Book review: The Business of Baby by Jennifer Margulis
18 Thursday Apr 2013
I was certain I wouldn’t like this book.
In fact, after reading only the first handful of pages and couple of anecdotal stories, I didn’t. I found the tone distracting and the stories themselves cherry-picked for the extreme.
But throughout the course of reading The Business of Baby, author and investigative reporter, Jennifer Margulis’s dogged research and compelling statistics changed my mind.
In fact I have started, stopped and flat-out re-written this review three times to be sure I convey the importance of Margulis’s detailed examination of the commercialized aspect of pregnancy and birth in the United States.
My change of attitude is not even related to the fact that my opinion of the book as a whole has changed – which it has, I really like her writing and even the content itself. Instead, it’s because my reaction to portions of the book have been affected so distinctly I even began questioning my own decisions regarding my past births.
And that is exactly the point.
The fact that she has made a skeptic like me read, re-read and then re-evaluate is testament to not just her skill as a writer but her skill as a reporter. The strength of Margulis’s latest book lies in the author’s passion and desire for knowledge – and her skill of sharing that knowledge.
In The Business of Baby, Margulis examines how oftentimes business, not medical ethics, dictates the health of the birthing process. She shows how from pregnancy through the early years of parenting, commercialism is at work through product placement in some of the most unexpected places: labor rooms and pediatrician’s offices. She also explains how some medical intervention isn’t medically necessary at all and is, in fact, sometimes dangerous.
But as is often the case with subject matter that is so closely tied to our passions, agendas have a way of creeping into even the most diligent reporting. Therefore, in addition to this review highlighting the fact that this book is, indeed, an important read for any pregnant woman or new parent, it is also imperative to make note of the fact that much of the information being presented is, unfortunately, done so without rebuttal.
Although everything Margulis presents is well-written and thought-provoking, it is often one-sided. She rarely offers an opportunity for refutation. I understand the focus of her book is to show the business of pregnancy, but as an investigative journalist she also has a responsibility to pull the curtain all the way back.
Throughout the book there were several instances where she didn’t offer both sides of an issue, including an interesting section referencing ultrasounds and how, after describing that there are risks involved in using ultrasound, that there are physicians who order additional scans for profit only. There are no real facts to back up the claim, no statistics, only one doctor’s damning quote, hanging in the air like a vague finger tsk, tsking in the direction of American medicine.
The biggest problem with quotes such as these is that, even though what they are presenting may be true in some cases, by not offering an opposing buffer, the words become a broad, swooping generalization of all other obstetricians.
Which I can personally attest is not the case.
My 20-week ultrasound did more than just confirm there would be a bevy of blue wrapping paper at my upcoming baby shower. It also showed that my boys were identical twins, which – thanks to Web MD – I understood immediately added an extra layer of risk to my pregnancy. Because my sons shared a placenta there was a possibility that blood supply rations could get misdirected, leaving one boy with too much and the other with too little. At the worst, this situation is life-threatening for the babies. At best, the recipient baby can require heart surgery.
Although the disorder – twin-to-twin transfusion syndrome – is rare, it is also very scary, especially for a high-strung first-timer who had a penchant for routinely logging onto Web MD. So the next day I did the only thing that made sense to me: I called the doctor’s office, sobbing incoherently, and pleaded with the nurse to allow me to have daily ultrasounds.
The OBGYN I had is one of the most popular obstetricians in our area, allowing for mothers to dictate the course of their birth plans with as little medical intervention as necessary. He even offers vaginal birth as an option for twins or even triplet pregnancies, and runs one of the only offices in the region to provide VBACs. So as you can imagine, his office was always busy, which means that his nurses were always busy.
But the nurse who took my call that day made the time to calm me down and had the courage to tell me the truth. After she finally convinced me that my boys were ok, she said that ultrasound had the potential to be dangerous if overprescribed. She explained the effect of sound waves on babies still wasn’t fully understood but that it wasn’t a risk they were willing to take.
At the time I was working for an insurance company, and my entire birth and all of the care leading up to it – including labs, stress tests and ultrasounds – were covered at 100%.
But in perhaps the most disturbing example of bias, Margulis offers details on a fascinating subject I had known nothing about, the practice of umbilical cord clamping and how she unveils doctors at hospitals are doing it too soon after birth.
Margulis interviewed a physician who explained that there is overwhelming evidence to suggest that umbilical cords should not be clamped immediately after birth, which he said is standard practice in American hospitals. The doctor said that cutting the cord while it is still warm is actually harmful because it is still circulating the newborn his own blood.
Fascinating, no doubt. But, as with many sections in her book, Margulis left me wanting more – like the other side of the story. Instead of interviewing an opposing opinion – of which, there must be several because, as the author says herself, the practice of allowing the placenta to pump blood into the baby even after birth is extremely rare and therefore plenty of doctors could have been reached for comment – she vaguely generalized that all other doctors who didn’t do this are too busy, rushing onto their next appointment.
And it isn’t as if opposing points of view are hard to come by either. It only took me ten minutes of conversation and a morning of text messaging to understand that there is a local medical center (one that, according to its 2009 data, delivered nearly 3,000 babies) that does, actually, practice what Margulis and her source claim is not being done.
A lifelong friend, mother of two, registered nurse, BSN and Internationally Board Certified Lactation Consultant explained to me that upon delivery, doctors at this hospital will leave the placenta attached and, in fact, elevated in order to facilitate blood and nutrient flow with each heart beat for about 150 beats per minute, which she explained results in about 300+ pulses. My source makes no mention of a doctor rushing to his or her next delivery; she says nothing of any doctor checking his or her watch for the next payday.
I suppose the length of time the placenta and baby are attached is relative. Three hundred pulses, 20 minutes, 30 seconds. Those units of measurements might mean different things to different physicians and even different midwives. But at the very least, Margulis owes her readers a dissenting quote in regards to this subject; we deserve to hear why, if this is in fact standard practice, doctors don’t take the time to allow the placenta to feed the baby one last time. If the author is going to identify herself as an investigative reporter, she should at least employ the most basic of reporter’s skills and offer both sides of the subject she is investigating.
But her skill as a writer and work as a researcher did give me pause and made me wish that this book had been available when I was pregnant. The Business of Baby was a surprisingly readable book, and Margulis does a great job of weaving personal stories throughout.
I love what she’s done; my only issue is how pieces of the book are presented. In addition to my desire for more two-sided points being made, I would have loved to have read anecdotal stories where medical intervention did actually help.
Of which there are plenty. In fact, I can name one: mine.
My twins caught the doctor’s attention because of the way in which they were growing – or, in one boy’s case, not growing. He did wind up eventually needing regular ultrasound monitoring.
As it turns out, one of those ultrasounds saved his life.
I will concede, though, that it’s quite possible that it didn’t. Maybe he would have been fine without the doctor’s constant meddling. But knowing what that ultrasound showed, I don’t believe I would have been willing to make that gamble.
But had I read Margulis’s book before or during my pregnancy, well, it’s hard to say if I would have followed my doctor’s advice in the beginning and continued to allow technology and modern medicine to interfere. And that scares me a little bit. Because she scared me a little bit.
Which is precisely why I recommend this book to everyone.
Because, if there’s one thing Margulis and I agree upon it’s that information is important and every parent should feel empowered. Educating yourself about all of your options will make you and your baby healthier.
But readers should be aware that the author is trying to make a point and uses specific sources to help her do so, which is too bad. Because to be fully educated, you need to be able to weigh all sides of an issue. And unfortunately for the author, that does mean including points of view that might inconvenience the one she’s trying to make.Pin It