Standardization–a good servant but a bad master

I must give full credit to Laura Ingalls Wilder for this observation. If any of you remember the Little House on the Prairie books, you may recall the story in which Laura began teaching school before finishing her own education; and at own point she had to write an essay on “ambition.” What she wrote was extremely short, and she felt that she had certainly failed; but she earned 100. The second paragraph began, “Ambition is a good servant, but a bad master.” There are many things that this could also apply to, but I’ve been struck lately by the standardization that has been applied to pregnancy, labor and birth, and feel that this is also a good servant, but an extremely bad master.

Most of you are probably familiar with the fact that pregnancy is considered to last an average of 40 weeks. Well….40 weeks from your last period, which is about 38 weeks of actual pregnancy. And that’s an average–you’re actually considered term from 37-42 weeks. That 5 week “window” always seems so huge when you’re in your third trimester, wondering if your baby is coming next week or next month! Several months ago, an acquaintance was induced for her first baby, right after reaching 40 weeks, simply because she had reached 40 weeks. Her body wasn’t ready to give birth; her mother tried to talk her out of it, telling her she ought to wait until she was ready, but, no, she felt like she needed to listen to her doctor, the “expert.” Of course, the induction failed. (Read more about how to determine if an induction is likely to work.) Then, because they had broken her water in an attempt to force her body to dilate when it wasn’t ready, a C-section was necessary. The “40 weeks” servant was a bad master.

Standardization can be a good thing–all CDs and DVDs fit into the same slot; all electric cords in all outlets; light bulbs work in every fixture–but when standardization is applied too strictly to humans, bad things can happen. The servant has become the master. There is a reason why studies into human nature and medicine take large groups to validate the results–we humans are too complex to fit into a little box. There are too many variables to take into account, for doctors or sociologists or any other group of experts to look at one person or a handful of people and extrapolate the results into the masses. That’s one thing that happened with Vioxx and the other Cox-2 inhibitors–the initial study groups that were used when the drug was initially being studied to determine if it could be released nationwide were too small. Once hundreds of thousands or millions of people started taking them (instead of the few thousand in the studies), it soon became obvious that the risks of the medication did not outweigh the benefits. The potential of a heart attack or other deadly ailments did not counterbalance the pain-relieving properties of the drugs.

People are not standard–they are different. That’s why there is a “range of normal” in medicine. That’s why there is the 5-week “window” of term–not every apple ripens at the same time. Here’s another way to look at it–did you and all of your friends start your periods at precisely the same time of life? Probably not–you may have started at the statistical norm (probably 12&1/2, but I’ve heard that girls are starting younger and younger, and people aren’t quite sure why), but one friend may have started at 10 while another didn’t start until 15. Should your 10-year-old friend have been given medicine to stop her periods until she reached the statistical norm? Should your 15-year-old friend have been given medicine at 12 to start her periods? There is a range of normal that exists for a good reason. People are not standard; they are different.

Standardization is a good servant, but a bad master.

2 Responses

  1. Love this post! I am hoping to work on a post about length of pregnancy and the pressure to induce at 41 or now even 40 weeks. I will definitely reference your post. 🙂

  2. […] The Lie of the EDD (Estimated Due Date) Posted on July 2, 2009 by Kathy Considering how much is riding on the question of how long a pregnancy lasts, the history of “40 weeks of pregnancy” is interesting. It’s an example of truth being stranger than fiction, in my opinion. It’s a good example of something being a good servant, but a bad master. […]

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