By Katie Moriarty, PhD, CNM, CAFCI, RN

Detroit is under the microscope for many reasons, one of which is its extremely, and persistently high infant mortality rate. Especially for those of us whose professions are dedicated to providing a high quality birth experience, this is unacceptable.

As we look for solutions to this dilemma, we are also concerned about impact of poor birthing experiences, not just those leading to death. On Sept. 20, the Detroit Nurse-Family Partnership, a program administered by the Detroit Wayne County Health Authority, hosted the Detroit premiere of the documentary Microbirth http://www.oneworldbirth.net/microbirth/.  Health professionals from around the world spent a Saturday afternoon examining the implications of poor birthing experiences, not only for the infant but for the future of our species.

We need to have these types of gatherings with multiple stakeholders present to discuss issues surrounding women’s health, pregnancy, childbirth, and evidence based care that is driven by data and science for the support of physiologic birth.

Several characteristics of physiologic birth are that women spontaneously enter and progress through labor, the birth of the baby and placenta occurs vaginally, the infant and mother are kept together during the postpartum period and are skin to skin with the support of early initiation of breastfeeding.  The lack of these elements has been, personally speaking, a true elephant in the room and I have felt there has been a cultural blindness to the impact of disrupting these normal processes.

Michel Odent, a famous French physician, has written about cul-de-sac epidemiology whereby there is evidence – however it is shunned by the dominant medical community and hasn’t been adequately covered by the media.  The viewing of Microbirth with multiple stakeholders allowed the beginning of an international discussion from varying perspectives.  It is essential to engage and build multi and interdisciplinary teams with varied and diverse backgrounds and perspectives.  We need to get out of our “echo chambers” and share and be open to accept and hear each other if we want a high quality maternity care system.

The need for this type of discussion is especially urgent in Detroit where we have the highest infant mortality rate (IMR) in the nation.  While the national rate is 6.1 deaths per 1,000 live births the State of Michigan is slightly higher at 7.1/1,000; however, Detroit babies die at a rate that is double the State rate — 14/ 1,000.  If you are African American you will have almost a 3x increased IM rate than a Caucasian woman (15.4 vs 5.5).

We have mapped out IMR by geocode and it shows that your address does matter!  The primary cause of our IMR is preterm birth.  The rate of preterm birth in the USA and Michigan is 12%; while in Detroit 18% of babies are born premature.  The differences in the rate of preterm birth are partially attributed to the significant racial/ethnic disparity that exists between African-Americans and other groups and issues surrounding toxic and chronic stress.    

Microbirth presents elements needed to “seed the microbiome.”  Scientists and maternal health professionals discuss epigenetics and the microbiome.  If there are no medical indications they present a scientific rationale for entering labor spontaneously, the benefits of traveling through the birth canal with a vaginal birth versus a caesarian section, breastfeeding and skin-to-skin contact.  Researchers, scientists, and educators discuss the impact from a population health perspective and a global financial perspective.

There are elements of the film that people agree with and disagree with; however, the fact that we were able to bring together a diverse group of people to consider the critical importance of childbirth and the potential of increasing strategies that promote normal physiologic labor and birth for better birth outcomes and long term health outcomes is notable. We need an ongoing dialogue on this topic.

The potential for improving maternal outcomes through a more careful consideration of birthing options may be one of the most important considerations of this era of dramatic change in our natural environment.

Dr. Moriarty is director of the Detroit Nurse-Family Partnership (NFP). The NFP staff will be scheduling community presentations of this program. For more information, contact Dr. Moriarty at 313-871-3751 or kmoriarty_nfp@dwcha.org.