Review by Booklist Review
Pregnancies don't always end up happily ever after, even in the skilled hands of a maternal-fetal medicine physician like Karkowsky. It's comforting to know how much she and her colleagues care about their patients and think about ethical issues involved with informed consent, including "signing tubal papers" for sterilization surgery. As Karkowsky notes, rather than providing an exhaustive guide, she is sharing a collection of stories (with details changed to protect confidentiality) that are loosely organized to follow the chronology of a pregnancy. Just the same, she provides a great deal of helpful information, carefully explaining an alphabet soup of acronyms, such as VBAC (vaginal birth after cesarean) and TOLAC (trial of labor after cesarean). And in nonmedical terms, she spells out why some pre-existing conditions in pregnant moms can lead to problems. For example, hypertension and diabetes mean the blood vessels that grow to meet the placenta are not wide enough. It's reassuring to know that maternal deaths are rare and that doctors try so hard to help at-risk moms and their babies beat the odds.
From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Publisher's Weekly Review
Karkowsky, a physician who specializes in maternal-fetal medicine, shares experiences and lessons for fellow medical providers and future parents in this educational, and sometimes harrowing, debut. She covers medical basics for prospective mothers, such as choosing a doctor (she recommends opting for one who displays "pragmatic compassion") and undergoing prenatal diagnostic testing, discussing why it's both important and challenging. In Karkowsky's case, she relates how receiving test results that her--ultimately, perfectly healthy--daughter was at risk of being born with a genetic disorder "stole the joy" out of her pregnancy. She also explains "Medical Language, the official language of Doctor," and how it allows doctors to "describe but distance" themselves from patients. But it's the book's case studies that provide it with drama and suspense. Stories from Karkowsky's practice include the heartbreaking one of a mother faced with giving birth either via a traumatic cesarean procedure, to a baby which might survive, or vaginally, to a baby which almost certainly wouldn't. Readers prepared for this book's harder-hitting passages will find it an illuminating and often riveting report from the front lines of labor and delivery. Agent: Jessica Papin, Dystel, Goderich & Bourret. (Mar.)
(c) Copyright PWxyz, LLC. All rights reserved
Review by Library Journal Review
Reflecting her journalistic and medical experience, Karkowsky's first book uses stories of former patients, statistics, and historical references to portray the world of high-risk pregnancy. The book is organized around the stages of pregnancy, and chapters cover issues relating to each trimester, including the increased use of genetic testing, the challenges of medical language and miscommunication, the resurgence of home births, the difficulties of Cesarean deliveries, and maternal and infant mortality patterns. Karkowsky candidly acknowledges the ongoing problem of implicit bias and its harmful impact on black patients. This well-written narrative is moving and medically dense. Clearly not a simple pregnancy manual for the average patient, the book provides vivid insights into the more intense aspects of reproductive medicine. VERDICT Karkowsky raises important issues concerning patient autonomy and the treatment of women in the health care system. For those who enjoyed Perri Klass's The Real Life of a Pediatrician and anyone interested in the challenges of modern health care.--Antoinette Brinkman, formerly with Southwest Indiana Mental Health Ctr. Lib., Evansville
(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review
A maternal-fetal medicine specialist explores the intricacies of pregnancy.Karkowsky (Obstetrics and Gynecology/Albert Einstein Coll. of Medicine) begins her high-risk tales with the account of a pregnant woman over 40 who "had almost no working organs in her body" and was on dialysis three times per week. Through meticulous monitoring and in-hospital care, she had a successful cesarean delivery of a preterm infant who survived intensive care and went home. The author then takes readers through the key elements of each trimester. Initially, it's often nausea and vomiting that, for an unlucky few, can persist through all nine months. Before IV hydration, such women could die. The second trimester is the time for genetic testing. Amniocentesis is a prime test for Down syndrome, but there are now less invasive tests for many genetic anomalies. An issue here is that false positives or negative rates can be high enough to make decision-making tough. Perils in the third trimester include preterm labor, stillbirths, hemorrhaging, and the soaring maternal blood pressure of potentially fatal preeclampsia/eclampsia. In addition to graphic accounts of complications, Karkowsky also examines how pregnancy care is evolvingnot always for the better. She deplores the fact that cesarean deliveries account for one-third of all births in America today (malpractice fears? financial gain?), and she is incensed that maternal mortality is high among white women but three times higher for African American womenand not because of socio-economic factors. She suggests implicit bias is at work. The author believes consent forms are a mess and hates that women seeking a vaginal delivery after a cesarean birth have to sign a consent form to permit it. Overall, Karkowsky urges better communication between doctors and nurses and doctors and patients, especially in conveying tragic news. She also makes frequent references to her own experiences as a wife and mother, subject to some of the risks she describes.A solid primer on pregnancy risks as well as a cogent plea for progress to make childbirth even less perilous. Copyright Kirkus Reviews, used with permission.
Copyright (c) Kirkus Reviews, used with permission.
