Monday, April 29, 2013

When There's Such a Thing as Too Much Medicine

This past weekend's New York Times magazine cover story, "Our Feel-Good War on Breast Cancer," explains how a very well-meaning campaign to save women's lives has terrified women and resulted in unnecessary medical interventions, without actually saving lives.

It was impossible to read the story without feeling strong emotions. We all know someone who is a breast cancer survivor, and we are of course grateful that those friends or family members (or ourselves) are well. But what does it mean to be a survivor of a disease that may not have needed treatment all all? What if the treatment is permanently damaging, but does not change the overall outcome? The idea of watching and waiting doesn't sit comfortably with many of us patients. We want doctors to heal, and to act. But what if, sometimes, there's nothing at all to be done? What if the research supports watching and waiting?
Yet who among them would dare do things differently? Which of them would have skipped that fateful mammogram? As Robert Aronowitz, the medical historian, told me: “When you’ve oversold both the fear of cancer and the effectiveness of our prevention and treatment, even people harmed by the system will uphold it, saying, ‘It’s the only ritual we have, the only thing we can do to prevent ourselves from getting cancer.’ ” (Peggy Orenstein in New York Times Magazine, 4/28/13)
All this made me think about the over-medicalization of birth. Replace the words cancer with "birth" and "prevention and treatment" with "caesarean", and you have yet another area where women's bodies and selves are often being harmed under the guise of being saved.

There are many reasons why 1 in 3 births in the US are by cesarean, but an important one is that women are oversold the fear of birth. Because birth most often takes place in the hospital, where people usually go to have pain-free operations under sedation, people (both men and women) often believe that women should be passive and calm when they give birth. When if fact, birth is not designed to be a passive experience. To give birth, women need first and foremost to be empowered. They need to be reminded that their bodies are designed to give birth, and be given the freedom to follow the signs that there own bodies are giving them in labor--to move around, to stay upright,  to have privacy, to vocalize, and/or to do whatever they need or want to do (with whomever they need or want present to help them).

But instead, women are sold fear. When I was pregnant with my first daughter, I told one doctor that I wanted to have a normal (intervention-free) birth, and she responded by saying, "Don't set yourself up for disappointment." Not one word of encouragement. Birth is not easy, but it's a lot harder when everyone around you tells you you can't do it. (This is why I hired a doula: I needed to have someone in the room who knew what normal birth looked like, and who believed in me.)

Many women who have unnecessary caesarean births are told by their doctors that the surgery was life-saving. But what they aren't told is that it is the cascade of interventions that have become standard in hospitals that often leads to the moment of distress: making women lie on their backs in bed attached to an IV, preventing them from eating and drinking, attaching them to continuous fetal monitors, giving them medicines that prevent them from moving around and actively using their own bodies to move the baby down through the pelvis--all of these interventions work against a woman's ability to give birth normally. These interventions often cause labor to stall, or make a woman's efforts at pushing less effective, or cause the baby's heartbeat to drop, all of which can lead to the fearful all-too-common moment when the doctor announces that this just can't go on any longer--the baby must be taken out now.

Just like women are "oversold both the fear of cancer and the effectiveness of our prevention and treatment", women are also oversold the fear of birth and the effectiveness of the cascade of medical interventions that supposedly make birth safer. But surgical birth is not safer, and it is not without consequences, both physical and psychological. 

One thing I know, as a health care consumer who has given birth three times in this country, is that trying to have a normal birth in a hospital is an uphill battle. (The exception was my second birth, which was midwife-attended in an in-hospital birthing center.) I also know that birth can be beautiful, empowering, fear-free and peaceful.

The result of all this, for both birthing women and for women considering mammography and/or cancer treatment, is a confounding quagmire wherein doctors are trying to treat and satisfy patients while protecting themselves from those same patients--who have the right to pursue justice in the courts if they don't like the outcome of their birth/ illness. One thing patients forget (encouraged by a litigious environment) is that life is not without inherent risks; doctors may do their best, and a certain percentage of the time, things will not go right. In court, a doctor can defend herself better if she did something, than if she did nothing. Even if nothing would most likely in most cases, based on research evidence, be better and safer. 

I do believe that doctors want to do right by their patients--that they want to protect women and give them what they want. But I also think that the system sometimes acts against what is actually in women's best interests. Doctors too often worry about worst-case scenarios, so they treat every patient as a potential disaster. This attitude may protect a small percentage of women, but it has the potential to harm many more. 


  1. Addendum: Yet another relevant example in women's healthcare, from today's NYT, "Questioning the Pelvic Exam": 'Dr. Sawaya says it’s time to change this practice, in which doctors “put patients in a perilous situation and then act like they’re rescuing them.”'

  2. I appreciate this post Rachel! Thanks, as I have questioned all of it for some time now...the mammogram, the annual medical exam, drawing "routine" blood, etc. Had a mammogram at age 40 and it was awful; uncertain about when I will do it again. In the mean time, I just try to focus on healthy eating and reducing stress. There is so little engagement from the medical community on making the focus holistic health rather than fear, and we know that you have to do alot of hand holding and engagement to get people to adopt healthy life habits.


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