Sunday, June 10, 2007

Cradle or Grave

Cradle or Grave is a review by Michele Pridmore-Brown of three books on childbirth in the May 30, 2007 Times Literary Supplement. Looking at birthing through history and internationally, these books show "the extent to which birth is in fact not just some timeless event, but culture- and class-mediated," subject to religious manipulation, scientific vigilantism and expensive and often harmful fads. The review also focuses on the appallingly high rate of infant and maternal mortality in the US:
Proof that things are amiss in the US: it has the second worst newborn mortality figures in the industrialized world, despite having the most expensive maternity system. Women are 70 per cent more likely to die in childbirth in the US than in Europe.
In his book "Born in the USA" Marsden Wagner wonders how Americans continue to be duped by the obstetrical industry:
Obstreticians are still too much “like priests in white robes”, writes Wagner, practising in insular “cathedrals”; continuing the metaphor, pregnant women are then faithful parishioners when they should be sceptics. Wagner enjoins pregnant women to shun any birth book that advises “trusting your doctor” or “listening to your doctor”. Such phrases are red flags. Instead, they should trust the scientific evidence and “trust their bodies”. I am not sure what trusting one’s body means, given that interpreting bodily signs is itself a culturally mediated, indeed often faddish, affair – as Cassidy’s book makes abundantly clear. But, certainly, basing decisions on scientific evidence is sound advice – that is, assuming the evidence is robust. And Wagner does marshal plenty of evidence that midwives are the safest attendants for low-risk births – because they are trained to wait patiently for and facilitate birth, rather than to intervene in and/or hasten it. Evidence also suggests that when the C-section rate goes over 15 per cent, the maternal mortality rate increases. And evidence also shows that planned home births for low-risk patients are as safe as hospital births. But Wagner’s trump card when it comes to policy is probably the bottom line: acting on this evidence in the US would not only lower death rates but save vast sums of money.

Read the whole review, and support your local midwife.
HT Natalie at Philobiblon

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