In the tradition of Jessica Mitford’s The American Way of Death, an eye-opening work of investigative journalism that challenges our common wisdom about pregnancy, childbirth, and the first year of a baby’s life, showing how the mother and child’s wellbeing are often undermined by corporate profit margins and the private interests of the medical community.
Why, despite our state-of-the-art medical technology, does the United States have among the highest maternal and infant mortality rates in the industrialized world? Why do pregnant women who are planning to breastfeed receive “free” samples of infant formula from American obstetricians? Why are American newborns given a vaccine at birth against hepatitis B, a sexually transmitted disease? The Business of Baby, an eye-opening work of investigative journalism, exposes how our current cultural practices during pregnancy, childbirth, and the first year of a baby’s life are not based on the best evidence or the most modern science, revealing how American moms and their babies are being undermined by corporate interests. An illuminating combination of meticulous research and in-depth interviews with parents, doctors, midwives, nurses, health care administrators, and scientists, Margulis’s impassioned and eloquent critique is shocking, groundbreaking, and revelatory. The Business of Baby arms parents with the information they need to make informed decisions about their own health and the health of their infants.
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About the Author
Jennifer Margulis, PhD, is an award-winning journalist and Fulbright grantee. Her work has been published in The New York Times; The Washington Post; O, The Oprah Magazine; Parents; Parenting; Brain, Child; Mothering Magazine; More Magazine and on the cover of Smithsonian. A Boston native, she lives in Ashland, Oregon with her husband and four children.
Read an Excerpt
Your Baby, Your Way
“You’re going to have so much fun,” I said with a smile to a friend when she was thirty-nine weeks pregnant. Whitney’s jaw dropped to her knees.
“Fun?” she cried. “No one has ever told me that before!”
In this age of oversharing and infinite access to free advice on the Internet, the sheer joy of pregnancy and childbirth often gets left out of the equation. But it is joyful. And fun. When expectant couples ask me how best to prepare for childbirth, I share with them my twist on midwife Ina Gaskin’s sage advice and suggest they compile a list of jokes, the bawdier the better; to smooch like crazy during labor (you probably won’t want to, but do it anyway); and to remember that a woman’s body is powerful, that we are connected to the generations of women who all came before us, and that our bodies and our babies usually know just what to do.
Which does not mean it’s easy. During my last pregnancy, I trotted behind my six-year-old son as he bicycled to the park, did calisthenics, and took a prenatal swim class. I ate as healthily as I could, and tried to teach myself to meditate. With three children clambering for my attention, I did not successfully master the meditation part. Still, I made time several days a week to float in a warm bath and repeat positive phrases in my head: I am a healthy mama. I will have a healthy baby. I am powerful. I will have a gentle birth. My baby and I know just what to do. Then I would heave my mountainous belly out of the tub feeling centered and relaxed, excited about the imminent birth, patting myself on the proverbial back for being so proactive about preparing for labor.
I would be a beautiful, glowing, laboring woman, an expert at birth. We planned to have the baby at home and I was sure this would be my most peaceful labor. I had been reading about pain perception and had been telling myself the labor would not be painful, that I would ride the contractions instead of fighting against them.
You know where this story is going, right?
The timer on the bun in the oven did not go off until seven days after my estimated due date, and by then I was as big as a house, my belly button had popped out like a fleshy nose, and I was sure the baby would be a full-grown adult before deciding to make an entrance into the world.
Then one Wednesday morning I woke up feeling crampy. I had had lots of contractions before (Braxton Hicks, or practice contractions), and what I was feeling was intense but I wouldn’t describe it as painful. I honestly wasn’t sure if I was in labor. My eight-year-old daughter wasn’t as uncertain. She brought the joke list she had prepared for my labor into the kitchen. Another contraction. This one took my breath away.
“Where did the seaweed find a job?” My daughter asked. I leaned against the kitchen counter, gritted my teeth, raised my eyebrows quizzically in her direction, and tried to remember to breathe.
“The kelp wanted ads!”
I threw back my head and laughed.
