Book Review: Dissident Doctor by Michael C. Klein

Dissident Doctor – Michael C. Klein (Douglas & McIntyre, 2018)

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.)

14 thoughts on “Book Review: Dissident Doctor by Michael C. Klein”

  1. This sounds fascinating! Like you said though, I imagine a book on pregnancy and childbirth written by a man is always going to require at least a small pinch of salt, however well researched he is on the subject.

    1. Anyone who hasn’t given birth personally, really. He’s way more knowledgeable about birth in general than I ever will be (and my own doctor is a man so I’m certainly not against men working in this field), it’s just when he occasionally talks about the way birth feels or when/how pain control should be used that I found myself disagreeing.

  2. Gosh, you are lucky to have had your own GP with you through most of your journey. Over here, childbirth has become almost like a factory process with the mother getting little say in who is involved, although some attempts are being made to make it feel a little less regimented these days. I doubt if any of the GPs I worked with had been present at a birth since they qualified, though… except the women who, I guess, were present at their own kids’… 😉

    1. I am really lucky. It’s a major advantage of living in a small town like ours (up until he retired a couple of years ago, Peter’s GP was still the doctor who delivered him). It’s not at all the norm in the city though. Most of my friends elsewhere have gone the route of midwives with a hospital birth, simply to have that continuity of care. But I love that I’ve had the same doctor all the way through and that he’s still the one the girls and I see for check-ups etc. Klein did a year sabbatical in Oxford and talks about how his experience there encouraged him to really support midwives in Canada and push for their legalization.

  3. Orgasmic birth? Oi vey. I had somewhat difficult experiences with both of my births-vaginal, but a third degree tear the first time and an episiotomy the second time, so medical intervention was something I was grateful for! LOL My kids were both ok though, so I’m so thankful for that, even though I was busted for a few months afterwards. Life of a mom ammiright?

    1. Agreed! It’s nice to be able to give birth without medical intervention but when it’s needed, it’s needed. Overall, I think Klein would argue that better information needs to be given to pregnant women so that they can make more informed decisions regarding their care. I know there’s a lot I didn’t know or think about before giving birth but there is also not a lot I could have done differently in either birth.

  4. I’m interested to read this book! As you know, midwifery care was our choice for a variety of reasons, and I know we’re fortunate to even have a choice in care providers (and my experience with smaller-town physicians is that they have a similar holistic approach as our midwives). In the end we still had some interventions but felt reassured those were best interest of babe and mum and evidence-based. Most GP’s here don’t deliver babies and don’t have hospital privileges (we had a Med student observing #2 birth and I think it blew his mind, lol)

    1. I think you’d find this really interesting. I know so many choosing midwives for that very reason of continuity of care (and GPs not having hospital privileges.) Klein talks about how so many doctors only see births when something goes wrong and he tells a story of a medical student witnessing a normal birth and being so amazed by it. Sounds like your med student might have had a similar experience!

  5. OMG! Karissa! I actually saw a whole special about women who have orgasms when they give birth. They found that (at least in the U.S.) most women have an epidural, so when they do have an orgasm, they don’t know it. But yeah, there was a whole study and it’s actually a thing. Doesn’t happen to everyone, though, so I can see why you would roll your eyes.

    Even though I don’t have children, never am going to have children, and never wanted to have children, I do tend to read and watch a lot about birthing practices in the U.S. vs. other countries because I think it says loads about the health system, prevailing ideas about how to bring a baby into the world, how women are frequently made too afraid to give birth naturally, even when it’s safe. In fact, some women plan their birth with a C-section and then get a tummy tuck at the same time in the U.S.

    1. What was it called?? I’m sure it was interesting but I’m still SO skeptical. I had Rose without an epidural and let’s just say it was not orgasmic. Did it talk about how common it was supposed to be?

      Birth is very interesting, just as you say, and what it tells us about healthcare in general. I’ve heard that the US has the highest maternal mortality rate of any developed nation (but I don’t know that I’ve ever heard a source for this so it could be false). I think there is a lot of fear surrounding birth – Klein even talks about the numbers of female OBGYNs who opt for c-sections because they themselves are so afraid of giving birth. It’s strange to me that we’ve accepted fairly major surgery as safer than a natural physical process humans have always gone through, even though I’ve felt afraid of giving birth too.

    2. The U.S. definitely has the highest rate of maternal death in a developed country. This big news story just broke about this hospital in Indianapolis, a hospital connected to Indiana University, that serves poor women. Instead of using doctors for high-risk pregnancies, they were assigning the cheaper method: a midwife. Midwives are great, but do not have the appropriate training for high-risk pregnancies. Lots of mothers and babies were dying. I don’t remember the name of the show I saw, but I Googled orgasm and birth and loads of articles and books came up.

    3. That’s so horrifying. And from my understanding, minorities are at an even greater risk of maternal mortality. Midwifery in the US seems really different than here in Canada. Here, midwives are highly trained medical professionals and they do a lot of their training under doctors. (A student midwife was following my doctor for part of one of my pregnancies.) It seems like there is a much greater variance in training for American midwives. You’re right, they don’t have the training for high-risk pregnancies, though you’d hope being in a hospital, there are also doctor available if needed. That’s so awful to hear of deaths just because someone wanted to save money.

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