As I mentioned in an earlier post my OB/GYN’s office gave me a folder of information about pregnancy, as well as a book. The book, Your Pregnancy Week by Week, is co-authored by an MD, and supposedly one of the best and most widely-used pregnancy guides around – obviously, if they are handing it out to every pregnant woman who walks into a clinic. I have already read many books on pregnancy, and I can say that this one is hands-down the worst.
My first complaint? The authors do not cite any of their sources. Not a one. No footnotes, no endnotes, no list of peer-reviewed studies they consulted during the writing of this book. Nothing.
I am currently reading a fascinating book called Origins by Annie Murphy Paul, concerning the study of fetal origins. She concludes her book with over forty pages on endnotes detailing all of the studies she read and all of the experts she consulted. Birthing from Within by Pam England and Rob Horowitz, the most recent labor and delivery book I have read, has quotations and citations within the text, as well as another hefty section of endnotes. The MD author of Your Pregnancy Week by Week, however, saw no need to cite his (yes, the main author is a man) sources. He instead begins sentences with the words “studies show,” never indicating which studies, and then expects his readers to take his word for it. Perhaps this is because he is an MD he feels that his knowledge is somehow infallible, that no reader would even bother to investigate further, but would simply take him at his word, passively absorbing whatever supposed facts he presents in his writing.
My personal favorite? “Research has shown that giving birth at home is an extremely risky undertaking.” What research? Where? I would love to know what studies he is citing. Do these studies include only planned, midwife-attended home births? Or do the statistics include emergency situations where women progressed through labor too quickly to make it to a hospital and deliver alone at home? Do they include teenagers who give birth alone, with no prenatal care or instruction on birthing, after having hid their pregnancies from their parents? I would love to find out. But I cannot, because he does not cite his sources. Does he feel that the general population is entirely disinterested in or incapable of reading scientific literature?
It is my body, my baby, and our health, so I am darn well interested. And I can actually cite studies that show planned, midwife-attended homebirths to be no riskier (even healthier) for mother and child. Mehl, L., Peterson, G., Shaw, N.S., Creevy, D. (1978) “Outcomes of 1146 elective home births: a series of 1146 cases.” J Repro Medicine is a great example. In this case, babies born in the hospital were 3.7 times more likely to require resuscitation, 2.5 times as likely to suffer meconium aspiration, 2.5 times more likely to have meconium aspiration, and 17 times more likely to have respiratory distress. There were thirty birth injuries in the hospital (mostly due to forceps) and none at home. The neonatal and perinatal death rates were statistically the same for the two groups, but Apgar scores were significantly worse in the hospital. The conclusions I draw? A midwife-attended home birth is no riskier than a hospital birth, and a hospital birth attended by an OB/GYN is, simply put, overmedicalized, which leads to increased risks to both mother and baby due to possibly unnecessary interventions.
And in another study, 88% of women who intended to deliver at home were able to, and for those who did transfer to a hospital, medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and cesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labor, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated. Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
As I continued reading through this book, the phrase “when you’re a hammer, everything looks like a nail” kept coming to my mind. Maybe, likewise, if you are a doctor trained to intervene to fix illnesses, then everything looks like a disease. Even pregnancy. During the “Week Eight” chapter – week eight! as in only barely pregnant – this book advises husbands to walk the dog for their wives, because “the pull on the leash might hurt her back” and to take over buying dog food to save her “from the strain of lifting heavy food bags.” Gee, I didn’t realize I was so fragile that I should not walk the dog or carry forty pounds. Guess I had better tell Nick to step up the pet care. Heaven only knows how I have managed to keep swinging those 53lb kettlebells around all the way into week ten of my pregnancy.
Pure and utter ridiculousness. I feel the best I have ever felt in my life. Pregnancy is not a disease, an illness, or a disability. It is the most natural and healthy thing a woman can do – bringing a new life into the world. Why make it into a state of fragility, when it is really the ultimate state of strength, when supporting not just one’s own life but also another? I wonder if doctors like to make pregnancy look like a disability because it makes women feel like we should willingly submit to their medical interventions, that we must need them, since we are, apparently, so weak.