Paradox

Royal Darwin Hospital

Every month at the hospital I’m currently working at we have a meeting to discuss “Perinatal Morbidity and Mortality”. The point of the meeting is to review all recent cases of stillbirths and neonatal deaths, and see if there were things that would have resulted in a better outcome if they had been done differently.

There were two things that struck me at the meetings Ive attended – firstly, there were very few cases, and secondly, for most of them, almost nothing could be found that if done differently would have made a difference to the outcome. This of course is in marked contrast to what a Perinatal Morbidity and Mortality meeting would have been like in Motta, in Ethiopia, where a meeting with as many cases could be convened every few days, though Motta was barely half the size of the Royal Darwin Hospital. The Ethiopian cases would have been much more dramatic and tragic, and analysis would reveal in almost every case multiple opportunities where tragedy could easily have been averted by mostly simple interventions.

Controlled Burn-Off Rejuvenates the Bush

What we have done so brilliantly in the West, as these meetings testify, is to reduce the risk of childbirth to almost its irreducible minimum both for babies and for mothers. And yet - and this is the paradox that I am currently trying to get my head round – in the West where it is now safer than it has ever been to have a baby – indeed its incredibly safe – we seem to be terrified and  more afraid of it than ever. The result is that the extraordinary condition of being pregnant and giving birth - to what most mothers and fathers would agree is the most precious thing in their entire life, their child  - has become something to endure rather than

 celebrate in this age of almost absent risk, a time of rising anxiety and dread.  The pregnancy becomes a time of continual search for reassurance from tests and scans that get repeated and repeated and repeated,  as if in seeking to reassure we simply create uncertainty and more doubt. Once labour starts, if it hasn’t already been artificially started because of fear about what may happen if one is “overdue” the hysteria reaches a crescendo that results in demand for an epidural to completely numb the body, and then a caesarean by doctors or family who panic when theres the slightest deviation from what has been determined as “Normal”.  As a result the caesarean section rate, even during the course of my short Career, has doubled to 33% with almost zero increase in measurable benefit to either mother or baby. The thing that I find so sad about  all this, is that  fear and anxiety destroys what must surely be the most wonderous and elemental and fundamenatally human and fulfilling experience a woman and a family can be part of . I keep thinking “we only live once, why are we allowing fear to rob us of the opportunity to experience what life actually is?”

I think this paradox comes about because when risk is so very low, adverse outcomes become very rare and beyond the experience of most of us. We then develop a heightened fear of such things, the fear of the unknown, a fear which is out of proportion to the risk, but which can lead us to make all sorts of irrational choices.

Oxygen bubbles  released from the roots and trapped underneath the leaves help to keep them afloat!

This is not something that’s limited to childbirth of course. We, in Australia at present apparently have the soundest economy on the Planet, with the lowest unemployment, a growing economy that never went into recession, a forecast Budget Surplus and so on – in other words it could hardly be better, but the Polls have the Government at record low approval and popularity levels , and no-one seems happy. Even though we are arguably better off than anyone in the world, the mood is not of  sympathy or generosity towards the tiny few asylum seekers who come here on boats from Indonesia, but  of hostility and fear about what might happen in the future to our standard of living, and they are locked up for months and even years at a time while exhaustive efforts are made to make sure they are genuine refugees – and of course, in the end they almost always are. In the meantime they are going mad and committing suicide in their detention centers. And in the USA where to protect themselves everyone has a hand gun and a few other weapons under the bed nobody feels secure.

What is it with People that when risk is virtually eliminated they become more fearful, when life is abundant they become less generous, when they have protection, they feel less secure? Actually I'm wondering if I may have stumbled on an explanation for the way in which indigenous people up here are so unimpressed with all our efforts to get them healthier. Maybe they have noticed that we might live longer as a result, but our lives are poorer, in the non-material sense and really, did we gain years but lose life? Maybe for them Life is more important than years, living is more important than staying alive?

Something to think about!