William Harvey

In the early 17th century, before the scientific method began its ascendancy in the Western world, the Englishman William Harvey described how the blood circulates through the human body, solving a mystery that had stumped scientists for centuries.

Some other scientists — Galen, the ancient Greek; Ibn al-Nafis, who worked in Egypt in the 13th century; and Michael Servetus, a 16th-century Spaniard — had got a chunk of the story right.

William Harvey

William Harvey

Only Harvey, who assiduously tested his theories on living animals, figured out that blood circulates throughout the entire body.

He published his thesis in 1628, as On the Motion of the Heart and Blood in Animals. His discovery is considered one of the most important achievements in medical history.

Harvey introduced the "experimental and observational approach" to scientific inquiry, the British medical historian P.M. Dunn writes in an article for the Archives of Disease in Childhood.

In addition to his revolutionary work on blood, Harvey also advanced our understanding of human reproduction. His practice extended to obstetrics, and he was interested in and knowledgeable about birth.

Harvey's 1651 book On the Generation of Animals, published with the stunning essay "On Parturition," debunked the idea that embryos were fully formed at conception, and advanced the theory of epigenesis, which held correctly that a chick, for example, grew all its various parts from a single cell.

Harvey also addressed labor, advising birth attendants to let nature take its course rather than to intervene unnecessarily. Harvey's tract was the first original work on obstetrics written by an Englishman. Aside from these famous works, the rest of his prodigious writing has been lost.

What remains is "truly remarkable when judged against the ignorance of the times and the prevalent reliance on ancient authority," Dunn writes of Harvey.

Fascinated with blood

I'm embarking on a series of posts about blood. I can't help it. I'm fascinated with blood.

The final classic symptom of amniotic fluid embolism is disseminated intravascular coagulation (DIC). When I suffered an AFE during the birth of my younger daughter, I was nothing but classic.

Edward Cullen
Also fascinated by blood

I hemorrhaged to the point where all the blood ran out of my body three times over. I didn't die from this event because I received a total of 87 units of blood and blood products — whole blood, plasma, cryoprecipitate and extra clotting factor.

I am alive to tell our birth story because thoughtful strangers had donated their blood, a large stockpile of blood was five minutes away when I needed it, and because a whole raft of people had done the work over centuries to figure out how to make someone else's blood work in my body.

And, by 1997, the blood supply had been made safe again, after a horrific tainting with the HIV/AIDS virus.

The bill for my daughter's birth, including two surgeries (a Caesarean section and separate hysterectomy performed to stop the bleeding), a stint for the baby in the high-risk nursery, a night for me in the intensive-care unit and an additional four days in the hospital, was $100,000 all those years ago.

Blood accounted for $13,000, more than 10 percent of the total.

Blood was a major factor in giving our birth story a happy ending. Fascinating!

On the cusp

This is my 75th post, something of a milestone for me, especially as it coincides with roughly six months of blogging — and a change of status.

I was part of a group laid off last week from the Chicago Sun-Times, where I had loved, loved, loved being a features reporter. The economics of print journalism caught up with me, as they have with so many others.

Where do I go from here? This is no idle question for me, and I'm just beginning to work out the answer.

Over the course of the past couple of years, I have enjoyed learning about new media, and now here I am, with both feet in the 21st century. I blog three times a week, I tweet, I even built my own website (with lots of help).

At the same time, I believe in the values of old media — checking facts, maintaining a certain distance from sources, and allowing both sides to have their say in a civil discourse.

Even while I find myself slipping into the conventions of the new, I hang onto my belief that the best journalism serves the reader's need to know about, and understand, the society she lives in.

I think I have picked a great topic to write about, because it seems to me that birth is on the cusp, just like me. Modern medicine knows how to make birth safe, and yet the maternal mortality rate appears to be going up.

Not only that, but I can't help but notice that while 99 percent of American women have their babies in hospitals, most of the voices making themselves heard in books and blogs belong to women who are dissatisfied with and critical of the hospital experience.

