Push for profit: Births, babies and the bottom dollar

Reliable research into safe and healthy childbirth is being ignored by maternal hospitals in Australia. 

Women are not told of the adverse effects of current interventions and practices in childbirth, or that not a single long-term study exists of the almost 50 childbirth drugs currently being used. 

The majority of birthing mothers are drugged in some way and one in three women describes their birthing experience as “deeply horrifying”. 

Viable alternatives, such as homebirth or birth centres, are systematically defunded, demonised by the media and discredited by the medical establishment. 

If mothers and babies are not benefiting from the current practise of childbirth, who is?

Could it be that beyond the public veneer of childbirth, past the discourse between obstetric and midwife care and the debate over medical versus natural birth, there is a murky but powerful push for profit? 

Big Pharma

In the wide range of commercial interests from conception to birth, one seems to avoid the spotlight despite its integral role. 

Pharmaceutical corporations are involved in more than 80% of Australia’s 300,000 births annually, and this number is growing unchallenged.

Despite there being no accessible data on how pharmaceutical corporations profit from childbirth, we can look to caesareans to discern profits for Big Pharma. 

The World Health Organization’s recommended rate for c-sections — unchanged since 1985 — is no more than 10–15% of births. More than double this number are currently undertaken in Australia. 

The plethora of drugs used pre-operation, during and in the “cascade continuum” (caesarean morbidity) are well beyond evidence-based drug expenditure. The profit margin is unambiguous.

Numerous research studies have shown pharmaceutical companies influence medical professionals, universities and clinical trials. Big Pharma funds prominent experts as “key opinion leaders” to advertise, defend and justify. 

Different but similar are the Canberra lobbyists and government health agencies so often implicated in providing tacit support of Big Pharma.

Maternal deaths

Current birth management has not coincided with notable improvements in neonatal mortality and is implicated globally in maternal deaths.

Amnesty International’s Deadly Delivery revealed the United States, the world’s most medicalised birth system, is also one of the most dangerous: it ranks second highest of developed countries for neonatal deaths and 41st in maternal deaths. 

According to National Maternal Mortality Data Collection Committee former chair Professor James King, Australia’s convoluted system for recording maternal deaths underestimates them by 30%. 

Yet not one long term, double-blind study on the effects of the drugs used in childbirth exists. 

Misoprostrol

One drug that has been studied — cyotec or misoprostrol — has clear results. Designed and approved only for gastric ulcers it is used “off label” for post-partum haemorrhage internationally and in the US for induction. 

Misoprostrol’s manufacturer Searle sent a letter to every US doctor in August 2000 outlining a list of serious adverse effects of its use on pregnant women, including: “maternal or foetal death; uterine hyperstimulation, rupture or perforation requiring uterine surgical repair or hysterectomy; amniotic fluid embolism; severe vaginal bleeding; retained placenta; shock; fetal bradycardia; pelvic pain”. 

The Australian Therapeutic Goods Administration states that, “uterine rupture/perforation, retained placenta, premature birth and foetal death have been reported” as a result of misoprostrol use.

Misoprostral is cheap, but as a potent induction drug, the cascade of intervention it causes is where the profit lies. 

Induction drugs artificially bring on intense, rapid contractions with no rest for baby or mum. Misoprostrol is the most powerful one used internationally and is implicated in many complications, including emergency caesareans.

So why would the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) endorse its use for labour inductions? 

RANZCOG president Professor Steve Robson was chair of RANZCOG Women’s Health Committee when it released a statement that read: “Both vaginal and oral administration of misprostrol are effective methods for cervical ripening and for induction of labour … Misprostal is an effective uterotonic and can achieve sustained uterine contraction in the third stage.”

Pharma sponsorship

Perhaps its because Pfizer and Ferring, who sell misoprostrol in Australia, have sponsored RANZCOG. 

An example of how this looks is found on the Medicines Australia disclosure database. “Gold sponsors” Pfizer, Bayer and Vifor Health contributed $113,667 to RANZCOG’s 2015 Annual Scientific Congress. 

The amount Ferring paid as “Silver sponsor” is undisclosed. The same congress launched Ferring’s Misodel, the vaginal insert version of misoprostrol, at a breakfast symposium. 

Members of RANZCOG also benefit from connections with Big Pharma. 

A key public childbirth figure is obstetrician and gynaecologist Gino Pecoraro, who is a former RANZCOG secretary and the current Australian Medical Association’s obstetrics spokesperson. Pecoraro’s research and appearances are cited as paid by Bayer, Ferring, MSD, Lily and Organon.

Michael Paech is the only chair of Obstetric Anaesthesia in Australia and chief editor of the International Journal of Obstetric Anaesthesia. Paech is a lecturer, clinician, researcher and author of more than 150 papers, mostly obstetric related. He has been active in the numerous professional societies and committees and is an honorary fellow of RANZCOG. 

He is also on the advisory panel for Merck Sharp & Dohme and has been a clinical consultant for Schering Plough, Hospira and Xenome. 

How much he and the other childbirth leaders are paid and how this may influence their work is something we do not know. 

What we do know is influential figures and organisations in the birth industry that directly influence childbirth are often financially connected to pharmaceutical companies.  

Alternatives

What would happen if profit was taken out of the equation?

To find out we can look to birth practitioners who empower women. 

Even as far back as the 17th century, midwife Catharina Schrader’s meticulous notes show an intervention rate of 5% for 3017 births.  

Northern Rivers doctor David Miller attended 133 homebirths between 1983 and 1988 and had a caesarean rate of 1.5%.

The Mercy In Action birth centres located in the poorest Filipino favelas show, as founder Vicky Penwell says, “that demographically high risk women (anaemic, malnourished, physically abused, unmarried and impoverished) can still have good birth outcomes using a model of mother friendly/baby friendly care run by midwives in an out of hospital setting in a poor and underdeveloped country such as the Philippines”. 

In a country where 1 in 280 women die from childbirth complications Mercy in Action has a zero maternal death rate. 

US “granny midwife” Margaret Charles Smith, a midwife at more than 3000 homebirths of poverty stricken, malnourished and over worked African American women living in the deep south has not lost a single mother and very few babies.

Women and their babies in Australia are set up to fail in a system that overrides the most basic science in favour of profit. 

We know how to give birth. Now is the time to turn the spotlight on the slow-cooked but cataclysmic corruption of birth in the push for profit by pharmaceutical companies.