Delivering ante-natal anxiety

In The Business of Baby, Jennifer Margulis tries to fight institutionalised fearmongering with scare stories of her own.

Kate Prengel

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Jennifer Margulis, a journalist and a bit of a self-proclaimed parenting expert, is out to tell us what’s wrong with pre-natal care in America. Here’s her list: hospitals driven by the profit motive; doctors so scared of being sued that they spend their time ordering expensive lab tests instead of talking to their patients; and a strong tendency on the part of doctors to treat pregnant women like parts on a factory assembly-line. These, she argues, are just some of the joys of pregnancy in middle-class America.

Based on my own thoroughly unscientific, personal, and anecdotal observations, I’d say that Margulis is spot on. Pregnant women in America are disempowered, frightened and harassed by a medical system that seems determined to identify more and more pregnancies as high-risk. Mothers-to-be face endless restrictions – eat this, not that, or else your baby might be born with a birth defect – and are subject to endless warnings about rare diseases. It’s no wonder that many women describe pregnancy as a frightening, humiliating time.

And of course, it’s hard not to see money as the cause of all fearmongering. The more laboratory tests a doctor orders, and the more often she wheels out the ultrasound machine, the more she can bill her patient’s insurance company. Pregnant women are a vulnerable, anxious bunch to begin with, and most are unlikely to argue with a doctor’s recommendations – especially if it’s the insurance company, not them, who is footing the bills.

This is an important topic, one which needs to be widely discussed. We hear a great deal about how much pressure mothers and fathers are under to ‘parent’ their children correctly – we don’t hear enough about the fact that this pressure starts even before birth.

And yet, sadly, Margulis is also missing the mark. She writes passionately about the one-size-fits-all, mechanical sort of doctoring that goes on. And she argues that every woman is an individual who deserves to be treated as such. She also provides some heartening stories of women who successfully defy their doctors and get the outcome they want. But in The Business of Baby, Margulis pushes a one-size-fits-all approach of her own. Midwives are better than doctors. Home births are better than hospitals. Breastfeeding is better than formula. This is hammered home on just about every page of the book. Maybe you agree with Margulis’ outlook, and maybe you don’t – but it certainly doesn’t fit the real needs of every woman in America.

Margulis talks a good game about how doctors cause their pregnant patients unnecessary stress and fear. But she weaves plenty of fear into her own book. She likes to stress the fact that America’s infant-mortality rate – and its maternal-mortality rate – is the highest in the industrialised world. Well, yes – but that’s still not saying much. Fear sells books, though, which may explain why Margulis spends page after page on anecdotes about women who died in childbirth – always, of course, in situations caused by over-medicalisation. You’d think, reading The Business of Baby, that no woman or child ever died in the pre-industrial world; you’d think all our grief is the fault of modern medicine.

The book claims to be aimed at pregnant women, but I for one would question whether it’s helpful to be told that worrying excessively about your baby will lead to its being born with a low birth-weight and abnormally small head. I also wonder why, in a chapter about the dangers of pre-natal testing, Margulis included a story about a couple who refused such testing and were surprised when their baby was born with Down’s syndrome. Surely this falls into the category of fear for its own sake?

The second half of The Business of Baby is all about the evils of vaccines, plastic diapers and pediatricians, and it all falls along familiar lines. Again, you may agree or disagree with Margulis’ point of view, but she leaves no space for variety or opposition. The second half of the book lacks what made the first half worthwhile – originality. Did Margulis’s editors insist that she bulk out her book with a few extra chapters? It would have been nice, instead of the old-fashioned screed against vaccines, to read about how socio-economics related to pre-natal care. After all, the women in The Business of Baby are almost exclusively white and middle-class, with high-quality medical insurance. What happens to poor Americans when they get pregnant? Are they subject to the same kind of testing and anxiety?

The Business of Baby came in for a lot of criticism when it was first published this spring. The New York Times, in particular, was up in arms at Margulis’ ‘unscientific’ and anecdotal approach – the Times, of course, likes to defend the scientific establishment. There’s no reason that Margulis needs to be more scientific than she is. Her book is very effective at diagnosing a big problem in American healthcare. What’s needed, now, is a broader look at the causes of, and solutions to, that problem.

Kate Prengel is a writer and art critic living in New York.

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 Lin, by Jennifer Margullis, is published by Scribner Book Company. (Buy this book from Amazon(UK).) 

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