Pregnancy for Dummies
Competition in the book business is fierce, and nowhere is it more fierce than in the pregnancy information and self-help books. Several years ago I was invited by a New York publisher to submit a book proposal for just such a pregnancy book. This particular publisher was fired a week later, but since no one told me, I continued my research earnestly in pursuit of what I was sure would be a lucrative non-fiction writing career.
Here is what I found:
If you were to actually look into who are writing these books, as I did, you would be very surprised. One of the most popular books is co-written by a nurse, a physical therapist, and a mother. There's an introduction by an obstetrician, which beefs up the credentials a bit, but the book is still written by parties only interested in childbirth. For the most part, these books all take apart what is a natural process and generically describe all of the famous feelings, pains, phenomena, and miseries of pregnancy. The information is in most part accurate and legally safe, but it assumes that one size fits all.
Another book is written by a woman with a feminist agenda, espousing the beauty of natural childbirth at all costs. Having been in this profession for over twenty years I can assure a woman that each person is different and what might be good for one may not be for another.
One of the best books I saw was put out by a huge women's magazine publisher. I was impressed with the detail until I read the blurb about the author on the back cover. The "author" was a model and fashion consultant who had never been trained medically, but gained her knowledge by "attending several seminars." It's no secret as to what's going on here. This book was written by someone who knew what he or she was talking about, but the model was placed on the cover as the alleged author to assure the buying pregnant readership that it was a book for women...by a woman.
This whole thing of being a woman to add legitimacy to the field of obstetrics is a very funny joke among us male and female obstetricians. We have all trained hard to do what we do, and we are proud of the talent we bring to the practice of our specialty. Yet when we hear a woman on a TV commercial talk of what her ObGyn recommends in tampons, we hear the character say, "Well, 'she' says..." Of course it's assumed that a woman needs to be treated by a woman, just as it makes as much sense that a person with cancer should only go to an oncologist who has cancer as well. An obstetrician is usually slightly uncomfortable knowing a patient sought him or her out just to get a female OB--or a male OB. And these books sneak in the same type of politically correct agendas. Many speak as if it is understood that one way is far superior to another. Of course it's better to have a vaginal delivery than a C-section (But at what cost?). Of course it's better to breast feed than bottle feed (but at what cost?). Of course it's better to go Lamaze than to have an epidural (But at what cost?).
Having a vaginal delivery that causes trauma that takes two hours to repair instead of a C- section that takes a half hour is a victory for who? Breast-feeding in a woman who can't get it right either because of her or through no fault of her own should not risk malnutrition of her infant. A woman who screams her way through natural childbirth in spite of having attended all of the classes will have only negative memories of the whole process. Although it's true that vaginal delivery is better than surgical delivery, breast-fed are best fed, and Lamaze will allow the right candidates to experience a life event like no epidural will afford, still everyone is an individual. An individual won't find the particular chapter with her name on it in these books that offer no perspective.
No perspective creates a misunderstanding wherein rare complications of pregnancy are given equal time with common problems, equally suspect with a given symptom. A patient of mine read that oral sex could kill her when she was pregnant. It's not my job to get involved in anyone's choice of intimacy, but what she was referring to was a passage in one of the more popular books that described a fatal air embolism that was reported once. Yes, all we obstetricians have heard this story--it is quite famous. But it is famous because of its unusual outcome, not because it is commonplace. Herein underscores my point: There is no perspective. So when my patient asks me, "Then who should I ask these questions?" I reply...
The doctor-patient relationship is a special one, especially in pregnancy, for it deals with not only doctor and patient, but also the mother as protectorate to her unborn son or daughter. Every foursome (doctor-expectant mother-expectant father-baby) is unique. The books are helpful, but the perspective comes from the doctor-patient relationship, for it is the professional knowledge and experience of the doctor that will deal with the unique presentations of the patient. With perspective comes one of the most important qualities of an obstetrician--judgement.
Another shortfall of these books is that they sometimes assume a woman's doctor should be mistrusted first. They not only suggest a woman ask all of her questions, but in some instances, even challenge every decision. "Birth contracts" have been recommended in which there are certain understandings that both doctor and patient agree to in management of the labor and delivery. For instance, inductions, episiotomies, IVs, medications, etc. are all suspect and are negotiable points. In our practice we have an open mind to anything that won't adversely affect the mother or the baby. But birth contracts, like the books that espouse them, lack perspective. Of course we don't want to use forceps, but if your baby suddenly develops life-threatening jeopardy, the forceps are a really good idea regardless of the contract.
Contracts are good for providing services. But we're not building a house here, we're building a human being. Parenting isn't negotiable after a year, it's a commitment for life. A patient who feels that a birth contract must be signed is probably going to the wrong doctor, because she doesn't trust her (him?). I feel that once the doctor-patient relationship is established, there already is a contract of sorts. It is an understanding that a doctor will provide for his (her?) patient the latest of care with the minimum of intervention for the best outcome for both her and her baby.
Any knowledge is good, and these books do much more good than harm, so in fact I recommend them. My best patient experiences have been with patients who read and learned about the miraculous process they were involved in. Parents-to-be taking an interest in the anatomy, physiology, and psychology of a pregnancy is always refreshing to me. But involve me, too. Or the nurse practitioner. Or the nurse mid-wife. We're the filters for the information. One size does not fit all. We're the perspective and the judgement, and we're all on the same side.
If all women, developing babies, and fathers-to-be were identical like the parts in a computer, there would be no need for judgement. All one would need to do is go to the self-help section at the bookstore, just like in the computer self-help area, and pick up a copy of "Pregnancy for Dummies."
©1999 Gerard M. DiLeo, M.D., F.A.C.O.G.