Thursday, March 22, 2012

Alice Dreger on technology, ethics, and birth

The Most Scientific Birth Is Often the Least Technological Birth - The Atlantic

A number of important points worth further discussion are slipped into this piece:

De Vries suggests that the organization of maternity care in this country -- "the limited choices that American women have for bringing their baby into the world, what women are not told about dangers of intervening in birth, and the misuse of science to support the new technologies of birth" -- actually constitutes an ethical problem, although we typically do not recognize it as one.

and also a quotation from a medical researcher

"We're all very interested in having healthy babies and it is pretty easy to make the kind of cognitive errors that people make, and attribute to technology benefits that don't exist. At the same time, when there are problems in a pregnancy, that very same technology can be life-saving. It is easy to make the [problematic mental] leap that technology is always going to be necessary for a good outcome."

In other words, that most pregnancies are treated as though they are high-risk does not create an overall benefit.

This issue, a personal one for me and many other women (and their partners) is tied to numerous philosophical issues: the appropriate role for medical ethics, how values are introduced into research design, analysis of evidence, communication of results, and translated into clinical practice. There are also issues of social epistemology: why don't women know which common procedures are couple with risk and which are not? Who benefits from the creation of ignorance in this case? And how can ignorance of risks (and even of variation from one practitioner to another, such that some OB's perform 'routine' episiotomies and some never perform them at all) continue to exist despite easy internet access to scads of information?

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