Pushed Thoughts

If you are looking to get fired up about about birth activism, I recommend reading the book Pushed by Jennifer Block. This book is seriously GOOD! 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 originally checked this book out of the library, but after seeing all of the data contained within—she pulls together vast quantities of data about effectiveness of “routine” practices, etc. and makes it accessible to the average reader—I quickly ended up acquiring two copies (one hardback and one soft cover, both autographed from when Jennifer was our featured speaker at FoMM‘s annual Cookie Day event!).

Yes, I was a geeky fangirl in the Capitol rotunda in 2009 when Jennifer Block spoke at the annual Friends of Missouri Midwives Cookie Day event.

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 Block’s 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) than the small chance of natural uterine rupture. 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.  ::sob:: 😦

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

Some assorted random thoughts and quotes from Pushed:

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.”

While my feelings about unassisted birth have been “refined” and tempered somewhat since first reading Pushed in 2008, I did find the sections about UC to be frustrating and annoying. 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 makes me 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, regardless of any other personal opinions, I think they are just as demeaning and restrictive to women as the anti-homebirth sentiments are.

Okay, brief rant aside for 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.” [emphasis mine]

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.

For some ideas that address the above, read my small-stone birth activism article 🙂

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