Pushed: The Painful Truth About Childbirth and Modern Maternity Careby Published 4 Jun 2007
|Pushed: The Painful Truth About Childbirth and Modern Maternity Care.pdf|
|Publisher||Da Capo Press|
Pushed: The Painful Truth About Childbirth and Modern Maternity Care Ebook Description
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In the United States, more than half the women who give birth are given drugs to induce or speed up labor; for nearly a third of mothers, childbirth is major surgery - the cesarean section. For women who want an alternative, choice is often unavailable: Midwives are sometimes inaccessible; in eleven states they are illegal. In one of those states, even birthing centers are outlawed.When did birth become an emergency instead of an emergence? Since when is normal, physiological birth a crime? A groundbreaking journalistic narrative, Pushed presents the complete picture of maternity care in America. Crisscrossing the country to report what women really experience during childbirth, Jennifer Block witnessed several births - from a planned cesarean to an underground home birth. Against this backdrop, Block investigates whether routine C-sections, inductions, and epidurals equal medical progress. She examines childbirth as a reproductive rights issue: Do women have the right to an optimal birth experience? If so, is that right being upheld? Block's research and experience reveal in vivid detail that while emergency obstetric care is essential, there is compelling evidence that we are overusing medical technology at the expense of maternal and infant health: Either women's bodies are failing, or the system is failing women.
"Pushed: The Painful Truth About Childbirth and Modern Maternity Care" Reviews
I read this book quickly and with interest. It is a rather alarming look at obstetrics--for that reason I don't know whether to strongly recommend it to other expectant couples or whether to dis-recommend it. Once you read the book, it is hard not to be suspicious of your doctors and to push back against their decisions -- this may be for the best, but it is not a comfortable position to be in. It is hard to judge exactly to what degree this is a reasonable book and to what degree it is an alarmist book. After reading it (and doing a lot of research inspired by reading it), I think it is on the whole quite reasonable, which is quite frightening.
The book ends with a section on rights with a number of frightening cases -- cases of hospitals that got attorneys to represent the foetus of mothers who refused procedures and forced those procedures on women. The points the books make strike me as right on: that it is a violation of a woman's body to force a procedure on her without consent; that it is absurd to believe that women don't have the best interest of the foetus in mind when they make their decisions.
One of the most interesting points the book makes is that groups that push for "reproductive rights" have been slow to include among those rights women's right to choose how they have their babies. Which is to say, it seems strange that a woman's right to choose encompasses her right to abort a pregnancy but not her right to have her baby vaginally in any number of cases in which hospitals insist on C-Sections. In an absolute sense, it seems a woman should always have a right to refuse a C-Section, since it is a procedure which undoubtedly puts her at greater risk than a vaginal birth. In a more pressing sense, women have good reason to refuse many C-Sections, since there is compelling evidence that far too many are performed in the U.S.
The role of malpractice insurance is invoked as the main reason hospitals and obstetricians make decisions to operate or to induce when it is not in a woman's best interest (convenience is another, more cynical, reason, but one that I'm sure operates on a subconscious level--I can't imagine a doctor knowingly putting a patient at risk to free up a weekend). At first I was sceptical that malpractice insurers would push for something not backed up with data and would have such sway over hospitals, but conversations with our doctor seems to confirm that it is true: he confirms that malpractice insurers give "cut rates" to doctors or hospitals who won't do VBACs, for example (which our practice regularly "do").
I wonder in how many other places in the medical system malpractice insurance makes a big impact on care. If it does, it seems quite worrisome because it means that what plays well to a jury determines what is good care, and it's not hard for me to believe (or for me to believe that insurers believe) that juries don't think scientifically. My impression from taking classes with pre-med students in college was also that med students are not very good scientific thinkers, so the malpractice monster pushes things from bad to worse.
Thus, regardless of whether monitoring a baby's heartbeat is shown to help babies and mothers, monitoring is routine in hospitals so that doctors faced with a suit can say they did everything they can. And it goes similarly with other interventions.
Thus, a kind of hysteria sets in, and the results are decisions which individually may seem unassailable to jury and patient (we just want to make absolutely sure your baby is safe) but on a societal level clearly cause more harm than good (we have a 30%+ C-Section rate).
I felt "pushed" into being induced when I was pregnant with my second child. My doctors induced me and several other women who attended the same practice on the same morning--so the doctor's schedule wasn't affected. (We were told that by the nurse!) I have never felt good about my labor experience. As I started to read this book, I felt vindicated and realized I am not alone.
