What You Don't Know Can Hurt You: An Interview with Jennifer Margulis, Author of The Business of Baby
Her book will blow your mind. It has made some people very angry. Read what Jennifer Margulis wants you to know before you give birth in America
Move over, What to Expect—there’s a new book on the scene that every pregnant woman—and new mother—needs on her nightstand. Investigative journalist Jennifer Margulis’ The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line is a fascinating, disturbing and ultimately empowering look into the American birthing system. (Frankly, it blew my mind.) Wherever you fall on the pregnancy, birth or parenting spectrum, this book will make you question what you think you need, want and know. I got to ask Margulis a few of my own questions after reading it. Read on for our candid Q&A.
The American medical maternal care system is the most expensive in the world, and yet we lag behind other developed nations in terms of safety. (Our maternal and infant death rates are alarmingly high.) What gives?
We actually have among the highest, if not THE highest maternal mortality rate of any country in the industrialized world. People also don’t realize that about 34,000 women in America almost die during childbirth in American hospitals. (These are called “near misses.”) The problem is that we have so over-medicalized birth that we have made it unsafe. What used to be a life-saving operation—C-section birth—has, in America, become a life-threatening operation. One study of pregnancy-associated mortality in New York found that 79 percent of the women who died during childbirth died after complications from C-sections. That study confirms what dozens of others have shown: that the majority of women who die during labor die from complications of Cesarean birth. Many American obstetricians are not committed to vaginal birth, have never seen an un-medicated childbirth and wrongly believe that they must intervene. Unnecessary intervention is leading us to poor outcomes.
Because one intervention leads to others by introducing side effects and complications? I’ve heard this called the “Cascade of Interventions.”
Right, exactly. But you won’t hear about this in the mainstream press. What you’ll hear on the nightly news is that our high maternal mortality rates are because American women are too fat or have high blood pressure or gestational diabetes, or are waiting too long to have babies, or are pregnant with multiples. We love to blame women. While there is some truth in this—birth is more dangerous if you are obese or develop gestational diabetes—the problem really lies with our maternity care, which profits from a high-intervention birth system.
What are the top three questions American moms (and moms-to-be) should be asking their doctors (or themselves), but aren’t?
First question: Do I really need a doctor? Having a highly trained surgeon (which is what an obstetrician is) at a low-risk birth is like having a pediatric neurologist babysit your 2-year-old, as Marsden Wagner, M.D. former director of Women and Children’s Health at the World Health Organization, points out. There was just a big study that came out from WHO showing that midwives do just as well, and often better, than doctors in delivering babies.
Second question: Am I eating food (and is my doctor)? This sounds so simple, but the truth is most of us do not eat food. (And I include myself in this. My 3-year-old daughter spent a lot of yesterday eating edible food-like dye-laden substances. Happy Halloween!) A childbirth educator I know likes to remind women, “You are what you ate three months ago.” The lifestyle change you have to make when you are pregnant or wanting to conceive is to start eating real food. And if you want your children to be healthy, you need to make sure they are eating food as well, which is a lot harder than it sounds! That means a baked potato instead of potato chips, carrots and oranges for a snack instead of Doritos, lots of fresh vegetables, as little refined sugar as possible, whole grains and high quality protein like hard-boiled eggs or grass-fed, grass-finished meat, preferably cooked rare.
Finally, moms and moms-to-be need to ask themselves if they are getting enough exercise. Recent studies show that sitting for long periods of time is harmful for humans and that if you do an hour of exercise but sit the rest of the day, you actually negate the positive benefits of the exercise. Doctors spend very little time on exercise because it falls out of their scope of practice, but you wouldn’t climb Mt. Everest without adequate training. If you’re pregnant, the more time you spend moving your body, especially outside, the better. Exercise helps your body metabolize sugar so you can avoid gestational diabetes, it helps you avoid pregnancy side effects like leg cramps, it improves your sleep, and it bathes the fetus in the endorphins you feel as well after a good workout or a long walk with a friend.
And here’s a question for your doctor: What is your Cesarean section rate? And what is the C-section rate at the hospital? (Buyer beware: When you ask, your doctor will likely refuse to answer you, get very defensive, and change the subject as quickly as possible.)
What about moms who want a C-section, without medical necessity? Should these be as readily available as they are in our culture?
