12.02.2010

Book review: Origins

I just finished Origins:  How the Nine Months Before Birth Shape the Rest of Our Lives (Annie Murphy Paul, Free Press, 2010).  I read it because I'm doing some research and writing now on prenatal testing, and I thought this book might be relevant.

Let me preface my thoughts by saying that Trey might accuse me of having a bad attitude.  And he might be right.  So I'll try to be reasonable, but I suspect there will be quite a lot of snarkiness.

Here is my general review:  if you are pregnant, do not pick this book up.  I'm very glad I didn't read this book while I was pregnant.  I'm not pregnant, and yet reading it made me a bit antsy, because the whole book is about fetal origins.  It's about the ways in which the nine months in utero shape a person--and not only that person, but future generations of persons.  If you're exposed to certain sorts of toxins, or have certain sorts of bad experiences/feelings/thoughts, or ingest certain sorts of wrong things, your child could be affected--and then your grandchild, and great-grandchild, and so on.  For real.  You could fuck up whole generations of your family if you do the wrong thing as a pregnant woman.

Paul wrote the book while she was pregnant, so she repeatedly acknowledges that this sort of research could be used to make pregnant women (and mothers) feel guiltier and more worried than they already feel.  She notes, "It's all too easy to imagine how fetal origins research could become the basis for a whole new species of mother-blame, finding fault with mothers even before their children are born."  She was aware of the dangers--and aware in her personal experience as well as in the abstract--but she expressed hope that this research could instead be used to make the world a better place for pregnant women.

But the scientific research she cites generally focuses on the dangers, the ways in which fetuses can be and have been harmed.  So I came away from the book not feeling encouraged about changing the world, but guilty about the ways in which I might have unknowingly damaged Maybelle and future generations of Biffle-Piepmeiers.  And as a small but significant complaint, I'd like to point out that she had a lot to say about IQ.  Like, such and such behavior can lower a child's IQ.  Testing three years out shows lower IQs for babies with low birthweights, babies whose mothers had experienced high stress, babies whose mothers ate too much or too little, babies whose mothers had the wrong hairstyles.  And I get that we're all concerned about IQ; I certainly was when I was a pregnant woman, although I knew even then that IQ testing was sketchy.  Now, for perhaps obvious reasons, I'm a bit skeptical of an emphasis on IQ as a key factor that determines someone's health, well-being, and general quality of life.  Just saying.

I know that it's not Paul's job to be a scientific researcher, but some of the science she cites struck me as dubious--like the claim at the end that a C-section might be a preferable birth for a person because it doesn't cause the baby any pain (and yet the other person involved in the C-section has a significantly more difficult healing process, right?).  So, in general, I don't recommend this book.  Pregnant women should stay far, far away from it.

13 comments:

Amanda said...

I'm mad at this book already and haven't even read it. It's almost impossible, especially in our culture, not to be stressed out when you're pregnant - and I'm sure that's one of the negatives she mentions. A glass of wine might help with the stress, but I'm sure that's on the no-no list, too. Beyond that fact, IQ isn't a measure of well-being and success, and even if it were, it's not an objective or accurate measurement. Finally, the part about C-sections just leaves me shaking my head. Who says childbirth is painful to the baby? And what about epidurals which cross the placental barrier? My friends and others of our generation were grown in utero on cigarettes and cream sherry, and if our IQs are diminished, so be it. There are more important things to worry about, like cholera in Haiti and malaria.

Aaron Piepmeier said...

I'd like to read this book.

When dealing with people (development, cognitive function, mental health, etc) it's important to remember that we (and our brains) are plastic, not rigid. Change is what our body does best. What I mean by this, is that just because something happens in utero it doesn't mean this is where this change stops. It'll keep going.

I agree that a focus on IQ is not the best argument to be making. A better argument would be to talk about brain volume variances between differences conditions (abused, malnourished, etc.).

OK. That's it. Just a warning, in the next few years I'll be ears deep in developmental/cognitive psych lit. So, maybe I'll be able to converse on the blog a bit more.

Alison said...

Here's a comment from Claire, who is somehow forbidden by all Blogger blogs from being able to post comments:

I read an article (somewhere?) recently that made an interesting argument about vaginal birth and exposure to necessary bacteria – and that somewhere docs are bathing babies in some sort of bacterial yogurt after a c-section because they noted higher rates of asthma in c-section babies. So there to c-sections (what responsible person writes a book praising c-sections? )

Anonymous said...

I had level four tearing with my natural birth, so the c-sections I had after were nothing, I cannot even compare the amount of pain I went through the first time to the nothingness of everything of the process and recovery of two c-sections. So...
but why wouldn't keeping an infant from the pain and compression of natural childbirth be potentially good for them. My first child's head was extremely compressed, and I know the very long labor had to be a stressor for her. I did attachment parenting to keep them from stress when their brains were so young and (from what I could read) sensitive to the stress hormones in even more serious ways than we are as adults.

That said, shouldn't pregnant women (I'm one again now) just be philosophical about this? Of course you can't bring about a perfect environment. Who expects to? In any context? That would be a problem. This is not a big problem- those who are hoping for some weird perfection or control are just in need of thinking long term and more comprehensively about life. It isn't a contest.

