I’m an internist, a doctor who specializes in the prevention and treatment of adult diseases. To do this, you have to know what it is that causes us harm, how to prevent it, and how to treat it when prevention either doesn’t work or isn’t possible. I can’t prevent someone from getting, say, lupus, but I can prevent a lot of people from having heart attacks.
Some prevention is quite simple and effective: if I can get people to quit smoking, lower their blood pressure through the use of diet, exercise, and/or medications, I can prevent a lot of heart attacks and strokes. If I can get women who are trying to get pregnant to take folic acid I can help prevent birth defects such as spina bifida.
Often, the so-called alternative medicine community tries to claim prevention as their own, as if real doctors either don’t know or don’t care about prevention: we know, and we care very much. We also realize that human beings are imperfect, that life if full of bad luck, and that not all disease can be prevented.
Often enough, behavior simply can’t be changed. Many people suffering from serious consequences of obesity may never be able to lose sufficient weight, leading to a cycle of weight gain due to inactivity and inactivity due to weight gain. Like many illnesses, obesity, tobacco dependence, and other diseases that appear to be amenable to simple behavioral changes are not so simple and are real disorders of physiology that are not under the patient’s conscious control.
But some things are clearly (to me) under someone’s conscious control. Choosing not to wear a motorcycle helmet or a seat belt is just stupid. So is giving birth to a child in a pool full of urine and feces.
The evolution of human birth practices is pretty damned interesting, something we all have a stake in. Until quite recently, most babies, even in wealthy countries, were born at home with family in attendance. This was dangerous and not infrequently led to the deaths of mothers and babies. It became a fad in later years to give birth in hospitals, a practice which was quite dangerous until the cause and prevention of childbed fever was discovered.
In much of the mid-20th century, hospital births became the norm, but so did a paternalistic approach that often reduced parental involvement to nothing: the father was kept out of the delivery room, and the mother was given little control over the birthing process. (For a more complete and accurate history, browse Dr. Amy’s blog.)
Childbirth is still dangerous for mother and child, especially outside of the industrialized world, but there are ways to make it safer for mother and child. We have, for example, institutions in this country called “hospitals” which contain surgeons, neonatologists, nurses, and other experts at keeping moms and babies alive through one of the most dangerous events in either’s lifetime.
For many reasons, some people choose to try to go back to the bad old days and deliver babies at home, or even worse, at home under water. My first experience in labor and delivery was awesome. The controlled chaos, the smell, the change in shape of anatomy, the smell. Most moms would pee and poo during labor and the nurses would rush to keep the field clean for the baby. And the babies were beautiful. They would be delivered by mom and doctor, someone would cut the cord, a pediatrician would make a quick assessment, and the baby would be given to the mom. Aside from the smell and the surprising anatomical distortions, it was beautiful. But picturing all that urine, feces, and amniotic fluid floating around waiting for a baby to slip into it without the benefit of immediate emergency support, that’s just insane.
Prevention is usually better than treatment, especially if the outcome you’re trying to prevent is the death of a mom or a newborn.