... In Tuba City [Arizona] last year [whose hospital is run by the Navajo Nation and financed partly by the Indian Health Service], 32 percent of women with prior Caesareans had vaginal births. Its overall Caesarean rate has been low -- 13.5 percent, less than half the national rate of 31.8 percent in 2007 (the latest year with figures available). This is despite the fact that more women here have diabetes and high blood pressure, which usually result in higher Caesarean rates. <...> Dr. Amanda Leib, the director of obstetrics and gynecology at Tuba City, said: "I think the midwives tend to be patient. They know the patients well, and they don't have to leave at 5 to get home for a golf game or a tennis game. As crass as that sounds, I do think it has some influence." <...> Some of Tuba City's success probably arises from Navajo culture and customs. Couples often want more than two children, but repeated Caesareans increase the risk of each pregnancy, so doctors and patients are motivated to avoid the surgery. Also, Navajos regard incisions as a threat to the spirit, something to be avoided unless necessary. Birth is a joyous affair here, and the entire family -- from children to great-grandparents -- often go to the delivery room. "I've had 12 family members in the room," said Michelle Cullison, a nurse-midwife. "I've frankly never seen a place like this. Whoever that woman wants to be there is there. It's something I would take out to the community." Linda Higgins, the head of midwifery at Tuba City, said: "All of a sudden Mom is surrounded by women, and they're all helping her and touching her." As a result, many young women have already seen children born by the time they become pregnant, and birth seems natural to them, not frightening. ...
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Dr. Amanda Leib, the director of obstetrics and gynecology at Tuba City, said: "I think the midwives tend to be patient. They know the patients well, and they don't have to leave at 5 to get home for a golf game or a tennis game. As crass as that sounds, I do think it has some influence."
Some of Tuba City's success probably arises from Navajo culture and customs. Couples often want more than two children, but repeated Caesareans increase the risk of each pregnancy, so doctors and patients are motivated to avoid the surgery. Also, Navajos regard incisions as a threat to the spirit, something to be avoided unless necessary.
Birth is a joyous affair here, and the entire family -- from children to great-grandparents -- often go to the delivery room.
"I've had 12 family members in the room," said Michelle Cullison, a nurse-midwife. "I've frankly never seen a place like this. Whoever that woman wants to be there is there. It's something I would take out to the community."
Linda Higgins, the head of midwifery at Tuba City, said: "All of a sudden Mom is surrounded by women, and they're all helping her and touching her."
As a result, many young women have already seen children born by the time they become pregnant, and birth seems natural to them, not frightening. ...
Wonder what Elisabeth Badinter would have to say about yet another "anti-science" retour en force du naturalisme originating in the U.S. The march of civilizations is a series of defenses that man has put up against the dread of pure existence.
Doctors and midwives here earn salaries and are not paid by the procedure, so they have no financial incentive to perform surgery. (Doctors earn $190,000 to $285,000 a year, and midwives $80,000 to $120,000.) "My colleagues here truly want to practice medicine and help people," said Dr. Jennifer Whitehair, an obstetrician. "That's not true everywhere. Here they're not thinking, how much can I make off this procedure?" The hospital and doctors are federally insured against malpractice, in contrast to other hospitals, where private insurers have threatened to raise premiums or withdraw coverage if vaginal birth after Caesarean is allowed. As a result, Dr. Leib said, doctors in Tuba City are free to "think about what's best for the patient and not what covers our butts."
Doctors and midwives here earn salaries and are not paid by the procedure, so they have no financial incentive to perform surgery. (Doctors earn $190,000 to $285,000 a year, and midwives $80,000 to $120,000.)
"My colleagues here truly want to practice medicine and help people," said Dr. Jennifer Whitehair, an obstetrician. "That's not true everywhere. Here they're not thinking, how much can I make off this procedure?"
The hospital and doctors are federally insured against malpractice, in contrast to other hospitals, where private insurers have threatened to raise premiums or withdraw coverage if vaginal birth after Caesarean is allowed.
As a result, Dr. Leib said, doctors in Tuba City are free to "think about what's best for the patient and not what covers our butts."
