Pushed: The Painful Truth about Childbirth and Modern Maternity Care, by Jennifer Block, 2007. (Cambridge, Massachusetts: Da Capo Press, $26.00, 316 pages, hardcover.)
Most women assume that when they into a hospital to birth a baby, they will have access to the best in care. What they don’t realize is that far too many obstetrical practices are not evidence-based and in fact some of them can have harmful effects on the labor, the mother, and the baby. Block’s exploration of the current state of the maternity system in the US and how it got to be this way is compelling. Block’s book is meticulously researched, and she has a firm grasp of birth as a feminist issue. When we talk about choice, whether access to an abortion or access to a VBAC, we are talking about women’s rights.
Block raises great questions throughout the book: Why have feminists, bioethicists, and reproductive rights organizations failed to take on birth as an issue of women’s rights and bodily integrity? Why does the US lag so far behind other developed countries in terms of maternal and infant outcomes? Can we invoke the concept of choice for elective c-sections and then not give women the option to have a VBAC? How is it possible that we have created a system in which normal birth is criminalized and women are caught in a bind in which they may have to birth unassisted in order to birth in the way that they know is safest for their babies? Block delves into the legal, social, cultural, and medical issues incisively. She clearly presents a picture of a maternity care system that is complex and nuanced and shows the tension between the medicalized approach to childbirth and the midwifery approach in support of normal, physiological birth. Through research, interviews, and personal narratives, Block shows us how and why much of what takes place in modern obstetrical wards is in direct conflict with the best interests of mothers and babies.
Block’s objectivity and willingness to explore all angles make her conclusions all the more dramatic. She doesn’t shy away from hard truths. As a birth educator who knows how terrified many women are of birth and who is constantly looking for stories and affirmations to help them feel less afraid, I was at first disappointed in some of the stories she shares. At one homebirth, the baby cannot be resuscitated for more than 10 minutes, and the midwives attending the birth take that long to call 911. However, what may be seen at first glance as a critique of homebirth is really about the extreme risks that women have to take in some states because midwives are forced to operate underground and because the women have no other options.
I enjoyed Block’s section on the role of doulas, including Bari Meltzer Norman’s and Barbara Katz Rothman’s critique of doulas as enablers. She raises some hard questions for doulas and birth educators about their work and about the ways in which they are subservient to the medicalized system of birth. This is an important piece of the conversation for birth professionals, and Block doesn’t hesitate to go there. Block also raises important questions about the role of a doula as an advocate. Women need to acknowledge that if they need an advocate to assist them in having the kind of birth they want, then maybe they are in the wrong place to begin with.
A piece of the book that deeply saddened me was the story of Cynthia Caillaigh, a traditional midwife who is no longer practicing. Caillaigh’s approach to birth and birthing women was fascinating, and the fact that this amazing woman can no longer work with women and families is a real tragedy. In this section Block also explores the nuances and conflicts among the different kinds of midwives and obstetricians over licensing laws. Although early on Caillaigh was part of the regulatory effort, she quickly abandoned it, sensing that regulation would only put midwifery further under the thumb of medicine and that it would lead to restrictions for women birthing twins or breeches or those wanting VBACs. Caillaigh believes that while midwifery may survive under these regulations, traditional midwifery will be lost. This crucial distinction, sadly, will likely go unnoticed and unmourned by the majority of birthing women in the US today.
As tragic as much of this book is, some of the women we see have a good deal of humor and spunk, even when they are caught in painful situations. One woman remarks, as she is sneaking out of the hospital to avoid a c-section that she doesn’t want (or need), “I was running down the stairs in labor, barefoot and pregnant.” Unfortunately the sheriff soon calls her at home, and she is forced back to the hospital for a court-ordered c-section.
I also had to laugh (again, at the tragedy) of the doctor who, when Block asks him about the benefits of physiological birth, says, “Are there any?”
Women who choose to birth in a hospital are putting their trust in people who have not even been educated about the benefits of normal, physiological birth—who have probably never even observed a normal labor. Are these really the people who should be calling the shots?
My only real critique of the book is that it has no information on what we can do to fix this system that is clearly broken. The reader walks away from this excellent book feeling educated, engaged, and motivated, yet having no outlets in terms of where to direct her energies—still, this is an absolute must-read. The more educated women are, the more power we will have to effect the changes needed to make birth better for everyone involved.
Cesarean Voices, Krista Cornish Scott, Laureen Hudson, Jill MacCorkle, Pamela Udy, eds. 2007. (Redondo Beach, California: International Cesarean Awareness Network, $12.95, 68 pages, paperback.)
Imagine upon birthing your daughter that the first words spoken by the doctor are, “It’s a boy! Just kidding.” This is just one of the cesarean-related stories contained in this slim volume.
In 2003, a woman on the International Cesarean Awareness Network (ICAN) e-mail list asked, “Why shouldn’t I have a cesarean?” Four years later, ICAN has published this book of responses to that question from women who had had cesareans and were not happy with the experience or with the outcome.
