Atul Gawande’s article has an interesting form. The article begins with the introduction of Elizabeth Rourke, a pregnant woman almost at her due date. Gawande will skip around, discussing Rourke as she gets closer to delivering as well as discussing current issues involving child birth.
Rourke is an intern at a hospital and thus knows the pregnancy process fairly well. She is aware that she has to wait until her contractions are five minutes apart to call the doctor and go to the hospital. She also had decided on giving a natural birth, sans epidural and C-section.
Gawande then talks about the medical process of child birth, down to the gory details. In the first trimester, female hormones cause the joints of the pelvis to elongate and loosen. When its delivery time, the uterus starts to form a funnel shape, which the baby is ultimately pushed through via contractions. The cervix will slowly soften and relax as the baby’s head pushes against it. This is called ‘effacement.’ Finally, an opening will appear and slowly widen. Eventually the amniotic sac will burst and this pressure will increase the opening even more. When the opening is between 7 to 10 centimeters, the baby’s head will enter the vagina and ultimately be pushed out. This process is extremely dangerous. At any point, there could be mistakes or problems that could lead to harm to either the child or mother. In order to avoid such harm, midwives and doctors have been racking their brains for years. The first instrument invented was the crochet which had hooks to crush the fetus’ skull in order to pull out the fetus and save the mother’s life. Other devices were later invented that were specific to the position the baby was in. The forceps was the most successful tool invented although it was kept as a family secret by the Chamberlen’s for years. However, even with all these measures, in 1933, there was 2,041 maternal deaths in childbirth and of those, 2/3 could have been prevented. Presently, there has been a huge rise in Cesarean sections with about 1/3 of American women using this method for childbirth. Gawande later discusses the merits and problems of this
Returning to Rouke, she was having a lot of problems. Her cervix was not dilating fast and Rourke had already been in extreme pain for many hours. Finally, she opted out of her original plan and took epidurals. It also turned out that her baby ended up getting stuck. With these progressions, Rourke had already been in labor for 30 hours and the baby still had not been delivered.
Virginia Apgar made a huge contribution to the childbirth. She created the Apgar score which rated the condition of babies. This created competition by surgeons to have higher scores. Thus, more attention was paid to the babies after birth and if the babies looked unhealthy, they were not given up on as they had been previously. Thus, more babies were saved from what could have otherwise been death. However, the field of obstetrics seems to not have a huge attraction for medical students or professionals. Interestingly, it saves the most lives out of any other medical profession. Another intresting thing to note is the lack of forceps use in childbirth. Since it is an extremely difficult skill to teach, C-sections are instead turned to in such instances.
Back to Rourke: Rourke ended up having to have a C-section as she had been in painful labor for an excruciating amount of time. Her baby was successfully delivered with an Apgar score of 9 after five minutes. Gawande at this point goes into heavy detail of a C-section, commenting on the amount of risk attached to such a surgery. It is not as simple as women seem to think these days. There is still huge risk attached. Yet even with these risks, most surgeons are turning to C-sections. Is this because it fits better into their schedules and makes them more money? Natural births are no longer as heavily considered. C-sections are immediately offered. This shift to ready surgery is somewhat frightening.
The second article, “How Childbirth Went Industrial: A Deconstruction,” talks about and criticizes Gawande’s article. Goer begins by indicating a parallel between Rourke and Princess Charlotte’s childbirthing experiences. Goer points out that Gawande does not make a case that the current tools in obstetrics (such as Pitocin) have made a positive difference. Gawande also appears to have no argument to C-sections as he points out numerous positives associated with it. Gawande also praises doctors for doing whatever interests them regardless of research trials. Furthermore, there has never been a point where obstetric interventions have enhanced newborn results. Goer points to numerous studies to support this fact. Enhancement in chidlbirthing process came when doctors didn’t ‘meddle’ as much. Gawande also states that C-sections will save lives in difficult situations. However, the facts do not support this statement. Women are more likely to die in C-sections or have complications than during natural births. Goer also goes on to state a multitude of risks for the mother that Gawande ignored attached to C-sections which include hysterectomy and pulmonary embolisms. Newborn risks include respiratory complications and sensitivity to allergens. There are many more risks with having a C-section to a natural birth as Goer points out. Furtehrmore, the more C-sections a woman has, the higher risk she is at each time. Goer also looks at the standardization of care in obstetricians. This has done nothing to regulate the use of medical intervention. A careless attitude has been adopted and women who might not necessarily need C-sections are receiving them nevertheless. This attitude is also seen in many other surgical cases. Goer also comments on the Rourke story. Rourke’s story cannot be seen as typical. It is an irregularity. In 2005, a study done showed that only 2% of women received all the ‘care practices’ that Rourke received. Most women can have birth much more ‘naturally.’ Also Rourke did not receive a doula and she had idealistic hopes that were not realistic. Goer essentially criticizes and disagrees with almost every aspect in Gawande’s article.
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