Two couples in Victoria are suing their doctors for failing to diagnose Down's Syndrome antenatally. They argue that they are suffering 'psychiatric injury' and would have liked to have had the opportunity to terminate their pregnancies had they known about the diagnosis.
This is tricky. At the moment, we live in a time of unprecedented access to foetuses through technology. We are able to 'see' foetuses as early as a few weeks into a pregnancy, doctors can perform surgery on them and there are a slew of prenatal tests that can tell women if their foetuses have chronic ilnesses. Many women who participate in a medical model assume that doctors and technology are fail safe options when it comes to monitoring a pregnancy. But what happens when biomedicine gets it wrong? Or in this case a doctor may have failed to pick up Down's Syndrome? Is it fair that a couple can sue the doctor? Technology has become so sophisticated that we often forget that it is a person that actually has to diagnose and analyse tests results. Who's at fault here? The doctor for allegedly missing the diagnosis or the couples for getting pregnant 'alter in life' when the risk of having a child with Down's increases? What do you think?
Showing posts with label intervention. Show all posts
Showing posts with label intervention. Show all posts
Epidurals: get one even before pain starts
I know it was only recently that I wrote about epidurals and the post generated quite a large response...Nevertheless, epidurals are back in the news as a result of a new book Enjoy your labor: A new approach to pain relief for childbirth, by Dr Gilbert Grant, director of obstetric anaesthesia at New York University Medical Center. Grant argues that the old adage of 'natural' is best when it comes to birth is no longer applicable. In fact, Grant suggests that women should have an epidural even before they experience any pain associated with birth.
Whilst I agree, as Grant contends, that there is relentless pressure on women to give birth 'naturally' and that many women feel guilty when they choose to manage pain with epidural, the fact is that Grant suggests the opposition or at least the feminist critique of pain management methods in misogynist. He says:
"Childbirth instructors describe epidurals as unnecessary, or even harmful, interventions and make women feel that requesting one is a sign of weakness that may harm their baby. Labour is seen as an extreme sport - ‘no pain, no gain' - and yet this quasi-religious fervour is based on myth and misconception."
Hmm. While there are contingents of 'natural' birth advocates who argue that all pain medication in birth is 'unnatural' and 'bad', the majority of feminist critiques surrounding the use of epidurals is not that women are 'bad' mothers if they choose to use them. Feminists argue that it is the way in which epidural is presented as the default option for pain management in a highly medicalised environment that is problematic. Grants continues:
"It is barbaric that pain should still be viewed as an integral, even desirable, element of childbirth.”
In fact, I don't think the work of any feminist scholar of childbirth suggests that women 'should be in pain' in order to have a 'real' or 'authentic' experience of birth. Whilst this might be part of cultural narratives or even imperatives surrounding how women should 'do' birth correctly, this is a much different angle from scholarly work in this area.
Even more alarming is this suggestion:
"Technological advances mean that women are able to administer their own dosage and this makes them feel more in control. Furthermore, studies show that babies born to women who have had epidurals come out in better shape than those from ‘natural' childbirth."
What really bothers me about this statement is the association between control and technology. Women clearly can be empowered with medical advances in pain management as well as with other forms of reproductive technology. However, Grant fails to recognise that 'empowerment' rests on choice and in many American hospitals, for instance, the notion of 'choice' becomes blurry when women become part of a cascade of interventions which limit her ability to make decisions on her own. For instance, the reason so many women in America use epidurals is not just because they want them; with the induction rate close to 90% in some New York hospitals, for instance, epidurals become essential because contractions are so intense without a gradual build up. In these case, an epidural becomes routinised as a necessary medical intervention when perhaps many of those same women might not have chosen an epidural had they been able to allow labour to progress 'naturally'.
Nevertheless, I think it is a very dangerous proposition to suggest that epidurals should be part and parcel of birth without the inclusion of their risks. Moreover, this whole 'epidural before pain' framework only entrenches the notion that birth is scary and painful. Again, of course for some women it is intensely painful and everyone should acknowledge that, but the idea that women should be pre-medicating in anticipation is just ridiculous. Why not encourage women to learn alternative ways to manage pain before resorting to chemicals?
Moreover, the idea that pain must be pre-managed also suggests that women can never have 'positive' experiences with intense pain. If the pain of birth was so horrible, women would never have babies. Many women tell me that whilst birth itself was one of the most challenging moments of their entire lives, they felt like they had accomplished something; not because they had endured alot of pain and survived. They felt accomplished because birth is an intensely visceral experience and for some women, feeling childbirth in every ounce of their being is something they would not want to give up with medical intervention.
In the Netherlands, women are not allowed to have epidurals unless the mother is in a high-risk category. Whilst, I do not necessarily agree with this more extreme measure, the truth is that the majority of Dutch women give birth at home with a midwife and the maternal and infant mortality rate is extremely low. Why is it that in rich, 'Western' countries maternal and infant mortality rates are still relatively high? The answer lies in the unnecessary invocation of medical interventions (and not only epidural).
What do you think?