Women need to take back their bodies and control of their births! Too many women are being "pushed" to be induced and have unnecessary C-sections, and have way too much medical intervention in a completely natural process.
I would recommend this book to any woman who is pregnant, is considering becoming pregnant, or is interested in women's health.
It's an eye-opening, interesting read. And yes, it is very one sided, but it is a side we don't hear too often.
Women deserve choice in pregnancy and delivery. If you are ever thinking about having a baby, I wholly recommend reading "Pushed", by Jennifer Block.
What's the difference between this book and the gazillion other books about childbirth out there? For one, it's the documentation. Jennifer Block meticulously references legitimate medical research and studies throughout her book. Instead of making an empassioned tug-at-your-heartstrings plea for her case, Ms. Block makes her case with statistics and data. For two (ha), she remains relatively unbiased throughout the book, and while her opinions on the matter aren't exactly absent, she makes a concerted effort to show the opposing side's argument and their reasons for their actions. If you're looking for an unbiased and research-driven book that delves into modern maternity care, I unequivocally recommend reading this one.
I strongly believe in the power of intuition. I think that we're all put on this Earth to have our own experiences and challenges, and that we each have a different mission or purpose in being here. Whether it's a matter of making life-changing decisions, raising children, or simply driving a different way because we feel prompted to, I think that the power of a person's intuition is not to be taken lightly. In some instances, I would argue that the Spirit speaks to us via our intuition. In all of these cases, I feel like the decisions we make for ourselves and our lives are always going to be deeply personal, and aren't necessarily universally good choices for everyone. So... that's my disclaimer.
For me, I've always felt passionately about childbirth. I've always felt that there's something more to it than simply going to the hospital and coming home with a child; I feel like it's meant to be a life-changing experience. It's a rite of passage during which the veil to the other world is briefly parted for a family to welcome life into the world. To quote a midwife who is quoted in the book, I've always thought that "a woman meets herself in childbirth."
For both of my kids, I chose a midwife for my prenatal care and birth. I always thought that they would be more respectful of the birth and my touchy-feely approach to it. And I had what I considered to be fantastic prenatal care. Both of my deliveries ended up as scheduled inductions, and I had epidurals with both of my kids. While giving birth is a holy experience, no matter the method, I'll be honest in saying that I don't feel like I've yet 'met myself' during childbirth. I haven't had the full-body spiritual experience that I've yearned for, and that I've heard others speak of.
Looking back, I wonder if there's anything that I could have done differently. Should I have waited longer to see if I would have gone into labor with my first child? Would things have been judged differently with a different provider? Were my inductions medically warranted, or was I rushed into the delivery room "just in case," so that my midwife could look minimally negligent in the case of a lawsuit?
I understand that not all labors go perfectly, and that access to emergency obstetric care is a privilege that I should not take for granted. The reality is that many women and children have been saved by medical interventions, and I am grateful to live in a time when that is available. Also, I understand that in our modern litigious climate, care providers and hospitals need to watch their backs and do their part to avoid a potentially career-ending lawsuit. And I understand that, in court, showing that you did "everything possible" to avoid the detrimental outcome is important in winning your case.
But I also believe that birth is a physiological process, not a procedure. Unlike cancer or transplant surgery or other typically medical events, optimal outcomes for birth occur when labor is not actively managed, but instead watched, supported, and protected with the least medical intervention necessary. Overwhelmingly, research supports this theory. And so I believe that the majority of the time, a woman can birth a baby safely without any type of medical intervention. And I feel like the majority of women are pushed into being treated like the minority (who justifiably require more medical attention), and are being treated as though their bodies are unable to birth the babies they so perfectly created and nourished for nine months, despite all indications to the contrary.
I am not arguing that every woman should think that hospitals are the childbirth devil and thus plan to have a home birth. I just wish there were more options out there. Current hospital policies tend to be more litigation-friendly than birth-friendly. For example, many hospitals require continuous fetal monitoring, which restricts movement during labor. Most hospitals require a woman to give birth within 24 hours of her water breaking, despite several research studies showing that this arbitrary deadline does not decrease the incidence of infection. Most hospitals augment (or induce) labor with pitocin, despite research showing that it markedly increases the incidence of fetal distress. Many hospitals require a woman to give birth within 24 hours of being admitted, whether vaginally or by c-section. Unfortunately, not all bodies work within these time limits.
