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.
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