I gathered the following points from our discussion:
1) Patients need to advocate for themselves
2) Patients need to know how to advocate for themselves
(What questions are we supposed to ask?) Angela and Heather had good ideas. I encourage you to post the advice you gave us
3) Gawande's chapter on Birth was problematic with its empathises on Cesarean births.
4) We all have different expectations from our health care providers, for example- I love that my nurse practitioner also treats my parents so that she is aware of all of the health issues in my family. I also like that I can rat out my parents when they aren't following their instructions. Other people would hate this. It really depends on the individual Dr./Paitient relationship.
5) I noted that Gawande's explanation of positive deviance because it failed to mention that besides finding solutions from the front lines- there has to be valid comparisons to derive the deviance from.
I encourage all to post comments- I also would be willing to coordinate a second meeting to discuss Better with anyone who is interested.
Please vote for your preferred time for our May meeting above. Several people will be out of town for the May meeting. So let us know by voting below what works for you. Vote for any of the times you can make it and we will go with what ever dates has the most votes.
The May Slection, The Good People of New York, is already in at Bookworks.
Stay clever-
Keep reading
Monique
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A future Midwife’s thoughts on Better’s chapter on Childbirth:
Childbirth is not a process that can be grouped into the neat and efficient package of the modern medical system. Gawande’s application of his betterment model to childbirth was myopic, offensive and insufficient. His beliefs simply do not have the same application in this realm. What the author failed to acknowledge is that the process of childbirth cannot be measured or “improved” using his model.
To view caesarean as the catch-all to reduce poor outcomes ignores many key truths. First of all, caesarean has NOT been shown to improve either maternal or infant outcomes. He also ignores the fact that caesarean is major abdominal surgery and actually invites a whole host of complications to develop. These include, but are not limited to, infection, hemorrhage, accidental nicking of organs and/or infant, pulmonary emboli, infant respiratory distress, and even death. In future pregnancies, it may result in decreased fertility, placental and uterine rupture, and tubal pregnancies. One caesarean also ensures that, with few exceptions, all subsequent births will be caesarean. And finally, caesarean is a surgery that has major implications emotionally and spiritually for all parties involved, and eliminates a rite of passage that many believe is important to both mother and child. The downsides of caesarean do not overturn this truth, however: caesarean and medical interventions, when used appropriately, do indeed enable the survival of women and infants who would otherwise perish.
Gawande’s standpoint reflects his training as a surgeon, which emphasizes surgical intervention, and education in the medical model, which views birth as a pathological process. Midwives, on the other hand, believe birth is a normal process that ushers the greatest transformation a woman can ever possibly experience. A comparison of quotes highlights these varying viewpoints. A physician may state something along these lines: “normal birth is a retrospective diagnosis. No birth is normal until after the fact. All births are complicated until proven otherwise.” A midwife, on the other hand, tends to adopt this standpoint: “women’s bodies have near-perfect knowledge of childbirth…it’s when we force external rules on laboring women…that their births may veer off track. Furthermore, “given the freedom of [midwifery], the pregnant woman [discovers] a wisdom more valid than any [medical] method we [try] to superimpose on the natural process.”
Gawande’s beliefs regarding childbirth are not isolated or unique. It is unfortunate, however, that his voice is the one most loudly heard in today’s society. Because his account has such far-reaching application, it is important to view his statements with a high level of skepticism and scrutiny. They are not absolute truths; they are just statements of a man who failed to examine the belief system that produced them.
• These quotes were taken from the autobiographical novel, The Baby Catcher, written by Peggy Vincent.
• Complications of caesarean childbirth were found in Ina May Gaskin’s Guide to Childbirth.
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