The birthing of a new baby is one of life’s great medical and human dramas. When it goes well, it is a loud and joyful mess. But when it goes badly, it is a travesty, devastating not only to hopeful mothers, but also to their doctors – regardless of how well they have learned to anticipate and navigate the myriad hazards of obstetric medicine.

Catching Babies, a new novel by medical writer J.D. Kleinke, charts the professional and personal struggles of those doctors, following a group of OB/GYNs as they complete their residency in a busy urban teaching hospital, embark on ambitious careers, and try to mend personal relationships neglected through years of training and sacrifice.

Catching Babies also explores the broader landscape surrounding obstetrics and women’s health…

• • the culture clash of religion, reproductive rights, and medical technology
• • the emotional brutality of residency training
• • the politics and bureaucracy that drive today’s academic medical centers
• • the struggles of disenfranchised women trapped inside a broken health care system
• • the truimphs of many women to get and stay pregnant against the medical and
  technical odds and America’s ongoing civil war over abortion rights

In obstetrics, both the courage and callowness we have come to expect of our individual physicians find some of their most dramatic expressions. Catching Babies spins their stories into a gripping mosaic of the obsessions, grandiosity, anxieties and heroism of doctors who have chosen to preside over the joyful messes and heart-breaking travesties in our hospitals’ delivery rooms.

Catching Babies was published by Fourth Chapter Books of Portland, Oregon, a new imprint launched this year by the creators of Portland’s Underland Press.

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Author’s Note

Catching Babies was conceived in 2003 as a non-fiction expose of the messy and often fierce technical, moral, and cultural conflicts at the heart of high-risk obstetric medicine and womens’ health. My earlier study of the clinical practice patterns of childbirth and gynecologic surgery – combined with fortuitous friendships with physicians and midwives at critical moments in their training – coalesced into a possible explanation as to why the field of obsterics and gynecology is unique among medical specialties for the intensity of emotion, political fury, and cultural angst it inspires. It was a stark idea I had yet to encounter in the health services literature: OB/GYNs stand at ground zero of a broader health care system pulled apart by polarizing forces that often have little to do with medicine, ethics, or patients’ real needs.

Our nation’s permanent civil war over abortion rights—electrified with religious passion, political hypocrisy, and gruesome rhetoric scarcely related to the clinical and behavioral realities of abortion—is the most glaring example of how America’s philosophical and psychological conundra play themselves out in our health care system. Our neurotic obsession with breast cancer, highly out of proportion with the disease’s actual prevalence and lethality, is one of the more subtle examples of the same phenomenon. The political, financial, and legal fights over the way we care for women and deliver their babies are the supercharged versions of this spillover effect, of America’s most intractable conflicts perennially finding their angriest voices in arguments about health care. For clearest proof, one look no further than the noxious and occasionally bizarre rhetorical gas released during the 2009-2010 health care reform debate – and the jarring fact that passage of the entire legislation hinged, in the 11th hour, on the funding of abortion.

Catching Babies was originally intended as a clinically detailed study of how these wildly problematic and deeply misunderstood medical subjects play out in the real world. It was conceived as the general public’s first hard look behind the medical curtain into the practice, politics, and often bizarre culture of obstetrics and gynecology, as smashed together into a single specialty and “organized” in the most disorganized health care system in the world. It would also map out the complex turf war among most (but not all) OB/GYNs and the growing and highly diverse ranks of midwives.

As I dug more deeply into these cases and their often unlikely outcomes, I noticed the recurrence of an odd phenomenon that has confounded health researchers for decades: medical decisions and outcomes often have less to do with what the patient needs or even what society demands, and more to do with what’s eating at the doctor, what’s making the patient act out, or what’s wrong back at either one’s home. Fast-forward through a few rough drafts and a few rough years, and suddenly the medical cases I had assembled to illustrate some of health care’s thornier problems struck me as far more interesting than the problems themselves.

Many of the cases began and ended not with medical facts, economic prerogatives, or philosophical positioning, but with the full spectrum of human impulses: fear, control, compassion, repression, projection, self-hatred, self-aggrandizement, the search for meaning, the leap of faith. The human compulsions at work in these cases begged questions not only about a unique patient’s irrational response to her medical situation, but also about the pathological drives of her caregiver.

Who exactly are these physicians, midwives and nurses all thrown—as forcefully as their pregnant patients—into a maddening system not of their own design and often in conflict with their most deeply held values? The systematic brutalization of these caregivers, in particular OB/GYNs during their long and difficult training, has turned many into heroes, some into detached technicians, and a few into monsters—each, of course, in his or her own exquisite way. The closer I looked for patterns, the more elusive such patterning became, until I had crossed, perhaps inevitably, into the realm of narrative fiction. Fast-forward through a few more years and my own terrifying encounter with the realities of the health care system, and the “medical cases” had metamorphosed into human stories.

Catching Babies still seeks to tell the larger story of how and why we deliver most babies and care for most women in the odd and often maddening ways we do. But somewhere in the long process of research, composition, revision and reflection, I discovered that the real story is best told through the myriad fractures and fissures of the human drama – through the doctors, nurses, midwives, patients, family members and others struggling inside the system as they have found it. Catching Babies is about them.

J.D. Kleinke
Portland, Oregon
Labor Day, 2010