm pretty sure we were holding hands at that point. Yeah, I think I turned to him and I was like, can you see our baby? And he was like, yeah, I think it's okay. What felt like minutes later, we just heard this tiny, this like teeny tiny, like, like baby noise. We were like oh thank god like it was it was super scary and so for blight's family things ended up okay and baby's fine and baby's healthy looks like a cabbage patch kid it does i guess you know listen he never had the pointy head that can happen when they smush you out of the birth canal.

So little round-headed baby. No, you saw early pictures. He looked like an old toe that somebody left in the bathtub. So doctors are making decisions on the fly here. And yeah, maybe sometimes they're too keen to meddle. But there are other times like Blythe's when that is exactly what you need. After the break, though, we'll hear the other side. The argument that not only have doctors been botching up vaginas for decades,

but also what it can be like to give birth without a doctor in the room. She was just like in this euphoric trance. It was amazing. Coming up. Welcome back. Today, we're talking about whether doctors need to get their grubby mitts out of our uteruses and let us have our babies naturally. We just heard that, sure, doctors might be intervening too much, but they're in a tight spot, and there are some really good reasons to be doing stuff like C-sections.

But then there's the flip side. People who say that during childbirth, you're often better off without a doctor in the room. Because doctors can make things worse. And right off the bat, we found some clear examples of this. In the 1920s, doctors started doing this thing during childbirth where they would cut a vagina with scissors or a scalpel. It's called an episiotomy, and quickly it became the norm. Why? Well, during birth, the vagina sometimes tears as the baby's coming out.

And doctors figured that the vagina would tear less if they did this cut themselves first. And so, for decades and decades, doctors did this, cutting thousands and thousands of vaginas, without actually doing the research to see if it worked. It wasn't until basically the 1980s when doctors finally bothered to study this properly. And guess what? We now know that cutting vaginas like this, it often led to worse tearing. In the most extreme cases, the tearing went all the way from the vagina into the butt. Here's Sharla Konomi, our doula from the start of the show.

It's crazy that that used to be something that was very routine. And it took decades for them to even do the research to work out this wasn't a good idea. Yeah, and you still have some care providers, especially like older care providers, that still believe in it and they still do it. The World Health Organization says that while sometimes you need an episiotomy,

doctors shouldn't be doing them willy-nilly. But in some countries, it's still the norm. And in the US, studies find that some hospitals still do them way more than they should. I've only, thankfully, I've only been to one birth where someone had an episiotomy. And it was almost like traumatic when it happened. It was traumatic for her. I, when it happened. It was traumatic for her. I hated that it happened. It happened without her consent too. It was, it was awful. So sometimes doctors are messing up childbirth by relying on dusty old textbooks.

At other times, they're treating their patients like crap, which can have horrible consequences. A survey of more than 2,000 women giving birth in the U.S. found that of those who had had their babies in a hospital, almost one in three felt like they were treated badly there. Doctors and other staff members were doing things like shouting at them, threatening them or ignoring them. That was almost one in three women. And the studies are showing that doctors seem to be especially bad at taking care of Black people during childbirth. So, for example, in that survey we just talked about, Black women were twice as likely to say that when they asked for help, they were ignored or that healthcare workers were slow to respond. That was compared to white women.

Now, this problem got a lot of attention when it happened to Serena Williams. She had dangerous blood clots after giving birth to her daughter. And when she asked doctors for help, they were slow in getting her the treatment that she needed. She said she almost died. If Serena Williams, you know, talented, successful, if she can be ignored in her care, then I and anyone else who looks like her absolutely can. This is Dr. Crystal Berry-Roberts, an OBGYN in Texas. Black women are thought to be these, you know, super people that should be able to deal with anything, any level of pain, anything that comes their way, they can handle it. No.

And the stakes are so high here. While it's really rare to die from childbirth in the U.S., the risk is higher for Black women. Yeah, maternal mortality for Black mums is three times higher compared to white women. And it doesn't matter about your income or education. And we see this pattern for babies too. Black babies are more likely to die in the US compared to white babies. And part of this is because some white doctors aren't doing their jobs properly when it comes to caring for black babies. So one big study recently found that when a black newborn has a black doctor, that baby is more likely to survive compared to if the doctor was white. For me, when I read that and I see that, I'm a black mother of two children, ages four and seven.

So it hasn't been that long ago that I had newborns. And to know that newborns that look like mine have a higher risk of dying based on whether or not the physician looks like them is disheartening. It's unfair. It's unjust. And it's another reminder of the deep permeation of systematic racism. Let's just call it what it is. And this happened, we're talking about hours into this world.

