Science vs. Technology

When I was pregnant with Hooper, my midwife palpated my belly. Her eyebrows raised and a look of surprise came over her face as she proclaimed, “he’s a long boy!”. Fast forward to his birth, where he measured 23 inches. She nailed it, he was a long boy. And that’s just one of many things I love about midwives; they use and trust their hands.
When I went to see my new backup OB, he confessed that he cannot tell the difference between a babies rump and head when he is palpating a woman’s pregnant belly. He also confessed that although he wears one of the most expensive stethoscopes around his neck, he hardly ever uses it and cannot tell the difference in various heart rhythms. Instead, he said, he relies on ultrasound for detecting the baby’s position and an EKG to determine heart rhythm. He’s young and he’s the product of modern day machinery, I mean medicine.
At any rate I recently read a fascinating article, “The Most Scientific Birth Is Often the Least Technological Birth”, written by Alice Dreger, a professor of clinical medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine. She starts the article by sharing the answer she received when asking her medical students what came to mind when they envisioned someone who chose a midwife over an obstetrician. The students described a granola girl. You know, they one’s that look almost Amish and frolic in fields of grass and mix herbs from their gardens in their spare time.
I don’t consider myself a granola girl at all, in fact, I’m slightly offended when someone refers to me as a “hippie” because I’m choosing a home birth. Instead, I consider myself very rational. I also find myself to be a hostage of my own principles. It’s nearly impossible for me to do something I don’t believe in. And I do believe in medicine, otherwise I would not work at a large hospital as a registered nurse. But I believe their is a time and place for medical intervention.
Dreger goes on to make a clear differentiation between science and technology, noting that the scientific literature shows that interventions used during birth actually increase the risk to mother and child instead of decreasing it. A bold statement made by someone both in the academic and medical worlds, no? She states the problem with her medical students is that they think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this, she says, makes them dangerous.
It goes without saying that all woman want a healthy outcome when it comes to birthing their child. The problem today, she says, is that no one seems to tell them what the data indicates is the best way to get there.
Recounting her own pregnancy in 2000, she says:
“My mate and I consulted the scientific medical literature to find out how to maximize safety for me and our child, here’s what we learned from the studies available: I should walk a lot during my pregnancy, and also walk around during my labor; doing so would decrease labor time and pain. During pregnancy, I should get regular check-ups of my weight, urine, blood pressure, and belly growth, but should avoid vaginal exams. I should not bother with a prenatal sonogram if my pregnancy continued to be low-risk, because doing so would be extremely unlikely to improve my or my baby’s health, and could well result in further tests that increased risk to us without benefit.
According to the best studies available, when it came time to birth at the end of my low-risk pregnancy, I should not have induction, nor an episiotomy, nor continuous monitoring of the baby’s heartbeat during labor, nor pain medications, and definitely not a c-section. I should give birth in the squatting position, and I should have a doula — a professional labor support person to talk to me throughout the birth. (Studies show that doulas are astonishingly effective at lowering risk, so good that one obstetrician has quipped that if doulas were a drug, it would be illegal not to give one to every pregnant woman.)”
Drawing from several experts in the birth world, Dreger points to the problem in the way birth is conceived in America — as “dangerous, risky, and in need of control to ensure a good outcome.” She also touches on the lack of insurance coverage for births outside of the hospital setting, the misuse of science to support the new technologies of birth, the lack of information provided to woman regarding the dangers in interventions offered, and the limited options women in America have in regards to bringing their child into the world.
I had to fight hard for home birth coverage. I wasn’t even aware that coverage could have been obtained the first time around and thus had to pay out of pocket for something that in hindsight could have been covered had I had more knowledge or had someone presented my options to me. Instead, obtaining home birth coverage was something I did proactively. I made home birth an option for myself, no one presented it on a silver platter. It’s unfortunate because I know a lot of women don’t have the time or energy that I did to put toward it, even if our desires for the best birthing outcome are the same.
Dreger concludes by stating, “We’re all very interested in having healthy babies and it is pretty easy to make the kind of cognitive errors that people make, and attribute to technology benefits that don’t exist. At the same time, when there are problems in a pregnancy, that very same technology can be life-saving. It is easy to make the [problematic mental] leap that technology is always going to be necessary for a good outcome.”
I get that this is a touchy subject. You can check out the comments to her article if you really want to get fired up one way or the other. I get that a home birth is not for everyone. I get that a natural birth is not for everyone. I get that some women are more comfortable birthing in the hospital setting and I get that some prefer an Obstetrician to a Midwife. But my bottom line has never wavered: Women need to be educated. The consequences of many of the interventions throughout labor need to be discussed and options need to be more available.
What are your thoughts on the topic?
You can view the whole article here.
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9 Responses

  • So do you know of a good doula you can recommend? Exactly how involved are they? I’m kinda scared of someone I don’t know all up in my grill but I would like that extra encouragement and motivation. I’m torn my husband love him to death but he really isn’t a good couch plus he is afraid himself. If you could give me more info on doulas I’d appreciate that! And prices too. If you can thanks ash!

