Book Introduction

Making informed decisions on childbirth

Here’s the introduction to my own book on pregnancy and childbirth:

Making informed decisions on childbirth
One scientist’s international perspective
               by Sofie Vantiers, Ph.D.

   available on:
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Introduction

I set out to write a book for pregnant mothers and expecting partners (regardless of whether they are male or female) who are preparing mentally, emotionally and psychologically for the biggest change in their life. Rather than convincing you of my personal right (or wrong) way of doing things, I aimed to make the reader aware of the issues that might come up, open up the discussion and provide some tools of investigation. I used to be quite firm in my beliefs of how to best give birth, feed a baby and raise children in general. Writing this book and doing more research actually made me more moderate in my opinions and more sympathetic to opposing or just different viewpoints.

Just to avoid confusion and false advertising regarding the title of my book, I want to clarify that although I am a scientist, I do not hold a degree or have received any formal training or education in medicine, midwifery, obstetrics, or any other health-related field. I hold a Master’s degree in Geology and in Oceanography, a PhD in Geophysics and I did three years of post-doctoral research in the University of Texas at Austin (U.S.) and in the University of Southampton (U.K.). You might think that my experience studying the Earth’s crust using sound waves helped me understand the ultrasound of the unborn baby, but that would be really stretching it! The belly and the crust are just too different. But more accurately and much more importantly my experience as a scientific researcher showed me how scientific knowledge is acquired and how received opinion can change. Most significantly it gave me the confidence to dig into the medical literature and do my own research, which ultimately led to this book.

I do not expect, nor do I want, my readers to simply take my word for what I write. Rather, I want to discuss the issues involved in childbirth and newborn care, and show how a non-specialist (like me) can go about exploring in an objective way the many different options that are out there. Obviously I am biased, as I did the research for the birth of my own children, drew my own conclusions from the data I gathered, and wrote my book accordingly. But to help you make up your own mind, I have included detailed references of where I got all statistical and other information. The large majority of the information I quote is from the medical and scientific literature, as opposed to the often misleading and dumbed-down versions in news articles or documentaries. If I, as a non-specialist, can read and understand what researchers say, so can you. No medical knowledge is needed, only a healthy dose of scepticism and motivation to dig deeper into whatever truths and myths any one culture subscribes to. Whereas the story line and message of this book is in the main body of the text, I’ve included boxes with additional and sometimes slightly more technical information for the interested reader.

Readers with Internet access can easily do their own research and check whether any more recent articles bring new or stronger evidence to light by doing a search on PubMed. PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content or abstracts only. If you do a simple google search, you might come up with blogs or newspaper articles. These can be very interesting, but it is always worth verifying their sources for yourself. Often primary research is misinterpreted, oversimplified and sometimes just mis-cited. And if a writer doesn’t even tell you where he or she got certain information and you can’t find it in any peer-reviewed journal, treat it with caution.

The big difference between a newspaper article and an article in a medical or scientific journal is that the latter has been peer-reviewed and accepted for publication by two to three specialists in the field. On top of that, for each article, PubMed shows which articles have cited that research, so you can read what other scientists have to say about it in other peer-reviewed articles. Although the system isn’t foolproof and bad science does get published from time to time, it is still infinitely more trustworthy than an article written by a journalist who might not understand all the subtleties involved, who may leave out the “ifs” and “buts” and other qualifiers for simplification or space constraints, and who may or may not have an agenda (such as selling newspapers). Even an article written by a healthcare professional should not carry as much weight as a peer-reviewed research article in an international journal. Every doctor, nurse or midwife is part of a certain country and culture with its own beliefs, and it is impossible not to be influenced by that. One way to dig deeper is to find out what opponents have to say and then check back what the responses are to those criticisms. Progress in science is based on scepticism: if there was no resistance, debate, controversy and opposition keeping scientists and doctors on their toes, doctors might still be bloodletting their patients.

