High Risk: Stories of Pregnancy, Birth, and the Unexpected

by Chavi Eve Karkowsky MD

Overview

A doctor’s revelatory account of pregnancy and the complexity of reproductive life—and everything we lose when we don’t speak honestly about women’s health.

“My work offers a window into the darkest and lightest corners of people’s lives, into the extremes of human experience,” writes Dr. Chavi Eve Karkowsky in High Risk, her timely and unflinching account of working in maternal-fetal medicine—that branch of medicine that concerns high-risk pregnancies. Whether offering insight into the rise in home births, the alarming rise in America’s maternal mortality rate, or the history of involuntary sterilization, Karkowsky offers a window into all that pregnancy, labor, and birth can entail—birth and joy, but also challenge and loss—illustrating the complexity of reproductive life and the systems that surround it. With historical insight and journalistic verve, Karkowsky unpacks what is involved for women, for a family, and for us as a society; and explores what’s at risk when these aspects of medicine remain clouded in mystery and misinformation.

Product Details

ISBN-13:	9781631495014
Publisher:	Liveright Publishing Corporation
Publication date:	03/10/2020
Pages:	312
Sales rank:	272,635
Product dimensions:	5.50(w) x 8.40(h) x 1.20(d)

About the Author

Chavi Eve Karkowsky, MD, is a maternal-fetal medicine physician working in New York City. Her writing has been published in Slate, the Daily Beast, the Atlantic, and the Washington Post.

Table of Contents

Introduction: No Little Thing

First Trimester

1 Nausea and Vomiting of Pregnancy Did We Save Enough of Your Life?

2 Choosing a Provider Scut Is Love 24

3 Genetic Testing Everything Is Probably Okay 35

Second Trimester

4 Anatomy Ultrasound Incidentalomas 65

Third Trimester

5 Periviable Birth A Necessary Story 95

Term Pregnancy

6 Trial of Labor after Cesarean Accept and Reject Intervention 107

7 Stillbirth When We Talk about Birth, We Need to Talk about Death 129

Going into the Hospital (Or Staying Out)

8 Informed Consent Sign Here and Don't Ask Too Many Questions 155

9 Medical Systems and Home Birth How Institutions Save You or Fail You or Both 185

Postpartum and Beyond

10 Maternal Mortality and Racial Disparities in Health Care Implicit, Complicit 223

Conclusion: Let's Go Home 243

Acknowledgments 259

Notes 263

Index 277

Editorial Reviews

12/02/2019

Karkowsky, a physician who specializes in maternal-fetal medicine, shares experiences and lessons for fellow medical providers and future parents in this educational, and sometimes harrowing, debut. She covers medical basics for prospective mothers, such as choosing a doctor (she recommends opting for one who displays “pragmatic compassion”) and undergoing prenatal diagnostic testing, discussing why it’s both important and challenging. In Karkowsky’s case, she relates how receiving test results that her—ultimately, perfectly healthy—daughter was at risk of being born with a genetic disorder “stole the joy” out of her pregnancy. She also explains “Medical Language, the official language of Doctor,” and how it allows doctors to “describe but distance” themselves from patients. But it’s the book’s case studies that provide it with drama and suspense. Stories from Karkowsky’s practice include the heartbreaking one of a mother faced with giving birth either via a traumatic cesarean procedure, to a baby which might survive, or vaginally, to a baby which almost certainly wouldn’t. Readers prepared for this book’s harder-hitting passages will find it an illuminating and often riveting report from the front lines of labor and delivery. Agent: Jessica Papin, Dystel, Goderich & Bourret. (Mar.)

Publishers Weekly

"Profound, gripping, unsparing, and compassionate, High Risk offers a nuanced examination of issues that impact so many of us, from a perspective we almost never get to hear. This is an important book that shines a critical light on the medicine and systems surrounding pregnancy and birth."

Rabbi Danya Ruttenberg

"Dr. Karkowsky knows her subject from the inside, and shows us, both through her narratives and her wise reflections on them, just why such 'knowledge is powerful and painful and damaging, but it's also powerful and healing and wonderful.'… Every doctor, medical student, and prospective parent should read it."