To date, this is the funniest joke I have ever heard.
My husband, James, took our kids to school. I had an article due, but I was too restless to sit at the computer and write. I rather reluctantly emailed my editor to tell her I thought I might be in labor and ask for an extension.
“Do you think I’m in labor or am I just being a wimp?” I asked when James finally came back.
“You’re just being a wimp,” he joked.
Three hours later I was making the most primitive animal noises you have ever heard. My plan to be calm and centered had gone out the window and I was howling and screaming. Somewhere in my rational brain I remembered to tell myself that my mother and my grandmother and her mother before her had all survived labor, which I found deeply comforting. But there I was in full-blown, toe-curling transition, sounding like a charging elephant when I had planned to be in perfect control. Labor is humbling.
When you get pregnant for the first time (or have started trying to get pregnant), you see pregnant women and new moms everywhere. They’re in the supermarket rubbing their bellies absentmindedly, in the parking lot wrestling with car seats and strollers, in the park wiping spit-up off their shirts. It’s amazing how there are so many more pregnant mamas and infants in the world when you are expecting.
And everyone seems to notice you. Whether it’s the kindhearted, white-haired lady who eyes your belly wistfully and confides that she “just loved being a mom,” the taxi dispatcher who ushers you to the front of the line, or your older child’s soccer coach who nods appreciatively at your full figure and says “you’ve really got your glow on” (prompting you to go home and take a shower), people are looking at you.
Once your pregnancy starts to show, you gain entrance into a club you never knew existed. Suddenly women—and their partners—are eagerly sharing their birth stories, requesting to rub your belly, and calling open season on giving you advice, whether you want it or not. People think nothing of asking you what are actually quite intimate questions about your horizontal relations (“Was it a surprise?”) and what were once your private parts (“Are you planning to breastfeed?”). It’s as if the body that was once only yours now belongs to the community.
Though the belly-rubbing liberties and unsolicited advice might drive you crazy, try to appreciate the attention. After all, you do have your “glow on” (nonstop burping, aches in muscles you never knew existed, and varicose veins aside). Pregnancy is a fascinating, bizarre, and life-altering time of life: you are growing an entire human being in your body. Your body knows how to make eyebrows for a whole other person. What could be cooler than that?
But all too often, pregnant women in the United States are not treated with the awe and excitement that should be their due. Instead of celebrating pregnancy as a state of health, and childbirth as an empowering rite of passage into motherhood, we have come to think of pregnancy as an illness, a terrifying journey that might result in a healthy baby and a healthy mom (if you follow the doctor’s orders and are very lucky), but is otherwise fraught with danger at every turn.
The sad truth is that pregnancy and childbirth have become so overmedicalized in the United States that it is actually more dangerous to have a baby today than it was twenty years ago. If you’re pregnant, I know you may already be feeling a little nervous and I don’t want to scare you, but the United States has one of the highest—if not the highest—maternal mortality rate of any industrialized country. And most people don’t realize that our infant mortality rates, while improving, remain ignominiously high.
The mainstream media like to blame American women for our current maternity health crisis: We are too fat, too old, or too diabetic when we conceive. But the science—as you will see in this book—tells a very different story. While poor outcomes are certainly caused in part by unhealthy eating, lack of exercise, and chronic health conditions, the biggest factor contributing to our difficulties during pregnancy, childbirth, and our baby’s first year of life is a system of for-profit medical care that prioritizes doctor convenience and hospital profits over healthy moms and healthy babies. American women’s bodies are not broken, incompetent, or incapable. But our health care system has stacked the deck against us.
If you have already had a baby and you are reading this because you feel unhappy about the way you were treated in the hospital, or are trying to make sense of what happened to you and why, you may find some of what you read in this book painful. It will be hard to learn that continuous fetal monitoring has been discontinued in countries with better birth outcomes after scientific research definitively showed that continuous monitoring does not improve pregnancy outcomes but does lead to unnecessary Cesarean births. If you chose to circumcise your first son because a doctor, who was himself circumcised at birth, recommended it, chuckling at your concerns and reassuring you in a patronizing tone that infants don’t feel pain, you may wince to discover that an increasing number of doctors are refusing to do infant circumcisions because it is a cosmetic, not a medical, procedure for newborns. Human babies not only feel pain (just like every other mammal), but we know now that pain can cause lasting trauma.
