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Birth Day

So many of the posts on this blog are critical and deal with examples of poor science or other problems. I’d like to offer a breath of fresh air in the form of a book by Mark Sloan, MD: Birth Day: A Pediatrician Explores the Science, the History, and the Wonder of Childbirth.

It is a very positive book. Sloan has attended over 3000 deliveries but he has not lost his sense of wonder. He tells us what life is like in the womb – how much the fetus can see and hear – and smell! He explains the labor process. He explains how a fetus has to rapidly adapt to life outside the womb with a number of physiologic changes. He reflects the joy of bringing a new life into a family, and the experience of becoming a father. He delves into the history of childbirth, with fascinating anecdotes about “salting” newborns, Queen Victoria’s influence on obstetric analgesia, and the attempt to keep forceps a proprietary secret of one family.

He shows the many contributions science has made to childbirth, some of the mistakes it made along the way, and how it corrected those mistakes.

He covers the history of medical interventions in childbirth both from a scientific and a sympathetic human viewpoint. Twilight sleep, epidurals, fetal monitors, C-sections, birthing positions, attendance by doulas, etc. He makes a strong case for having someone, anyone, stay with the mother throughout the process; there is evidence that this improves outcome. He covers the pros and cons of various types of analgesia and suggests that nitrous oxide could be used more often. He discusses the reasons for the rising C-section rate and carefully considers the risks and benefits of surgical deliveries, including physiology-based arguments I had not heard before. He covers the alarming new trend of elective primary C-sections by mothers who just don’t want to go through childbirth. He discusses circumcision from a neutral standpoint – he doesn’t recommend it, but he does it at parents’ request and he recognizes that there are medical benefits although they are far from compelling.

He explains the newborn reflexes like “stepping” and the Moro reflex in terms of evolution: primate babies needed to grab onto Mom and pull themselves to a nipple; and he says if left undisturbed on its mother’s abdomen, a human baby’s neonatal reflexes allow it to little by little inch itself up to the breast and find the nipple over the course of half an hour. I didn’t know that. I find it fascinating. I’d love to see a video of the process.

The book is full of interesting facts and anecdotes. A human birth takes 30 times as long as a gorilla birth: he discusses the anatomical changes in humans that prolong the process, and possible evolutionary explanations for them. He discusses cord care. The umbilical cord stump can take a long time to fall off – Dr. Sloan’s personal record was “88 parent-torturing days”! He tells about an embarrassing incident from his medical school days when he thought something looked funny about the fetal head but failed to recognize it was a breech presentation. He tells about Apgar Guy – a father who harassed him, wanting him to alter the medical record to show that his baby’s Apgar was really a 10 rather than a 9, as if that would somehow improve his child’s prospects. He tells about the expectant father who ran all the way to the hospital, slipped on the floor, knocked himself out, and woke up to find out his wife was at another hospital.

A fascinating book by a science-based doctor, a wise clinician, and a loving father. An example of what the scientific approach to medicine is all about, showing that it need not be cold and impersonal.

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