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Expecting Trouble; What Expectant Parents Should Know About Prenatal Care in America by Thomas H. Strong, JR., M.D. is a book on the prenatal care system in our country. It was written by a 2nd generation obstetrician with 2 doctorates in 2002.
I believe the goal was to educate the average parent on the system that they are entering upon starting a family. However, the first half of the book is hard to follow provided the frequent need to stop and pull out a dictionary. The advanced vocabulary does ease up only to be replaced by extensive legal jargon.
The 5th and next to last chapter is easy to follow, as it speaks on culture and more familiar topics to the average parent. Overall, it’s an enlightening yet challenging read.
What is Prenatal Care in America?
The book spends the first third of it’s pages highlighting the fact that we’re not sure what good quality prenatal care actually is. The human body has adapted to mostly be self sufficient in this process with little to no outside help.
Most of the ascribed benefits of prenatal care are unsupported by medical research and most of the procedures mothers are subjected to are done so unnecessarily out of show. We have a “quantity over quality” issue that makes the system appear more efficient than it is.
The philosophies in this book are undeniably important. Mothers and babies are at the center of all society. It’s where we all stem from and it’s what shapes us as adults and the influence we have on one another. And Yet, “American mothers are now secondary to the promotion of political careers, academic sessions and outright greed”.
The Broken Systems of Prenatal Care in America
The system is broken from top to bottom. Aside from the mostly useless procedures mothers are subjected to, they are also encouraged to come in routinely for no reason, taking time out of their lives to conform to the average and inconvenient business hours of most obstetrician establishments.
Doctors have little to no time to spend on truly needed patient care such as educating and counseling. Managed care systems brought on by insurance companies have made it to where doctors must see a high number of patients in a short amount of time in order to be profitable.
Managed care also ties doctors’ hands in referencing more complicated cases to special care which has seen some catastrophic outcomes.
The real driving factor of prenatal care in America
Moreover, Dr Strong goes on to elaborate on how malpractice insurance and suits generally work and how the legal system is rife with abuse. Most doctors are sued due not to negligence but instead poor bedside manners and communication.
If a patient doesn’t feel respected or included by the medical staff in the decision making process it leaves them open to influence from lawyers who stand to gain in a “high profile” case. Not that malpractice doesn’t occur daily. We allow standards of care below 100% that aren’t allowed in other equally dangerous industries.
The long and taxing journey it takes to build the credentials of a doctor is also what protects him from reprimand, as people are hesitant to strip someone of something that was so difficult to gain. This leaves us with bad doctors continuing to practice with little to no consequences for their actions.
Solutions to innovating prenatal care in America
The book doesn’t only highlight problems with our current system, but also goes to give us possibly solutions as well. Obstetricians and Gynecologists were originally 2 seperate specialties brought together in an act that seemed sufficient and sensly.
However, most OBGYNs seek to eventually survive off of older, gynecological patients and spend their earlier years taking only the easiest of pregnancy cases and referring out the more difficult cases to neonatal specialists.
With midwives more than capable in assisting the normal pregnancies, obstetricians have essentially made their jobs obsolete. No zoning factors in the system have also led us to have an overabundance of OBs in highly populated areas and nearly zero in rural areas where they are most needed.
Dr. Strong believes that mothers, babies and society as a whole would benefit much greater in systems that were more community driven. Inviting mothers to less appointments hosted in community centers such as churches, malls, mosques and other local institutions which would lead to a more wholesome experience that would likely bring the community closer together.
This is what’s needed to provide better pregnancy outcomes in our society. More togetherness, counselling and a sense of belonging. This culture centered focus has been observed as positive in the search for better care in America.
Contrast in Cultures
It’s been noted that natively born American women fair worse than their foreignly born counterparts in the same system. Culture and a sense of support from family and friends seems to be the biggest factor at play here.
When the culture sets pregnancy and child bearing as a high priority, as do the mothers which leads them to make better choices before and during their pregnancies that affect the outcomes more than any medicalized procedure or system could.
Overall, the book finds that the biggest factor of pregnancy outcome is the mother before and during her pregnancy. We should be supporting, educating and encouraging our mothers to take care of themselves and their babies instead of subjecting them to tests upon tests for virtually no reason.
More we can do
Family planning services should be the norm so that we’re ensuring more pregnancies that occur are wanted which provides better outcomes for those that are unwanted.
Birth control should be easily accessible to both adults and teenage girls to reduce this number and fathers should be held equally accountable for the planning and well being of their family as mothers have always been.
Our prenatal care system is not easily fixed and most of our pregnancy related outcomes rely on things that are outside of the prenatal care system’s scope of responsibility.
Obstetricians cannot provide psychosocial therapy or change policies that they themselves are bound by. Change has to take place within the culture and how pregnancy and child rearing are portrayed within it. This book highlights many directions that provoke thought on change and I believe we will live to see the outcome of positive change that is already taking place within our society.
Throughout this book, I couldn’t help but be pensive on the fact that it was written nearly 20 years ago and although most of the information still reigns true, I consistently found myself wondering about the current statistics and systems. Change happens faster and faster these days. What strides in progress, if any, have we succeeded in with our systems during this time?
Other Articles You May Enjoy
- Common Pregnancy Myths & Fear Mongering Misinformation as Told By a Midwife
- Birthing From Within; a book review for new parents
- Your Beliefs Around Birth Can Make Labor Easier or Harder
- Expecting Trouble; Prenatal Care in America (A Book Review)
- The Womanly Art of Breastfeeding; a book review for new parents
Author
S.S.Blake; Spiritual Life Coach, Yoga + Meditation Teacher and Founder of Earth and Water
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Citations:
Thomas H. Strong, JR., M.D. Expecting Trouble; What Expectant Parents Should Know About Prenatal Care in America