Tuesday, March 17, 2009

Currently reading

I love Interlibrary Loans. Right now I'm reading:
I also requested the two books on breech birth that I reviewed a few months ago: Breech Birth by Benna Waites and Breech Birth Woman-Wise by Maggie Banks.

I'm quite enjoying Wendy Savage's 2007 book Birth and Power. Dr. Savage was an obstetrician and Senior Lecturer in Obstetrics and Gynaecology and Honorary Consultant at the London Hospital Medical College. After 25 years of practice, she was accused of incompetence by her obstetrical peers in 1985. (If you've read Benna Waites' Breech Birth, you'll remember that she was one of the physicians and midwives interviewed about vaginal breech birth.) She had a highly publicized trial and was acquitted of all charges a few months later. This spurred her to write a book in 1986 about her trial called A Savage Enquiry: Who Controls Childbirth?. She retired in 2000.

Birth and Power is an updated look at the issues she raised in her first book. It includes six sections focusing on birth and power, accountability, incompetence, disciplining doctors, academic freedom, and what women want. Each section is introduced by Savage, along with several chapters authored by midwives, physicians, and consumer advocates. Birth and Power also reprinted the original text of A Savage Enquiry.

Some of the chapters in Birth and Power are heavily focused on details specific to the UK obstetrical and medical systems, so I skimmed when they became too dense or unfamiliar. I thoroughly enjoyed reading A Savage Enquiry, which outlines Wendy Savage's path to becoming an obstetrician, how she gradually became more woman-centered in her care, and the five infamous cases her obstetrician colleagues used to assert that she was medically incompetent.

A few quotes from Dr. Wendy Savage:

From the section "What Women Want" p. 171
From my own experience of caring for pregnant women I believe that the majority of women want a normal birth cared for by people they know and trust. They need peace and quiet in order to concentrate on the instinctive nature of giving birth. If one looks at animal behaviour, cats and dogs tend to go into a quiet dark place to give birth, and cows and sheep may stop labouring if moved. We are mammals, and it seems likely that we instinctively want to behave in the same way. It therefore seems plausible that the underlying reason for the increase in intervention in hospital practice is that we have set up a system which is antipathetic to the needs of women, for peace, quietness and privacy.

The modern British labour ward, where women hear the sounds of other women giving birth and of telephones and bleeps going off, and where the lighting is usually harsh fluorescent strips, could almost be designed to interfere with the natural process of labour. Add to these the frequent interruptions by midwives coming to "get the keys" to the drug cupboard (often without knocking on the door), changes of midwifery staff, the doctor's round when five or six people enter the woman's room and discuss her "case," and it is hardly surprising that in some hospitals almost half the women require labour to be strengthened by a synthetic version of oxytocin, the natural hormone with makes the uterus contract.
From the introduction to A Savage Enquiry p. 217
Pregnancy is not an illness. I belong to the school of thought which believes that every pregnancy is normal unless there are indications that something is wrong. Those at the opposite end of the obstetric spectrum believe that no pregnancy is normal, except in retrospect. This attitude, together with the labelling of women as high risk on the basis of statistical, rather than individual information, leads to a situation where too many women are forced to attend hospital clinics, rather than having the more personal care of the midwife or a general practitioner closer to home. I feel that as the risks in childbirth become smaller, statistical methods of predicting (on the basis of her age, number of children or income) which woman will lose her baby have limited use. In my view, if you look at each woman as an individual, and plan her care with her, you will get the best result.
And one from Dr. Marsden Wagner's essay "Birth and Power" in Savage's book (p. 40):
Half of informed choice is information: the information provided to pregnant and birthing women has been most inadequate and always very carefully monitored by doctors. I've often heard doctors say that we must not "scare" pregnant women, as an excuse for not sharing information. If sharing the information does elicit concern or fear in women then, rather than withholding this information, doctors must be prepared to work with women to cope with this anxiety--as well as their own. Sharing information also means sharing power.

The other half of informed choice, of course, is choice. To give women choice is to give up power on two levels. Firstly, the doctor loses control over what happens with that particular woman. Secondly, the doctor implicitly acknowledges that the woman also has valid information and should control her own body and life. Such an acknowledgement by the doctors would shift the ultimate power from the doctor to the woman. Rather than choice, the literature today is filled with discussions on patient compliance. To comply means to obey and is the opposite of choice.

The results of the power of doctors over birth might well be summarised by saying that the doctor has written the obstetrical drama so that he is the star, rather than the woman.


  1. wowzer, Dr Wagner's quote says a lot! It very much has to do with the idea that the "educated" doctor must know best because s/he knows "so much more" than me. I'm so glad that I've realized that I am capable of being an expert on myself, and can consult with an expert in medicine when I feel the need. When we put doctors too high up on that pedestal, we feed that illusion that they know better than us; we essentially abdicate our power to them.

    I'm also very glad I have a family doctor who is more than happy to be my "consultant." Thanks, Rixa, your blog is always a pleasure to read and ponder.

  2. I heart Marsden Wagner.

    The Labor Progress Book was really helpful for me. I knew I was going to have to work around my narrow pelvis, so I really drank up all that information about positions and movements.

    I liked Square Foot Gardening too. I was kind of planning to implement that kind of style of gardening anyway, since I am doing it all in pots, but if I ever have a real in-the-ground garden I want to do it Square Foot style. I also like the idea of staggering plants so you have a continuous harvest all season long.

  3. Urban Homestead sounds great! I am going to check that one out. Even though we live on 8 acres, I love knowing how to become more sufficient with smaller space (we don't plan on using all 8 acres if possible).

  4. Thanks for the wonderful book suggestions (I took them as sugestions!) and for the thought provoking quote. The doctor as the *star*-- how ridiculous and yet thats exactly it. sigh.


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