This oped piece was published in the Canadian Medical Post. Read my reply to the doctor at the end of the item. Gloria
February 18, 2003 Volume 39 Issue 07
OPINIONS / OBSTETRICS
OPED: The unpopular science of birth
We have to incorporate the connection ‘natural’ healers such as doulas
make with patients—without abandoning science
By Richard Gruneir
I’m beginning to think everyone but you and I are crazy, and I’m not so sure about you any longer.
I practise obstetrics. I know you are already questioning my sanity but I can assure you I remain moderately sane most of the time. But as Bob Dylan sang, “The times they are a’changin.’ ” What is going on around me is putting pressure on my tenuous hold on normalcy.
Everyone who has had a baby or knows someone who has had a baby, or even watched the scene in Gone With the Wind where the baby is birthed, thinks of herself as an expert on the subject of obstetrics.
I have attended about 7,000 pregnant women and have a good idea how the complicated collection of things that must come together in just the right way for there to be a good outcome actually come together. I still get a big kick out of seeing the “munchkins” show up. Truly a marvellous event.
What scares me is that the experts seem to be taking over. (See two
paragraphs above for who is an expert.) And they all purport to support something called the “natural way.”
I have seen the natural way and am pretty sure the women deep in the hinterlands of developing countries aren’t thrilled to have it so
Natural includes experiences that filled the obstetrics textbooks,
including dead babies, dead mothers and everything bad in between that can happen to both of them. These things are usually preventable if someone with skills and knowledge and understanding is there to help. Natural is what our grandmothers and great-grandmothers had here in Canada when only 30% of their babies reached their first birthday.
Off-hand, I was unable to think of anything natural around me that isn’t today considered pathologic. The great public health initiatives of the early 20th century intervened in the natural processes and life
expectancy skyrocketed. The two most important are likely water
purification and vaccination programs.
Just think about Walkerton, Ont., and what happened when the basic water purification system broke down. A substance everyone needs daily went from being safe to being deadly.
Some will argue water without contamination by civilization was clean to begin with, but that’s not true. Animals in the forest deposit parasites in the water that can find a human host not in the normal life cycle of the parasite (Beaver fever anyone? A great Canadian favourite).
Seen any smallpox, diphtheria, pertussis or polio lately? Ask your
mother what these epidemics were like when she was a kid.
So where did this worship of “natural” come from? What prompted women who otherwise seem intelligent and motivated to have good outcomes to trust helpers who are often uneducated, untrained and unlicensed with their health and the health of their babies? Where did all of these expensive helpers come from to give “natural treatments” to their “clients”?
When I say expensive, I really mean it. Apparently, doulas (a term from the Greek to describe a helper of women in labour) in the Toronto area are paid as much as $2,000 to help with the deliveries. The job requires being a coach, back rubber and supporter. The doctor who assumes all the responsibility for whatever happens gets only $340 in Ontario.
When I say uneducated I mean that the training course to become a doula is basically only a weekend, some reading and spending time with another doula during a delivery or two.
And unlicensed means no controlling body. Even your gardener is licensed to use pesticides. And bad or uninformed advice during labour and delivery can be as deadly as the incorrect use of poisons and pesticides.
The most incredible thing is that this “natural” approach trumps doctors and nurses. When did we become the enemy? When did it start to appear to our patients we didn’t have their best interests at heart? What did we do to lose our patients’ trust?
The only thing I can think of is that we are seeing an attempt to regain control. The white coats are much too scary and too much in a hurry to be viewed as empathetic and part of the process rather than just as controllers and disinterested observers.
We are going to have to slow down and reconnect with the mothers.
Maybe the real solution is just to act natural.
—Richard Gruneir is an ob/gyn in Leamington, Ont.
OPINIONS / OBSTETRICS
In response to:
OPED: The unpopular science of birth
Dear Medical Post
I read with interest the OPED piece by Dr. Richard Gruneir in which he
laments the rising trend of patient advocacy in obstetrics. (February
18, 2003 Volume 39 Issue 07) This obstetrician wonders why women in his community are spending up to $2000 per birth on a doula and asks the (probably rhetorical) questions:
“When did we become the enemy? When did it start to appear to our
patients we didn’t have their best interests at heart? What did we do to
lose our patients’ trust?”
These are truly valuable questions because, in examining them, some
solutions to the rising cesarean rate and malpractice insurance rates
might arise. Physicians have lost the trust of childbearing women
precisely because of the attitude that Dr. Grunier displays when he
makes the statement: “I have seen the natural way and am pretty sure the women deep in the hinterlands of developing countries aren’t thrilled to have it so natural.” By painting the desire to give birth normally as backward and
ignorant, he shows that he has no clue as to the sexual, spiritual and
social importance of the birth of a child in a woman’s life. This is
the same denigration of importance that many physician’s placed on
breastfeeding at one time.
Modern women cannot wait until some
“scientific” randomized controlled trial tells them that having their
abdomen sliced open is horrific. It took 50 years until we got the
“science” that told us what we had already known
instinctively—episiotomies are horrific. The science is coming that
will show beyond a doubt that epidurals hurt women and babies, breech babies are best born vaginally without medications, nitrous oxide is harmful to babies’ brains, learning disabilities are related to vacuum extractors, routine Vitamin K administered at birth does cause heart disease in later life, ultrasonic non-ionizing radiation does produce cellular changes in the fetus and the ova, etc, etc, etc. One day all the physicians practising today will do a mea culpa about the harm they have caused childbearing women and babies (or as Dr. Grunier prefers–munchkins). Meantime,
Canadian women cannot wait for the “science” of obstetrics to tell them what will hurt their children today. Dr. Grunier is correct in thinking that the rise of the doula is a sign of the mistrust women have toward those who used to have dominion over their births.
2002 Recipient CHOICES Women’s Voice Award
1997 Nominee YWCA Woman of Distinction Award
Advisory Board Member International Cesarean Awareness Network
Contributing Editor Midwifery Today Magazine