This guidebook presents the view point for the demedicalized, minimalist model of care during pregnancy, birth, and childhood, which is the opposing viewpoint to the highly medicalized, maximist model of care standard in the United States.
"We cannot blindly trust the medical establishment or the government to have our best interests in mind. We need to educate ourselves and make the best decisions we can for our families.” (page 248)
For readers new to the idea that the industrial-medical complex and the multinational corporations that make baby products do not act in the best interests of pregnant mothers, newborns, new mothers, and babies and toddlers, this book would be a good place to start. It is written in a conversational tone, laden with anecdotes, and contains 62 pages of citations, a list of abbreviations, and a glossary of terms. Readers already familiar with the push to normalize and demedicalize birth and individualize care based on each patient and his/her wishes will probably find very little new here.
The topics covered are prenatal care, the undisclosed potential risks of ultrasound, childbirth (traditional hospital standard protocol and profiteering), cesarean section, NICU admissions, circumcision, formula, baby product marketing, disposable diapers and potty training, vaccinations, and well baby care.
This book was published in 2013, so all the prices quoted are wildly out of date. There may also be more current research than that presented in the text. Evidence Based Birth is an excellent resource for finding up-to-date research on evidence-based medical care. It is run by a nurse with a PhD who offers easy to understand metadata analyses of research. The 2019 article (with accompanying podcast) on non-medically-indicated circumcision is excellent for readers wishing to learn more on the topic.
It physically hurt me to read all the stories of women treated badly during pregnancy and labor. While it is all well and good to tell women that they need to advocate for themselves, the reality is that it is extremely difficult to stand one’s ground in the face of pressure (and sometimes open hostility) by medical personnel especially if they play “the dead baby card” and/or threaten to call Child Protective Services.
Pregnancy and labor are stressful and vulnerable times, and having to fight tooth and nail on top of it for things that the World Health Organization states are acceptable options and/or recommended procedures places an undo burden upon women. In the current system, it is almost impossible to opt out and respectfully disagree. The only way birth practices will change in US hospitals is if women en masse begin filing official complaints for the way they are treated and filing legal assault charges against doctors and nurses for performing procedures against their expressed consent. Sigh.
I found the descriptions of maternity care in Iceland to be fascinating. I particularly liked there was a system for redress built into the healthcare system, so the mothers had the right and the opportunity to discuss any complaints/problems with both their treatment and medical care with their providers and the head of department, and I wish that kind of review were readily available in the United States.
I also appreciated the author pointing out how breastfeeding is undermined by the medical establishment at the same time it is supposed to be recommended.
In the section on well child care, the author raised the point that since pediatricians only see children for less than 10 minutes every three months, maybe parents shouldn't blindly follow their recommendations. There is a discussion of how pediatricians tend to rigidly adhere growth charts and medical guidelines without individualizing care or considering other factors such as genetics, which can have negative consequences for healthy children in the lower percentiles.
Personally, I've known multiple parents, who are smaller than average adults, whose smaller than average children have been diagnosed with failure to thrive and put through extensive (and expensive) testing the children's hospital only for it to be determined that they are perfectly healthy and just in the bottom percentiles. These parents suffered a great deal of unnecessary stress and worry, and many were even out right accused of neglecting their children.
Pediatricians also like to blithely dispense parenting advice despite this being outside the scope of their medical training. Besides their height and weight, my children's doctors know virtually nothing about them, and the five minutes they spend with them as a stranger in an unfamiliar setting can't possibly give them much, if any, insight into their personality, temperament, behavior, or psychosocial development. Yet this hasn’t prevented them from giving aggressive and unsolicited recommendations.
I once had a pediatrician tell me at my baby’s 12 month well check that I should stop breastfeeding because there is “no significant value after 1 year.” This was without asking me — the person doing the breastfeeding — how I felt about weaning and in contradiction to the World Health Organization’s guidelines. I have also been given outdated and medically unsubstantiated advice such as starting solid food at 3 months and adding rice cereal to a baby's nighttime bottle to get her to sleep through the night.
A caveat about doctors, which the author doesn't mention, is that their licensure doesn't require them to be retrained when standards of practice change. Thus, one never knows if the care s/he is receiving is current or years, even decades, out-of-date. This violates the bioethics principle non-maleficence, but so it goes.
Pediatricians also burn a lot of bridges with paternalistic, condescending, my-way-or-the-highway attitudes. For example, even if the American Academy of Pediatrics thought it was unnecessary and stupid, if they offered an alternate delayed vaccine schedule that accounted for parental concerns, they would get more parents on board with immunization. After all, doctors acting within current guidelines have impunity while parents are the ones who must care for vaccine-injured children, so parents have a valid reason to be overly cautious.