2013 Book Review #69: The Business of Baby

[jethrien]

Title: 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
Author: Jennifer Margulis
Genre: Parenting/consumer reports
Thingummies: 3

Synopsis: How corporate interests are interfering with babies' welfare.

Thoughts: I'm honestly not sure how I feel about a bunch of stuff in this book. There's a bunch of stuff that I agree with, and made me feel rather horrified on behalf of people who were not as privileged in their birth experiences as I was. There's also a bunch of science, especially related to vaccines, that I'm deeply skeptical of. The fact that I feel that a lot of the statistics that end each chapter are deeply manipulative isn't helping.

On the side of things that made me even more pleased with my experiences so far as a mom--I really, really like my OB and pediatrician. I happened to give birth on the Upper West Side of Manhattan, despite not actually living there, and being in a very progressive and privileged community really made a difference, I think. My OB's practice and my hospital take an aggressively non-interventionist standpoint and recommended that I go with the drug-free birth I'd wanted in the first place, not wanting to step in unless necessary. (I ended up drugged to the gills for high blood pressure after a brush with pre-eclampsia, but that was after delivery and mostly beside the point.) Say what you will about Bloomburg's nanny-state, but I really appreciated the fact that the nurses were not allowed to give infants formula unless a parent specifically requested it, and that they were all incredibly supportive, certified lactation consultants. In short, the first few chapters of this book are mostly horror stories about conveyor belt hospitals inducing labor and forcing C-sections for their own convenience, and then convincing parents not to breastfeed out of outdated notions. I knew that this happened elsewhere, and I'm very grateful for the doctors and nurses I had who tried really hard to get my kid started in life with a minimum of medical intervention.

But the later chapters, I'm not as sure about. There's a bunch of concern about vaccines, for starters. She phrases some of the argument well--babies are getting way more vaccines than I did when I was a kid, there aren't longitudinal studies for the effects of combined vaccines, and vaccine timing is geared towards protecting herd immunity more than an individual baby. Babies' immune systems probably would handle vaccines better a year or two later, but doctors don't think parents will bring their kids back for regular vaccinations after the first year of well baby visits. But some of her arguments don't fully hold water. She brings up the autism thing, which from everything I've read is fully discredited. She asks why Hep B is the first vaccine they get, when babies don't have sex or use needles, but earlier in the book cites reduced Hep B transmission as a positive for other more natural methods--if it's not a danger, why care? Also, her argument against rotavirus vaccination is that kids who are exclusively breastfed and aren't in daycare are unlikely to get rotavirus. Well, I agree that in a perfect world, my kid would be exclusively breastfed and at home with me all the time. Unfortunately, I'm underproducing and so he either gets some formula or starves. (Yes, I've tried all the pills/pumping/skin-to-skin you could ask for. I'm doing my best. It's not quite good enough. Welcome to the world, kid--I'll try for you, but I'm not perfect.) And since I live in the US, our work policies just aren't good enough for me to take a year off and not blow up my career. So you know what? My kid needs a rotavirus vaccine.

So on the issues I don't know enough about--is J&J's body wash really that bad? If my kid doesn't eat his diapers, does it really matter that the liner that never touches his skin might be toxic?--I'm not sure how I feel. I wish I had the knowledge to actually make judgement calls, but that would require doing a bunch of scientific studies I don't think anyone actually has done (or can ethically do). So now I'm mostly just adding to the giant pile of worry that comes with being a parent.

Comments

[trinityvixen.livejournal.com]

Ugh. If a book does nothing but make you worry more, don't give it three stars! You're doing FABULOUSLY, and don't let some book spook you.

[jethrien.livejournal.com]

Well, it did actually make me feel better about a bunch of decisions I'd already made, just not about decisions that I'm still in the process of making.

[momerath4.livejournal.com]

I haven't read the book, but I've actually read a lot of commentary on it, none of it favorable (though the places where I hang out on the internet these days are admittedly biased in the other direction). The New York Times absolutely panned it—bad science, bad journalism, the works.

It took me awhile (I started out my pregnancy as a believer), but I've come to be very suspicious of natural childbirth and lactivism. You're right about the manipulative statistics—it's ideology masquerading as science, and it's highly damaging to the women who buy into it but can't live up to its demands. You absolutely shouldn't feel bad for supplementing with formula if that's what your baby needs. And anyone who is anti-vax has zero credibility as far as I'm concerned. I've had pertussis—the danger of these diseases is very real, and people who don't vaccinate their kids are putting everyone else at risk.

In general, I think it's just really, really dangerous that so many people are being convinced by books like this to distrust their doctors and hospitals, when there are so many things in pregnancy and childbirth that can go dramatically wrong without warning—your experience is an example of that, and so is mine (totally uncomplicated pregnancy and routine labor, followed by a random lung problem at birth that could have been life-threatening if we weren't in a hospital with a NICU—as it is, baby was totally fine after a few days). And for some reason, this perspective seems so much more widespread in the media and on the internet than the mainstream medical perspective. Is it just that doctors have more important things to do?

[jethrien.livejournal.com]

I'm pretty comfortable with the approach my doctors have been taking with regards to medication and breastfeeding--ideally, you start with no medication and 100% breastfeeding, but then you add intervention as it becomes necessary (for whatever reason that is). I do think there are a lot of hospitals that jump to intervention too fast.

I think you might be on to something with the doctors being too busy (and not trained) to advocate on their own behalf.

[momerath4.livejournal.com]

I agree with that approach as well—of course no medical procedure should be performed unless it's necessary (though even then, there's a lot of gray area if a patient requests a voluntary procedure...) But my concern with the natural childbirth rhetoric is the way it portrays "interventions" as uniformly bad, and makes women who do really need them feel guilty or inadequate, or like they've had a traumatic experience because it didn't match the ideal birth they had envisioned (I've seen so, so much angst over this on internet forums, and despite knowing better I feel a little wistful about my own eventually-medicated labor)... or, worst case, convinces women to refuse procedures that are necessary for their own safety and the safety of the baby, or to attempt a homebirth, which can be disastrous in the event that something goes wrong (like what happened to my little guy). Same thing for breastfeeding—it's great if it works for you, and I think it's good that women are being encouraged to make a go at it, but I don't like the way that lactivist rhetoric makes formula out to be totally evil, as opposed to a perfectly nutritious alternative to be used when necessary.

[jethrien.livejournal.com]

I think I've kind of been regarding formula as being like Powerbars--it's food, it's got the best nutrition food science can cram in, and if it's what you've got to work with, you can survive just fine on them. Whereas breast milk is the homemade meal out of veggies and whole grains and such, which is definitely preferable...if you can get it. And so I'll cram in as much of the better stuff as I can into my kid, but you know what? A couple Powerbars aren't going to kill him. And if he had to live off them, he'd be ok. Maybe not ideal, but ok.

I'll also add that, as supportive as my OB was of unmedicated birth, her practice refuses to accept birth plans. They're clear on what their priorities are, but they don't want anyone getting wedded to a particular concept of what birth is going to be like, because it's never like how you want it to go. They're not even crazy about the touchy-feely birthing center that's at the hospital, and insisted on delivery on the floor that has better access to all the surgical stuff. For all that my labor was unmedicated, I was signing C-section release forms between contractions and they slapped a drip full of high powered drugs into my IV basically as soon as he was clear. The baby was fine--but if I hadn't been in a hospital, I was the one who might have died.