Pushed

You have got to read this book! (Pushed: The Painful Truth About Childbirth and Modern Maternity Care, by Jennifer Block)

I just finished it, and it is one of the most powerful books I've come across in a very long time. That's saying a lot, because little of the information in the book was new to me, and yet it still blew me away. I wanted to stay up all night to finish it, like Sage Femme, but frankly I cannot pull that off with a round-the-clock nursing baby! So I forced myself to put it down at 11 pm yesterday and finished it today.

Block's central thesis is this:

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 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 concerns, by a provider's licensing regulations and malpractice insurer. The evidence often has nothing to do with it.

Block paints a depressingly grim picture of modern maternity care in which only a handful of women experience physiological childbirth. The rest give birth plugged into machines. Drugs and hormones course through their veins; scalpels and scissors cut them open, often after coercion and frequently despite the woman's expressed refusal. Almost everyone she interviews admits there's a problem, but no one seems to be able to change the system. Those who buck the system altogether--home birth midwives and unassisted birthers, for example--face legal harassment, imprisonment, fines, or loss of custody of their children. Block's book points out several captivating ironies that, if they weren't so depressing, would be laughable:

1) ACOG recently decided to support elective "maternal request" cesareans--surgery for no medical reason--as ethically justifiable (even though the medical evidence shows that cesarean sections for no medical indication lead to higher morbidity and mortality for mothers and babies, rising sharply with each successive surgery) yet refuses to allow women to choose out-of-hospital birth, direct-entry midwives, or, in many hospitals, VBACs (even though the medical evidence clearly shows that these choices are safe & reasonable).

2) Although physicians and midwives tout the importance of evidence-based medicine, less than 2% of American women received "optimal maternity care" that consists of these six basic aspects, all of which are well supported by the best evidence-based medicine:
1. Labor begins spontaneously
2. Women have freedom of movement during labor.
3. Interventions are medically justified rather than routine.
4. Women have continuous emotional and physical support.
5. Pushing occurs in any position but flat-on-back.
6. Mother and baby are not separated.
In other words, 98% of women received sub-optimal care.

Surprisingly, this book gave me a greater sympathy towards obstetricians (well, some of them at least). Many of the physicians she interviewed held great respect for the natural, physiological birth process; bemoaned the current state of malpractice litigation, VBAC bans, and the dogma of automatic surgery for breeches; and secretly supported home birth midwives--often facing censure from their peers for their views.

Pushed shows a maternity care system that has gone malignant. Instead of being a tool to aid women when pathology arises, it is now our master. Obstetricians, nurses, midwives, birthing women and unborn babies are all slaves to the machines and the technologies that they have created. Birth, for most women, is managed by drugs, hormones, and clocks, rather than being a chaotic but gloriously intricate and rewarding physiological process. In this system, no one wins. Instead of being bathed in a complex "cocktail of love hormones," as Dr. Michel Odent put it, women are on morphine drips in post-operative wards. Their babies are intubated, suctioned, and injected. Mothers are separated from babies, vaginas are separated from birth, and birth is separated from labor.

I want to share a final excerpt from the book, which illustrates so exquisitely why a "natural birth" is so difficult to attain in a typical hospital setting. The vast majority of American births involve myriad kinds of medical devices, all of which tether the woman to an obstetric bed and deprive her of the ability to move freely during labor: IV, automatic blood pressure cuff, pulse oximeter, electronic fetal monitor, epidural catheter, urinary catheter, intrauterine pressure catheter, and circulation stockings. The latest device, just approved by the FDA, consists of two electrodes inserted inside the vagina that automatically measure cervical dilation. Judith Lothian (PhD, board member of Lamaze International, and professor of nursing at Seton Hall University) explains: "If we put women in hospitals with restrictive policies--they're hooked up to everything, they're expected to be in bed--of course they're going to go for the epidural, because they're unable to work through their pain." British midwife Tricia Anderson writes:

Let us bring them into harsh rooms with bright lights. Let us make them lie on their backs on hard narrow beds. Let us tether them to machines so they cannot move. Let us make them stay silent and make no noise with their pain. Let us expose their most private parts and threaten them with cold steel. Let us make them push their babies upwards, against the pull of the earth...In these conditions, labour swiftly becomes unbearable and pain relief becomes a woman's only hope....This is not the natural cry of a woman in labour bringing a child to birth, although if you have only ever witnessed childbirth in a medicalized setting you might be forgiven for thinking so. This is the screaming plea of a tethered animal in pain.