Friday, September 27, 2013

Value Women and Children: Medicalize Birth!

There has been a real push to normalize pregnancy and childbirth - a real rebellion against the "medicalization" of childbirth by governments, midwives and some doctors. Some patients have also bought into the idea that pregnancy and childbirth are not diseases, and should not be treated as such. Unfortunately - in the drive to save money and preserve market share - the reality that pregnancy and childbirth is a condition that brings with it significant health vulnerability for both women and their children, seems to have been forgotten. The idea that the choices a woman makes during pregnancy and childbirth are medical decisions that are deserving of informed consent and respect, also seems elusive.

Pregnancy and childbirth, in modern developed countries - are not normal states of being for the vast majority of women. The normal state of being for an average Canadian woman is not pregnant or breastfeeding - these are brief diversions from normalcy that typically occur 2 or 3 times during a woman's lifespan - assuming a breastfeeding duration of a year, this accounts for a mere 4-6 years out of the 30 years that are considered "childbearing". It is not normal to gain - and lose 35 or more pounds in the space of two years. It is not normal to be nauseaous for months on end. It is not normal to be winded after ascending a few flights of stairs or to be in immense pain from activities that in a non-pregnant state are of no-consequence (ie. a shopping trip to costco with a full cart, mowing the lawn). It is not normal get all kinds of unsolicitated advice on how you should conduct yourself. Further, it is not normal to be at such a heightened risk of death or long-term disability as is the case with pregnancy, childbirth, and the year post-partum. Indeed - there is little about the state of pregnancy, childbirth and the year post-partum that should be considered "normal".

Indeed, it is the degree of health vulnerability while pregnant, childbearing and the year post-partum that makes it ideally suited for "medicalization" - after all there are few conditions where the application of intervention can have such a profound impact on the ultimate outcome for both mothers and their children. As such, the choices during pregnancy, childbirth and the year post-partum, should be considered medical decisions and given the same degree of deference -in terms of informed consent and respect- as decisions that are made with respect to any other medical condition (many of which are far more benign than pregnancy and childbirth).

Indeed, neglecting to recognize the profound need to medicalize pregnancy and childbirth can have profound consequences. Neglecting to recognize the need for folic acid supplementation leads to preventable cases of neural tube defects (they range from relatively minor cases of Spina Biffida to profound disabilities that are incompatable with life such as Anencephaly). Neglecting to identify gestational diabetes and respond accordingly leads to over-sized babies that are at risk of delivery complications (ie. shoulder dystocia) and other adverse events including stillbirth. Failing to identify and respond to pre-eclampsia (abnormally high blood pressure) can result in maternal death. Neglecting to address the potential for a severe tear, and the adverse consequences of a severe tear or to improperly repair a severe tear can lead to urinary and or fecal incontinence, pelvic organ prolapse, and sexual dysfunction. Failure to provide access to effective pain relief (ie. epidural), leads to profound suffering which may be associated with longer-term psychological problems such as post-natal PTSD. Failure to provide timely access to cesarean delivery may also inflict considerable harm to both mother and child - and the choice of planned delivery method is a significant one.

In closing, I believe that the greatest disservice we can do to women and children is to demedicalize birth - decisions that are not “medical decisions” do not demand informed consent. Conditions that are not “medical conditions” do not merit research or the scientific process – and do not benefit from the improvements that result. If we value women and children, as humans – the very least we can do, is medicalize an event that has a profound impact on their health and well-being over their lifespans.

3 comments:

  1. I wish there was a "like" button here!

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  2. Sure, and if women were in a normal state, they could drink as much as they normally do, smoke as much, eat whatever they want and be able to go out in public without being inundated with unsolicited advice from well-meaning strangers. I am all about medicalization of pregnancy. Mine was about as medical as possible, from conception on down, and I am thankful that I live in a time and place that made it possible for me to have the wonderful, healthy children I have today.

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