Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block – FOUR STARS
The term physiological birth is often used to describe “natural” birth, as opposed to birth that is aided and assisted and managed along the way. Physiological basically just means having to do with the body, but I saw it in another context while reading this book. At one point the word comes at the end of the line so it’s broken up by a dash “physio-logical”, and I pondered the breakout of the word logical there. Birth is certainly a logical process, driven by the body. It’s not just that things tend to happen in a certain order, it’s that there’s a logical reason why they happen in that order. For example, babies born by cesarean section have more breathing problems, likely because they simply are not ready to be born yet.
This little idea came just a few pages into the start of Pushed and set the stage just right. The book begins by talking about how birth has been transformed into a highly managed medical whirlwind.
On the one hand, I generally trust that doctors are doing the right thing. On the other hand, I have to realistically keep in mind that they are people with biases and different priorities than me, that they are employees with bosses other than me, and that they are participating in a corporate process that has needs of its own. A nurse in Pushed talks about women being induced or given cesarean sections because the hospital needed a bed free or because the doctor had somewhere else to be. This bothers me, but it doesn’t surprise me.
In the tale of one woman’s birth, the medical procedures attached to or inserted into her body included a prostaglandin suppository, an arm IV, an electronic fetal monitor around her belly, a sleeping aid, puncturing the amniotic sac, an infusion of Pitocin, an epidural, a urine catheter, a blood pressure cuff, a pulse oximeter, and then after all that “failed” to make the baby come “soon enough”, a cesarean section. And did this woman actually experience any particular problems or have any particular risks? She was given three reasons – she was “past her due date, her baby was ‘measuring big’, and her amniotic fluid looked low.” All three of these reasons are controversial, at best. What was probably gearing up to be a perfectly normal birth was instead prodded, poked, and pulled straight to a c-section. And the image of being strapped down and strapped in to all that medical equipment really bugs me. It’s so hard for me to imagine attempting to have a difficult, meaningful experience surrounded by that level of interference.
One of things that made this book hard to read was learning that some things that I’ve believed to be “true” aren’t. This happened when I researched obesity and discovered that many of the obvious truths just aren’t. And now here it is happening with birth stuff, and it makes my blood boil. For example, there’s a “24 hour rule” that’s been around since the 60s that basically says that once your waters break, you need to give birth within 24 hours, because the risk of infection is increased. I’ve heard this claim over and over, it makes sense, and I’ve believed it. I wouldn’t feel particularly bound to a rigid timeline, but I’d certainly keep the standard in mind. I have personally been judgmental of women on freebirthing lists talking about walking around for days after their waters break. Now this book talks about a 1996 study of 5000 women showing that there is “no increase in neonatal infection in [women with prelabor rupture of membranes] that were watched for up to 4 days after rupture.” Fuck you. That’s what I have to say about that. When you’re the high-paid expert on these things, when you cultivate a cultural story that says that you “know best”, you need to be right. Okay, doctors don’t have to be right all the time. When it turns out that you’re wrong, though, you need to admit it. This study was published in 1996. Almost 15 years ago. Fuck you. Turns out what causes the increase in infection is vaginal exams. Reason after reason after reason why I want to stay home for my birth. The book goes on, covering other common inductions and assistances, almost all of which are based on dubious motives and many on dubious evidence.
Then there’s an entire chapter on cesarean section. And this is so painful to read. The cesarean section as a procedure is brilliant in some ways. It’s one of those high-tech advances that we should marveled at and be grateful for, like prosthetic limbs. But the modern American bottom line is that a third of women give birth by c-section. And it’s hard to process what that even means. One third is HUGE and the rise in this percentage shows no sign of stopping. The risks and consequences of the rising induction and cesarean rates require an entire chapter in Pushed.