TMae said...

I haven't read this book, but I am HIGHLY skeptical of creating any more ammunition for the pregnancy police. Like Amanda says, a glass of wine might do mom good on occasion during pregnancy, but in the United States mom better have that glass of wine in a dark closet in her house, or be very VERY prepared to ignite a fury diverted eyes and whispers. I hate the pervasive attitude in the U.S. that subverts the autonomy of women to their unborn fetuses, and I feel like this book might tow that line.

Might not. Maybe I should read it...

Taylor said...

Jeez! Is this book about fetal forecasting?! That's the idea that in utero fetuses "decide" and put limits on certain things like metabolism and age of puberty, that have ramifications on their susceptibility to disease later in life. First of all, this is all speculative. As Aaron mentioned, humans are very plastic. Individuals and different populations are all effected differently by environment, genetics, evolution, and culture (check out Margaret Lock's work on local biologies). Instead of focusing on all the "bad" things mothers do to their fetuses, can we focus on social and cultural reasons for why certain mothers are more likely to have low birth weight and premature babies? These women are more likely to experience racism (which has been linked to premature birth) and not have prenatal care because of a lack of accessible, affordable, and appropriate healthcare, nutritious foods, and safe environments.

Oh, Claire is totally right, C/section babies are more likely to have asthma and allergies because they are not exposed to the good bacteria in the vagina and anus.

Plus, know IQ tests measure? How well you can take an IQ test. They are culturally-contingent and the people that make them are usually American born, white, upper-middle class males. So guess who usually has the highest IQ score? American born, white, upper middle class males.

And C/sections are TERRIBLE! Your baby is drugged via anesthesia, and so are you, so you can't breastfeed early after delivery. Thus putting you at risk for breastfeeding problems. Plus, it's major surgery! Hope you don't want to pick up your baby for 2 weeks, because you can't. Not only are you uncomfortable because of the effects of the anesthesia, having your abdominal wall sliced through, and being given antibiotics and tons of fluid, but you are also at risk for catching a "superbug" at a hospital. One mom this week is in critical condition because of necrotizing facetis--a complication from her C/section.

Ok, I am now off of my feminist medical anthropologist soap box.

Anonymous said...

These reviews seem so unfair to the author. I wonder if she could be asked to weigh in. If she actually did make her data up, or asked why she thinks women can handle information like this. She is being accused of misrepresenting the science because things don't "strike" the reader as right. That seems so unfair. Just research the matter and give her a fighting chance. I think sense can be made of the author's one criticized claim as stated. As stated (human birth may not be ideal) I'd like to applaud it since it encourages a thinking attitude toward some static benevolent idea of "nature", which is warranted by the selection process that got us here...

And then in this thread it is asserted that we know the cause of asthma (we do not, and it is not the case that most people with asthma came from c-sections) YET MAKING THIS ARGUMENT, along with the one about the epidural harming the baby- is doing what the author is being accused of... it is just a matter of arguing for one conclusion over another on the basis of the science. (Although I would assume that to get published, the author had data to support her claim...)

Even if people think c-sections are terrible, they save lives in a large percentages of cases. So please don't deride a technique that is so necessary. Even if you believe in a big conspiracy among immoral doctors to push c-sections (so evil of them, those evil doctors) the women getting them are assumed to be too vain and stupid and unlike you to have made their own choice? Furthermore, it is strange to deride a technique that is lifesaving. Think of the women who die because they cannot get c-sections, worldwide. And the asthma link- wholly unproven- kind of shows that there is a wish for data to make a case already chosen in advance of any. (As women with c-sections can tell you, they did breastfeed and pick up their babies.)

What worries me too is this tone of "women are so dumb" that they can't be expected to handle learning about (even reliable) information on fetal development. I mean, give me a break. Do female OB's not have children? What is going on here? What makes anyone think women are this weak or stupid? I know no women who cannot handle reading information on fetal development or anything else. The pregnant women I know were competent at everything they did. They kept working at the highest levels giving lie to the idea that women are somehow incapable of this when pregnant- and here I read that these wilting flowers should not be exposed to a pop science book? We know different women, I guess.

Women can have healthy babies while fleeing a war (I know some who have) or while living in refugee camps (and they do), and this might be more stress than is involved in trying to make the perfect child to compete with some imagined peers. I think anyone who has the second kind of stress is wrong for having that aim. Why can't that be the upside of this book?

Joel said...