And with Caesarean-section rates rising out of all proportion to any statistical need for their use, those voices are gaining an intelligent and often passionate following.

Where do we go from here? I believe that one thing that will help us answer that question is an understanding of how far we have come.

 

ACOG vs. midwives in NY

A fight worth watching is shaping up in the New York State Legislature, where a bill that would ease restrictions on the practice of midwifery has attracted opposition from the American Congress of Obstetricians and Gynecologists, the new political arm of the 59-year-old organization that represents physicians who specialize in caring for women.

The bill, dubbed the Midwifery Modernization Act by its supporters, would give midwives the right to attend pregnant women without first obtaining a written practice agreement from a medical doctor.

On June 17, ACOG held a press conference in Albany to warn that the bill could compromise the safety of mothers and babies by exposing them to the risk of delivering without medical backup in the event of an emergency.

Midwives say that they sometimes have a hard time finding a doctor, say, in rural areas, willing and able provide a written practice agreement. And, they say, the problem is not confined to the boondocks.Pregnant Graffiti

After St. Vincent's Hospital in New York City closed last April, seven midwives who attend home births found themselves without a practice agreement, according to a story in the New York Times. St. Vincent's, a Catholic hospital, reportedly was uncommonly sympathetic to home births.

New York has as many as 900 midwives, more than any other state, according to Laura Sheperis, president of the New York Association of Licensed Midwives, in a separate story. Fifteen states so far do not require written practice agreements, which Sheperis has characterized as a "cumbersome and unnecessary barrier to health care and provider choice."

The bill would not prohibit doctors and midwives from creating written practice agreements; it would remove the requirement for them.

ACOG came out swinging against home births (along with the American Medical Association) in 2008 in response to "The Business of Being Born," a film that featured the home birth experience of actress/former talk-show host Ricki Lake.

"...Monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies," ACOG stated in 2008.

Obstetricians deliver about 70 percent of American babies, while midwives, mostly nurse-midwives, handled roughly 8 percent of births in 2004. Family physicians attend about 20 percent of American births.

"Pregnant Graffiti" by Petteri Sulonen

Being there

There is more than one way of looking at this, I know, but I believe I cheated death when I survived an amniotic fluid embolism during my younger daughter's birth in 1997. These extra 13 years, and counting, seem like a stupendous lagniappe tacked onto the lifetime I was meant to have.

That might be why, every so often, an event comes along that reduces me to a heap of gratitude for the medical advances, the professional competence, the technology — and the luck — that saved me. My older daughter's college graduation last week was one of those events.

Nora's graduation
Nora

Nora had just turned 10 when Maeve was born. She had not enjoyed being an only child, and was thrilled about the prospect of welcoming a new baby into our family. I had spent 4 1/2 months on bedrest, punctuated by a couple of terrifying bleeding incidents, which Nora had suffered through along with her dad and me. We were all relieved when the pregnancy reached term, and I went into Prentice Women's Hospital for a scheduled induction.

That fall Friday was a holiday from school, and Nora was off picking apples with friends in a far suburb, hoping that when she came home she would meet her new sister or brother.

She came back instead to a phone call from her dad, telling her about Maeve, who by that time was swaddled up in Prentice's high-risk nursery. Nora wanted to talk with me, but her dad said I had had a rough time and couldn't come to the phone. At the time he was talking with her, he still didn't know if I would live or die.

What if I hadn't survived? Both my girls would have been motherless, but Maeve wouldn't have known anything else. Nora would have suffered a devastating loss.

That didn't happen, of course. Because I have been there these 13 years, I know the scrapes Nora has been through, the joys, the disappointments, the accomplishments. Success in school never came easily to her, but last week, she graduated cum laude from DePaul University in Chicago.

I don't want to take credit for Nora's successes, but I do believe that mothers make a difference in their children's lives. I am proud of the wonderful young woman my daughter has become, and I am grateful that I have been there to see it.