Today on Connecting the Dots, contributor Hillary Melchiors, PhD, MPH, LCCE, CD(DONA), a medical anthropologist, doula and childbirth educator reviews Michael Klein, MD's new book, released earlier in 2019. Published by Douglas and McIntrye, Dissident Doctor: Catching Babies and Challenging the Medical Status Quo is a fascinating peek into the contributions and lived experiences of a change-maker in the field of maternal-infant health. - Sharon Muza, Community Manager, Connecting the Dots

Introduction

Michael C. Klein was born a “red diaper baby” to politically active parents who began his dissident education early. Since then, Dr. Klein has been fighting against dominant paradigms for as long as he can remember. His position as an outsider working within the medical field includes publishing groundbreaking medical research on episiotomy and questioning routine obstetrical care in multiple countries and contexts. Dr. Klein has lead a rather extraordinary life full of both trials and triumphs that have led him to some very uncommon conclusions, especially for a physician. He is a huge advocate for family practice medicine and is not afraid of pushing back on enormous systems from hospitals to national healthcare to medicine as a discipline. He has been an outstanding ally for changes in maternity care for his entire career, and this book is part autobiographical and part call to arms for perinatal professionals.

About the Book

Sprinkled throughout the stories of traveling the world to learn and practice medicine, we find Dr. Klein’s very strong opinions about the state of maternity care as he has seen it throughout the years. The reader learns how he himself has tried to both work within the system while at the same time subverting it using his insider medical knowledge, skills, and contacts. From the United States to Mexico to Ethiopia to Canada, Dr. Klein has an enormous amount of experience and perspective that shines through in his writing. Reading this book feels like sitting next to him as he regales you with stories of years gone by and how they apply to the very issues that we are having now, in the most wonderfully unapologetic way. His personal stories flow seamlessly with his professional ones such that you see just how intertwined his career trajectory and personal beliefs have been and how they have shaped him into the unabashed nonconformist that he is.    

In this book you will hear about pushing for family-centered maternity care, conversations with Margaret Atwood, (the author of the dystopian novel The Handmaid's Tale), how to get physicians to change their routine practices (hint: statistics are helpful), and improving the relationship between physicians and midwives. Woven throughout the text are Dr. Klein’s impressive professional resume and his quirks as well. What is clear to the reader is that he is deeply passionate about holding systems (and individuals that work within them) accountable for change and pushing toward both the evidence-based and the humane way to practice maternity care. 

For Childbirth Educators

I had the chance to speak with Dr. Klein and we had a really interesting conversation. When I asked him how to change the culture of medicine that does not want to be changed or is very slow to, he replied: 

“It depends on the issue! In an episiotomy content analysis from 1920-1990, the information was unchanged despite the fact that it was false. It was an issue for the practitioners themselves. They didn’t believe episiotomy was a problem, they believed it was a solution. OBs in North America will only believe their own research, nothing from midwives in other countries. Push back is inevitable with unwelcome information that challenges the nature of the discipline of OBGYN. DeLee’s original paper is worth reading from 1920. Don’t be surprised if you enrage the establishment, and if you aren’t getting that kind of pushback you aren’t doing your job! Women need to be engaged in the enterprise. Go back to the history of the family-centered maternity model; it was women who were demanding change and marching on the hospitals. The problem today is that the actual language that was used to defend routine episiotomy is now being used to defend routine cesarean section, especially on maternal request, which is being reframed as human rights and autonomy for women which is turning it on its head!”

I was also extremely interested in hearing what Dr. Klein thought might be the role of the childbirth educator in helping people be better advocates for their own care. He responded:

“The kind of movement that it took to get family-centered maternity care was driven by consumers. If we look at current history, the people who ran that movement and were successful are now grandparents. They don’t seem to be advocating for their children and grandchildren. The revolution has been won, but not completely. We’ve moved from enemas and bringing in partners in the delivery room to complex issues around choice, autonomy, and the role of women in society, and a much more sophisticated analysis. Who is leading that revolution? Not the grandmothers! They think they have solved it. There are people who are dissatisfied with the way things are, but the fervency is missing. There is a debate as to whether it is a problem at all. The whole dialogue has changed in a way that is much more complex and is much more difficult than it was for the grandmothers. There are leaders who are promoting cesarean section on maternal choice as an autonomy issue. Masquerading it as a women’s rights issue is both subtle and un-subtle depending on how you look at it. I think it requires a reframing of the whole issue as a TRUE women’s rights issue and less susceptible to being aggregated by power structures.”

What was abundantly clear from our conversation is that Dr. Klein genuinely values childbirth educators for our contributions to maternity care, and hopes that we are able to take some of the lessons from this book and push maternity care onward and upward even more than he and his generation already have. 

In Conclusion

If you enjoy an unorthodox approach to childbirth and medicine peppered with personal stories and travelogues then you will enjoy this book. Dr. Klein has a meandering storytelling style that has you following the trail of his life and profession. The book brings a great historical perspective to how far maternity care has come and how opposing the system is not easy but so very important!  

References

DeLee JB. The prophylactic forceps operation. Am J Obstet Gynecol 1920; 1:34-44.

About Hillary Melchiors

Hillary Melchiors PhD, MPH, LCCE, CD(DONA) is a medical anthropologist, childbirth educator, birth doula, and writer in Evansville, Indiana. She received her PhD in Medical Anthropology and Masters in Public Health from Case Western Reserve University and has practiced as a birth doula since 2014 when she founded the Doula Group of Evansville. She has served as a leader of the Evansville Birth Network and member of the Southwest Indiana Breastfeeding Coalition, as well as serving on the DONA International Advocacy Committee. You can follow her on Twitter: @HillaryMelch and contact her through her website - Doula Group of Evansville.

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