Like me, you might not recognize Michael Klein’s name. You might better know his daughter, Naomi. But as I read Dissident Doctor I came to understand just how Klein has influenced my own life. Klein details his decades of medical experience, his career as a family doctor, and his research into maternal care. He was at the forefront of supporting the legalization of midwifery in Canada and he pioneered some of the research that has decreased the rate of episiotomies. His experiences and research led him to believe that birth was becoming over-medicalized. The numbers and evidence he gives is fascinating and extensive and while his personal opinion is clear, he always backs it up with experience and references. In Klein’s opinion, as medicine has moved away from the model of the family doctor (and fewer family doctors being involved in actual births) and into more specialization, this has been to the detriment of maternal care.
Interestingly, the model that Klein seems to advocate the most is the one my family and I have lucked into. Because we live in a small town, our local doctors all take turns also working at the hospital. My own doctor is a GP, one of a few locally who takes on maternity patients. While he didn’t deliver Pearl because she had to be born at a different hospital, he provided all of my prenatal care for all of my pregnancies and he did deliver Rose. He’s now the family doctor for both girls and myself. He knows our family and has a great overall view of our health. Unfortunately, this isn’t the norm for most women giving birth, many of whom are transferred to whichever doctor happens to be on duty when they go into labour. Midwives have become a popular choice for many in British Columbia simply because of the continuity of care they provide.
Knowing that Klein was an advocate of minimal intervention, I was especially curious to read about his thoughts and experience surrounding caesareans and epidurals. I’ve given birth twice. My first birth was about as full of interventions (a c-section followed by a NICU stay) as could be. My second was a closely monitored VBAC (vaginal birth after caesarean) done drug-free. While I’m proud that I was able to deliver Rose completely naturally, I also know it was largely due to luck. I was able to have that natural birth because I was closely monitored, with an OBGYN standing by, ready to operate if necessary. Having delivered both ways, I find it hard to believe that any woman would choose to have a c-section unless it was medically necessary. After Pearl was born, I told Peter I would do that one more time, simply because we knew that we wanted to have more than one child. I can’t imagine putting my body through the strain of a c-section voluntarily. None of the women I know who have had c-sections did so as a first choice. At the same time, I am hugely thankful for my c-section. My life was never in danger but I know that once upon a time, when a baby was in a transverse position, the likeliest outcome was the death of both mother and child.
This isn’t to say that the book will only be of interest to those who are involved with or affected by maternal care. Klein’s life has been varied and fascinating. He talks quite a bit about his early life and his parents’ involvement in left-wing politics. His father worked for Disney and was fired after his involvement in unionization. This was also the era of McCarthy and Klein details the long-term effects on his family and the impact of FBI surveillance.
As a medical student, Klein spent time in Mexico and Ethiopia, practising medicine and learning about varying methods. He tells several stories of specific cases that keep the reader interested, often focusing on the human aspect rather than just the medical.
More recently, he looks at the differences of practising medicine in the United States and Canada. Klein has had the unique position of practising in the USA and in Canada, both before and after universal health care was introduced. His choice to move to Canada was influenced by the Vietnam War (he attempted to get status as a conscientious objector but ended up immigrating instead) but his choice to stay in Canada was due to what he saw as the flaws of the American health care system. At the end of his career, Klein moved to Vancouver and worked at the B.C. Women’s Hospital. This is my hometown, and the hospital where Pearl was born. He also has family connections to the Sunshine Coast and so discusses a little bit about the hospital where I now live and where Rose was born. At one point he even tells a story that involves my OBGYN.
Klein has strong opinions. About politics, about government, about health care, and about how to give birth. For the most part, I found that I agreed with him but I could imagine that a reader who found themselves on the other end of the political spectrum might not enjoy the book quite so much. And, as experienced and researched as Klein is, he is still a man, who has never actually given birth. So I did find myself rolling my eyes when he briefly discusses the idea of orgasmic birth.
Overall though, this is an enjoyable and informative memoir. As a look at pregnancy and birth in the 20th century, it is especially fascinating.
Michael Klein will be one of the featured authors at the Sunshine Coast Festival of the Written Arts this summer and I read Dissident Doctor as part of my Writers Fest 2019 challenge.)