Much of what is in this book will come as a shock to women and families in America. There are two reasons for this. The first is that accepting that our present maternity care system is as abusive as documented here is a hard pill to swallow. No society wants to believe itself capable of putting its most vulnerable members pregnant women and babies at such risk. The second reason is that the American obstetric profession has managed to keep a big secret from the public for fifty years. When I was a medical student, decades ago, I was shocked when I first became aware that obstetricians don?t attend women during their labor but instead rush in at the last moment to catch the baby (and the money). I talked about the situation with other students, and we all thought it was a terrible scandal, particularly since the laboring women had never been told that their doctors were not going to be there. But at the same time we were learning to be doctors ourselves, and that meant we were learning that great power is available to doctors who are willing to play by the rules and rule number one is never talk about medical mistakes or bad practices. Think about it: How often have you heard of a medical whistle-blower? It is a rare occurrence in medicine, and it is a rare occurrence in maternity care, where medical students, obstetricians, midwives, nurses, and everyone else in the field is under pressure to keep their mouths shut or risk losing their ability to practice. For me, however, there came a time when it was no longer possible to stay silent. The final straw was my horror at the widespread use of a drug called Cytotec for inducing labor a drug that is not approved by the Food and Drug Administration (FDA) for this purpose and has resulted in unnecessary complications and even death for women and their newborns. As it became clear in the 1990s that the use of Cytotec to induce labor was not going to stop and was for the most part being kept secret from the American public, I knew it was time to pick up the whistle (or pen) and start blowing.

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