Raymond De Vries, a sociologist in the University of Michigan's Center for Bioethics and Social Science in Medicine, has compared birth in the U.S. to that in the Netherlands, where he is a visiting professor at the University of Maastricht. He finds that, in the U.S., "obstetricians are the experts and the experts have come to see birth as dangerous and frightening." De Vries suggests that the organization of maternity care in this country -- "the limited choices that American women have for bringing their baby into the world, what women are not told about dangers of intervening in birth, and the misuse of science to support the new technologies of birth" -- actually constitutes an ethical problem, although we typically do not recognize it as one. Medical ethicists "would rather look to the [comparatively rare] problems of in vitro fertilization and preimplantation genetic diagnosis than to the every day issues of how we organize birth here in the U.S.; they would rather talk about preserving women's 'choices' than to explore how those choices are bent by culture."
So true. Ethicists love to talk about women's birthing choices as if they are informed and autonomous, but I can't count how many women have said to me that they "chose" pain medication during birth even though they were never told the risks of pain medication, never had anyone express confidence in them that they could birth without medication, and were never offered a doula to walk and talk them through the pain. What kind of "choice" is that? As Libby Bogdan-Lovis told me, "Today's average childbearing woman thinks the notion of an unmedicated birth is the equivalent of suggesting that women should eagerly embrace torture."
I think of all the choices I made, the one that shocked my peers most was not getting a prenatal ultrasound. But just a few years before I became pregnant, a major U.S. study -- involving over 15,000 pregnancies -- published in the New England Journal of Medicine showed that routine ultrasounds did not leave babies safer. That work was led by Bernard Ewigman, now chair of family medicine at the University of Chicago and NorthShore University Health System.
I recently called Dr. Ewigman and asked him why so many low-risk pregnancies now involve routine ultrasounds. He suggested that it was partly emotional -- people like to "see" their babies -- and partly due to the unsubstantiated belief that knowing something is necessarily going to lead to better outcomes than not knowing. But, he agreed, routine prenatal sonograms in low-risk pregnancies (that is, pregnancies in which there have been no problems) do not appear to be supported by science, if the outcome you're seeking is reducing illness and death in mothers and children. Routine prenatal sonograms don't seem to be dangerous, but they are also not health-giving.
Dr. Ewigman told me, "The approach you took to your pregnancy was rational and well informed. But most decision-making when it comes to medical issues involving a pregnant woman or baby are not well informed and not based on rational thinking." He added: "We're all very interested in having healthy babies and it is pretty easy to make the kind of cognitive errors that people make, and attribute to technology benefits that don't exist. At the same time, when there are problems in a pregnancy, that very same technology can be life-saving. It is easy to make the [problematic mental] leap that technology is always going to be necessary for a good outcome."
Dr. Ewigman and I talked about how some people derive false certainty from prenatal sonograms, thinking that if the clinicians see nothing unusual, the baby will be born perfectly healthy. I explained to him that that was one reason I didn't bother; I knew from my own research on birth anomalies how often sonograms mislead. He observed that our culture has "a real fascination with technology, and we also have a strong desire to deny death. And the technological aspects of medicine really market well to that kind of culture." Whereas a low-interventionist approach to medical care -- no matter how scientific -- does not.
I'm not against taking into account, when making birthing choices, the kinds of hard-to-measure outcomes that may matter deeply to some pregnant women. I get that there are some women who don't want a baby shower like mine, where most of the gifts consist of yellow and green baby clothes, instead of pink or blue. I get that some want to have those fuzzy pictures of the babies in their wombs. I get that some might want to abort if a sonogram were to show a major anomaly.
And I get that some women want a particular experience of birth -- I mean, I really get that now that I have had a birth that left me feeling more powerful, more humble, more focused, and more devoted to my lover than I ever thought I could feel.
But I wish American women were told the truth about birth -- the truth about their bodies, their abilities, and the dangers of technology. Mostly I wish all pregnant women could hear what Libby Bogdan-Lovis, my doula, told me: "Birthing a baby requires the same relinquishing of control as does sex -- abandoning oneself to the overwhelming sensation and doing so in a protective and supportive environment." If only more women knew how sexy a scientific birth can be.