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Pregnancy manual serves as helpful guide

Beth Cooney The Stamford Advocate

There was a moment when Dr. Joel Evans decided his brand of medicine needed healing.

It happened in 1994 with an office visit from a new mother, whose baby Evans had delivered by Cesarean section. The patient’s incision was infected, which sometimes happens with such surgical wounds. “It meant we needed to see her a lot to make sure she was OK,” says Evans. “And of course, the last thing in the world a new mother needs is a lot of doctor’s appointments.” Evans got the feeling his patient was angry and frustrated. And as she left, her cutting remark confirmed it: “This would have never happened, if I hadn’t had a C-section.” For Evans, who by this time in his career had delivered hundreds of babies, the remark was devastating. And insightful. He calls it his “aha” moment.

“She had truly needed the Cesarean,” says Evans. “But I had failed her as a doctor because she didn’t trust my decision or feel like she was part of it.” That moment, as Evans describes in his new book, “The Whole Pregnancy Handbook,” (Gotham Books, $20), was the beginning of the transformation in the way he practiced medicine.

“I decided the only way I could continue to practice was if I became my patient’s partner,” he says. “So if they asked me about something, like the safety of an herb, I changed my answer from, ‘I don’t know about that stuff,’ to ‘Let’s investigate that and see if it’s something that we might be able to try.”’ For the next decade, Evans gradually began to alter the way he treated patients. For him it was an evolution that included a new reliance on tools including meditation, yoga, Reiki. He learned about herbs, acupuncture, massage and the finer points of nutrition. “The kind of things that don’t get any mention in medical school,” he says.

Although he became a faculty member at the Center for Mind/Body Medicine in Washington, D.C., Evans continued to be a traditionalist in some respects. For example: He never has presided at anything other than a traditional Western delivery at Stamford Hospital, where he is on staff. Yet he says he never would discourage a patient from delivering at home or with a midwife if he felt it was safe and appropriate.

“It’s not the kind of delivery I do, but I don’t think it’s wrong for some patients,” he says.

He became more open to considering other options for his patients, especially expectant mothers, women going through menopause or struggling with infertility. He added a nutritionist to his staff at the Center for Women’s Health in Darien, Conn., then an acupuncturist. He welcomed birth coaches known as “doulas” to work with his patients and help them through childbirth. Even the office where he consults with patients is an oasis of New Age serenity. Besides family pictures, he keeps a tiny Buddha, a small waterfall of running water and lit aromatherapy candles.

Among his most unconventional and surprising beliefs is that fathers are not always the best birth partners in the delivery room. “Women need a lot of emotional support during delivery and some men just are not very good when their wives are in pain,” says Evans, who attended the delivery of his sons, Jarad and Spencer, but says his wife relied heavily on the emotional support of her mother. “I would rather a woman have a sister or a friend or a mother than have a guy who’s a wreck,” he says. “Of course, there are plenty of men who do fine. It’s just a matter of a couple figuring out who the best person is to play that role.”

The evolution in Evans’ thinking prompted him to write a pregnancy book that included discussions of such alternative topics for expectant mothers. He envisioned a manual that spent equal time explaining epidurals and hypnotherapy and acupuncture as different approaches to labor pain management and the merits of foods rich in omega 3 fatty acids for mother and baby.

“Most of the books out there don’t touch on this stuff or dismiss it,” says Evans. “I wanted to see something that addressed questions my patients were asking, but also dealt with many mainstream issues.”

The book has received excellent reviews; Publisher’s Weekly said in March: “This thoughtful book lays out the numerous options available to pregnant women, and is essential reading for those who want to thoroughly savor one of the must fulfilling and transitional phases … of life.”

It provides month-to-month information on pregnancy basics along with detailed discussions of herbs, nutrition, exercise and alternative therapies and their appropriateness for common pregnancy complaints. Also included is a detailed chapter on yoga poses appropriate for pregnancy in each trimester.

Evans says he strove to be nonjudgmental in writing the book. He doesn’t, for example, condemn practices such as epidurals for pain or the incision known as an episiotomy to help a woman deliver even though both sometimes are criticized by practitioners who advocate more natural births. He wants, he says, for a woman and her doctor to feel good about any manner in which a baby is delivered.

“One of the nicest compliments I’ve received from women who’ve read it is they wish they had this book when they were pregnant,” says Evans.

Writing the book with Robin Aronson, former editor in chief of Parents.com, also helped Evans negotiate a difficult transition in his medical practice. Last year, he stopped delivering babies, an agonizing decision he says he made after his annual malpractice insurance premium hit $130,000. “With that kind of premium,” he explains, “I would have had to see so many patients I couldn’t give them the kind of care I felt they needed or deserved.”

He decided to become a consulting physician to pregnant women seeking advice on holistic therapies. He also continues to provide gynecological care to women in all phases of their lives. Still, he says, as much as he values his new work, he still struggles with guilt about leaving the delivery room.

“By the time I wrote the book, I had come to the conclusion that pregnancy care was broken,” says Evans. He points to growing rates of Cesarean births and induced labors as examples of a delivery system gone wrong. While such interventions often are merited, Evans says their rise also suggests doctors are making calls that are safe rather than absolutely necessary.

“Very well-intentioned doctors are not giving women the kind of care they want or need,” he says. “Doctors today are overworked, tired and too worried about lawsuits to break away from the norm.”

He pauses and says, “I know I sound grandiose, but the system has gone so wrong I had to stop delivering babies and that was something I never imagined doing.” To that end he says he hopes his book will become reading for doctors and patients alike.

“Having a baby should be a wonderful experience,” he says. “Even though I’m not in the delivery room anymore, I hope to contribute to that experience in some positive way.”

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