  • You can start by asking your OB if there is a doula he/she has worked with in the past and could recommend. You can also contact any local midwife, as all midwifes that perform home births also act as doulas. You can discuss with them even starting your labor at home and waiting until later to transfer to the hospital. This would allow you to move about freely and avoid all the hospital protocol stuff. By the time you got to the hospital, you’d be relatively close to pushing. My husband was not the best in the delivery room either. Can you blame them? I don’t know what either of us would have done without our midwives direction. As you know, the nurse has other patients and the doc doesn’t show up until there’s a baby ready to catch, so for the majority of your labor you are on your own. The statistics regarding the outcomes with doulas are so strong. As for having a stranger all up in your grill… let it go. You know as a nurse that once you’ve seen one you’ve seen most. The nurse assigned to you will be a stranger too and trust me that as labor progresses you’ll have no inhibitions anyway. Better to be a stranger all up in your grill with your best intentions than a stranger who just wants to get through their shift. The doula won’t be doing exams in the hospital anyway. Think of the liability the hospital would have it someone else was performing exams and assessments on patients. They act as more of a coach and an advocate. A priceless advocate. For example, I had urinated completely just before delivering Hooper. The nurse was about to in and out cath me after giving birth and my midwife immediately stepped in and questioned if she really thought I needed that. I didn’t get cathed, and thus I was exposed to one less intervention that was not only entirely unnecessary but also ran the risk of infection. My midwife also advised me to eat an energy bar even though I was “NPO” and thus I had more energy. She encouraged change in positions, made sense of things on the monitor, encouraged me to ask that they broke my water (active labor started immediately following, so this was perhaps the best advice ever), supported me mentally and physically, and helped my husband help me. Midwives/doulas simply know the ins and the outs and are able to guide you through the process, alleviating unnecessary bumps in the road. So, I would start by contacting your OB. If you hit a dead end there, call around to the local midwifes. I have yet to meet a bad one. Prices vary, but you should know going into it that the price they quote you can be somewhat negotiable. I believe it’s somewhere around the $2,000 range, but prices to vary and can be adjusted based on what your needs and desires are. If you chose to start your labor at home, for example, the price would probably be more than if they just met you at the hospital. Don’t let the price tag detour you, call around and get a few quotes and ask a few questions first. I’m telling you, it’s the best thing you can do for yourself. Think of the patients in the hospital that have their own private caregivers. Way better care, right? Let me know what you find out or if you have any more questions. I’m happy to help.

  • My question is how did you get your homebirth covered by medical insurance?? I have the time but don’t know where to start! We paid $6K out of pocket to have our first boy at home, and are already saving for the next child. How nice it would be to spend the time harping on Anthem/Blue Cross’s phone so it’s covered next time!

  • I’m always so glad any time I find another woman out there advocating for better education for American women on pregnancy and birth. The misconceptions are so wide spread and deep set! My mom had all three of us at home, so I grew up knowing it was what I wanted for myself. It was a no brainer. Unfortunately, the small town where I live did not have any midwives willing to deliver at home. There were a few Nurse Midwives who would deliver in hospital – but I didn’t want to be there. We ended up choosing a birthing center with a midwife in a town about an hour and a half away and I am SO GLAD we did. Sadly, we paid for it out of pocket. This is infuriating to me, for a number of reasons. To penalize women for choosing a route that is safe and healthy for them and their babies…. Agh. I get heated. Hopefully, the more people know, the sooner this will begin to change.

    • We paid out of pocket for the first home birth as well. I refused to pay, and frankly couldn’t afford it, the second time and actually ended up getting insurance to cover it. My son is nearly 7 months and we’re still waiting on them to fully reimburse us… but it is coming… so there is that… I couldn’t agree more. I get heated as well. Every woman should have the right to chose and we shouldn’t have to fight tooth and nail to get things like home birth covered. It’s so ridiculous. Anyway, thanks for your comment.


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