I found Atul Gawande’s article “The Score” very difficult to read at times. The author uses graphic and explicit language to describe the birthing process in a brief historical overview. As someone who still needs to lie down after having my finger pricked at the doctor’s office, I especially had trouble making it through the evolution of methods used to deliver “stuck” babies. In addition to being turned off by Gawande’s casual rhetoric, I found Goer’s falsification of many of the statistics within “The Score” to be particularly interesting. While reading Gawande’s article, I couldn’t help but question some of the statements the author offered throughout his piece. The author suggests “those of us in other fields of medicine don’t use these measures anywhere near as reliably and as safely as obstetricians use theirs” (7), when referring to obstetrics being perceived as having little scientific justification of their actions. Since already skeptical of Gawande’s appreciation of accurate information, I was not entirely surprised when Goer discounted several of the author’s numbers within her response piece.
Although I believe Gawande’s article contains many deep flaws within its arguments, I am not in complete support of Goer’s deconstruction either. While Henri Goer does an effective job of identifying the paradox and seeming lack of attention to the individual woman within Gawande’s piece, she too seems to be on the far extreme at the opposite end of the spectrum. Goer seems to go over-the-top in comparing excess newborn harms to those in vaginal birth when she suggests “cuts,” “mother’s negative early reaction to mother” and “failure of breastfeeding” as differentiating problems between the two types of births. I would be curious to see how small the percentage is of these instances in c-section babies and then consider whether or not the trade-off would be worth the risk.
Noticing this potential exaggeration is not intended to imly c-sections should be the go-to solution. I was surprised and impressed by the statistics provided on the success rate of normal vaginal births however think it is important to recognize each author comes from a very opinionated and (possibly) extreme stance. Goer’s recommendations are simply not accessible to all women. Hiring a “doubla” most likely comes at no small cost and it seems unrealistic to suggest Rourke may have prevented her birth complications had she had a doubla present.
One point that was brought up in Gawande's 'The Score' as well as during the brown bag regarding historical development of obstetrics is how the field of obstetrics and technologies used developed slowly and unevenly among those involved in the field. The specific example that Gawande cites is the development of the forceps by the Chamberlen family. Developed by a French obstetrician the forceps represented a considerable advancement for medicine yet it was unable to flourish due to the Chamberlen family keeping the technology a secret for three generations, followed by another obstetrician keeping the forceps secret for another sixty years. After reading this I was immediately reminded of the point brought up during the brown bag about how the role of doctors in the child birth process did not advance until after the Italian doctors in Padua decided to breach gender barriers and allow males to study and have medical contact with vaginas. Both of these examples, the covert use of forceps and this inability for men to study and learn about the birthing process, presented huge disservices to the advancement of this process. I could not help but imagine how many unnecessary people died from the, as Gawande highlights, gory effects of a breached birth or prolonged labor process. While the technology and field have advanced considerable lengths up to today where the use of crochets is no longer available as I highlighted in my news flash on maternal healthcare in America there are still great lengths to go. It is almost as if we are witnessing similar hindrances to the success of this practice today but instead by lack of coverage as opposed to lack of technology, or more appropriately the even distribution of technology, involved in the process of child birthing.
ReplyDeleteSimilar to Teal, I had difficulties with Atul Gawande's article,"The Score: How Childbirth Went Industrial." Although sections of his article were particularly graphic, I realize that such in depth descriptions may have been necessary to support his argument - an argument that was unclear from the start. As a whole, I found Gawande's article confusing to follow. He seemed to be criticizing the way that the field of obstetrics has transitioned over time, a process he calls "the industrialization of childbirth." He consistently pointed out how standardized and impersonal the entire birthing process has become, for both the doctors and their patients. According to Gawande, medical professionals no longer have to become "experts" in specifics: "Whereas before obstetricians learned one technique for a foot dangling out, another for a breech with its arm above its head, yet another for a baby with its head jammed inside the pelvis, all tricky in their own individual ways, now the solution is the same almost regardless of the problem: the C-section. Every obstetrician today is comfortable doing a C-section. The procedure is performed with impressive consistency" (9). Later he adds, "we have reached the point that, when there's any question of delivery risk, the cesarean is what clinicians turn to - it's simply the most reliable option... clinicians are increasingly reluctant to take a risk, however small, with natural childbirth." Gawande never cites the sources of the statistics and studies that he references in his article, so it is difficult to decipher how accurate his claims are. Either way, he spends pages and pages describing how childbirth is becoming "readily surgical," but then he says that this results from the desire to limit risk to the babies. Is reliability a bad thing? Is that even what he is saying?
ReplyDeleteTo make things even more complicated, I was completely thrown off by Henci Goer's deconstruction - Goer is clearly arguing against Gawande, and advocating natural birth. However, I didn't think Gawande was arguing against natural birth, I think he was simply saying that childbirth is becoming more specialized and surgical. But then again, I'm not sure. For me, reading Goer's article simply made the ambiguity of the argument more confusing.
Great responses, all! Nora, you make a really crucial point here: Goer paints Gawande's article as a one-sided, pro-industrialization opinion, when it is really far more impartial and conflicted, as Teal points out. Dave, your observations about the distribution of technology and coverage add an interesting component to this article, as does your thoughts on Goer's doula solution, Teal: who has access to the best care, the best technology, and the most options, and how can we make all of this more accessible for all women?
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