Wednesday, January 9, 2008

I found trouble

I recently read the book "Expecting Trouble" by Dr. Thomas Strong, Jr., an OB who calls out the American system of providing intensive prenatal care to pregnant women. He calls attention to the number of prenatal visits typically done in other developed countries, with better infant and mother outcomes in the US. The main point of the book is that prenatal care has been proven to do nothing to improve outcomes for women or reduce the incidence of prematurity and other complications of pregnancy.

So why do we, as pregnant women go upwards of 14 prental visits when we are expecting perfectly healthy babies and are experiencing perfectly healthy pregnancies?

For many women, prental visits 5 -10 minutes with the OB or doctor. More time is spent in the waiting room and with the nursing assistant, just for the doctor to pop in, brush the expecting mother off and reschedule for next month.

Anyone else recall those experiences as a waste of time?

What Dr. Strong didn't mention in his book is the possible connection between increased number of prenatal visits and increased rates of "complications." The title of the book addresses it, though. Is the maternity care system in the US "expecting trouble" in intensively monitorring and looking for problems in populations of low risk, healthy women? Is the system overestimating the seriousness of complications or minor derivations from normal in higher risk women?

How can women respond when learning that the prenatal care expected of them is excessive? Do they avoid prenatal care all together, as an unnecessary production? Or become choosy about which appointments to attend and consciously refrain from the whole schedule?

Imagine being the woman who only sparadically shows up to the "schedule" prenatals. What would the practice's social worker have to say about that?

Some women do their own prenatal care. I'd include the link to the Unhindered Living website on the topic, but alas, it has been moved with no redirecting address.For more broad spectrum of childbirth topics covered on the site: look here.
Maybe the links will get working again soon.

Dr Strong raises some interesting questions. The answers he provides are obviously unwelcome to the general obstretrical community. Move prenatal care into the domain of nurse midwives (he refuses to recognize the possibility of Licensed Midwives or Certified Professional Midwives)and then reduce the number of prental visits to a schedule more like European models. He also advocates using prenatal visits as educational opportunities to inform and prepare women for birth. He even hints at counseling women for social risk factors like income level, marital status, abusive relationships, etc.

All that's not going to be covered in 5-10 minutes, now is it?

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