Who do you want on your birth team?

Here's one Q & A exchange — the last one, in fact — from an interview Tara Parker-Pope, who writes the "Well" blog for the New York Times, conducted last year with Randi Hutter Epstein, physician, mother of four and author of the 2010 book on childbirth, Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank.

Q (TPP)  Should the care of women during childbirth be reserved for other women?

A (RHE)  I look at it as a doctor-patient relationship history, more than a man-woman kind of thing. When you hear women say, “I’d much rather give birth with a midwife than a doctor,’’ I think, “Why?” I love my ob-gyn. It’s sad people think you’ll have a nicer person if you avoid the medical system. That’s the feeling you get when you talk to women. I think if women had better relationships with their doctors, I think that would help. They would be more informed. They would believe the information their doctors tell them.

I agree with some of what Dr. Epstein is saying. I loved both my ob-gyns, too. I believe, though, that to choose a midwife for a birth attendant instead of a doctor is to opt for, or at least to attempt to have, a qualitatively different experience.

It isn't just a hope to deal with a nice person. It's embarking on a whole different journey.

What do you think? I would love to hear from you.

The art and science of women’s health

The Women's Health Initiative, a series of randomized controlled trials begun in 1991, was supposed to be definitive in terms of the role hormone-replacement theory would play in managing the health of post-menopausal women. However, the WHI has yielded unexpected and sometimes apparently inconsistent results.

The medical establishment expected the WHI to show that HRT, which had been popular for years, helped prevent cancer, heart disease and osteoporosis in older women.

L'Arlesienne / Vincent van Gogh
"Sheesh"

Instead, in 2002 researchers announced in the Journal of the American Medical Association that they had stopped the trials, which involved more than 160,000 women, because participants receiving estrogen combined with progesterone were developing invasive breast cancer at substantially higher rates than were women receiving a placebo, and their rates of heart disease were also high.

HRT, which to that point had been prescribed liberally for post-menopausal women, virtually disappeared as a therapy, in spite of the fact that it did seem to be helping women avoid hip fractures and colon cancer.

Just last week, though, again in JAMA, a group of WHI researchers reported that a smaller study of women who have had a hysterectomy, who were treated with estrogen alone for a median of 10.7 years, showed a decreased breast cancer risk with the treatment, with no significant increase in heart disease.

Well, that's disconcerting. Should post-menopausal women be asking their doctors about HRT after all? Probably not most of them.

“Women are different — it’s relevant to almost every medication and almost every intervention,” Joann E. Manson MD told Tara Parker-Pope in a story in last Sunday's New York Times.

“With this study, in many ways, science worked the way it’s supposed to work. It’s a little like watching sausage being made. It may seem on the surface that the study was a real problem and had many, many flaws, but in reality, it ended up giving invaluable information,” said Dr. Manson, a WHI investigator who is also chief of preventive medicine at Brigham and Women’s Hospital in Boston.

Adds Pope, "The most compelling lesson of the research should be that science is always worth the wait. Consumers should insist that doctors make recommendations based on scientific evidence, say investigators, rather than allowing drug companies or marketing hype to dictate patients’ health care choices."

That's true for middle-aged women, pregnant women, men and parents as well.

Image: Vincent Van Gogh's "L'Arlesienne"