Meredith's Reviews > Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First

Born in the USA by Marsden Wagner
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Jun 16, 11

bookshelves: nonfiction, pregnancy
Read in June, 2011


This book is in the same vein as Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block. Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience by Ricki Lake, and The Thinking Woman's Guide to a Better Birth by Henci Goer. But Dr. Wagner also raises several interesting issues not in those books.

In the first chapter he points out that in the United States it is virtually impossible to find out exactly how a patient was treated, what the alternative treatments were, why that person received certain treatments instead of others, and who is responsible if there was negligence or malpractice without filing a lawsuit. While most American medical professionals don't comply with legal standard of informed consent, it's rather frightening to have this spelled out so clearly. He elaborates on this theme in Chapter 7, saying "Many people believe that physicians in the United States are resistant to the idea of national health care because they would make less money, but I think that an equally strong reason is the fear physicians feel around disclosing what they're doing and being held accountable for it" (206).

Chapter 2 takes the reader into the world of doctors and what Dr. Wagner terms "tribal obstetrics." Doctors keep each other's dirty secrets to the detriment of their patients. This chapter illuminates how in cases of malpratice or negligence medical professionals don't want to risk by shunned by their medical community and will rarely break ranks to report or testify against a colleague. As evidence, Dr. Wagner cites several examples about how he got into hot water by blowing the whistle on obstetric practices that violated the medical community's edict to practice evidence-based medicine.

Chapter 7 discusses legal protection afforded to pregnant woman. As mentioned in other critiques of American maternity care, obstetricians tend to pratice defensive medicine. "The constant threat of litigation also means that many obstetricians in the United States go about their practice with a defensive mindset. The decision to do a C-section, which we might call the ultimate intervention, is often based not on medical need but on a desire to avoid litigation" (154). Doctors -- in this field as in many others -- tend to do what is in their best interest instead of the best interest of their patients.
Dr. Wagner provides a very important piece of information not mentioned in other books. This is that patients aren't required by law to sign a hospital's consent form and that they have the right to customize it to reflect their wishes about certain treatments. Not signing any blanket permission form that allows hospital personnel to do whatever they deem "necessary" is a great piece of advice although it should be given with the warning that the hospital may then refuse to treat anyone who refuses to sign away his/her rights. He also lists the fundamental legal rights of women protected by constitutional, federal, and international laws as well as ethical guidelines of the American Medical Association and the American College of Obstetricians and Gynecologists. The most important of these to remember being "The right to revoke consent to treatment at any time, either verbally or in writing" (174).

In Chapter 8, the author describes his vision of how American maternity care could be reformed based on more humane Dutch and European models. Dr. Wagner then goes on to outline ways that these changes can be brought about in Chapter 9.

Born in the USA is a worthwhile read for those interested in the crisis for American maternity care. Although, it is drier than other books on the same topic and lacks the plethora of personal stories, and the only first-hand accounts are from Dr. Wagner himself.
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Comments (showing 1-3 of 3) (3 new)

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message 1: by Jill (new)

Jill Herendeen, While I felt this was a terrific book, overall, I also thought it had a few flaws...I think the author felt OBs have more power to change the status quo than they really do, and I think his faith in our legal system to set things right was over-optimistic (though of course it's easy for me to say that, five years later w/ the c/sec rate still climbing merrily. Hindsight is 20/20). He enthusiastically mentions, on p. 117, NY's law to guarantee access to hospitals' basic birth data, apparently not knowing that, even in 2006, many hospitals were blythely ignoring their obligation, even when prospective patients were sufficiently aware of this law to ask REPEATEDLY. As for the right to sue, an ICAN poster posted a few months ago her personal experience of knowing several women who'd been carted off to the OR for c/sec's while shouting that they knew their rights, they did NOT consent, they would sue, etc. Post-op, they went out to find lawyers wherewith to sue, and were told, "Are you alive? Is baby alive? That's that." and were unable to find any local lawyer to take their cases. I think The For-Profit System has more to do w/ crappy maternity care than mere OBs are able to do much to mitigate.


Meredith The fee-for-service model of medicine practiced in the United States is definitely a factor in the horrible state of our maternity care.


message 3: by Jill (new)

Jill Herendeen, So do I. And I believe that the rest of the industrialized world gets better maternity care & results precisely BECAUSE care is what they're striving for, not profits. In short, care and profit are opposite goals.


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