"If we as a nation want to take care of our children, we must first take care of our mothers". Kitty Ernst CNM MPH I was thrilled to hear of and read this much needed book. Dr Strong, a perinatologist, had the courage to remind us that we as a nation are doing a shameful job in attending to the needs of our childbearing mothers and their unborn children. He begins with the disturbing data on babies born too soon and too small, and goes on in a thoughtful and scholarly way to explore the issue. It seems to be human nature that when we recognize a problem, we knuckle down, determined to keep doing what we have been doing but doing it in a "better" way. That is exactly the problem with our system of prenatal care... and its not working. Its time to look at how we can serve pregant women in a different and better way. As a practicing nurse-midwife, i have long believed that pregnancy and birth must be addressed not as a medical event, but as a "mind-body-spirit" event, occuring within a social context, and that the "midwifery model" rather than the "medical model" of care is the appropriate approach for low risk women. Dr Strong suppports this point of view as one of the solutions to the problems he identifies in the delivery of health care during pregnancy and birth. I would recommend this book to EVERY student and practitioner of maternal-child nursing, midwifery,or obstetrics. THose people working within public health and public policy will also find it enlightening. Parents to be who have chosen nurse-midiwfery care for their pregnancies will be pleased to see the scientific and philosophical support for their decision coming from an expert in "high-risk obstetrics". If I ever return to teaching, it will be required reading for my students; i am circulating a copy among the obstetricians and nurse-midwives with whom I work. Enjoy!!!
Thomas H. Strong has written an excellent account of the inherent flaws of prenatal care in the United States, highlighting where Western medicine succeeds and where it fails. Looking critically at other health care systems around the world, he demonstrates how alternative health care for birth when delivered by midwives has higher success rates in preventing premature birth and various birth problems. If anything prevented me from giving this excellent work five stars, it was the fact that Dr. Strong, while praising health care systems like the Netherlands, decided not to address the fact that those same praiseworthy birth traditions are delivered by lay midwives, not the nurse-midwives found in other countries. While both lay (or direct-entry) midwives and nurse-midwives contribute important care to pregnant women, Dr. Strong failed to address the prejudices surrounding direct-entry midwifery in the United States despite its affordability and accessibility in remote areas. I think this is an important book for mothers to read, but be aware that it presents research and, while well-written, is not written in the accessible format of many books destined for the expectant parent. It would be an excellent book for anyone interested in the sociology or medical anthropology of birth and its inclusion in women's studies classes would enrich any curriculum.
This book supports with facts, figures and irrefutable statistics that our current system of delivering care care to pregnant women is failing miserably. Despite increased expenditures and so called advances in medicine and medical management, Strong presents a strong case for an illnesss based system. It fails to adhere to the "do no harm" oath and is not a system of health care. Rather it causes it's own problems in illness care and then congratulates the system when tyhe outcome is at least mediocre at best and then only in spite of the system, not because of the system. It validated and expanded on what I have believed to be true for the past 25 years of my experience as an advanced nurse practitioner. Judith S. Harmon, MS, RN, C-FNP Perinatal Clinical Nurse Specialist Certified Nurse Practitioner Co-author Manual of High Risk Pregnancy and Delivery, Mosby.
I'm about halfway through the book right now, and a quarter of the way through my pregnancy. Although Expecting Trouble is a death knell for prenatal care as we know it, the book was reassuring to me. It let me know that I needn't feel out of the loop in caring for my own baby- the doctor isn't the real authority in this case. Virtually all prenatal problems develop regardless of the mother's prenatal care, whether a birth defect occurs before a woman knows she is pregnant, or it is caused by genetics. It either happens or it doesn't happen. So many women look to their doctors as magical people who will diagnose and treat any potential problem. During pregnancy, this just simply isn't the case most of the time. I feel more at peace knowing that this is the type of situation that there simply is no way to control, beyond maintaining good health and avoiding known dangers. The majority of pregnancies are (medically) problem-free, and I will feel less stressed knowing that I will probably have one of them. And if something goes wrong, I will know that I couldn't control it.
I highly recommend this book, along with The Nature of Birth and Breastfeeding, by Michel Odent.
It's such a no brainer that prenatal care is really wonderful, helpful and good. Strong, second generation in the medical care of pregnant women, has a lot of reservations and a lot of data to back those reservations up. He also has some suggestions for how things could be improved: involve certified nurse midwives in prenatal care to avoid the temptation to complicate a normal pregnancy and birth, keep NICUs regional (so they don't turn in to profit centers, complicating life for normal newborns and their new parents). He'd like to believe that preconception care would help (by getting women help to stop smoking and so forth before they get pregnant), but he's sensible enough to recognize there are some hard limits on what the medical profession can do in the face of widespread social problems.
This book was enlightening to say the least. It really opens your eyes to the fallacies of Obstetric care in America.
The more you learn about birth, the more you doubt the so-called "professionals."
We have been duped into thinking childbirth is a mechanical event, something to be feared, and managed by some outside source. None of this could be further from the truth. And the truth can be found in this book.