Disrespect, bullying, ineffective epidurals, threats, postpartum pain. These personal stories reflect how medicalized childbirth in the 21st century has become (1/3 of pregnancies end in cesarean) and how along with that medicalization comes a devaluing, and even meanness, regarding the process. Women who think that having a c-section will make things easier should read this book before making a decision.
Cheryl K. Smith
The Big Stretch: Insights about Birth, by Alieta Belle & Jenny Blyth. (Australia: Earth Base Productions, AU$71.50, 45 minutes/20 pages, DVD and booklet.)
This DVD explores pregnancy and birth through the eyes of many parents. The intensity, the preparation and the confidence of birthing women are depicted through the women interviewed.
The visual images, along with the original music presented, capture your attention and your heart, sweeping you into the magic bubble birth creates. All the women and families share their insights in a way that allows you to absorb those insights and helps you find your own personal path toward a good birth. Partners give their views and explain ways to connect as fathers and lovers.
Staying humble to all the possibilities seems essential. Being nervous at the unknown seems normal, while staying supportive and excited gives the pregnant woman encouragement. Body awareness is discussed, leading women to believe in their instincts and their abilities. The film contains a beautiful song about vaginal awareness, which is combined with great visuals that teach about how women are able to stretch and open without fear.
It also shows a number of births, many in tubs, which helps the reader tie all the pieces together. We see many crowning heads and hear many moans, showing how women surrender, open, flower, and use their strengths and capabilities. Birth as a transformation in all its glory is revealed.
Perhaps my favorite part is the postpartum reflections and stories. Some births are difficult, some are quick. All the births reflect a great reverence to what a woman’s body can do and the true miracle of birth. I also enjoyed the section on asking for help. It was a wonderful reflection on including what we need without feeling discouraged or defeated.
Included with the DVD is a 20-page booklet with questions for reflection on the film’s content. The DVD also covers baby massage. Both the film and this booklet act as guides to birthing as a positive empowering experience. All the women and their families are beautiful, genuine and real.
I felt invigorated and uplifted by experiencing this DVD and recommend it for midwives, parents, and all people interested in birth.
The Official Lamaze Guide: Giving Birth with Confidence, by Judith Lothian and Charlotte DeVries. 2005. (Minnetonka, Minnesota: Meadowbrook Press, $12.00, 307 pages, paperback.)
The question for pregnant women in the information age is: How much information is enough? Knowledge is power, right? We have a responsibility to inform ourselves, don’t we?
We also have a responsibility to use available media responsibly, with an awareness of the effect produced not only on our minds but on our emotions. When I recently checked out a popular pregnancy book, the librarian said, “I’ve heard that’s a good book.” I told her it had provoked excessive anxiety for me during pregnancy, to which she responded, “Well, I guess they write about everything in there.” Fortunately, though, everything doesn’t happen to most of us. But we sure can worry ourselves to death thinking about the things that might once we know about them.
By contrast, in the preface to The Official Lamaze Guide, the authors write that this book “[I]s not an encyclopedia of everything that anyone could possibly know about pregnancy, birth, and breastfeeding. It’s not an endless list of obscure and unlikely complications…. It’s not a guide to medical birth but a guide to normal, natural birth. It encourages you to lay down the heavy burden of what-ifs that can squash confidence” (vii).
What is the basic message they believe pregnant women need to hear? “Birth is a normal and natural part of life” (v).
The contents cover early pregnancy (choosing a caregiver and birth site, myths about pregnancy) to early parenthood (bonding, co-sleeping), as well as chapters devoted to natural birth and the history of birth. The text includes stories and pull-out quotes from mothers, as well as sidebars with encapsulated information and quotes from practitioners. A simple, succinct chapter on middle and late pregnancy offers common sense advice on nutrition, baby showers, and the advisability of various standard tests, and includes a few paragraphs on enjoying your pregnancy and not letting unnecessary medical procedures spoil the experience. Several chapters on labor and birth discuss drug-free comfort measures and possible interventions—the associated risks, how to avoid them, when they might be necessary, and how to keep birth as normal as possible should they become unavoidable.
The book is evidence-based and easy to read, and it features a lengthy list of references and recommended resources in the back. The appendices also include “The Rights of Childbearing Women”; “Lamaze International Position Papers” on the benefits of breastfeeding, the hazards of c-sections, and other topics; and “The Birth Doula’s Contribution to Modern Maternity Care.” Essentially, the Lamaze Guide is a basic, informative, non-alarmist guide to natural pregnancy and birth in a technological age.
If that isn’t enough to recommend it, the Guide also cites a Finnish study that found that women who ate chocolate during pregnancy had babies who were more relaxed and happy at six months than the babies of women who didn’t (69–70). That’s the kind of book I want to read while pregnant!