Haven't read the book, but it seems that the majority of that research is correlational and, by its very nature, unable to demonstrate causality. For example, low birthweight is associated with many possible other problems - prematurity, certain congenital disorders, etc. These are what contribute to the IQ change, as well as the environment, social, and cultural orientation of the child as it grows. The birthweight is a symptom of a myriad of other possible overarching issues, not a cause. Regarding epidurals and spinals, most cesarean sections are done under spinal anesthesia and the amount of drug needed for that means that drugs in the baby are virtually undetectable and are not present in clinically significant amounts. The same is true for epidurals. The association between cesarean section and respiratory issues in babies is well-documented. There are two theories currently about why and the truth is likely that both contribute to the respiratory issues seen. The first was raised by your readers and is that the baby is innoculated with beneficial bacteria during its passage along the birth canal, although some women have some bacteria and things there which may not be so beneficial as well. The second is that the baby breathes amniotic fluid during gestation, and the passage through the birth canal, with contractions, acts much like the old wringer clothes driers and squeezes the majority of that amniotic fluid out of the lungs before they take their first breath. I agree that cesarean sections are dangerous. Any surgery involves risks, and the decision to go to the operating room has to be made based on the balance of risks for and against the surgery. There are times when the risks of not having a c section are much higher than the risks of having one. Either way, you can breast feed soon after your cesarean section without worrying about drugging your child if it was done with an epidural or spinal. As that medication wears off and you need to take oral pain medication, that can theoretically be a problem, though the necessary doses for pain control do not often reach the level needed to cause significant sedation in the babies.
Alison, I still check in occasionally, and it is a joy to watch your brain work.
JB

Myrlyn said...

Wow, Alison, you've opened a hell of a can of worms.

I can see where everyone's coming from with the correlation versus causation argument. Really, how the hell do you know what causes what with a baby when you cannot test these things in the infant immediately after birth? Not doing so hot on an IQ test very well might be what happened when you were still in the womb-- but it might also be because of... I dunno, one of the millions of other things that people say cause it, or something that people don't know that cause lowered IQ levels. Or maybe the kid's not that bright. Or has Down's. That happens, and none of them are anyone's fault.

Plus, really, what is this but a way to 'win' a non-existent competition? Or, even worse, take a very firm, controlling hand on who your child is when s/he's born, which is not your place, and even if it was, is a bad idea, because even if you can control what they're like at birth, Life happens.

I don't want to start anything, but I would like to point out to the lady that was all about how evil C-sections are-- seriously, for real, while natural might be the proper way to do it, it saves lives. My niece would've died in the birth canal if she'd gone that way. Now, my sister in law hates the wound, but she got to hold her daughter for nine days longer than she would have gotten to.
Also, the asthma bit? Who the hell said that? There's a lot of things that cause asthma, sure, and it is a growing problem, but... really? C-sections? Even if that were a causation issue, I think we need to eliminate other causes before we concern ourselves with that one. I was a natural birth, totally natural, and I still have the crappiest lungs this side of the universe. And my brothers and sisters do not. And the baby boy who Mom actually did get a good epidural with has a good set of lungs, too.

Third-- who's to say what's good and bad for your baby in utero? Who's to say what's good and bad for a future mother during her pregnancy? Yeah, there are consistencies-- you need your vitamins, you need to eat and sleep properly, you need to avoid heavy lifting/strenuous activity, don't snort cocaine, etc., but in the end, we're all snowflakes, and individual needs are individual needs, and that goes for the unborn. What affects you this way may not affect the lady down the road and vice versa. It's a crapshoot at best.

And, just a thought someone brought up to me-- what if the color of your doctor's scrubs influences what you become? (Which would explain to me why so many people I know love the color green...) All that in utero business? How could you possibly expect to be 'perfect' and not negatively affect your baby when something that trivial does something powerful?

That, and, really-- flaws are what make a person. Everyone can be loyal and respecting and a hard-worker-- but only you are loyal, hard-working, and love to roll up the car windows and let out a silent but deadly, or go as long as possible without blowing your nose and make that obnoxious snorting sound for hours.

Biffle said...

joel...

It sure is comforting to know that alison was in the hands of such competent, caring and thoughtful people....

Alison said...

Okay, folks, you have had a LOT of good things to say! Thank you for weighing in! Later today I'll have a post up at Girl w/Pen about this.

smartalek said...

Taylor said...
"So guess who usually has the highest IQ score? American born, white, upper middle class males."

Apologies for the interruption (not trying to derail here), but IIRC, it's Asian-Americans who tend to do best on IQ tests (as well as on a number of other standardized exams usually used as an acceptance criterion at the most "competitive" of colleges and grad programs).
Of course, this does beg the question of whether any of these exams measure anything that's of real significance in the world.
And on that, Taylor is almost certainly right... as well as on the more important concern, which is that the single best predictor of a person's SAT score is... wait for it... parental income.
Sadly, however, all this doesn't change the fact that, rightly or wrongly, these standardized tests are a key mechanism by which access to certain forms of higher ed is granted... or withheld.
And since higher-IQ kids *are* advantaged (and hugely so) in this respect, it's not totally unreasonable for a parent to want their kid to have the best possible chance at doing well on that kind of metric.

Anonymous said...

http://www.americanpregnancy.org/labornbirth/cesareanrisks.html

Note:

# Breathing problems: When delivered by cesarean, a baby is more likely to have breathing and respiratory difficulties. Some studies show an increased need for assistance with breathing and immediate care after a cesarean than with a vaginal delivery7.
# Low APGAR scores: Low APGAR scores can be the result of anesthesia, fetal distress before the delivery or lack of stimulation during delivery (vaginal birth provides natural stimulation to the baby while in the birth canal). Babies born by cesarean are 50% more likely to have lower APGAR scores than those born vaginally8.