Friday, October 19, 2007


This week I was delighted to finally read Pushed by Jennifer Block. This book is seriously GOOD! Wow! Lots of weighty, meaty information, scathing critiques, astute observations, and clever commentary. She has plenty of scientific backup for her claims and the book is written in an engaging, fast paced style that skillfully weaves facts into descriptive commentary and personal, illuminating interviews. I checked this book out of the library, but after seeing all of the data contained within--she's pulled together vast quantities of data about effectiveness of "routine" practices, etc. and made it accessible to the average reader--I knew I had to put it at the top of my Amazon wish list.

Pushed is a thorough critique of obstetrics as an industry and how women and babies are being HURT by the systems ostensibly in place to "protect" them. Especially thought provoking is her descriptive exploration of the cesarean epidemic. She points out on one occasion when discussing the whole uterine rupture straw man used to deny women VBACs, that people must prefer "controlled uterine rupture" (i.e. cesarean). Later, in a separate section regarding blood loss during birth, she mentions that average loss is 300-500 mil and over 500 is considered a hemorrhage. She then notes that during a cesarean the average loss is 1000 mil. Reading that, I thought so essentially with a cesarean you have a 100% chance of a uterine rupture AND a 100% chance of a hemorrhage. Wow! No wonder they are common ::sob:: :-(

The information about blood loss wasn't new to me, but I did learn something I hadn't known before--300-500 mil of blood is approximately 8-9 menstrual periods worth. Isn't the female body thoroughly awesome?!

Some assorted thoughts & quotes:

Re: EFM (external fetal monitoring): "For the natural childbirth movement, the emergence of the monitor was unfortunate timing. Just as activists were urging women to get up and birth, hospitals reined them back down in bed and strapped them, both physically & psychologically, to a machine that falsely promised a safe birth."

Quoting a midwife re: unassisted birth: "'That's not why you're hiring a midwife. You're hiring a midwife because you want her there for complications' Some of Linda's clients are such believers in birth that they toy with the idea of going unassisted. To this, Linda is fond of telling the story of a birth she attended where the baby had its umbilical cord wrapped around its neck three times and need resuscitation. 'You never know when you're going to have a problem,' she says. 'It's like playing Russian roulette.'"

This paragraph made me really sad and also frustrated and annoyed. Frustrated because those kinds of scare-tactic comments and implied "you must not really love your baby" subtext is EXACTLY the same as the conventional medical system's attitude toward homebirth. The midwife quoted seemed totally oblivious that her remarks are virtually identical to the things OBs say say about homebirth and are just as demeaning and restrictive to women as the anti-homebirth sentiments are. Makes me think of the Trust Birth Initiative's point:

"Being afraid to support a woman’s choice of UC is the same convoluted, illogical thinking
if we are talking about trusting BIRTH. If we say we trust birth, but only
IF________then we are saying we trust the place or the personnel more
than we trust birth. So then our trust for birth is totally dependent on so many
conditions that are totally outside our control. And once again we are saying that birth is
dangerous UNLESS___________. And we are back right where we started."

So, which is it, do you honor, respect, and trust birth or not?!

Okay, brief rant aside and another quote. This one while the author was observing a home water birth:

"It is at this point that I begin to fathom what supporting normal birth really entails. Linda is on her knees, sleeves pushed up, gloved hand in a soiled kiddy pool up to her bare elbow, gleaning diarrhea wisps with a spaghetti strainer by flashlight. I try to imagine a doctor doing this work and have great difficulty. This is not medicine. This is birth. It is messy, backbreaking, humble work."

During the conclusion of the book after a discussion about the NAPW and whether childbirth is a reproductive right or not:

"To her [a doctor who thinks it is not], it is a medical issue, one that may need reform, but one that belongs under the purview of physicians. 'To my mind, I'm all for people having a pleasant and safe birth experience,' she says. 'But my highest priority would be for them to have a safe birth experience.' But what's considered safe is political. What's safe changes. Thirty years ago obstetricians said VBAC was dangerous. Then they said it was safe. Now they've gone back to saying it's dangerous. ACOG says out-of-hospital birth isn't safe, but the research has consistently suggested that for women with normal, uncomplicated pregnancies it is not just safe, but safer, because those women are far more likely to have a normal, spontaneous vaginal birth and far less likely to experience harmful, unnecessary interventions...."

"...The goal is to have a healthy baby. 'This phrase is used over and over and over to shut down women's requests,' she [Erica Lyon] says. 'The context needs to be that the goal is a healthy mom. Because mothers never make decisions without thinking about that healthy baby. And to suggest otherwise is insulting and degrading and disrespectful'...What's best for women is best for babies. and what's best for women and babies is minimally invasive births that are physically, emotionally, and socially supported. This is not the kind of experience that most women have. In the age of evidence based medicine, women need to know that standard American maternity care is not primarily driven by their health and well-being or by the health and well-being of their babies. Care is constrained and determined by liability and financial considerations, by a provider's licensing regulations and malpractice insurer. The evidence often has nothing to do with it."

This the TRUTH and I hope women hear it.

The only critique I have of this book is one I echo from several other reviews. The book fires you up and has a lot of passion and energy, but provides no outlet or ideas for where to channel that energy. There is no "resources" section, no suggestion to join Citizens for Midwifery or your state midwifery advocates, no list of birth-positive organizations who are working diligently for birth change in our culture, etc.


Anonymous said...

Ugh! I complained to my OB (who was not able to be at my baby's birth) about the nurse who kept doing cervial checks and had me tethered to a monitor after I allowed the 20 minutes...because of one decel. 4 hours later, I felt bullied and abused. No one would "let" me go to the bathroom or get out of bed. They encouraged me to push before I was ready, and kept putting me on my back even when I protested, and lied to me telling me it was best to push flat on my back and I would "love" the stirrups. My baby was OP and the male OB on call realized this in the last few minutes, and had me get up and squat. When I complained about all the unneeded restraint and refusals to let me even go to the bathroom (I had no epidural, so I should have been encouraged to be upright) OB said, "I'm sorry you didn't get the birth experience you wanted." I replied, "It wasn't about birth experience, I think the heart decel and longer pushing stage were directly due to the nurse's restricting me to bed and putting me on my back." It was not about my preferences and was all about the fact that my baby was at risk of problems BECAUSE of medical intervention. I actually feared a c-section and thought the nurse was hell bent to get me in the OR by insisting on all the interventions I didn't want. I was in labor and lost my ability to fight, but this will never happen to me again. I will allow intervention when my baby and body show problems and show a risk for death or damage, never before. Never again. It's not about birth experience, it's about trusting that I know a lot about my own body. When I was in a dangerous position that caused heart rate to dip, it hurt more and made me agitated. When I was upright (which the later OB said would help turn my OP baby), it hurt less, and was what I begged to be helped to do...


Molly said...

What a powerful post, Dawn. You are right--YOU are the expert on your own body. I'm sorry that your birth experience was overtaken by the "hospital treadmill" instead of being truly based on the needs of you, your body, and your baby.