I found the discussion regarding childbirth between Gawande and Goer's articles to be quite informative especially in light of the New York Times article that recently reported that cesarean births have reached an all-time high in U.S. at 32%. And while all three articles come to leave the reader with varying conclusion on the state of childbirth in the U.S., what is interesting is the the NY Times article highlights several important points both made in the Gawande and Goer articles.
First, the NY Times article reinforces the point made in both articles about childbirth having become institutionalized to an alarming extent in the U.S. “We should do inductions for good solid medical reasons, not for convenience or the day of the week,” stated Dr. Macones said. The article mentions the increase in C-sections due to fears of OB/GYNs of being sued, but fails to fully suggest what then can be done about the problem. Grady mentions certain trends in c-sections today, like having repeated c-sections after the first, but she never cites a study that suggests this practice is unnecessary.
Secondly, Grady brings into the conversation the issue of cost and danger: all 3 authors seem to take separate stances on whether our institutionalized method of childbirth has higher risks for the mother and child, but they all three make note of the infamous issue of 'cost.' And while I understand Grady's point that c-section cost almost double that of vaginal births, one must also recognize her other point in that lawsuits are a real threat and problem. Yes, one solution for those doctors who simply perform the surgery out fear is to gain protections for these doctors, however, if c-sections are deemed necessary by the doctor for the benefit of the mother and child (in which hopefully most cases being performed it is), then I have trouble responding to the critiques of Grady and Goer against c-sections. I think Gawande has an interesting spin to his article in that he shows that an educated women in the field, Rourke (who Goer describes as having "unrealistic anxieties" due to her profession), is able to let go of her insistence on having this natural birth, reminding us that not all c-section are performed because we are eager to slice and dice patients now days. For me, it simply drove home the point that childbirth is dangerous and extremely scary. Some women want to do it naturally, but others do not. And regardless of the high costs, if a c-section means the mother and child are going to have a safe delivery (which Goer claims as having equal chances as vaginal birth in most cases, non-emergencies) then I believe the decision is the woman's and whatever makes her feel most comfortable. If your doctor recommends you have a c-section, and that is what you feel most comfortable with (even though, you may perhaps be able to give birth vaginally hours later), then I believe the decision is completely personal in nature and we should stop criticizing the system. Until extensive studies show that such c-sections are causing great harm, then I don't understand why the public is so concerned with which form of a childbirth a mother chooses.
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Gawande’s article definitely raises some interesting points for discussion. On one hand, for part of the time that I was reading it I kept thinking how far the birthing process has come from what is considered to be a natural process and one that has been established evolutionary. I think that in our society there has always been some sort of pre-established norm that if at all possible a mother should try to have a natural childbirth. However, now that I think about this critically, and as Goer points out, it seems quite unrealistic to me. However, regardless of how feasible it is for a mother to have a natural childbirth, she should always have a choice in the matter and this choice should be independent of any societal norm or pressure, similar to the pro-choice argument for abortion. In addition, the number one concern during childbirth should be to ensure the safety of the mother and the baby.
ReplyDeleteI think that Gawande’s argument about medicine adapting over time and seeing the results after you implement a new type of treatment is definitely an interesting one. For me I see it as a combination of a craft and an industry. I think that it is important to have the skills and training that will enable you to perform your job, but some sort of abstract training that provides physicians with a plan when things go wrong should accompany this training. In this case the Apgar score was established as practical addition to enhance the skills that had been provided in training. I think that there is no such thing as a predictable operation because while these surgeries may be done thousands of time there is still a chance that someone’s body responds different than someone else’s. In this instance I think that the idea of responding on the fly to these anomalies is an effective way to establish and improve medicine for the future, and adjusting rigid practices to make them more practical can be seen as an advantage in medicine. Goer claims that Gawande is advocating for routine intervention and that whenever something goes wrong a mother should have a C-section, however I think that there is more to this argument and it is impossible to say that Goer or Gawande is completely right. In a realistic sense each case should be decided as it occurs and the decision should ultimately rest in the hands of the woman.
I completely agree with David on a number of his points he made on the process and implications of natural childbirth. It is extremely difficult for an outsider to judge the collective decisions made during childbirth by the mother and doctor. As David points out, individuals can respond differently to operations or medications administered. Therefore, it is difficult to make generalizations on the practices used during childbirth. The mother and baby's safety and health should ultimately be the first and foremost concern during labor and delivery. I found David's concluding sentences that argue Goer and Gawande can be viewed as "completely right" from varying perspectives. Yes, sometimes a C-section is not necessary and the mother should have had a natural birth, but at the same time C-sections can be crucial in ensuring the safety of the mother and child. I think that overall David makes some great points in his response and strongly takes on both sides of the argument.
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