Summary Gawande and Goer

In the New Yorker article “The Score: How Childbirth Went Industrial”, Atul Gawande looks at a case study of Elizabeth Rourke’s experience with childbirth against the backdrop of the history of child-birthing procedures.  There are over 130 million births a year, and while many of them go well, there are some that are doomed to have complications.  Rourke avoided unnecessarily procedures and labor inducing medications when she went into labor, but when her baby got stuck facing sideways, she did not have many options and was forced to have a Cesaerean section, or a C-section as it is commonly referred to as today.  

In the midst of Rourke’s experiences, Gawande goes through the process of childbirth, from the moment the mother’s pelvis enlarges in the first trimester, to the change in the uterus during gestation, and the effacement of the cervix.  According to Gawande, the “transition phase”, which is the considered the most intense phase, occurs when cervical dilation is between seven to ten centimeters.  As dilations reach a high intensity, the baby’s head begins to emerge until the full baby is born and the umbilical cord is cut. 

While this process may seem relatively simple, in spite of the pain, Gawande goes on to talk about how many women used to and still do die from childbirth.  In fact, childbirth used to be the leading cause for deaths among women and infants for many years due to complications, such as hemorrhage, infection, or the “obstruction of labor” when the baby will not come out.  In these cases, abortion would most likely be necessary, but the abortion procedures back in the day were very different among doctors and midwives. One procedure included the use of a sharp instrument called a “crochet” that would essentially crush the skull in an attempt to save the mother. Then there are procedures, or maneuvers, that consist of pulling the baby out of the mother from various angles and by various body parts.  Gawande notes, however, that survival rates vary among these maneuvers and do not guarantee anything. 

During the 19^th and 20^th centuries, Cesarean sections, obstetrical forceps, and antiseptics were used by many doctors, prompting women to go to a hospital for childbirth rather than stay in the comfort of their own home.  Surprisingly, a study done by the New York Academy of Medicine revealed that more women were dying from childbirth in the hospital than at home, proving that maybe midwives were better suited for delivering than the “renowned” doctors.  In the aftermath of this study, doctors realized that if they wanted to deliver babies, they would have to standardize their practices to ensure safety. 

Virginia Apgar was a medical student who Gawande believes made this standardization possible with the introduction of anesthesia and the Apgar Score.  The Apgar Score has been used since Virginia Apgar to rate the condition of a baby when it is born on a scale of one to ten.  If a baby is deemed as being a ten, its condition is perfect.  This is, according to Gawande, how childbirth went industrial and how obstetrics changed the face of childbirth for the better.

Henci Goer, on the other hand, is very critical of Gawande’s article in regards to obstetrics and the industrialization of childbirth.  According to Goer, Gawande is naïve to say that obstetrics have proved to be safer and a much better practice than others in the medical field.  Furthermore, Goer sees Gawande’s takeaway message, which essentially makes the claim that C-sections are safe and easy while natural childbirth is painful and dangerous, is completely illogical and erroneous.  Using evidence from different studies, Goer shows that the immediate and potential future death rates from childbirths have historically been lower when the mother was not in a hospital setting and that a mother’s health and well-being might be in greater danger in a hospital setting.  Gawande does little to show the benefits for mothers who choose not use obstetrics, yet makes the false assumption that women who do are better off.  Goer argues that childbirth, “has everything to do with [the] caregiver’s philosophy and approach,” which sheds light on why Rourke’s experience may have not have been ideal.  Ultimately, Goer believes that a C-section should not be considered the norm or routine procedure, as it is stated by Gawande and experienced by Rourke.