HW 40 - Insights from Book - Part 3

This past weekend, I found myself at a cocktail party with Marsden Wagner, the author of the book I just finished reading. To demonstrate that I really read it, I said, "Hey - thanks for writing Born in the USA. Your idea that obstetricians in the US tend to be uninformed about how to treat regular, low-risk births, and instead treat pregnancy and birth as illnesses that need to be cured made me rethink the way I view medical care in the US.

But Dr. Wagner, surprised to be talking to someone who instead of sharing their own birth story actually rephrased the main idea of the text he spent months giving birth to, asked me, "Really, which parts were most effective or important for you?" So I told him: "Well, in the last third of the book you focused on what should change about how birth is treated, and how those changes could be implemented, which restated and added onto the ideas presented to the first 2/3rds of the book. But let me be more specific." And then I listed the top 3 ideas from that final third of the book (I somehow even managed to list page number references, probably because I have a photographic memory when it comes to reading and remembering details from books about how pregnancy and birth are viewed in the US).

1. Humanizing birth (treating it as a natural process) by educating the public, doctors, and other maternity care providers (midwives and obstetricians) (220).

2. Preserving the patient's right to sue a doctor, in order to make doctors more accountable for their actions (224).

3. Using science to improve maternity care - but using scientific data that is accurate in order to help women give birth, as opposed to using it to defend harmful choices made by doctors (246).

At this point, realizing that he was having a unique conversation with a serious reader of his book, Mr. Wagner asked - "But what could I have done to make this a better book - that would more effectively fulfill its mission?" I answered, "Well, let's be clear - your book sought to provide narratives, historical analysis, and policy analysis from the perspective of a practitioner and public health specialist (you), in order for the book-reading-public to better understand pregnancy & birth in our culture. Given that aim, and your book, the best advice I would give for a 2nd edition of the text would be to be a bit more concise - things don't need to be restated that much -  and explore more different aspects of birth, with the same detail that you used in Born in the USA.

But I don't want you to feel like I'm criticizing- I mean, I haven't even written a book (yet). I appreciate the immense amount of labor you dedicated to this important issue and particularly for making me think about how doctors become isolated from society after all those years in medical school, and how this changes the way they view their work and their patients - the hospital becomes a small world, centered around making people feel better, even when they aren't sick in the first place. In fact, I'm likely to view medical care and doctors in general differently as a result of your book - I'll probably be more skeptical about things I am told about medical care, and less likely to do what a doctor suggests without questioning it first."

Dr. Wagner replied, "Thank you! Talking to you has made me realize that teenagers today aren't as apathetic as the media makes them out to be, which gives me hope about our future as a society!"

HW 39 - Insights From Book - Part 2

Wagner , Marsden. Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First. University of California Press, 2006. Print.

A topic discussed in this book that "The Business of Being Born" did not touch upon is the interference of ACOG (The American College of Obstetricians and Gynecologists) in the world of obstetrics. ACOG tends to publish recommendations for how obstetricians should treat birth without providing any significant scientific data to back up these recommendations. This is one reason why so many obstetricians started using Cytotec in the 1990s - ACOG pretty much said it was okay to use it to induce labor (even though it sometimes caused uterine rupture). The book also has a whole chapter about how midwives are treated as inferior to doctors (even though becoming a midwife requires someone to attend many births before they are able to practice, unlike doctors, who might only see one or two births throughout their time in medical school) - this was something the movie mentioned, but did not go into detail about. 

The major insight the books seems to be communicating is on page 126: "Women in the United States have the right to choose who they want to attend the birth of their child, and they also have a choice regarding where the birth will take place - in a hospital, in an alternative birth center, or at home. These are two different choices; though if an American woman chooses a doctor as her birth attendant, she cannot choose a home birth, since doctors in the United States no longer attend home births. Home births are attended only by midwives, and since that represents a loss of business for doctors, doctors attack home births with zeal." My initial response to this was curiosity over whether women really do have these choices. He said that women have the right to choose who they want to attend their birth; however, the book also points out that there are times where a woman has a doula with her at the birth, but the doula gets kicked out by the doctors for "interfering". He also said women have the right to choose where they want the birth to take place. However, when there seems to be so much stigma associated with home birth, is choosing where to have a child really a choice? It can't be, if women aren't always given all the information they need to make the right decision for their own birth. 