In this book I heavily cite articles published by the Cochrane Collaboration: the gold standard of health care research. Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation and the accuracy of diagnostic tests. Because they assess and combine all research and data previously published on the subject, they carry more weight than any one small- or large-scale study that is found in the literature. Cochrane Reviews are also international, as contributors from more than 120 countries work together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. In contrast, medical research is often funded by pharmaceutical companies, and one can’t help but wonder whether interpretations and conclusions of these papers aren’t biased toward the commercial advantage of the company that paid for the research.

This book is not intended as a medical handbook or a scientific textbook. In no way is the reference list complete or comprehensive. Articles chosen might not be the only ones or even the best ones to make a point, and newer studies and discoveries will certainly make some of my conclusions obsolete. The references are there to show what kinds of questions are being asked and debated and, above all, to once and for all dispel the myth that obstetrics is an exact science and that your particular doctor (or midwife) in your particular country has all the answers.

That being said, I will do my best to post any updates, corrections or additional information on the subjects discussed in this book on my website sofievantiers.com. Please feel free to contact me there with any questions or comments you may have. If I think it’s something that might be relevant to others, I will create a separate post. In addition, if you’ve bought this book on kindle, you can check for updates by going to the “Manage your kindle” item on the Amazon menu. If an update is available, there will be a link next to this book’s title.

As someone who lived in Belgium for 22 years, studied and worked in the U.K. and the U.S. in a very cosmopolitan university environment for eight years, and then moved to France to become part of yet another international community, I can assure you that huge differences exist (yes, even amongst developed countries) between what’s considered the best way to give birth. I’ve personally witnessed Belgian doctors roll their eyes at French practices, French doctors look down their noses at Dutch home births, and American doctors turn a deaf ear to European practices. They can’t all be right, no matter with how much authority the medical profession in each country puts forward their policies. Just looking at what happens in different places already gives a good idea of the debates and uncertainties surrounding childbirth. One book that really opened my eyes, and one that I heavily recommend reading, is “Our babies, ourselves: how biology and culture shape the way we parent”[1]. Anthropologist Meredith Small describes the different parenting styles of several cultures, including traditional societies (the nomadic Ache tribe of Paraguay, the agrarian !Kung San society of the Kalahari Desert in Africa, etc.) and industrialized societies such as the U.S., the Netherlands and Japan. My personal experiences include being pregnant in the U.K. and France and giving birth in a birth centre in the U.K. and a “mother and baby friendly” hospital in Belgium. Other experiences and stories come from my international group of friends and family, with representatives of Belgian, English, Irish, French, American, Canadian, Australian, and German nationalities living in a variety of countries. To protect their privacy and anonymity, all their names have been changed, with the exception of Kalina Christoff who chose to reach out to mothers who had a less than ideal birthing experience via her birth trauma website and who is an advocate for human rights in childbirth via her humanize birth non-profit organisation. Mostly in order to protect the privacy of my children, I have chosen to publish under the pseudonym Sofie Vantiers. Upon reading the early drafts of my book, my sweet Canadian husband insisted on providing another side of our story. For this reason I have included little snippets of his personal experience and opinions on the different subjects taken on in this book. You can find his writing (which I have not tampered with!) in the boxes called “Leonard’s perspective”.

In any book about childbirth and newborn care, authors must make a decision on whether to address each baby as “him”, “her” or “it”. Whereas some writers avoid the decision altogether and use all three designations interchangeably, I chose to keep things simple. I apologise in advance for those who have daughters, but since I happened to have two boys, any baby is referred to as “him” throughout my book. Likewise, because I happen to be married to the father of my two children, and because this is still at least one of the most common scenarios in the world, I tend to write about the pregnant mother, with the child’s father as her husband. Please keep in mind that I have no intention at all of excluding any other type of family composition, which in our recent times can be very varied. Writing about husband and wife, father and mother, is simply a logistical choice to avoid complicated phrases such as: the pregnant biological mother or adoptive mother or stepmother who is either single or has a companion (male or female) or husband or wife, who may or may not be a biological parent). Apart from obvious biological limitations (for example: men can’t normally breastfeed nor give birth themselves) almost everything in my book will be applicable to all types of family constellations.

