Saturday, January 20, 2007

Spreading the Care for Truth

Everything I learn I apply to birth. How does any particular new knowledge corelate with what I know of the community of birth, the physiology of birth and/or the marketing of birth practices.

The Ghost Map
by Steven Johnson (Riverhead Books, 2006) chronicles the search for the cause of cholera. It highlights a particular epidemic in London, England. People thought cholera like other diseases were spread by bad air. London had lots of bad air. The sewage removal system was in its infancy. Sewage was poured into the River Thames from where a large portion of London had its drinking water piped to neighborhood pumps. Besides smelling bad, viruses were recycled back into the population at epidemic proportions. If the same percentage of deaths were to happen in New York City today, Johnson writes, as there were in the epidemics of the 1840s and 1850s in London, we would have 4,000 people a week dying in New York. A week.

Doctor John Snow's photograph makes me suspect he was gestating in a less than optimal foetal position (I'm not kidding, he looks, from the molding of his head, that he was probably occiput posterior, but perhaps breech). Evidently big thoughts were molded into his head, for he was a brilliant physician with a quick mind who saw relationships in events for the enlightenment of all. For instance, 3 months after the introduction of ether by a Boston dentist Snow figured out and invented a way to deliver ether in reliable doses to give more reliable pain relief and keep the patient alive more often. He was soon invited to give Queen Victoria Chloroform during her eighth birth and pain medications for labor suddenly became socially viable.

Meanwhile, Snow had been trying to persuade his fellow physicians that cholera was spread through contaminated drinking water. Marginally acknowledged and then ignored, Snow wasn't the only doctor investigating the waterborne theory. In fact, a Italian physician, Filippo Pacini, had just published his microscope findings on cholera. He, too, was ignored. The medical world simply agreed it was vapors that spread disease. Any research that challenged that assumption was inconceivable and aborted on contact with the medical community.

In 1854, a cholera outbreak only a few blocks from Dr. Snow's home gave him the chance to show the medical world some facts about the waterborne nature of cholera.

Reading this, I, of course, think about the spread of contagious habits in birth practice. As Marsden Wagner describes, the more doctors can know about the process of birth the safer they feel. This knowing trails along the assumption then that forcing all birth into the median of cases must be the safest approach. Rising prematurity rates and rising infant mortality rates result. The facts, however, can not defeat the marketable strategy of increasing obstetric internventions.

Research is no match for the contagion of profit boosting ideas such as induction of labor. There is plenty of research to shed doubt on the wisdom of inducing labor for reasons of gestational diabetes and suspected large babies, for instance. Yet it is done so often that the March of Dimes has launched a campaign to reverse the trend which causes rising rates of late prematurity. That is, a baby who is born at 35 or 36 weeks, shortly before term at 37 weeks the cut off date in gestation when a baby is considered full term. 37-42 weeks is the range considered full term.
Late premature babies die at a higher rate in the first year of life than babies allowed to gestate another week or two. Induction also increases the rate of cesarean section when the induction doesn't succeed at forcing open the unripe cervix.

Why do women allow this then? Why did people resist the news of the existence of tiny bacteria and viruses, which colonized weakened people and caused disease? Because influential people didn't yet believe the research. And we naturally want prestigious and wise people to care about us. If we adapt their belief system we can feel safe. There is a lot of sense to this and most of the time it is true. Their is strength in numbers. Women seek support when under stress.

Pregnant women reasonably seek the care of providers in the network of their insurance, friends or family or neighborhood clinics. They see care providers as caring, intelligent people who will do only what is best for them and their baby. And in the first two categories they are right. The providers do care, most of the time, and they are intelligent, no doubt. But they will not always do what is the best care practice for the mothers.

Why not? Because the best care as shown by new research is not the established norm. To change, providers will have to break social ties within their own support system and put themselves out on a limb. They would have to involve their nurses and clinic staff to change along with them. What a lot of work and with much suspicion and irritation among those that weren't interested in changing their daily routine. Then the profit margin may also be upset. One SC doctor quit after her hospital administration told her to increase her cesarean rate to 25% to match the other obstetricians in her hospital. That was the percentage, she was told, that made obstetrics profitable given the average rate of law suits against OBs. Only she wasn't getting sued because she had very strong relationships with her families who chose her specifically for her low surgery rate. Didn't matter, it wasn't fair to the other OBs.

Ok, if that is so, then why don't women walk out on the doctors who pump in the drugs and cut them open? Women in pregnancy are looking for a caregiver who is not only competent but cares about them and their pregnancy. Women see the caregiver, they hear the news that they will be induced (the baby's large, at 40 weeks, or 38 weeks, or "The baby is alive now, we can't guarantee that tomorrow"). They may be upset by the pressure to do something that feels wrong to them but where can they go? They have an established relationship with a professional. Even if she or he does things agressively they will still make it so mother and baby survive, won't they? If they break the relationship off, the pregnant women will be left to chance. They may put their baby at risk, so it seems better to go with the program than seek out a new relationship and be in limbo in the meanwhile.

Its said that Post Traumatic Stress Syndrome can occurr among women who had a normal childbirth (no complications reported). Its an epidemic of grief. Not to mention the injuries possible from unnecessary intervention.

What the birthing world needs is a visionary. What Dr. John Snow heralded for disease prevention we need in childbirth. We have visionaries, precious ones like Marshall Klaus and John Kennell, Michel Odent, Ina May Gaskin, Shiela Kitzinger and Marsden Wagner. These are some of the best singers in the choir. But who will shake up the docs?

And is it the doctors we have to change? Or is it the administrators of hospitals? Where is the point of vanishing returns on the mega marketing of machine-led childbirth?

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Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.