Source: http://women.timesonline.co.uk/tol/life_and_style/women/families/article3625980.ece
Whilst I agree, as Grant contends, that there is relentless pressure on women to give birth 'naturally' and that many women feel guilty when they choose to manage pain with epidural, the fact is that Grant suggests the opposition or at least the feminist critique of pain management methods in misogynist. He says:
"Childbirth instructors describe epidurals as unnecessary, or even harmful, interventions and make women feel that requesting one is a sign of weakness that may harm their baby. Labour is seen as an extreme sport - ‘no pain, no gain' - and yet this quasi-religious fervour is based on myth and misconception."
Hmm. While there are contingents of 'natural' birth advocates who argue that all pain medication in birth is 'unnatural' and 'bad', the majority of feminist critiques surrounding the use of epidurals is not that women are 'bad' mothers if they choose to use them. Feminists argue that it is the way in which epidural is presented as the default option for pain management in a highly medicalised environment that is problematic. Grants continues:
"It is barbaric that pain should still be viewed as an integral, even desirable, element of childbirth.”
In fact, I don't think the work of any feminist scholar of childbirth suggests that women 'should be in pain' in order to have a 'real' or 'authentic' experience of birth. Whilst this might be part of cultural narratives or even imperatives surrounding how women should 'do' birth correctly, this is a much different angle from scholarly work in this area.
Even more alarming is this suggestion:
"Technological advances mean that women are able to administer their own dosage and this makes them feel more in control. Furthermore, studies show that babies born to women who have had epidurals come out in better shape than those from ‘natural' childbirth."
What really bothers me about this statement is the association between control and technology. Women clearly can be empowered with medical advances in pain management as well as with other forms of reproductive technology. However, Grant fails to recognise that 'empowerment' rests on choice and in many American hospitals, for instance, the notion of 'choice' becomes blurry when women become part of a cascade of interventions which limit her ability to make decisions on her own. For instance, the reason so many women in America use epidurals is not just because they want them; with the induction rate close to 90% in some New York hospitals, for instance, epidurals become essential because contractions are so intense without a gradual build up. In these case, an epidural becomes routinised as a necessary medical intervention when perhaps many of those same women might not have chosen an epidural had they been able to allow labour to progress 'naturally'.
Nevertheless, I think it is a very dangerous proposition to suggest that epidurals should be part and parcel of birth without the inclusion of their risks. Moreover, this whole 'epidural before pain' framework only entrenches the notion that birth is scary and painful. Again, of course for some women it is intensely painful and everyone should acknowledge that, but the idea that women should be pre-medicating in anticipation is just ridiculous. Why not encourage women to learn alternative ways to manage pain before resorting to chemicals?
Moreover, the idea that pain must be pre-managed also suggests that women can never have 'positive' experiences with intense pain. If the pain of birth was so horrible, women would never have babies. Many women tell me that whilst birth itself was one of the most challenging moments of their entire lives, they felt like they had accomplished something; not because they had endured alot of pain and survived. They felt accomplished because birth is an intensely visceral experience and for some women, feeling childbirth in every ounce of their being is something they would not want to give up with medical intervention.
In the Netherlands, women are not allowed to have epidurals unless the mother is in a high-risk category. Whilst, I do not necessarily agree with this more extreme measure, the truth is that the majority of Dutch women give birth at home with a midwife and the maternal and infant mortality rate is extremely low. Why is it that in rich, 'Western' countries maternal and infant mortality rates are still relatively high? The answer lies in the unnecessary invocation of medical interventions (and not only epidural).
What do you think?
Source: http://women.timesonline.co.uk/tol/life_and_style/women/families/article3625980.ece
Freebirthing rant
As I was watching the Today show this morning (Australian version), my ears perked up immediately when I heard that they were doing a segment on freebirthing..no doctors, no drugs, is it safe? as if it were a conspiracy and with the requisite mysterious music playing in the background. I have to say there was nothing in this segement that was particularly 'new' or enlightening. However, I was very interested in how they were going to 'do' this segment and I assumed correctly that of course, freebirthing was too dangerous and too risky and women who do it were basically 'too optimistic' when it comes to the horrors of labour.
Of course, they went straight to Laura Shanley who is widely respected as one of the pioneers of the freebirthing movement in the US (in fact, Laura commented on my last post about freebirthing). Her positive experiences were contrasted with an incredibly idiotic doctor who of course had to say that birth was dangerous blah blah blah and women are stupid for choosing to avoid technologised birth. Not only was his argument vague but rather than saying 'interventionist' in reference to medicalised birth kept saying 'interventionalist'. Makes me slightly worried that he was allowed to leave medical school. In the studio, Dr. Rick Gordon, the medical editor for the show, was interviewedand he is not an obstetrician or an 'expert' in pregnancy or birth and he said 'death' so many times in the segment I just started to get even more angry.
You can watch the segment on the Today show link below and read the accompanying article. I think it would be great if women who have had homebirths or freebirths would write in about their positive experiences to the network and overwhelm them with responses because this was a completely one-sided story.
