Recently, I was asked to review a book Baby City, written by Dr. Frieda McFadden (previous books include The Devil Wears Scrubs, Suicide Med and who blogs at www.doccartoon.blogspot.com) and Dr. Kelley Stoddard. I will admit, that I only read about 150 pages of the book – for reasons unknown to me my electronic copy became unavailable the other day, as such my comments will be limited to the portions of the book I read (but if/when I manage to find my e-copy I likely will read the rest of it). I will also admit that I tend to stay away from books/movies that include portrayals of childbirth – as I know that I am sensitive to those circumstances. It is fiction, and as such personalities and situations are exaggerated –in general , this book is in line with other medical fictions that have a comedy bend to them (ie. Popular sitcoms The Mindy Project, and Scrubs come to mind).
The book follows an OBGYN junior resident – Dr. McCoy and her colleagues at a maternity ward in a New York city hospital. One of the first “cases” Dr. McCoy and her team handle is a patient who is dubbed “The Princess”. I know that the personalities and situations are exaggerated, however, I could not help feeling really offended by the portrayal of this patient and her care. “The Princess” is a mother who has requested a primary elective caesarean delivery – or a maternal request caesarean. Sadly, every harmful stereotype about maternal request mothers is used to portray “The Princess”. “The Princess” is impeccably groomed. “The Princess” is absorbed by her iPhone and appears to be self-centred, asking for her caesarean to be performed at 37 weeks because she is itchy and fears stretch marks (note, ideally, unless there are good medical reasons for an early elective caesarean, waiting until 39 weeks reduces the risk to the infant). “The Princess” has specified how long and where she wants the caesarean to be done by drawing on her body with a sharpie. She is portrayed as controlling, and at the same time is patronised in the course of her care. Dr. McCoy is critical of the high caesarean rate that the doctor who is providing care to “The Princess” has – but admits that the patients love him. Ultimately, without talking to “The Princess” during the surgery, the doctor extends the line the patient has drawn by an inch on either side – and “The Princess” is portrayed as being completely ignorant of the change after the fact.
I found myself, having to remind myself, that this is a work of popular fiction and to cut it some slack. That portraying maternal request moms as they really are, is not really funny – and that while I take the issues of patient care and maternal request CS very seriously, that there is no obligation for others to do the same. But. But how popular media portrays childbirth and motherhood is part of the problem. How this mom was portrayed in this book is part of the problem. I was disappointed that Dr. McCoy did not make an effort to connect with this mom – to really understand her, to understand the real reasons for her medical choice and to engage in a conversation about the real risks and benefits of the choices that were being made. I was disappointed that Dr. McCoy failed to address the real risks to the baby of an early elective caesarean – namely respiratory problems, and chose to patronise the patient by offering a cream that might reduce the risk of stretch marks. I was disappointed when without so much as a word – the caesarean incision line was extended by the doctor doing the surgery.
The thing is real caesarean by choice moms, are not this stereotype. They are moms who are truly worried about 3rd and 4th degree tears, urinary and fecal incontinence. They are moms who are worried about brain injuries to their children. They are moms who have survived birth trauma. They are moms who have survived sexual assault. They are moms who are educated and reasonable and who want patient centered care where their role as medical decision makers and partners in their own care is respected. They are also moms who are stigmatized and who have an incredibly hard time finding care providers who are willing to work with them to meet their needs. They are moms who do not deserve being caricatured by a stereotype that perpetuates all of the myths about them.
The thing is, had the book taken a slightly different slant, I might have enjoyed it – it was an easy read and the kind of sitcom that I usually find enjoyable. Instead – I was left feeling like popular media will never move past the stereotype of caesarean by choice moms. That an opportunity to portray the CS mom by choice as a likeable character was once again forgone in favour of the cheap shots at who this mom is and perpetuation of all the harmful stereotypes about her; the stereotypes about CS by choice moms that make being a real CS by choice mom a really hard slog for so many women.
I appreciated the opportunity to review the book – and thank Frieda McFadden for providing me a copy to review. I wanted to like it, I just found myself unable to like it and unable to have much more than loathing for the protagonist, Dr. McCoy. The one thing, I really, truly do like about the book is that a share of the proceeds are going to a charity that supports fistula care.