It took me years to come to terms with how I was treated during my first pregnancy and delivery. When my husband and I came home from the hospital with a healthy, olive-skinned baby girl who had elfin ears and frog-like legs, we were proud, terrified, and ecstatic, but we had no idea what we were doing. We were both in graduate school at Emory University, we had very few friends with children, and no family nearby. Holding my tiny new baby in my arms, it was easier and more reassuring to tell myself that the doctors in the hospital had saved my life, that birth was dangerous, that all the interventions I had were necessary. I had painful bleeding hemorrhoids and it took weeks for my leg to stop being numb from an epidural (I had asked the nurse to turn down the medicine; she ignored me). I convinced myself that my body was broken. It didn’t matter that I was twenty-nine years old, eating well, and in the best physical shape of my life. It didn’t matter that I had gained only twenty pounds during my pregnancy. It didn’t matter that the women in my family have wide hips and relatively easy births. The doctors implied by their actions that my body was broken. And I believed them.
Coming home from the hospital, I quickly learned that taking care of a newborn is a tremendous adjustment. In those heady hormonal days just after our baby was born, taking a shower and getting dressed felt like accomplishments. Someone told me back then that the days can be long—even interminable—but the years go by quickly. She was right. I have four children now and they are growing up so fast it makes my head spin. That seven-pound, one-ounce baby girl born at Crawford-Long Hospital in Atlanta, Georgia, is now fifteen years old and just passed her learner’s permit test.
It took many years; many thoughtful words of wisdom from knowledgeable, experienced, and gentle birth practitioners; three subsequent births; and an enormous amount of research into the physiology of pregnancy and childbirth for me to realize that there was nothing wrong with my body when I gave birth for the first time. A woman in labor is in a heightened state of awareness and vulnerability. How she is treated and what is said to her will have profound effects on her confidence. I slowly came to understand that the way things went during my daughter’s birth were caused by a broken system that included a burned-out labor and delivery nurse; impatient, incompetent doctors whose prejudices about birth (that it must be aggressively managed, that women don’t know their own bodies) affected my experience; and faulty hospital policy based on profitability, not best practices.
Women who experience profound grief—or even any bad or mixed feelings—after the birth of a child are often met with confused reactions. “You have a healthy baby,” friends and family will exclaim. “Why are you complaining?” No one disagrees that it is a wonderful gift to have a child (albeit a sometimes difficult, often overwhelming, and certainly poop-happy gift). But I disagree that having a healthy baby is the only goal of pregnancy and childbirth. Every woman has the right not only to have a healthy baby, but also to have a happy, empowering, inspiring birth experience, as well as to enjoy her baby’s first years of life.
My intention in writing this book is to empower you to make the happiest, healthiest decisions you can for yourself and your family. You won’t find conventional parenting “advice” in this book, “advice” that is often disseminated by corporate America and a for-profit medical system to target women at the most vulnerable time of their lives in order to sell them products. Instead, you will find the information you need to help you make your important choices. A nice side effect of becoming knowledgeable about birth and alternative practices is that almost 100 percent of the time the “alternative” methods are cheaper, easier, and more convenient in the long run. When you learn that the baby soap used in hospitals actually contains a host of unpronounceable, possibly toxic ingredients and that studies show there is no need to wash a baby, you may choose not to use any soap on your baby (since it’s completely unnecessary and may actually be harmful), inadvertently saving your family hundreds of dollars a year. When you discover that Americans spend upward of $27 million a day on “disposable” diapers, and that diaper manufactures have a perverse and very real financial incentive to discourage American parents from potty training, you may decide to use cloth diapers, forgo diapers altogether, teach your child to use the potty early, or all three, saving $2,400 (the average cost of diapering a child in “disposables”) and keeping plastic waste and human fecal matter out of the landfills to boot. Or then again, you may decide to stick to conventional methods.