Email: today@nine.com.au
Source: http://today.ninemsn.com.au/article.aspx?id=417872
Of course, they went straight to Laura Shanley who is widely respected as one of the pioneers of the freebirthing movement in the US (in fact, Laura commented on my last post about freebirthing). Her positive experiences were contrasted with an incredibly idiotic doctor who of course had to say that birth was dangerous blah blah blah and women are stupid for choosing to avoid technologised birth. Not only was his argument vague but rather than saying 'interventionist' in reference to medicalised birth kept saying 'interventionalist'. Makes me slightly worried that he was allowed to leave medical school. In the studio, Dr. Rick Gordon, the medical editor for the show, was interviewedand he is not an obstetrician or an 'expert' in pregnancy or birth and he said 'death' so many times in the segment I just started to get even more angry.
You can watch the segment on the Today show link below and read the accompanying article. I think it would be great if women who have had homebirths or freebirths would write in about their positive experiences to the network and overwhelm them with responses because this was a completely one-sided story.
Email: today@nine.com.au
Source: http://today.ninemsn.com.au/article.aspx?id=417872
Home delivery is apparently just for pizza
The American College of Obstetricians and Gynecologists has just released a statement on their anti-homebirth position as a means of quietly confronting the 'popularity' of Ricki Lake's On The Business of Being Born. As can be expected from a group of highly paid doctors working in hospitals, ACOG states the most ideal model for birth is inevitably in a hospital with an obstetrician where risk can be managed. They say:
"Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby."
Not only does the ACOG discount all of the legitimate medical literature arguing for the benefits of homebirth, the idea that millions of American women are jumping on the homebirth bandwagon from seeing a movie is insane. If only this was the case! Despite the seeming popular appeal of homebirth, the fact is that most American women (about 99%) still give birth in hospitals and only about 1% of all births are 'alternative' with midwives, in birth centres or at home. Moreover, increasingly homebirth and midwifery are becoming harder to access in a number of states. A bill has passed through the Utah legislature that seeks to ban homebirths altogether and is just another way in which women's rights are being curtailed, providing fodder for the black market of midwives that is thriving in states across America.
According to ACOG, birth is just an emergency waiting to happen. It is a frightening proposition that this medical body says that they support a woman's right to 'choose' how she will give birth but implicit in that statement is the suggestion that if you decide to avoid intervention you are irresponsible. This raises very serious questions about what is considered to be 'high-risk'; increasingly having a big baby, a premature baby or a previous caesar are grounds for intervention whereas earlier they would not.
What's worse is that the high caesarean rate in America is attributed to pregnant women being too overweight and too old; ACOG places no responsibility for the 45% rate of caesars on obstetricians themselves. As Jennifer Block so convincingly argues in Pushed, the reality of hospital birth today is contingent on doctor's wanting short shifts, fast births and women to just shut up about it. ACOG speaks of midwives as if they are the devil's advocates and categorically state that as a result of their lack of comparable skills and inability to address 'high-risk' pregnancies, midwives are not to be trusted. What about all of the literature suggesting that birth with a midwife actually lowers caesarean rates?
In a nutshell, ACOG says in no uncertain terms: "Choosing to deliver a baby at home... is to place the processof giving birth over the goal of having a healthy baby." There is no 'right' way to give birth and to suggest that women are irresponsible for moving away from the medical model is an appalling abuse of biomedical power.
Source: http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm
http://www.kcpw.org/article/5301
"Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby."
Not only does the ACOG discount all of the legitimate medical literature arguing for the benefits of homebirth, the idea that millions of American women are jumping on the homebirth bandwagon from seeing a movie is insane. If only this was the case! Despite the seeming popular appeal of homebirth, the fact is that most American women (about 99%) still give birth in hospitals and only about 1% of all births are 'alternative' with midwives, in birth centres or at home. Moreover, increasingly homebirth and midwifery are becoming harder to access in a number of states. A bill has passed through the Utah legislature that seeks to ban homebirths altogether and is just another way in which women's rights are being curtailed, providing fodder for the black market of midwives that is thriving in states across America.
According to ACOG, birth is just an emergency waiting to happen. It is a frightening proposition that this medical body says that they support a woman's right to 'choose' how she will give birth but implicit in that statement is the suggestion that if you decide to avoid intervention you are irresponsible. This raises very serious questions about what is considered to be 'high-risk'; increasingly having a big baby, a premature baby or a previous caesar are grounds for intervention whereas earlier they would not.
What's worse is that the high caesarean rate in America is attributed to pregnant women being too overweight and too old; ACOG places no responsibility for the 45% rate of caesars on obstetricians themselves. As Jennifer Block so convincingly argues in Pushed, the reality of hospital birth today is contingent on doctor's wanting short shifts, fast births and women to just shut up about it. ACOG speaks of midwives as if they are the devil's advocates and categorically state that as a result of their lack of comparable skills and inability to address 'high-risk' pregnancies, midwives are not to be trusted. What about all of the literature suggesting that birth with a midwife actually lowers caesarean rates?
In a nutshell, ACOG says in no uncertain terms: "Choosing to deliver a baby at home... is to place the processof giving birth over the goal of having a healthy baby." There is no 'right' way to give birth and to suggest that women are irresponsible for moving away from the medical model is an appalling abuse of biomedical power.
Source: http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm
http://www.kcpw.org/article/5301
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