Childbirth and the Precautionary Principle

Reading Gawande's piece got me thinking about the precautionary principle.  This concept is something that I have discussed in classes many times before but is particularly on my mind because we are currently going over it in my Environmental Hazards class. In learning about toxic chemicals, we have gone over cases such as Love Canal, Woburn, Massachusets and the contamination of their water supply with TCE, Warren County, North Carolina and their toxic, PCB-laced soil, etc. In each of these cases, it is women who have been at the forefront of the movement, and even created a movement out of their unrest in the Warren County case called the Environmental Justice Movement. Because women are often times more in-tuned with their child's health and bodily changes then their partners, they will be the first to notice a recurring rash, repeated complaints of nausea, chronic colds, etc.  Women are also more likely to share miscarriage stories with their close friends and notice if there is an alarmingly high incidence of miscarriage or birth defects in a given area.  These reproductive health and childhood health issues are the tell-tale signs of toxic contamination, either through the water supply, soil, or air. In the case of childbirth, Gawande discusses that obstetrics as a field is known for not conducting randomized trials or following the model of evidence-based medicine. "If a strategy seem[s] worth trying doctors [do] not wait for research trials to tell them if it['s] all right," they just try it and see how childbirth patterns continue. It is an incredible transformation that childbirth has evolved from being a highly dangerous and high risk procedure to one with relatively low death rates, with advanced problem-solving techniques available. Human ingenuity has changed the way doctors respond to childbirth, with the focus now being "how many loaves the bakers burn" in reference to babies and how to increase yield.

Elizabeth Rourke, who had every intention of giving birth without intervention, ended up having to try almost all of the intervention techniques available. My mom gave birth to two daughters, both by cesarian section.  I, being the oldest, was an emergency case but my sister's birth was entirely planned, down to the minute. It is, I guess, common practice that if a c-section is used with the first born, it should be with the second as well. I remember thinking that my sister was exactly on time, but in reality, she had no say in the matter; she was scheduled. Medical advancements have drastically increased the survival rate of women and children and is one of the characteristics features of developing countries. I worry, however, that we do not know the full effects of the medicines and techniques we are using. Many women, like Rourke, have dreams of giving birth naturally in the woods surrounded by fairies, basically in a peaceful, medicine free setting. For many women's safety, that simply cannot be done and medical intervention is necessary, but what will the long-term health effects of this be?