Follow Up: Responding to Hilary

I, like Hilary did not know which side to take between the notions set forth by Atul Gawande and Henci Goer. It’s interesting to read about the evolution of childbirth and the advent of medical technology that has altered the child-rearing process. Goer criticized Gawande’s article in terms of the necessity of performing C-Sections and believed he provided unreliable data for his analysis.

I had no reason at first to doubt any of Gawande’s conclusions. I felt that the take-home message of “How Childbirth Went Industrial” is that women can have a safe, easy C-section or they can undergo difficult, risky labors and then have cesarean surgery. He provided an extensive amount of data, which I had no reason to doubt, but then Goer analyzed it I was surprised at how unreliable it was. It made me wonder how mothers and mothers-to-be can be truly informed about this issue as it is a huge decision in one’s life.

I see where the controversy of childbirth practices lies in the sense that some women prefer to keep the process natural by avoiding the Cesarean Section. There are certainly positive and negative consequences to a C-section. Gawande reveals a positive to this approach to medicine, while Goer criticizes his statements. I agree with many of Goer’s arguments; I feel that in many cases, Caesarian Sections can be the safest and most efficient way to deliver a child. As he states, it is “comfortable” for obstetricians, can be performed “consistently,” “easy to teach,” and is a “simpler, more predictable way to intervene.” However, like Hilary, I think that Goer’s response was extremely condescending. The way he could have argued his points should have been laid out differently.

I liked Gawande’s comparison of OB's to carmakers:

“Obstetrics went about improving the same way Toyota and General Electric did: on the fly, but always paying attention to the results and trying to better them. And it worked.”

There are negative consequences to this "on the fly" approach. When you choose to give birth in a hospital with an obstetrician, the general assumption is that the doctor must do something, while it will be dangerous to just wait and see what happens. What has the standardization of childbirth created for women? I wonder if this standardization process really is the best technique for childbirth. While many individuals benefit from cesarean sections, some see that obstetricians and hospitals are restricting women’s ability to give birth normally; many people strongly hold the belief that “natural birth” is the best way.

While it has improved outcomes, as Gawande notes, I think it has also robbed women of something vitally important. I agree with Gawande when he says, “We are losing our connection to yet another natural process of life. And we are seeing the waning of the art of childbirth.” Goer adds, “Standardization meant applying obsetric interventions to everyone needed or not.” I think it is a tough call in some cases of whether or not to have a C-section because on one hand, safety for the mother and child is most important, yet so many women will do anything in their power to have birth the natural way. But what exactly is natural? I think its meaning is more ambiguous than previously thought. I was shocked when I heard about a woman who, when she heard that her baby could die and would need an emergency c-section, she told the doctor, “I would rather have my baby die than have a c-section!” It makes me wonder: Do we care more about the process of birth than the product?

After reading these two articles, I conclude that the mother and baby mortality rate was much higher before modern medicine developed to what it is today. We have so many choices that help us to have the kind of birth experience we desire, with safety as the top priority. In moving forward in our society, if OBs and midwives work together, we can achieve the best possible outcome in birth situations. Like Hilary notes, safety of mother and child must be the highest consideration in any circumstance. This collaboration will result in beneficial outcomes and revolutionize the child-rearing techniques.