And so women are basically given the option to either acquiesce to the hospital's litigation-driven policies, or to birth in an alternative environment (home or birthing center). And I understand wanting to have access to emergency obstetric care - it makes perfect sense to me to want to have somebody there in case something does happen. So I am militantly frustrated at the lack of options out there for a woman who wants to have a minimally invasive birth with access to emergency obstetric care... it seems like you get one or the other these days.
Why are we so quick to induce labor (40% of all labors are induced)? Why does our great nation lag behind virtually every other developed country in maternal and infant mortality rates? Why are 1/3 of our women giving birth via c-section, when overwhelming research shows that this number shouldn't be above 10% or 15%? Why don't we trust our bodies to go into labor on their own? Quite frankly, I have a hard time believing that God created women to create and carry babies and then disabled most of them from being able to give birth normally. Why don't we trust our bodies to give us the cues? Why is there no divinity in birth anymore? Why is it considered to be a medical event rather than a natural one?
To lift a paragraph from the book (page 140):
"In the womb, the lungs are filled with fluid, and the fetus receives oxygen through the umbilical cord. The remarkable process by which the fetus adapts in seconds from water to air is still unclear, but the current understanding is that it begins purging its lungs of fluid in the days prior to birth. 'Somehow, the fetus comes to know that it is about to be born," is how Lucky Jain, MD, professor of pediatrics at Emory University, puts it. Jain has studied the transition from one respiratory medium to another and has found that the process continues during spontaneous labor and birth. Hormones are released that prime the lungs for air, and the squeezing effect of the birth canal helps purge the lungs of excess fluid. Cesarean babies often must be heavily suctioned or intubated to facilitate breathing; Jain says that a significant number of those admitted to NICUs are in fact term or near-term respiratory cases, and cesarean birth has been linked with childhood asthma in a number of studies.... Jain estimates that for every 1 million cesareans, there will be 25,000 cases of respiratory distress and 5,000 cases of outright respiratory failure."
Why aren't we allowing our bodies to give us the signal, rather than giving the signal to our bodies? Is it possible that our modern medical system, while amazing in its advances and technology, is not as good at birth as our bodies are?
For example, in the 1940's, common medical practice was something known as "twilight sleep," where a woman was given morphine and scopolamine, which sedated a woman enough to give birth but not remember any of the pain. However, after almost two decades of routine use, studies showed that it had the unfortunate side effect of decreased attachment between mother and baby, difficulty breastfeeding, a depressed central nervous system in the infant, which caused babies to have decreased breathing capacity. Then heralded a landmark achievement for women and obstetrics, today, the era of twilight sleep is considered to be a dark time in obstetric history. Sometimes, I wonder if we'll look back at today's birth practices with the same regret.
There is so much more to this book than my rant details, but if you're looking for more information about it, you can check out the author's website, and I highly recommend reading my friend Bridget's (much more intelligent and less rambly) review of the book at http://myadventuresintucson.blogspot.....
To close, I'm not saying that you should agree with me on the "ideal birth experience." In fact, I don't expect you to at all. But I do think that you should be able to choose your ideal birth experience without the constraints of hospital policies and practices. Just as you should give "informed consent" for any procedure in your care, you should also have the option to give "informed refusal" for anything you don't want. Your doctor is an advisor to your care, but you should be the one making the final decision, and you should be allowed to do so.
Ultimately, I agree with one of Ms. Block's closing statements:
"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.
Today women have unprecedented access to the information they need to make the best decisions for themselves - and therefore the best decisions for their babies. They are in fact in a far better position to make evidence-based decisions than their doctors. They have a right to make those decisions, and they should make those decisions."
Women of earth, trust your intuition, and take back your birth.
Pushed is a shocking documentation of medically managed childbirth in the United States. The first four chapters detail the standard practices and current trends (a la 2007) and the effect these have upon the women giving birth. Jennifer Block challenges the sacred cow of an idea that the definition of a successful birth is simply a live baby and live mother. She makes the case that the trauma incurred during the birthing process through unnecessary medical intervention and surgery, artificial time limits, and practices that hinder and harm the natural working of a mother's body should be factors in declaring a birth "a success."
