Margulis - The Business of Baby: What Doctors Dont Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line

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CHAPTER 1
GESTATION MATTERS: The Problem with Prenatal Care

CHAPTER 2
SONIC BOOM: The Downside of Ultrasound

CHAPTER 3
EMERGING EXPENSES: The Real Cost of Childbirth

CHAPTER 4
CUTTING COSTS: The Business of Cesarean Birth

CHAPTER 5
PERINATAL PRICES: Profit-Mongering After the Baby Is Born

CHAPTER 6
FORESKINS FOR SALE: The Business of Circumcision

CHAPTER 7
BOTTLED PROFITS: How Formula Manufacturers Manipulate Moms

CHAPTER 8
DIAPER DEALS: How Corporate Profits Shape the Way We Potty

CHAPTER 9
BOOST YOUR BOTTOM LINE: Vaccinating for Health or Profit?

CHAPTER 10
SICK IS THE NEW WELL: The Business of Well-Baby Care

CHAPTER 11
So Where Do We Go from Here?

For my mother, Lynn Margulis

T wenty-nine years old and pregnant for the first time, Marijana Picton noticed her nausea only went away when she took long walks and ate stapci, Serbian-style salty pretzel sticks. It was 2009. Marijana and her husband, Richard, had been living in England but they moved back to ipovo, the small town in Bosnia and Herzegovina where Marijana grew up, when she was seven months along. ipovos bars were filled with unemployed men and two of the towns four factories had not fully reopened for businesstangible signs of the war that once tore the former Yugoslavia apart.

After taking a birthing class in England, Marijana and Richard had a long list of questions for the staff at the Mrkonji Grad clinic where they would have their baby: Would her husband be allowed to stay with her? Most husbands in Serbia dont, they were told, but the staff could make an exception. What kind of pain medication would they provide? None, the doctor answered, unless you need a C-section. What about epidurals? If you want it, you have to buy it yourself, the doctor responded. Most people get them from Italy. And then you have to find the anesthesiologist to give you the injection.

Marijanas water broke that November on her birthday. She called the clinic to tell them she and Richard were coming so they could turn on the heat in the labor room.

Two years earlier in Oaklyn, New Jersey, twenty-eight-year-old Melissa Farah, a special education teacher at Avon Elementary School, was pregnant for the first time. Melissa and her husband, Dan, were planners: They had been married for almost two years and had begun trying to start a family on their first wedding anniversary. Melissa felt especially lucky because a close girlfriend, Valerie Scythes, was pregnant too. Both women planned to have their babies at the same hospital in Woodbury, New Jersey.

Heres the question: Which young woman would be better off, the one in a small Balkan country still recovering from a brutal civil war, or the mom in the richest and most powerful country in the world with state-of-the-art medical equipment and know-how?

The answer: Marijana.

According to the most recent reports, the likelihood of a mom like Melissa dying due to pregnancy or childbirth in the United States is more than four times higher than in Bosnia and Herzegovina and seven times higher than in Italy or Ireland; the likelihood of her dying as a result of childbirth is five times greater than in Germany and Spain, and fifteen times greater than in Greece.

The United States also lags behind most industrialized countries when it comes to the health and well-being of infants. Eight American children per 1,000 live births will not live to age five.

Fact: A child in the United States is more than twice as likely as a child in Finland, Iceland, Sweden, or Singapore to die before her fifth birthday.

We feel great sadness and shock when we hear about a baby dying: Avery Cornett of Lebanon, Missouri, who was ten days old when he died on December 18, 2011, of a bacterial infection thought to be contracted from contaminated infant formula; a two-week-old unnamed baby boy who died in September 2011 from complications due to an out-of-hospital circumcision; six-week-old Ian Larsen Gromowski, who died of a severe reaction to the birth dose of the hepatitis B shot on August 10, 2007. We stop in horror, our hearts in our throats for the grieving parents. But we consider these deaths isolated incidents, rare occurrences that garner our sympathy, sure, but that certainly wont happen to us.

Fact: The United States has one of the highest infant death rates of the industrialized world. It is safer to be born in forty-eight countries than in the United States.

Fact: Of the some 4.3 million babies born in America each year, more than 25,000 will die in their first year.

Fact: The maternal mortality rate in the United States is among the highest in the industrialized world.

After taking that birthing class in England, Marijana had been scared of giving birth and was sure she wanted an epidural. But the clinic in Mrkonji Grad was the only hospital she and Richard could find in Bosnia and Herzegovina where Richard would be allowed to stay with her. So Marijana ended up having no pain medication and no fetal monitoring during labor. When she was fully dilated and climbed onto the ratty operating table, her contractions slowed. The doctor and midwife heaved her upright and told her to walk around the room some more. Her son was born vaginally about three hours after her water broke. The doctor joked you couldnt find another baby like him in all of Bosnia. Richard is half English and half Nepali and the baby, whom they named Stanley, looked to Marijana like a little Chinaman.

Twenty-eight years old and in good health when she went into the hospital, Melissa Farah gave birth to a healthy baby girl via C-section in April 2007. But the birth did not go as expected: Melissa was transferred to another hospital due to complications from the operation. Doctors were not able to stabilize her and Melissa bled to death the next day. She is not alone: More than seven hundred American women die in childbirth every year, though most of these deaths go unnoted. The vast majority of maternal deaths in the United States are never investigated in any true sense: In 2007 only slightly more than half the deaths related to pregnancy or childbirth were autopsied, and theres evidence that autopsy rates in hospitals are declining; a review of the death is almost always conducted behind closed doors by a committee comprised only of hospital staff, and the information garnered is not released either to the family or to the public; journalists and other outside investigators are often hindered from accessing information because (they are told) of patient privacy concerns. When there is obvious wrongdoing, hospital lawyers work tirelessly to cover it up, negotiating financial settlements that include gag orders so the details of what happened cannot legally be made public. Only twenty-four states require hospitals to report adverse maternal outcomes to the state government. And only a handful of these statesincluding Ohio, New York, and Californiarequire that this information be available to the public. But even when the reporting is mandatory and the numbers are submitted to the state (noncompliance is an issue), most states have no system in place to investigate maternal deaths. A 2010 investigation revealed that twenty-nine states and the District of Columbia have no maternal mortality review process at all. Melissas case became national news because it was the second death at Underwood-Memorial Hospital in Woodbury, New Jersey, in two weeks. Her good friend Valerie Scythes died two weeks earlier after having a planned C-section. Her husband told the BBC that doctors scheduled the operation because Valerie was thirty-five and had had ovarian cysts in college.