Main Post for 3/25

The dissension that propels the divide between Atul Gawande’s article, How Childbirth Went Industrial, and Henci Goer’s response, How Childbirth Went Industrial: A Deconstruction, has shaken and confused my previous knowledge and beliefs about childbirth. Suffice it to say that after reading the two diametrically opposed views and not having any medical background myself I have no idea whose side to believe. As I distrust my ability to medically assess these two opposing ideas, I can only share my gut reaction while reading these articles.

Having read Gawande first, I was tempted to defend my newfound knowledge of obstetric advancements when I later read Goer. Contentious medical opinions aside, however, Goer’s reply struck me as condescending and hasty. Not only is her article poorly written when compared to the beautiful prose and organization of Gawande, but her condescending tone right from the start is a red flag for subjectivity. While Goer accuses Gawande of using prejudicial language, she herself is guilty of this tactic. I believe Goer also stretches her defense by incorporating evidence that is weak at best. The use of ambiguous language in her list of cesarean side effects illustrates this point, “unsatisfactory birth experience, poor overall physical functioning, poor overall mental health and self-esteem, possibly depression,” (Goer, 5).

Rhetoric aside, I was bothered by the fact that Goer attacked Gawande for taking a pro-obstetric advancement stance. To the contrary, I believe he laid out an engaging personal story, an historical context, and some thoughtful commentary along the way. Gawande even openly admits to his own struggle to reconcile the obstetric trend, “It is not mere nostalgia to find this disturbing. We are losing our connection to yet another natural process of life. And we are seeing the waning of the art of childbirth,” (Gawande, 10). Although Goer criticizes Gawande for presenting only one view, I think he did a far greater job of providing both sides of the story. Perhaps the best proof of this is that after reading his article I felt informed and interested, not coerced or brainwashed. In fact, I found Goer’s article so fanatical that she immediately lost her credibility and my respect.

Even though Goer believes there is a simple solution to the latest industrialization, she fails to explain some key points. Repeatedly she pronounces natural birth or birth with the assistance of forceps as superior and safer to cesarean section; however, Goer ignores the fact that using forceps is a highly skilled procedure which very few obstetricians are qualified for. Another alternative suggested is the use of a doula, “By rejecting doula care, Rourke condemned herself to fighting the system with no one in her corner,” (Goer, 10). I do not doubt the benefit Rourke would have receive if she had a doula during labour; however, if doulas are the only way to give birth naturally then it appears that childbirth has become the latest privilege. It only takes watching one episode of 16 and Pregnant to confirm that not every pregnant woman/girl has access to or knowledge of alternative forms of childbirth.

After combing through the differences of these two articles, I am left with three imperative yet poorly articulated ideas. The first is the importance of recognizing the power of women helping women. Whether one chooses a midwife or a doula, the sisterhood and experience that is shared between women is something that no male obstetrician can compete with. As the brownbag Obstetrics and Childbirth in a time of Henry VIII illuminated, just because a man has Dr. in front of his name does not necessarily mean he’s more qualified than a midwife. Gawande ,too, alluded to this during his recount of obstetric history, “Doctors may have had the right tools, but midwives without them did better,” (Gawande, 4). The second idea is that having the flexibility and open-mindedness to accommodate for a dynamic delivery is imperative for both the mother and fetus’ health. If women are told that one form of delivery is superior to another, then they run the risk of choosing what is socially acceptable versus what is best medically. It comes as no surprise that Rourke suffered forty hours of labour as she tried to maintain her rigid delivery plan, “I wanted no intervention, no doctors, no drugs…I didn’t want any of that stuff. In a perfect world, I wanted to have my baby in a forest bower attended by fairy sprites,” (Gawande, 2). I do not believe doctors should be judged for sending an early labourer home, increasing Pitocin, or deciding on an emergency cesarean section. Accepting that all forms of childbirth can be perfectly healthy will hopefully allow for even higher survival rates. Finally, the third idea is that women should have the ultimate authority over their bodies, which ties into the conversations we have had regarding abortion. Whether childbirth involves doulas and hot tubs or surgeons and scalpels is of little importance if the end result is a healthy mother and child. Just a women should have the right to choose an abortion, so too should they have the right to choose the terms of their delivery.