The Business of Baby – One Long Conflict of Interest Disclosure

“This book is not an advice book and it does not offer One Right Way to parent. Because every baby is different, every parent is different, and every circumstance is unique, each triad of parents and baby come to figure out their own way in their own time.

What it does offer, however, is valuable information to help all of us in America stop blindly following the status quo and start doing our own research. In order to most effectively protect and raise our children we have to figure out the best way to do things ourselves. Parents, not for-profit companies or health care professionals, are actually the real experts when it comes to gestating, birthing, and raising our babies. Though we need support and advice, we do not need to be bullied or intimidated. We know more about what works best for our families and for our children than anyone else. As Benjamin Spock famously told the generation of nervous parents at the beginning of the baby boom in 1946, we can trust our own instincts; we know more than we think.”

The above is an excerpt from Jennifer Margulis’s book 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. Sounds like a Thinking Mom, doesn’t it? If you’re anything like me you breathed a gentle sigh of relief when you read, “though we need support and advice, we do not need to be bullied or intimidated.” As parents in our society, we find ourselves bullied and/or intimidated rather often, don’t we? It often starts the moment you walk in the obstetrician’s office after a positive pregnancy test.

The first obstetrician I saw told me right off the bat that I “should gain 17-22 pounds.” If not, I risked a difficult birth as well as a C-section. Huh? I’m a big reader and had already been through a few pregnancy books. All of them addressed weight gain, several including equally specific ranges, but all of them were broader ranges than that quoted by this obstetrician. What’s more, the books I liked the best said not to worry too much about weight gain as your body would know what to do if you let it. That felt right to me. I’d spent my twenties learning to be less compulsive about food and weight by trusting my body. It didn’t make sense to let a natural process like pregnancy destroy my peace of mind because of the rigid restrictions of an obstetrician who had never given birth. I never went back.

I found out later that my sister, who had her babies in the late 60s and, unlike me, had always been thin, gained 35 pounds with both of her pregnancies, despite an obstetrician who told her not to gain more than 15 pounds. She was young, perfectly healthy, lost the weight within the first year, and had relatively easy births, but her experience of pregnancy was forever tainted by a nagging obstetrician who was, quite frankly, wrong. “In 1970, a review of the scientific evidence by the National Academy of Sciences concluded that the usual practice of restricting maternal weight gain was associated with increased risk of low birth weight.” Despite a slow start, I too gained approximately 35 pounds with each pregnancy. I had three big babies that I birthed naturally (no pain medication), despite the fact that I’m medium height and wear a size small in most clothes. Guess I really didn’t need that doc’s bullying, intimidation, or plain ol’ advice.

Margulis doesn’t mention bullying about weight, but it’s clear she’s had similar disillusioning experiences. For her first pregnancy, she and her husband were broke graduate students with very little choice in providers. They knew they wouldn’t choose to abort regardless of test results, so they tried to forgo some routine prenatal tests in order to spare themselves unnecessary cost and stress, which is generally a good idea in pregnancy. Stress can wreak havoc on your hormones and, consequently, your baby. One provider told Margulis she would “buy” herself a C-section if she refused a particular test. Later on, when she requested no Pitocin or epidural while in labor, the doctor on call at the hospital told Margulis she was selfish for putting her family through “so much waiting,” and she should stop thinking only about herself.

*Gasp* “OH NO, HE DI’N’T!”

First off, I guarantee that first and foremost she was thinking of her child’s well-being. Studies show that outcomes are better without interventions like Pitocin and epidurals. In addition, each intervention increases the total monetary cost of your birth, as well as your risk of a C-section (which raises the costs to a whole new level). While Caesarean births are certainly necessary from time to time, they are major surgery, require a much longer recovery time, introduce a number of potential complications, and make it more difficult for mothers and babies to do their initial bonding. Parenthood is hard (trust me). It’s better when you’re crazy in love with your baby.

Secondly, thinking of herself and her comfort, both during and after labor, is exactly what a woman in labor should be doing. A woman’s body comes with a good dose of innate wisdom. If she feels like getting up and walking around in labor, chances are really good that would be helpful. If she feels like getting down on all fours, or howling with each contraction, chances are good those things would be helpful as well. Taking Pitocin to hurry the contractions along short circuits the feedback loop that helps a woman do what’s necessary to birth her child safely. Then, the epidural taken to numb the abnormally strong contractions from the Pitocin takes her even further out of touch with her own body. One thing we have found across the board here at the Thinking Moms is that when we move away from what our own intuition tells us in response to the bullying of others we end up sorry. As a parent of a child who died and a member of a group of autism bloggers, I have heard many, many parents express regrets over the years. Not once have I heard someone say, “I’m so sorry I listened to my gut on this one.”

How do you counteract institutionalized bullying and figure out what’s right for your situation? You arm yourself with information. When you know that studies show that internal fetal monitoring (requiring the laboring mother to be on her back attached to a monitor) has not improved outcomes, you find it easier to say, “No, thanks. I don’t want to do it that way.” When you find out hepatitis B is a blood-borne illness that is not only rare in children in this country it’s virtually non-existent outside the families of IV drug users, it’s not so hard to ignore the nurse’s squinched-up face when she sees that your birth plan says, “No hepatitis B vaccine.”

