Why More Medicine Doesn't Always Equal Better Medicine

Sometimes less is more when it comes to prenatal testing and maternity healthcare.


­I was listening recently to an episode of Fresh Air on NPR in which the show's host, Terry Gross, interviewed journalist Elisabeth Rosenthal on the high price of healthcare, and in which the two women spent quite a lot of time discussing US childbirth costs.

A few weeks back I blogged about Ms. Rosenthal's New York Times piece, "American Way of Birth, Costliest in the World," and told my own story about how I haggled for healthcare with my second pregnancy. In this week's Fresh Air interview, Rosenthal mentioned that "more medicine" doesn't necessarily equal "better medicine" and in fact, excess medical intervention often leads to "worse medicine." That's a really hard concept for many American mothers to wrap their heads around, but here's an example of what that looks like:

Lisa went to her six-month prenatal appointment feeling just fine. Her baby was moving well and her vital signs were normal. She was healthy, happy, and feeling good about her pregnancy. That is, until her doctor said, "Let's just do a quick ultrasound and make sure your baby's in the right position."

Not knowing any better, and because Lisa always liked taking a peek at her baby, she agreed to the procedure and hiked up her shirt. Her doctor squirted on the ultrasound jelly and said, "Just what I thought. Your baby is in an awkward sideways position. He's going to have to turn head down pretty soon if we're going to let you have a vaginal delivery. Otherwise, he might get stuck that way and I won't be surprised if we have to do a C-section."

And just like that, Lisa's happy, healthy pregnancy turned on a dime. All of a sudden, Lisa thought she had a pregnancy complication and her attitude about everything changed. She went from feeling good about her pregnancy to feeling worried that there was something wrong with her baby lying sideways in what we call a transverse position. She'd been committed to having a vaginal birth, but in the blink of an eye her doctor planted the seed that she might need a C-section. She went from feeling empowered to giving her doctor all the control. In fact, using that word "let" as in "if we're going to let you have a vaginal delivery" implies that she'll be lucky if he gives her permission to have a normal, vaginal birth.

There was nothing wrong with Lisa or her baby. Lisa had what I like to call a faux-complication. In truth, there's no reason in the world why she needed that "quick ultrasound." There was nothing wrong with her that needed checking out. Babies are small at six months and they flip and swim all over the place at that age.

If Lisa's doc took another quick peek half an hour later, he'd probably find her kiddo in some other position. By practicing "more medicine" as in "just a quick peek" (aka an unnecessary ultrasound that her doctor billed to Lisa's insurance), Lisa's doctor led her to believe she had a potentially big problem that will require additional follow-up ultrasounds and possibly a c-section.

In truth, Lisa needed none of that, and since her insurance only pays a portion of her medical bills, the price of Lisa's prenatal care and childbirth services just jumped to a much higher bracket.

Should Lisa have known better than to agree to that ultrasound? I hate to place the responsibility on the patient's shoulders, especially when the doctor knows better and the patient is young, pregnant and vulnerable, but the truth is that every patient should know better by now. We all need to be savvy medical consumers and approach our healthcare like smart shoppers. If you don't need it, don't buy it--no matter how cute your baby looks on the ultrasound screen.

When it comes to prenatal care and childbirth, we need to utilize a simpler, more common sense, "less is more" attitude. Save the extra interventions for the real complications. Right now, midwives are the experts in this type of low-intervention prenatal care because they're trained to see patients, pregnancy and childbirth as normal physiologic processes. Doctors are trained to see the complications. And far too often, if they don't see any on the surface, they go looking for trouble. It's time for doctors and patients alike to start using a different approach, namely: If it ain't broke, don't fix it.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to jeanne@jeannefaulkner.com.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.