One of the things I enjoy about the book Mother’s Intention: How Belief Shapes Birth, by Kim Wildner is how straightforward, matter-of-fact and unapologetic the author is when exploring concepts, realities, facts, and beliefs about birth. In a section addressing perceived risk and birth, she shares an effective analogy about health clubs and heart disease paralleling the accident-waiting-to-happen mentality of modern obstetrics:

A multitude of things CAN go wrong with any system in the body, but seldom DO. Take the heart/circulatory system for example. Heart disease is the leading cause of death in the US. 873 per 100,000 die of heart disease (CDC). (Remember, natural birth is between 6 and 14 per 100,000 in the US, depending on the population.) Some have arteries on the verge of clogging. Some have heart defects they are unaware of. Some have damage they don’t know about. Something could go wrong at any minute and immediately available surgery can undoubtedly save lives.

Using the logic of obstetrics, all health clubs should be in hospitals and all fitness trainers should be cardiac surgeons. Any independent health club with ‘lay’ trainers would be ‘practicing medicine without a license,’ subject to prosecution. It’s for your own good.

In fact, in order to know if a problem is developing, close monitoring and ‘management’ is required. We will need to place straps on the muscles to measure the intensity of the workout. of course, it will be restrictive, but we need to know how hard the muscles are working to know if the heart can take it. We’ll need to monitor heart rate, blood pressure, fluid output. We’ll need to give an IV because with sweat excreted, you could dehydrate, and of course, we simply can’t take the risk of letting you drink anything lest you need emergency surgery….

Later in the book, the author employs another helpful analogy, again using cardiology as an example to make a point about inappropriately applied maternity care interventions:

What if…

You went to the doctor complaining of chest pain…not bad pain, but bothersome. To rule out a heart problem, the caregiver listens to your heart. He scowls, then excuses himself to make a phone call. He comes back in and tells you that you need to be admitted to the hospital for a test that requires the use of a drug. The drug has a low risk of serious complications, which is why you must be in the hospital, but he feels confident in taking that risk.

You go, and within minutes of having the drug administered, you have a heart attack. You are rushed into emergency open-heart surgery. Complications arise, but they are dealt with. You nearly bleed to death, but with a blood replacement you recover.

The repair doesn’t go well, which may mean you will need further surgery later…maybe even a heart transplant. You definitely will need to change your previously active lifestyle.

Later, you discover the call your care provider places wasn’t to a specialist, but an HMO lawyer who advised him not to let you walk out the door, just in case the routine examination missed a serious problem. You also learn there were less dangerous ways to determine if there could be a minor problem.

It turns out, you really did have a minor case of heartburn. All you have been through was avoidable, but “As long as everyone’s ok now…that’s all that matters”…right?

A comment like that, to a mother who has suffered unnecessarily, when she would have–or could have had–the result of a live, healthy baby without such sacrifice, disregards her feelings of loss.

Parents should be expecting more!

In Open Season, by Nancy Wainer, she refers to OBGYN care is referred to as “gynogadgetry.”

In The Doula Guide to Birth, I marked another quote that feels very relevant to the others above: [a March 2006 study in the American Journal of Obstetrics & Gynecology] “reviewed all fifty-five of ACOG’s current practice bulletins, calling these articles ‘perhaps the most influential publications for clinicians involved with obstetric and gynecological care.’ The study concluded that ‘among the 438 recommendations made by ACOG, less than one third [23 percent] are based on good and consistent scientific evidence.'”

Enough said.