History of Childbirth

A couple of months ago I started to have time to think about the pregnancy. At the same time I also noticed two strange phenomena: the news is filled with stories of pedophiles, and everyone seems to have a story of a birth gone very, very badly. While I have been reading the New Yorker for years, I have never noticed a story on childbirth and its risks but this week, there just happens to be an article on the very topic.

The article is written by a physician -- Atul Gawande. He went to Harvard Medical School, did a surgical residency, and I believe he is now a professor at Harvard. Before medical school, he was a Rhodes scholar and studied philosophy at Oxford. I have always enjoyed his writing and so, I was compelled to read this one.

Everyone knows the history of childbirth is not pretty. Gawande weaves a story of a physician giving birth in New York today with the ways in which the profession of obstetrics has "evolved". As recently as 100 years ago, there were "dozens of maneuvers" -- from forceps to fracturing the baby's collar bones -- used to get a baby out. Around the 1930s, standards for training and cleanliness were set in hospitals but still a mother's chances of dying were 1 in 150. The baby's chances were 1 in 30.

He then credits the improvement of infant mortality rates to a physician named Virginia Apgar -- anyone who has had a child or works in medicine knows the Apgar score rates an infant's vital signs at birth. He seems to credit the improvement in maternal rates to caesarian surgery, and the "industrialization" of birth. Today in the US, a full term baby dies in every one of 500 births, a mother dies 1 in 10,000.

It is impossible to argue that conditions for women have not improved over the last 100 years. However, Gawande implies that Caesarian may one day replace a natural birth -- right now 1 in 3 women gives birth this way. He acknowleges that the only scale used to determine if the birth is successful is the Apgar for the baby. There is no similar scale for how the woman feels or recovers. If she lives, then all is well.

This is so troubling. Why is pregnancy treated like a medical disaster waiting to happen? Litigation? Fear? A desire to control women? I have no idea. The irony of it all is the more medical intervention you have during your labor, the more likely you are to have more intervention. Pitocin leads to surgery 50% of the time. And surgery is filled with complications and a long recovery .. I'd rather not deal with either.