Do you talk to your Black patients about this or are they sort of relieved when you're the OB that's on call for their birth? In a lot of cases, they've sought me out. I'm getting definitely more patients who are coming to me already aware of the studies, the data, the reality that is out there. Okay, so since some doctors are doing a crap job here, should we just do away with them? Would most of us be better off having our babies at home? Some people say that this is not only safe, but it can be a really amazing experience. Sharla, our doula, remembers this one home birth that felt pretty magical. She was just like in this euphoric, like, it was like she was in a trance.

It was amazing. And she was just euphoric. She was butt naked the entire time. And I remember it was almost like we were dancing as I was supporting her. It was very hippie, but I'm into that. So I loved it. Man, it was an amazing birth. It gives me chills thinking about it. While you might not be butt naked and in a trance, home births do chalk up some wins in the data. A big review paper found that people who decided to do their births at home tended to feel good about them and they also had fewer complications and there was less medical meddling compared to people who planned to deliver at a hospital. So, for example, without snip-happy doctors around,

home birthers had fewer episiotomies. But it's not all good news here. The American College of OBGYNs said that in home births, there is a slightly higher risk that the baby will die. They figured that if you had 1,000 home birth babies, there would be one or two more deaths compared to 1,000 hospital babies. Plus, even if you plan for a home birth, there's a pretty good chance that you'll end up rushing to the hospital anyway because something's gone wrong. In the U.S., it happens roughly 16% of the time.

Here's Crystal, our OB-GYN. It's interesting. You hear the real positive flowery stories of the home births way more than the negative. What you don't hear is when those same types of births don't go well. And that patient gets transferred urgently to a hospital setting

because something negative has happened, like bleeding, like a baby that's in distress. A mom's been pushing for hours and still hasn't delivered. And now baby's shoulder is stuck or something like that. It just, things can go wrong. And the American College of OBGYNs says that in some cases, like if you're having twins or the fetus is in a funky position, when it comes to childbirth, don't try this at home. So where does this leave us? Are doctors mucking up childbirth? Well, it's tricky, eh? They are getting involved when they don't need to be. But ultimately, if something goes wrong in your birth,

you want a good doctor around. And something that we heard over and over again from OBs and midwives and doulas that we spoke to is that every childbirth is so different. And there can be beautiful C-section births where everyone is so happy. And there can be so-called natural births that are actually really, really tough. And no matter how many podcasts you listen to about this,

when push comes to shove, ultimately, you can't control how everything's going to go for you. Like Abdullah Sharla. She had a home birth for her daughter. There was just midwives, no doctors around. And that was what she wanted. But even she didn't get her perfect euphoric moment. Sharla was in labor with her daughter for 33 hours. I just never imagined I would be doing that for 33 hours. That's the part that really threw me for a spin.

I knew it would be challenging. I knew it would be challenging, but not that long. And so do you remember what it felt like when she came out? Yes. It felt like, oh, my gosh, this is finally over. It was it was amazing. It was amazing. And I just didn't have that moment, you know, that that moment, I guess, whether it's because of the things that we read about or we hear about, where we feel like it's supposed to be this huge magical moment, you know,

I felt just total exhaustion. Like, I was wiped out. So even without a doctor around, having a baby isn't all butterflies coming out of your vagina. You are literally making a miracle right now. I tell people that when people are laboring, they're like, it's so hard. I'm like, you think a miracle is going to be easy? You know, like you're doing some of the most amazing work a human can do right now.

And that's beautiful. That's Science Versus. Hello? Hi, Meryl Horne, producer at Science Versus. Hi, Wendy Zuckerman. How many citations in this week's episode? We have 117 citations. 117. And if people want to see these citations, where should they go? They can go to our website or our show notes and follow the links to the transcripts. And if you want to see a photo of my own placenta, head to our Instagram because I was so excited after it came out.

I was like, I need to document this. So what does it look like? It kind of looks like a big hunk of meat oh my god all right so if you listeners want to check this out go to science underscore vs on instagram i i have to see this image this is amazing how big is it um it's like the size of like an artisanal pizza, like a tiny pizza. What did you have to use pizza? Thanks Meryl.

Okay. This episode was produced by Meryl Horne, with help from me, Wendy Zuckerman, as well as Nick Delrose, Taylor White, Michelle Dang, Rose Rimler and Akedi Foster-Keys. We're edited by Blythe Terrell, with help from Caitlin Kenney. Fact-checking by Angelie Mercado and Taylor White. Mix and sound design by Bumi Hidaka.

Music written by Peter Leonard, Marcus Begala, Emma Munger and Bobby Lord. A huge thanks to all the experts we got in touch with for this episode, including Tammy Hall, Azad Nadari, Dr. William Grobman, Dr. Ana Betran, Professor Vincenzo Bergella, Dr. Pabchiran Gill, Kate Dirk, Carol Burke and Dr. Ellen Mazurkiewicz. A special thanks to Jack Weinstein, Navania Tero,

the Zuckerman family and Joseph Lavelle-Wilson. I'm Wendy Zuckerman. Back to you next time.