So your baby can have a designer birthday? Apparently 11-12-13 has become a very popular date for scheduled C-sections. Absolutely not.
I know lots of moms whose doctors “recommended” C-sections—and other procedures—when they weren’t necessary. How can moms make the safest, smartest decisions for their babies in a system that doesn’t necessarily have their best interests at heart? (How can moms distinguish between what’s really necessary and what isn’t?)
I was at a family fair this weekend and met a mom whose daughter is 4 years old. Her doctor—who is known to be gentle and non-interventionist—was on vacation during her birth, and this healthy young mom ended up with a C-section because the doctor on call got impatient. There was so much pain in her voice when she talked about it. Then there are moms who have vaginal births who wish they had had C-sections because the labor was so protracted and difficult. It’s very normal to have mixed feelings about your childbirth, and every parent wishes for a chance to do things over again. Some C-sections are absolutely necessary and life-saving. It’s important to remember that.
The best way to make sure you get evidence-based care is to use an experienced midwife and give birth in a birth center or at home. I’d also recommend educating yourself before you have a baby. Watch The Business of Being Born, and Orgasmic Birth; read Marsden Wagner’s book Born in the U.S.A. and Ina May Gaskin’s Guide to Childbirth, and seek out mamas who had the birth experience you are hoping for. Before I had a baby I didn’t know anyone who had even considered home birth, and I wasn’t even sure it was legal. In retrospect, I wish I had talked to some moms about why they decided on out-of-hospital births and what their experiences were like.
Two other wonderful books are Simply Give Birth by Heather Cushman-Dowdee and Belly Button Bliss by Jennifer Derryberry Mann. You can also read Laura Shanley’s book, Unassisted Childbirth—Not because you should have an unassisted birth but because Shanley is so far outside the box that reading her book will make your choice to have a midwife-assisted birth center or hospital birth or a birth at home with an experienced licensed midwife seem normal!
What surprised or shocked you the most in researching for your book?
That we are doing so many ultrasounds on healthy women, for no reason, and that ill-timed or prolonged exposure to ultrasound may be one of the triggers for autism.
For parents who choose to have home births, or not to vaccinate, or to go against the mainstream in other parenting decisions, how do you recommend they handle grandparents’/friends’/random strangers’ “concerns” that those decisions are unsafe or irresponsible?
When my oldest brother saw me nursing my not-yet 2-year-old, he freaked out. “When you gonna stop that, Jenny?” he asked me. He thought she was way too old to still be breastfeeding. “I plan to nurse until she goes to college,” I said back. “I’ll rent an apartment nearby.”
That shut him up. Humor helps.
Having an interesting statistic at your fingertips also helps. When someone says, “How could you consider a home birth? They’re so unsafe!” You could answer: “Did you know that nearly 30 percent of births in the Netherlands take place at home and their infant and maternal mortality rates are much lower than ours?! And that Britain is actually encouraging moms to consider home birth because they’ve realized it is so much cheaper for the NHS?!” That way, you’re engaging them in an intellectual conversation and defusing some of the emotion.
Why has The Business of Baby made some readers and reviewers so angry?
We all do the best we can with the information we have at the time. This book presents information that is totally new to some readers, and sometimes that information is upsetting so some readers find it easier to blame the book than to look at what is going wrong in our system.
But getting angry at the book is shooting the messenger. The book makes me angry, too. It should make you angry. Our system is harming women and children, and needs to be changed. Not reading my book won’t make our children any healthier, birth any gentler or our autism rates any lower. Reading the book will open your eyes. As one reviewer put it, “You’ll be shocked, you’ll be angered, and you’ll start to think about how the system may have manipulated you without you even knowing. Even if you question Margulis’s conclusions, the evidence she presents will make you think and begin to wonder if your best interests have been pushed to the side in the race to make more and more money.”
How can we work toward a more balanced birthing system? (Corporations have so much sway … what can individuals do to change this picture?)
We will definitely see some changes once the Affordable Health Care Act goes into effect, and I suspect that may be a stepping stone to an overhaul in our healthcare system. In the meantime, we all need to spend as much time researching our birthing options as we do researching the tent we are going to buy to go backpacking next summer. We can vote with our pocketbooks. If your practitioner does not respect your wishes or ridicules your birth plan, choose a different practitioner.
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