HW 39

The book "Born in the USA" by Marsden Wagner deals with the heirarchy and elitism of the OBGYN sector of doctors in the US medical system. The profession of OBGYN is highly regarded in the medical field. The beginning of the book tries to give the reader insight into the pride and cult like society that comprieses the OBGYN profession. Wagner emphasizes greatly the loyalty of this specific medical field as well as the status that accompanies it. However, the essential question this book deals with is the reform and reconstruction of a medical profession which is set up for failure in dealing with normal births. Wagner tells stories of neglectful and unsympathetic OBGYN's who are not compassionate with patients, make unneccesary interventions and put their own schedules over the needs of the mother or the baby. However, he makes a very distinction between a cartoony view on the situation and a realistic view. Although he aknowledges the wrong that many people in this profession are guilty of he places the blame on the system more so than individual. Wagner shows how the impossible amount of work and the OBGYN specialties conflict with many of the patients they deal with who have normal births. OBGYN's are surgeons who are taught to make incisions and "cut first when in doubt". The conflict here is obvious, birth is a natural process and OBGYN's are surgeons. Birth is not a medical problem that needs to be fixed by doctors. A more effective healthy way is assisting with the birth rather than trying to control. This is where the pride and loyalty in the profession restrains change. It is hard for doctors to admit they are doing things incorrectly or make mistakes because they are viewed as the experts who are all knowing on the subject, when in reality the are humans and they are bound to mess up as well.

The biggest message I have extracted from the book was that the problems we face are very easily solvable however the system in place is very resistant and restictive against change. There is a strong sense of traditionalism even though sientific evidence opposes many of the practice deemed normal by OBGYN's. Wagner has expertly stated his opinions and used very concrete, relative, and influential evidence to back it up. He used a number of personal stories, stories from patients, and numerical data to back up all his opinons. Besides the point he is trying to prove being pretty obvious, he does a good job of explaining the complexity of the issue and why it hasn't been solved already. Once again it is the system, ideals, and tradition that are holding us back from progressing and bettering the way we deal with birth.