Negative Book Review: Why is Pregnancy Viewed as Pathology?

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 The authors do not cite any of their sources.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.

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5 Responses to Negative Book Review: Why is Pregnancy Viewed as Pathology?

  1. LucienNicholson says:

    I enjoyed the vigor in the post. I think you would agree, though, that medical intervention does have its place and we are fortunate to live in a place where we can get access.

    However, I wholeheartedly agree that too often women are meant to feel weak and inferior when they’re pregnant. My guess is that doctors aren’t acting in bad faith, and they are only products of their environment.

    I’d like to see if you’ll comment in the future about any books in defense of hospitalized births. I think it’s an interesting debate.

    Keep up the good work.

    • elliemaeh says:

      If I end up being in the 10-15% of women who need medical intervention, I will be eternally grateful to the medical establishment for ensuring the health of my baby through the birth process. I was one of the 10-15% of babies who had to be delivered by c-section in order to survive. I am grateful to the doctors who performed the operation, and to my mother for going through major abdominal surgery on my behalf. I believe that medical interventions are wonderful for those who need it, and I am grateful that we have the knowledge and resources to perform them, but I think, in uncomplicated deliveries, that unnecessary medical interventions can be harmful to both the mother and baby, that forceps can cause multiple birth injuries, and that the use of epidurals can make bonding and breastfeeding more difficult.

      I simply wonder why the number of women who “need” medical intervention in order to birth their children has been rising so markedly in the past half of a century. In defense of doctors, one factor is probably the proliferation of malpractice lawsuits. If a doctor performed a c-section, then it certainly appears that he did everything he could to ensure the baby’s well being, whereas if he allowed the mother to labor naturally and something then happened to the baby, a jury might be made to believe that he “should have known” about the risk of negative consequences and intervened earlier.

      I do also think that doctors are to a certain extent (just like everyone else) a product of their environment. If the only information they have concerning birth came from medical school (not from talking with midwives or women who have birthed naturally about teaching preparedness to birth, alternative methods of coping with pain, moving the baby down), then they will more than likely toe the medical establishment’s line on how birth should happen, at what point interventions are necessary, and what interventions are the “cure” for what situations.

      I think that another very important factor at play here is also the cascade of medical interventions. Just for an example of what I mean, many women, when admitted to the hospital, are put on continuous fetal electronic monitoring (although intermittent EFM or Doppler are no less effective – probably just a CYA procedure). Continuous EFM seems innocuous enough (it is not invasive), but it requires that the woman lie on her back, in bed, without moving. Since lying on one’s back is about the most painful position possible for laboring, and since the woman is unable to shift positions in any meaningful way, this raises the chances that she will ask for an epidural (which most hospitals are very happy to offer, anyway). Lying on one’s back is also one of the most difficult positions to birth a baby: the hips are closed, and the mother must fight against gravity to push her baby out. As opposed to a more natural position like squatting, this increases the chances that she will require a forceps or vacuum delivery, or even a c-section. And if she has had an epidural, she has the added disadvantage of not being able to push effectively, thus again increasing the odds of a vacuum, forceps, or c-section delivery, all of which come with their own set of risks.

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