Information is what The Business of Baby is about. Margulis provides the kind of information that makes decision making easier, information that folks who want access to
your pocketbook would really rather you didn’t have. I suspect that’s why The New York Times ran such a vicious review. I’m sure that a number of big Times advertisers are really hoping that a lot of people don’t read this book. As you may suspect, wicked subversive that I am, that in itself would be reason enough for me to read it. As I have no monetary interest whatsoever in hospitals, insurance companies, formula or diaper manufacturers, or (I’ll bet this comes as a shock) pharmaceutical companies, you will get an honest assessment from me.

This is the book I wish I’d had when I was having my first child. Many of the topics discussed are things that I researched either then or later, so I know Margulis is on the money (pun intended). Margulis takes you through pregnancy, birth, infancy, and toddlerhood, giving you the lowdown on the monetary costs of everything she talks about – as well as the potential human costs – and makes it eye-openingly clear that, whether they themselves are aware of it or not, doctors and hospitals have strong monetary incentives for their policies. She covers major parenting decisions (circumcision, vaccination, obstetrician vs. midwife, hospital vs. homebirth, breastfeeding vs. formula, cloth vs. disposable diapers, etc.) and makes it clear why the “experts,” OBs and pediatricians in particular, may not give you the best advice for your child. The book is one long conflict-of-interest disclosure.

According to Margulis, and this is borne out by a number of studies I’ve seen lately, the healthcare statistics for mothers and babies in this country lag behind virtually every industrialized country in the world. We have the highest C-section, maternal mortality and neonatal mortality rates, while at the same time having the highest health care costs. Frankly, I think those two facts are intimately intertwined. The fact that healthcare is a “for profit” industry in this country means that providers are always on the lookout for treatments with high profit margins, which is an obvious conflict with a patient’s concerns. If the profit element were taken out of the equation, we, as a country, would be looking for the best practices: the ones that do the most good, for the most people, with the lowest cost, which is not to say that therapies or treatments with higher price tags would be unavailable, just that they wouldn’t be our go-tos for ordinary situations.

For instance, in 2010 the U.S. C-section rate was 32.8 percent of all births. As a Caesarean is major abdominal surgery (and costs an average of $19,000 more than a vaginal delivery) that happens right when a mother really needs to be on the ball –learning to care for a newborn – it cannot be the best thing for one-third of all of mothers and babies. It is, however, remarkably profitable for both the doctors and hospitals. Those costs are passed on to the insurance companies or Medicaid, who pass them on to their customers and taxpayers. Iceland, on the other hand, had a 14.6 percent C-section rate in 2010, and a woman is almost five times less likely to die in childbirth there than a woman in the United States. There are twice as many midwives delivering babies in Iceland than there are obstetricians. Doctors in training watch three midwife-attended births before they do any baby delivering of their own.

I have one tiny quibble with Margulis, and that’s in the chapter on diapers and potty training. She gives the evidence that many children today are having trouble potty training, even though it is being done later than it was in the past. This is since the introduction of disposal plastic-covered diapers. I’m not exactly a fan of disposable diapers, but I think this is one area where “correlation does not equal causation.” In one regard, it’s likely that there is some causal link between disposable diapers and later, more difficult, potty training in that children whose diapers feel wet have a greater incentive to get them off. However, I suspect that one of the reasons many children are potty training at an older age, or have greater difficulty, is the prevalence of gut disease in today’s children manifesting as either chronic diarrhea or chronic constipation. Most readers at this site will know that gut issues run rampant in children with autism spectrum disorders, but they are by no means uncommon in the bulk of the childhood population as well. My son didn’t have solid poop at all until he was past two, and even with enzymes and probiotics, we had a tough time getting him to a point where we felt comfortable trying to potty train. My four-year-old, neurotypical niece has had tremendous problems with constipation. If your bowels aren’t working properly chances are good that your body signals are going to be off, making potty training far more difficult.

In summary, the New York Times may not want you to know it, but “baby” is indeed very big business in the United States – which means that the folks most likely to be giving you advice are those most likely to profit from it. Obstetricians and pediatricians all look the same in those lab coats; it’s tough to tell the players without a scorecard. Jennifer Margulis’s The Business of Baby is that scorecard. Choose your team wisely.

~ Professor

Additional reviews:

San Francisco Book Review http://citybookreview.com/the-business-of-baby-what-doctors-dont-tell-you-what-corporations-try-to-sell-you-and-how-to-put-your-pregnancy-childbirth-and-baby-before-their-bottom-line/

Houston Chronicle http://blog.chron.com/bookish/2013/04/review-the-business-of-baby/

San Francisco Chronicle http://www.sfchronicle.com/books/article/The-Business-of-Baby-by-Jennifer-Margulis-4467525.php