Furthermore I would like to take the opportunity to dispel an old fashioned belief people might still have that children must have a male and female parent to thrive. A 2014 large-scale Australian study collected data on 500 children of 315 same-sex parents (of which 18% were male-male parents). They concluded that children in same-sex parent families actually fared better than the general population in terms of general behaviour, general health and family cohesion[2]. All other test results (on growth and development, mental health, physical activity, temperament and mood, self esteem, family activities, peer problems, hyperactivity/inattention, emotional symptoms, rates of immunisation, …) were similar to those of the general population. Female same-sex parents did better on breastfeeding than the general population. For obvious reasons male same-sex parents did worse regarding breastfeeding rates. But despite their biological limitations, 22% made sure that their child received some breastmilk in early life, and 5% still provided breastmilk when their baby was four months old (via surrogate milk donation). Sadly, the study also pointed towards the fact that same-sex families do encounter stigma and homophobia. As with race-based stigma and social stigma in single-parent families, stigma related to parental sexual orientation is associated with a negative impact on the child’s mental and emotional wellbeing. In terms of perceived stigma and homophobic bullying, Australian children of lesbian parents fare better than their American counterparts, but worse than children living in the Netherlands[3]. For those who remain sceptic, the most important take-home message is that even with this added difficulty thrown into their life, simply due to the fact that we live in a society that remains ignorant and intolerant to some extent, children of same-sex families fare just as well and on some levels even better than the general population.

To end, I would like to point out that any medical or other intervention in the natural process of giving birth, however small, has an effect. Our bodies and all the physiological processes involved in giving birth and breastfeeding today are the culmination of several million years of evolution towards a balanced system. Like an ecosystem, it needs only a small intervention to bring about a cascade of effects. Examples that I will cover are: use of epidurals that slows down labour, the bacteria needed for a healthy immune system that are normally picked up from passing through the birth canal, and the extra iron that is transferred to the newborn via the umbilical chord if you wait a few minutes before cutting it. Other examples that come to mind are: breastfeeding effects on the mother’s uterus getting back to its previous size, breastfeeding effects on later risks of cancer for the mother, and so on.

Also like an ecosystem, our bodies appear far too complicated for us to understand all the intricate connections and to be able to predict both short- and long-term consequences of a seemingly small change. I am not an advocate of “natural is always better”. Rather my motto is “natural is safer in the long-term unless significant benefits outweigh the possible unknown risks”. In other words, if the most recent (bio)medical research shows only a marginally better outcome or no difference at all for a certain intervention, don’t use it! Even if it is considered harmless! Not to use a drug or intervention that doesn’t work may sound obvious, but in practice it is done all the time. In 1953, published research showed that DES (Diethylstilbestrol), a synthetic oestrogen that was believed to prevent miscarriage or premature birth, did not work. However, DES continued to be prescribed until 1971, when it became apparent that a previously rare vaginal cancer that was only diagnosed in women over 40 suddenly appeared in a cluster of girls and young women between 15 and 22 who had been exposed to DES before birth. Even when DES was withdrawn by the U.S. Food and Drug Administration (FDA) from use for pregnant women in 1971, it still continued to be prescribed until the 1980s in some regions of the world. DES daughters have an increased risk of a certain rare vaginal cancer, reproductive tract differences, pregnancy complications and infertility. It is now also known that DES sons are at increased risk of testicular abnormalities[4]. Why did doctors continue to prescribe a drug that didn’t work? Because they thought it was harmless. They thought wrong. No drug or medical intervention can ever be proven to be completely harmless simply because it would be impossible to test its long-term effects on everything. So if you’re not absolutely certain that it works, why take the risk?