Five interesting aspects of pregnancy and birth that deserve wider attention:

- "To give birth, a woman must open up her body, wide. This profound social and biological act requires everything a woman has and is. All maternity services should reflect this fundamental fact and should be designed to assist and support this woman. Most of the present care system for birthing women is designed not to assist the mother, but rather to control her." (190)

- Using an Electronic Fetal Monitor does not increase the chance of a healthy baby, and can increase the chance that invasive interventions (such as c-sections) will be done unnecessarily. (154)

- Every year, the National Center for Health Statistics reports an increase in home births attended by midwives. (151)

- "Fear of litigation has become an excuse that allows doctors to continue to use interventions such as induction of labor and C-section that they prefer to use for other reasons." (159)

- "Hospitals are highly symbolic of the medical model of birth - twenty-first century cathedrals with priests in white robes. A hospital is usually one of the biggest buildings in town, the halls are quiet, and outsiders are awed when they enter and feel reverence for those walking by dressed in white." (187)

A claim made in the second hundred pages of the book is: "Direct-entry midwives aren't even eligible to take the standardized national midwifery examination until they have attended at least fifty births, but there is no requirement for a labor and delivery nurse to have experience as a birth attendant before a hospital assigns her to monitor women in labor, and doctors who do not become obstetricians often finish medical school having attended, if they are lucky, maybe one or two births, but any M.D. is licensed to attend births" (117). I was surprised by the fact that there is a number of births that midwives have to be there for, so I researched whether that was true in all cases. I found a passage in the book Midwifery and Childbirth in America by Judith Rooks that states that midwives (as of 1981) must assist at fifty births and act as the primary attendant at another fifty throughout their three years of training. So the evidence the author gave was valid (although he actually understated it), and helped prove his point: that midwives go through a lot of training, and should not be considered inferior to doctors.

HW 38 - Insights From Pregnancy & Birth Book - Part 1

Born in the USA: How a broken maternity system must be fixed to put women and children first, by Marsden Wagner.

1) The book seems to be organized the way a lot of non-fiction books (that focus on an issue/problem) are: What is wrong, how it went wrong, and what can be done to change it. This is done with the book overall, and it is also done within each chapter; a chapter will have an anecdote that serves as an example of a particular aspect of what is wrong with birth, and then the author will go on to explain how it got this way and what can be changed.

2) While the title of the book would indicate that the question it tries to answer would be somewhere along the lines of "How can a broken maternity system be fixed?" it seems like the real question the book is answering is more like "How is the current maternity system in the US molded to be convenient for doctors, as opposed to being better for women?" I guess my answer to this would be that doctors see pregnancy as an illness, and they want to make women "better" - as long as this can happen in a time period that is convenient for them. This makes it impossible for pregnancy to be suited to an individual woman's needs, and therefore impossible for it to be a better experience for her.

3) The insight the author seems to be trying to communicate (so far) is that a lot of the time, many interventions doctors do aren't necessary - the birth would have happened fine if the woman was left alone. While I agreed with this, I do think that there are times where it is better for people to be in a hospital for birth. The author keeps saying that most births are low-risk, and don't need to happen in a hospital, but how does one know whether a birth is low-risk before it even happens?

4) Aspects of birth that deserve public attention:

- When doctors are in medical school, they only see births where something went wrong; they go through school without ever seeing a normal birth.
- There is an increased chance of a baby dying if the baby is born at night, when there are fewer doctors around.
- It is hard for a woman to sue a doctor (to find a lawyer that will take her case) for giving her an episiotomy without her permission, because the doctor can always argue that it was necessary (even if it wasn't).
- Doctors spend so much of their training in hospitals that they forget about the real world; they are removed from any outside life, which makes their job their life.
- Many women choose to have c-sections because they want a scheduled birth, or because they don't want to face the "risks" of having a vaginal birth.

