The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line

Author: Jennifer Margulis

The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line. By Jennifer Margulis. New York: Scribner, 2013. 344 pages. Review by J. Steven Svoboda

Award-winning journalist Jennifer Margulis, who is also the mother of four children, has written a book that has much to say about the interface of capitalism and our deeply flawed medical system with pregnancy, childbirth, and raising a baby. Surely The Business of Baby, which was famously panned by the New York Times, is not a perfect book. Margulis seems less than a perfectly judicious and objective author, probably likely to favor anything alternative and a sure bet to find fault with most anything that is sold by big corporations that relating to pregnancy or raising a young child.

That is just fine by me. While I was initially skeptical, this book eventually converted me to a view more or less aligned with that of the author. Margulis is an excellent writer, opening her book with two compellingly contrasting stories of prospective mothers, 1) a Serbian-born woman, Marijana, living in London who upon becoming pregnant for the first time, moves back home with her husband; and 2) a New Jersey elementary school teacher, Melissa Farah, having her first child at the same hospital as a close girlfriend, Valerie Scythes, who became pregnant at more or less the same time. The author’s trenchant question: “Which young woman would be better off, the one in a small Balkan country still recovering from a brutal civil war, or the mom in the richest and most powerful country in the world with state-of-the-art medical equipment and know-how?” The answer of course, is that statistically, Marijana is better off, and in fact, both Melissa and Valerie died in childbirth.

In terms of infant mortality, no fewer than forty-eight (!) countries are safer than the United States, which has one of the highest death rates in the industrialized world. An American child is more than twice as likely as a child in Finland or even Singapore to die before his or her fifth birthday.

Meticulously, painstakingly, in many different contexts, the author shows us that “time and time again corporate profits and private interests trump what is best for mom and babies.” Ultrasound is badly overused and doesn’t necessarily provide any clinically useful information, at least not enough to justify the inherent risks of the procedure, but it does contribute to obstetric intervention, which can sometimes even prove fatal. It also may be causing autism.

The author comes up with lots of shocking facts. It is more dangerous to have a baby in the US in the twenty-first century than it was two or three decades ago. Margulis builds a convincing case that Caesarean sections are often performed for the convenience of the doctor.

Margulis includes a chapter on circumcision and the title alludes to the sale of foreskins for high profits. She discusses alterations in baby’s brain chemistry that response from painful stimuli, and the need to respect each person’s genital integrity, all the more so with procedures that are irreversible and not medically necessary. The author discusses evidence from ARC Board Member David Llewellyn that botched (Editor’s Note: so-called as every circumcision may be considered a botch) circumcisions are much more common than is believed and reported.

Another shocking topic is the medical establishment’s continued hostility to breastfeeding mothers. The US was found to rank last (thirty-sixth out of thirty-six) in a recent “assessment of how well wealthy countries support breastfeeding moms.” The cluelessness of physicians and nurses in believing that a healthy baby would be “choking” on breast milk or would be at risk for “convulsions” without formula supplementation again reminds us of ignorance such as that of Dr. Brady’s comment to me in our October 2013 debate in South Carolina, “No one knows the functions of the foreskin.” Doctors don’t receive adequate training in medical school on either breastfeeding or the intact penis’ functions. Formula, Margulis shows us, is literally killing babies in the US. In Norway, a baby has half the chance to die in infancy relative to here, and one main reason for that is that breastfeeding rates in Norway are among the highest in the world.

Analogies applicable to intactivism repeatedly crop up in discussions of other topics. Caesarian sections seem to be done so frequently at least in part because they are more lucrative for doctors than normal deliveries. Ultrasound, like circumcision, has come to be routinely performed while incurring significant risks without clearly providing any benefit. Babies are kept in neonatal intensive care units longer than they need to be there because this practice is lucrative, just as financial incentives have similarly helped perpetuate circumcision.

Margulis’ later chapters are less compelling than the early ones. The last one, on the lack of need for well-baby care, is probably the least convincing of all. Before that, the author lost me a bit with her chapter about corporate profits shaping the desire to potty train children at ostensibly premature ages. There may be something to this but it just doesn’t strike me as of a piece with the earlier chapters. And I frankly find it hard to believe, as Margulis claims, that “kindergarten teachers now report having to spend up to one third of their time dealing with urinary and fecal accidents in the classroom.” I volunteered in both my kids’ kindergarten classes and I don’t remember a single such incident occurring throughout two entire school years. I do agree that it is a bit creepy that Procter & Gamble is evidently extremely reluctant to reveal the ingredients in their diapers!

As the husband of a pediatrician and a firm believer in vaccination, which has saved many lives, I also can’t fully embrace Margulis’ chapter on vaccinations. Still, as with the chapter on potty training, no doubt grounds exist for some suspicion of the medical stories we are fed and the author is to be commended for questioning them. Certainly we may be given pause by the counter-intuitive finding of one recent study that nations that require more vaccines tend to have higher infant mortality. And I can certainly embrace the author’s argument that current vaccine schedules may be driven by capitalism rather than by babies’ best interests, given that breastfeeding rates and general infant health are much higher in Norway and Iceland, where children receive no vaccines before they are three months old.

Jennifer Margulis has written an important and thought-provoking book, the sort of work that it is difficult to get exactly right in every detail, yet exactly the sort of book we need in this day and age. Much can be learned from it about illuminating analogies between other medical practices and male circumcision. I highly recommend it.