A Normal Pregnancy is a Retrospective Diagnosis

J. D. Kleinke is a medical economist, author, and health information industry pioneer, and the author of a new book, Catching Babies.

Over at The Health Care Blog, he has published one of the best essays I have ever read revealing “how little obstetricians really know – and how limited the specialty is in its ability to test and expand that knowledge – thanks in part to the visceral fear inspired in patients by statements like ‘a normal pregnancy is a retrospective diagnosis.’”

While protecting the name of his sources, he describes what happens when “Hannah’s” labor does not proceed as quickly as expected:

“Hannah is starting to weary of the process, and she’s hungry; they have put her on a restrictive diet, of course, assuming she will soon go into labor and deliver. When her blood sugar starts dropping, they let her go back on solid food. Her energy picks up, enough to start arguing that maybe she should just go home and wait. ‘Maybe this is a sign that Sam is fine,’ she says, ‘and he just doesn’t want to be born yet.’

“The Kaiser people get wind of our conversation when they walk in to check her IV, and send in the CNM who has just begun her shift.

“She runs through the same argument that had brought Hannah in two days earlier “This time, Hannah argues back.

“’Do you know what could happen, if you wait?’ the CNM finally says with an impatient sigh. ‘Your baby – he could be – stillborn.’”

What can Hannah say?  She is put through the agony of an induced labor:

“The artificially induced contractions are severe, throwing her from the bed. The pain is too intense, and Hannah finally relents and agrees to an epidural, which will numb her from the midsection down and cut her off from the core sensations of the birthing process . . .”

Read the entire post here.

8 thoughts on “A Normal Pregnancy is a Retrospective Diagnosis

  1. Hi Chris–
    I just didn’t word it very well, but I meant to say read Kleinke’s entire post here.
    So I meant to link back to THCB.
    But thank you.
    (And I may write about Kleinke’s post this week-end. It raises many issues …”

  2. The comment thread to the post is also fascinating — an illustrative nexus of opinion, politics, and raw emotion. It’s a very difficult subject to be dispassionate about. Perhaps this is because, among all medical topics, nearly all adults are involved in one way or another with childbirth.

  3. Maggie:
    I guess my wife and I were blessed to have 3 of 4 normal births. The one lost one early on hit her with an impact I had not seen in her before or ever again. Forunately, we had one at home to cradle then.

  4. Chris, run 75441
    Chris–Yes, the thread is revealing, and it runs the spectrum of emotions.
    run 75441– My mother lost a baby at nine months. Unfortunately she was in her early 40s and not able to have another child. She never got over it.
    I’m so glad that you and your wife were able to have more, though of course one child can’t replace another.

  5. I would very much like to read the rest of this article- but it seems the link no longer works.