Medicine is not an exact science and never has been. A lot of improvements have been made in the last hundred years, but it is still a science of trial and error. Which interventions are utilised in any one country is often more a function of history and culture than of available evidence of its effects. By the 1930s, X-rays were a routine part of prenatal exams. When a 1956 study showed that even a very small dose in a single diagnostic foetal X-ray doubled the chance of childhood leukaemia[5], no changes were made in hospital policies. Even after subsequent studies confirmed the link, doctors in the U.S. continued to do the foetal X-ray exam for another twenty years, until insurance companies began to reimburse for the replacement ultrasound exam[6]. Today ultrasound used on an unborn baby is considered completely harmless and is carried out as a routine screening test in many countries. In fact, by many, it is considered unsafe to not have an ultrasound scan when you’re pregnant. But no studies have confirmed the absence of long-term effects with the much higher intensities of ultrasound used since 1991. Despite the fact that biologically adverse effects are known from animal studies[7], that many medical researchers worry about the long-term effects on neurodevelopment of the baby, and that research has shown that routine ultrasound does not improve outcome for babies[8], it is still a part of routine antenatal care, even for low-risk uncomplicated pregnancies. And despite warnings against the non-medical use of ultrasound, there is no law in the U.S. prohibiting sales of a non-medical ultrasound keepsake picture or video of your unborn baby. Since we should not blindly trust authorities, medical or otherwise, to keep our children and ourselves safe, we have to do the research ourselves. My book intends to show you how.

Sofie Vantiers

Leonard’s perspective on research and science

Sofie (my lovely wife and author of this book) and I met when we both worked as research scientists at The University of Texas at Austin. At first I couldn’t believe that such a beautiful woman could possibly be interested in me. After seven years of marriage I understand better that we share an important perspective on the world because we’re both scientists. We come from different continents and worked in different scientific specialities but we share a common scientific culture wherein we try to understand the world, question our sources, and are generally sceptical of dogma. It’s hard to communicate this perspective of healthy scepticism without swinging the pendulum too far or sounding like a radical. But having worked as scientific researchers, having witnessed and indeed participated in the acquisition of new science, we know how experts can be wrong and how perspectives evolve as a field develops.

An important lesson is that there is no such thing as an exact science. Physicists like to think that their field is the most exact and most fundamental – I know, I teach theoretical physics to undergraduates. But even physics is not exact in the following sense: as it evolves, the new ideas don’t simply add to old ideas but often contradict or at least put new limits on old ideas. Other sciences are less exact because they study more complicated things. The human body is one of the most complicated things in the universe: more complicated than the Earth’s climate system, and certainly much more complicated than a simple proton made of three irreducible quarks.

In short, we have great respect for science and (most) scientists but we recognise it as a very human activity with all the foibles and failings you would expect from humans.

By the way my name isn’t really ”Leonard”. I asked Sofie to name me after Leonard Susskind, the brilliant theoretical physicist who combines just the right mix of confidence and humility that I recommend everyone strive for.

Leonard Vantiers

Making informed decisions on childbirth

Click here to read more excerpts of:

Making informed decisions on childbirth
One scientist’s international perspective
               by Sofie Vantiers, Ph.D.


available on:

Amazon.co.uk logo Amazon.fr logoAmazon.de logoAmazon.ca logoAmazon.com logo

References

  1. Small, M.F., Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent. Reprint ed. 1998: Anchor. 292.
  2. Crouch, S.R., et al., Parent-reported measures of child health and wellbeing in same-sex parent families: a cross-sectional survey. BMC Public Health, 2014. 14: p. 635.
  3. Bos, H.M., et al., Children in planned lesbian families: a cross-cultural comparison between the United States and the Netherlands. Am J Orthopsychiatry, 2008. 78(2): p. 211-9.
  4. Bamigboye, A.A. and J. Morris, Oestrogen supplementation, mainly diethylstilbestrol, for preventing miscarriages and other adverse pregnancy outcomes. Cochrane Database Syst Rev, 2003(3): p. CD004353.
  5. Osborn, S.B. and E.E. Smith, The genetically significant radiation dose from the diagnostic use of x-rays in England and Wales; a preliminary survey. Lancet, 1956. 270(6929): p. 949-53.
  6. Epstein, R.H., Womb with a view, in Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank. 2011, W. W. Norton & Company: New York. p. 352.
  7. Buckley, S.J., Ultrasound Scans: Cause for Concern, in Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. 2009, Celestial Arts: Berkeley. p. 348.
  8. Bricker, L., J.P. Neilson, and T. Dowswell, Routine ultrasound in late pregnancy (after 24 weeks’ gestation). Cochrane Database Syst Rev, 2008(4): p. CD001451
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