5) The author uses pretty sound evidence throughout the book; however, it seems like he is repeating the same thing over and over, just citing different sources. There are lots of statistics; at times it seems like the author is simply listing them, without analyzing them. It does seem like the evidence is reliable though, and the author has an annotated bibliography in the back of the book detailing the sources he used and the ideas each source discusses. The author also anecdotal evidence to bring up new issues; for example, he will tell a story of a woman who had trouble giving birth due to the fact that the nurses were told to wait until the doctor arrived, and then he will explain the reasons that this happens a lot, and how it is harmful to women.
Also, because the author used to be a doctor, he has insight into the culture of a hospital and the stresses that doctors and nurses have to deal with; this is an aspect of hospitals and birth that someone who wasn't a doctor wouldn't have insight into.

HW 37 - Comments on Birth & Pregnancy Stories

Comments on my blog:

Chris: "Wow, this is a really good and complete post, honestly I was thinking for a while how i could try to help you make this better and there are not many ways that I think you can make it better. You did a great job recording your interviews and analyzing what you learned and what you put in bold was a good idea that I had also thought about in many of my class. Its something that i wrote about in my blog post and you'll see this when you read it but here is your best line ""When someone said "it's a girl," I realized my eyes were squeezed shut and there was already a bundled up baby in my arms. Instead of being overcome by instant love like everyone told me I would be, I just felt kind of awkward. I wasn't sure what I was supposed to do or how I felt." I like this a lot even though its a quote because it sounds like something that most moms would say but I think its like this because mothers do love their babies and i talk a lot about why I think this is in my blog so you blog and mine have a lot of the same ideas. Good post."

Lily (Protege): The part I liked best was this~
"And I was actually glad to know that it's okay to feel uncertain, or to not know what to feel. Her story showed me that even with something as natural as birth, people still feel awkward sometimes."
I thought this was really relatable. The above quote was the best for another reason, too. You seem very earnest and you're interperting the interview with a lot of emotion while maintaining admirable professionality. I can't think of anything to change, your work is really remarkable for this.

Marilena (Mentor): I thought your best line was:
"I was struck by how different her story was from the way birth is usually described. While I knew labor and birth were painful, I always thought that it would all be okay in the end - this is what people have always told me. I always figured that while going into labor would be scary, it would also be somewhat exiting - I mean, you're about to have a child."
This was good analysis, as it shows how what you learned is different then you have previously heard. It also reveals what you think the experience of birth would be like (which has been affected by what you have previously been told).
The only suggestion I have is that you could have gone more in depth with the analysis of the third interview."

Amhara: I thought it was smart of you to explain the physical and mental effects DURING a pregnancy, which is something I didn't really have in mind going into this assignment. Its important to explain those specific things because in our culture there are many assumptions and stereotypes of women while pregnant. It was also interesting for you to talk about how other people treated her during the pregnancy because that is also definitely a factor.
I believe that your best thought was:
"I thought it was interesting how her friend's death made her want to have another child. "
because you were touching on the big idea of what motivates people to have children! and this is a very unique and beautiful example of that.

My comments on others blogs:

Chris: I thought this line was really interesting:
"If a child is a child when its first in the womb at about a month old because it has to be taken care of then how come the men don’t help. If they are only going to help after the baby is born then maybe women are more suitable to take care of the children."
It is interesting how no one ever points out the fact that the baby needs to be taken care of before it's even born. I liked your idea that the father should be willing to help throughout the pregnancy as well as after the birth.
Your interviews seemed to contrast each other - while the mother in the first interview described the father as being extremely involved (which was, as you said, not the expected answer), the mothers in the second interview described the fathers as being less willing to help.
I thought you did a good job of displaying this contrast between the two interviews, and questioning why mothers don't get the support they need during pregnancy. All in all, nice post.

Amhara: First off, this was my favorite line from the interviews:
A- "Did you receive any pain relievers?"
F- "No, this wasn't America" {Laughs}
I really liked the whole first interview, because it was interesting, as you said, to hear about how birth happens in other countries (like how there are maternity homes instead of hospitals).
You also built off your previous ideas after each interview, and you brought up many different topics: natural vs. induced labor, whether the father should be there for the birth, and why birth makes people uncomfortable.
I also didn't know until recently how common it is now for labor to be induced by a doctor; I've heard this isn't very good for the mother or the baby.
All in all, I thought your post was well done and organized. I also liked this line of yours: "It was also interesting to see how these two different parts of the birth process were connected to one another. It makes me imagine the process as a game board where your path is altered depending on where you move."