I do not believe there is “one right way” to do things when it comes to parenting. Perhaps the best example is the controversial topic of vaccines (Chapter 9). Parents who choose to vaccinate differently are often unfairly vilified in the media, and their children—no matter how healthy—sometimes even kicked out of pediatric practices. Yet I believe that how, when, and even if you vaccinate your children is your choice. I have a healthy respect for vaccines, am myself übervaccinated (I lived and worked in one of the poorest countries in the world, so I’ve had vaccines for diseases that most Americans have never heard of), and have chosen to vaccinate my children. But I have been accused of being an “antivaccine fanatic.” Why? Because I do not have an irrational fear of unvaccinated children or the childhood illnesses that vaccines help prevent. I support every parent’s right to vaccinate their babies their way, and I have continued to publicly push for more evidence-based and safer national vaccine schedules.
You know your body, your baby, and your family better than anyone else does. You don’t need experts to tell you what to do, though their advice certainly comes in handy sometimes. But you do need to have the whole story. That’s what this book gives you. With that knowledge, you get to have your baby your way.
Your Baby, Your Way is the culmination of more than a decade of research and fifteen years of parenting. Though you will find information in this book that you have not read elsewhere, when you check the endnotes (which I encourage you to do), you will see that the majority of the science presented here comes from peer-reviewed medical journals, government documents, and other mainstream sources.
In our for-profit medical system and culture at large, pregnant women are consumers. Yet most of us spend more time researching car seats than we do researching hospitals. Both deserve our scrutiny. Knowledge is power. As I’ve learned from my own experience and that of others, the more you inform yourself about your birth options and parenting choices, the healthier and happier you and your family will be.
What People are Saying About This
"A new mother's first instinct is to protect her newborn. But how can she best do that in a consumer culture so focused on its bottom line? The Business of Baby exposes some hard and shocking facts about how even the most well-meaning American parents unwittingly buy into systems that do documented harm. Thought-provoking and exhaustively researched, this book is destined to inspire much-needed dialogue about the current American way of birthing and caring for our young.
“Pregnancy and childbirth are wildly vulnerable times, andone is desperate to put one's faith in the doctor. Jennifer Margulis revealswhy that trust is sometimes misplaced, and helps us to make wise choices whenthe stakes are high. This is a must-read book for parents and parents-to-be,and for the medical professionals who care for us.”
“Jennifer Margulis's searing and well-researched exposé is a must-read for expectant mothers. Whether she is discussing common obstetric practices, circumcision, vaccination, breastfeeding, bottlefeeding, diapering, or choosing a pediatrician, she points the way to rational, health-based decision-making.”
Most Helpful Customer Reviews
This book was scary! I always knew that birthing babies had become a business, but I never realized just how bad it was. Jennifer Margulis really went to great lengths to get to the bottom of the truth. The way that the major corporations control the baby business is obscene. And the greed of doctors and hospitals to force unnecessary and expensive, and sometimes dangerous, procedures on women who think their doctors are looking out for their best interests, is horrific. As a nation, we have to stop blindly following the paths that everyone else are taking, especially when it comes to our babies, and get educated. We need to do our own research and make our own informed decisions. This is an invaluable book for all of the hard evidence Ms. Margulis presented. I highly recommend it.
I’m so glad to see that Ms Margulis has done this kind of book. Basically, this book and its author the 1st ones of this kind and which I have been waiting for. All of the others ones have focused on particular part/s of this/these subject/s or generalization of it. Know that I just started to read it, but I know its going to be worth the read and the buy in the long run. Decided to buy my own copy instead of borrowing it from the library. Unlike what I did with my previous book Homeward Bound: Why Women are Embracing the New Domesticity, Emily Matchar and which it turned out be a bad idea from the let go. In which I know this one isn't going to be and its what I have been looking forever. At least since I can remember. Think thats it for now.