Terrence Holt

"Dr. Karkowsky unflinchingly probes the expectations, precedents, myths, realities, and curveballs of modern pregnancy and delivery. This book is a significant contribution to the discourse about women’s health and medicine today."

Danielle Ofri

"Pregnancies don’t always end up happily ever after, even in the skilled hands of a maternal-fetal medicine physician like Karkowsky. . . . [S]he provides a great deal of helpful information, carefully explaining an alphabet soup of acronyms . . . [S]he spells out why some pre-existing conditions in pregnant moms can lead to problems. . . . It’s reassuring to know that maternal deaths are rare and that doctors try so hard to help at-risk moms and their babies meet the odds."

Karen Springen

"What a gift to find a voice like Dr. Karkowsky's in the literary conversation around birth. Her humility, introspection, self-examination, and expertise is precisely what we need from our most highly trained specialists.… A fascinating dispatch from the front lines of high-risk obstetrics."

Elisa Albert

"An edifying and utterly enthralling meditation on the joys and sorrows of being a doctor at the frontlines of high-risk pregnancies. Dr. Chavi Eve Karkowsky is a clinician who loves what she does, who grapples with tough decisions and who cares deeply about women’s reproductive health…This book should be mandatory reading for any woman who has been pregnant or considering pregnancy and everyone who provides health care to women.”"

Randi H. Epstein

"As a physician and mother expecting my second child, I found this book to portray pregnancy as the nuanced and poignant experience that it is. A compelling and engaging read."

Dr. Leana Wen

01/01/2020

Reflecting her journalistic and medical experience, Karkowsky's first book uses stories of former patients, statistics, and historical references to portray the world of high-risk pregnancy. The book is organized around the stages of pregnancy, and chapters cover issues relating to each trimester, including the increased use of genetic testing, the challenges of medical language and miscommunication, the resurgence of home births, the difficulties of Cesarean deliveries, and maternal and infant mortality patterns. Karkowsky candidly acknowledges the ongoing problem of implicit bias and its harmful impact on black patients. This well-written narrative is moving and medically dense. Clearly not a simple pregnancy manual for the average patient, the book provides vivid insights into the more intense aspects of reproductive medicine. VERDICT Karkowsky raises important issues concerning patient autonomy and the treatment of women in the health care system. For those who enjoyed Perri Klass's The Real Life of a Pediatrician and anyone interested in the challenges of modern health care.—Antoinette Brinkman, formerly with Southwest Indiana Mental Health Ctr. Lib., Evansville

Library Journal

2019-11-20
A maternal-fetal medicine specialist explores the intricacies of pregnancy.

Karkowsky (Obstetrics and Gynecology/Albert Einstein Coll. of Medicine) begins her high-risk tales with the account of a pregnant woman over 40 who "had almost no working organs in her body" and was on dialysis three times per week. Through meticulous monitoring and in-hospital care, she had a successful cesarean delivery of a preterm infant who survived intensive care and went home. The author then takes readers through the key elements of each trimester. Initially, it's often nausea and vomiting that, for an unlucky few, can persist through all nine months. Before IV hydration, such women could die. The second trimester is the time for genetic testing. Amniocentesis is a prime test for Down syndrome, but there are now less invasive tests for many genetic anomalies. An issue here is that false positives or negative rates can be high enough to make decision-making tough. Perils in the third trimester include preterm labor, stillbirths, hemorrhaging, and the soaring maternal blood pressure of potentially fatal preeclampsia/eclampsia. In addition to graphic accounts of complications, Karkowsky also examines how pregnancy care is evolving—not always for the better. She deplores the fact that cesarean deliveries account for one-third of all births in America today (malpractice fears? financial gain?), and she is incensed that maternal mortality is high among white women but three times higher for African American women—and not because of socio-economic factors. She suggests implicit bias is at work. The author believes consent forms are a mess and hates that women seeking a vaginal delivery after a cesarean birth have to sign a consent form to permit it. Overall, Karkowsky urges better communication between doctors and nurses and doctors and patients, especially in conveying tragic news. She also makes frequent references to her own experiences as a wife and mother, subject to some of the risks she describes.

A solid primer on pregnancy risks as well as a cogent plea for progress to make childbirth even less perilous.

Kirkus Reviews

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