The Smart Mother’s Guide to a Better Pregnancy: Book Review

June 22nd, 2010

I have had the opportunity to read The Smart Mother’s Guide to a Better Pregnancy and I have to say that this is a really handy little book for expectant mothers. The book is broken down into four parts

1) Selecting the Right Healthcare Provider

2) Routine Prenatal Care and Potential Problems

3) High-Risk Problems During Pregnancy

4) Thirty-Six Weeks and Beyond

Each section really gives great practical information about how to navigate our crazy US health care system and in turn, to minimize potential misunderstandings or worse-life threatening complications to mother and baby.

Linda Burke-Galloway, MD, is the author and she really knows her stuff.  She has specialized in high risk pregnancy for much of her career and has a particular interest in public health and safety. This passion is evident as you read through the book. She repeatedly provides vignettes pertaining to prenatal care and often provides real life stories of  “what went wrong” to substantiate her recommendations.  Several of her insights can only come from someone who has been there. This is especially true in  “Selecting the Right Healthcare Provider”. Dr. Burke-Galloway gives step by step instructions on how to research a provider, including checking their credentials as well as investigating whether or not they have any legal judgments against them-past or present. She addresses the danger of selecting a provider from an insurance directory list without performing these crucial checks and she gives vital advice on how to deal with a provider who has decided not to obtain medical malpractice insurance as well as those with numerous satellite offices. An unknowing woman could easily fall prey to pitfalls of these practices, but with this book, they are educated, prepared and quite possibly protected.

My favorite section is, of course, the section on “High Risk Problems During Pregnancy.” Dr. Burke-Galloway gives very good explanations of chronic hypertension and pre-eclampsia. I have to disagree with her about incompetent cervix, however. She states that this is a fairly uncommon problem. Now perhaps it’s because most of the women that I work with are on bed rest or its this age of assisted reproductive technologies, but I see a lot of women with incompetent cervices. Now I don’t have over 20 years of experience like Dr. Burke-Galloway has, but in my observation and with the women with whom I am dealing, incompetent cervix is not “infrequent”.

One of the best parts of the book is the list of references at the end. Dr. Burke-Galloway gives an extensive list of resources for women to be able to do the research and to ask the questions that she suggests.

I was a little disappointed that Dr. Burke-Galloway did not address VBAC at all. There was no mention of giving a woman a trial of labor after a c-section or what to do if you wanted to try for VBAC. While Dr. Burke-Galloway may not be a VBAC advocate herself, I do think that this topic-so prominent in today’s health care debate and in discussions on how to reduce maternal mortality-at least deserved a mention. I was also disappointed that she did not mention methods of labor relaxation such as showering, using a birth ball or other tools, massage or other means of relaxation. It seemed like she was only advocating a “mechanized” labor and delivery-in hospital, in bed, fetal monitor attached. This tone will likely turn off a lot of women.

I was also surprised that Dr. Burke-Galloway did not speak more about post partum depression. She gave some important facts and statistics, but didn’t really delve into the etiology of post partum depression. I really think that it would have been helpful if she had talked about a patient of hers that had had post partum depression, how she diagnosed it and how she treated it.

Which brings me to my final comment about this book. I am a physician assistant by training so much of this book was a good review for me. Yes, I did learn some new things while reading it but much of it was review. As I read the book, I felt a real distance from the author. This is not a “warm read”. Now granted, these aren’t  “warm and fuzzy” topics about which Dr. Burke-Galloway is speaking. Yet, for a book that is directed at mothers-and I am assuming laywomen-this book was too formal. For example, Dr. Burke-Galloway uses the term “Labor Assistant” in the section on labor and delivery. Why not use “doula”?  I realize that there are more than one type of labor coach. It could be a spouse or family member. But in my experience, when women think of a labor coach or assistant, they are referring to a doula.

In some ways the book reminded me of a Grand Rounds presentation (a presentation where one health care professional is speaking to a group of other health care professionals). Much of this book made sense to me because I have previous education and experience from which to draw. My concern is that many women who may read this book may miss a few of the points that Dr. Burke-Galloway is trying to make because they won’t have the frame of reference in which to place the topic. For example, in one section, She talks about having “spirited discussion” over a case with another provider. Why not say “We argued”? In fact, if she could have shared some of the argument, I think it would have given meat to what she was trying to say. Much of her stories are bare bones facts and it would be nice to have more “flesh” to be able to draw a fuller mental picture.  In one section she talks about a colleague who was delivering. Why not give her a name (even a pseudonym) and refer to her by name instead of as “my colleague”? She talks about feeling relieved after such a difficult delivery, but it would have had more impact if she had given just a few more details, let us know how concerned she was, the specific perils she faced and how she managed them and then talked about the relief she felt after.

These last comments are purely stylistic and in no way take away from this book. I am simply suggesting that if Dr. Burke-Galloway writes subsequent editions (which she says she wants to do in the forward and afterward) that she make the text more conversational. It is a good book and I think that it will help a lot of women-especially a woman who may be relocating to another area and needs to find a new provider or a woman who become s pregnant unexpectedly and is really unprepared for what she needs to do to take care of herself and her baby. However, I think that for a number of women, the cool tone and the lack of attention to more holistic methods will be a turn off.

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