Amongst medical professionals, part of the story they tell is that it’s women pushing for c-sections. Women are afraid of this-or-that complication with their bodies or this-or-that complication with the baby. My first reaction to that is that it’s not fair to push that off onto women, since they are steeped in a culture that’s constantly talking about how dangerous birth is, so how difficult is it to hold a different opinion? And that “dangerous birth” meme is most certainly perpetuated by doctors, who are, after all, the ones insisting that you need to be hooked up to every machine they can think of “just in case”. But, Pushed dives a little deeper and finds that it might not really be women who are pushing for c-sections after all, but that the fault might lie more squarely on the shoulders of doctors. It’s hard to call it “patient choice” when your doctor is sitting there fear-mongering about the things that can go wrong or when your doctor is outright advocating for a c-section. As I said earlier, when doctors cultivate the “doctor knows best” story, a lot more responsibility falls their direction. Pushed also delves into the relationship between lawsuits/malpractice insurance and the c-c-section rate and offers some solutions to the rising rate, most notably increasing the use of certified nurse midwives in hospitals and midwives at home.
The chapter “Denied Birth” goes into breech births, twins, and birth after a previous cesarean. For all of these, the resounding cry from doctors is “No!” In many areas of the country it’s impossible to find a doctor who will agree to a vaginal delivery in these situations. I was delighted that this chapter also covers freebirthing – giving birth with no medical/birthing professionals – which is what I plan to do. The book presents the many reasons that women might choose this, including woo-woo “create your own reality” stuff and the inability to find the kind of care they want from the medical profession.
The “Mother’s Helpers” chapter talks about doulas and birth plans and pain medication. All three strike me as management responses to a broken system, and I’m generally not interested in that. All three feel inadequate and inappropriate to me, and I skimmed this chapter.
Another two chapters discuss the underground and oftentimes criminal status of midwifery in America. This, too, held little interest for me. It’s almost too depressing to read. I’m already so opposed to laws on some really fringe ideas, that it’s even more absurd in this arena, when so many women clearly wish for the care of midwives. While I have decided against having a midwife, I ache for the pregnant and birthing women who can’t find the caregiver they desire and ache for the women who practice midwifery under threat of criminal charges.
And finally, Pushed wraps up with the fear-mongering chapter, “Rights”. I have mixed feelings about this chapter. Stories of women being court-ordered to have a cesarean sections terrify me. I do want to know that this possibility exists. I want to understand that going to a hospital with the intent to refuse some of the common procedures puts you at risk for legally-sanctioned medical procedures done against your will. I want to know that many women have procedures done on them without even their knowledge. I want to know what I’m getting into when I go to the hospital. BUT. There aren’t really statistics on these things. How different is this chapter from some doctor who talks about all the risks of vaginal delivery? What are the actual chances of hospital staff freaking out on you?
Ultimately, I guess I want this chapter in there. Recently, on a birth/parenting message board I’m on, someone asked, “When you go in for labor and delivery, what kinds of things can you refuse?” and the answer to that ought to be, “Anything and everything.” Some women responded with things they had refused and others piped up with, “Wow, you’re allowed to refuse things?” That breaks my heart. But at the same time, if you are aware that you are ostensibly legally allowed to refuse things, you also need to be aware that those refusals will be met with pushback. Whether the pushback amounts to a bit of whining on the nurse’s part or whether it amounts to a court-ordered surgery depends on a lot of factors like your income level, your race, and the area of the country you’re in. I’m a big proponent of telling people their rights, but it’s important to know the risks to demanding those rights, too.
The “Rights” chapter finishes up by talking about the legal and social ongoing efforts to support women’s reproductive rights.
In the end, this is a slightly overwhelming book to read, and I’d probably recommend it in little chunks. Reading page after page after page about the complete and utter fuck-up that is hospital birth in America was a bit tiring on my psyche. If this is a topic that interests you, this is a great, comprehensive book on the subject of modern maternity care in America. Make no mistake, though, it’s not a pretty picture. This book is a dark look at the state of affairs, and many of the statements from nurses and doctors and many of the women’s birthing stories are shocking and horrifying. This is not a feel-good book about birth at all.
I’m glad I read it. I do worry about my decision to stay out of a hospital, and I’ll probably keep worrying about it a little bit, right up until the end. However, I did have a chuckle when I first started reading this book. I realized that any time I’m in doubt, all I have to do is read a snippet from this book and I’ll be right back to solid in my decision to stay as far away from a hospital as I can.
Pushed: The Painful Truth About Childbirth and Modern Maternity Care
by Jennifer Block