Block also delves into how procedures, instruments, and drugs that were developed to combat certain complications and particular potentially deadly situations suddenly became standard practice for all pregnancies regardless of whether they were low risk and showed no signs of complications. She also describes the potential side effects, increased risks for further interventions, and complications of common and standard practice medications, surgeries, and practices -- information that is usually omitted or downplayed because it might make women less likely to blindly submit to them.
Interestingly enough, the author doesn't take the opportunity to discuss the naive American mindset that everything a doctor does is in the patient's best interest rather than because it is in the best interest of a drug company or hospital or convenience-driven in general. Fun fact: a cesarean takes a doctor 45 minutes while a woman delivering vaginally can labor for over 24 hours creating over a day's worth of intermittent updates.
There is a lot of very good information about vaginal birth after cesarean sections, and the authors does include a defense of doctors who refuse to allow VBAC in that she explains the cost of malpractice insurance and hospitals' general unwillingness to take up the time and resources while risking a potential lawsuit to provide this option. Of course, she doesn't explain why hospitals don't simply allow women seeking VBAC to sign a waiver relinquishing their right to sue in the event of a negative outcome. There is also no suggestion of a nationwide initiative to push for at least one centralized hospital in each of the 50 states that would allow VBAC.
I wished that she would have gone into more detail about alternatives to the standard lithotomy (flat-on-back) birthing position. It's simply taken for granted that because this is the most convenient position for the doctor that there's no hope of changing hospital procedure even if it's the worst position for a woman's body and could end the practice of giving routine episiotomies.
I also wished that she would have spent more than half a page on the detrimental effects of "coached/directed pushing" in the lithotomy position. She explains that this practice originated with the advent of early pain medication when women were totally numbed from the waist down and had to be told when to push and for how long since they had been rendered medically helpless. And she mentions that it is now standard practice and can cause severe pelvic floor damage, but beyond adding that this is not insisted upon by hospitals considered "baby friendly" by UNICEF and that having a doula can help you avoid this, she lets the subject drop.
In just about every single, television, birth documentary filmed in hospital setting, the nurses have the woman begin directed pushing in the flat-on-back position as soon as she reaches 10 cm, but not once in all my TV viewing did I ever witness a member of the hospital staff ask the woman if she wanted to wait until she began to feel the urge to push as pushing before the baby was in a good position could result in lasting pelvic floor damage.
Pushed provided the statistical data to support my anecdotal evidence. From what I've witnessed, the norm for women in the United States is horrible impersonal care dominated by medical intervention as if birth were an emergency on par with a heart attack. Over the last 10 to 15 years, I have not known one woman among all my friends, acquaintances, and co-workers who has been allowed to go into labor naturally. Not one. Three had complications/high risk pregnancies that warranted inductions and scheduled cesarean sections, but the majority had the "big baby" card played on them. Now it is always possible that every pregnant woman of my acquaintance over the past decade fell into the 5 to 10% of all pregnancies that develop macrosomia (baby too large to deliver). But the statistical odds are against this.
These women were all told at or before 37 weeks that they needed to be induced in order to prevent complications such as shoulder dystocia, an event that the medical literature states is impossible predict and occurs 50% of the time in babies smaller than the macrosomic weight of 8 lbs, 13 oz. Their doctors also insisted on inductions out of fear for a big baby despite the fact that fetal macrosomia can only be diagnosed after the child is born and that the guidelines issued by the American Congress of Obstetricians and Gynecologists recommended against elective inductions in cases of suspected fetal macrosomia because labor inductions only raised the odds of having cesarean sections without changing the fetal or maternal outcomes.
While decidedly anti hospital and pro home-birth, this book is very well written and researched and has a lot of evidence to back up its position. It discusses in detail the ways in which augmentation can disrupt the physiological birth and what that can mean for mom and baby. It also details cesarean section and the many risks involved with such a major abdominal study. While the author’s bias may have led her to overstate some on the complications, I don’t think I fully understood the ramifications of having a cesarean until reading this book. Not only the physical and psychological effects of the surgery itself, but also the absolute lack of choice in many places to even attempt a VBAC for subsequent pregnancy. What makes an OB’s life a little easier and makes sure he get’s home in time to have dinner with his family has lifelong effects for the mother and strips her of her basic reproductive rights. I found myself getting very angry reading about how doctors and hospitals look at how a potential procedure could affect their malpractice liability instead of how it would or wouldn’t benefit the mother and baby. And baffled that so many women’s rights organizations don’t want to include mother/labor rights with reproductive rights.
Borrowed from the public library.