Omega 3 Fatty Acid Supplementation During Pregnancy

Aug6

This week, I was contacted about some new research being presented at the The Era of Hope conference in Orlando, FL about omega 3 supplementation during pregnancy reducing the risk of breast cancer for the baby girl in the future. Era of Hope is a scientific meeting funded by the Department of Defense Breast Cancer Research Program (BCRP). I was offered the opportunity to do a short interview with the researcher, Dr. Georgel:

Q. What are some easy tips for pregnant mothers to increase their consumption of omega 3 fatty acids?

A. Select the right type of oil when you go shopping:

Avoid corn oil and chose canola oil instead. Price is similar and canola proper ratio of omega 3 to omega 6 fatty acids (i.e., 1-2).
Wild caught salmon is a viable option; avoid farm-raised
Walnuts and broccoli are also good foods to incorporate into your diet.

Q. Are supplements (i.e. fish oil or flaxseed oil in capsule form) as effective as other foods?

A. Yes, if you select them properly. Read the label; for fish oil, you have to make sure that the amount of omega 3 fatty acid (combined EPA plus DHA) is around 1600 mg/day. If the label says, “essential fatty acids,” it usually contains and high level of omega 6 and low omega 3 (which is not optimal) so you want to avoid those.

Q. Is the effect dose dependent? (i.e. how much do women need?

A. Yes, 1600mg of combined (EPA plus DHA) omega 3 fatty acids per day.

Q. Since it is World Breastfeeding Week this week, I’d love to tie this research in to research we already know about the role of breastfeeding in reducing a woman chance of breast cancer. Any thoughts on that?

A. Our research indicates that the maternal diet (in utero and during breast feeding) containing omega 3 fatty acids has the potential to reduce the female off-spring’s incidence of breast cancer.

I also asked about the following: finally, there is some evidence that supplementation with EFAs postpartum has an effect on reducing the incidence of postpartum mood disorders. Any thoughts on how prenatal supplementation might have a similar impact? But, since Dr. Georgel’s research does not explore mood disorders, he was unable to comment on this question. Here are two great handouts from Kathleen Kendall-Tackett about EFA supplementation postpartum:

Can fats make you happy? Omega-3s and your mental health pregnancy, postpartum and beyond

Why Breastfeeding and Omega-3s Help Prevent Depression in Pregnant and Postpartum Women

Health Care or Medical Care?

Aug5

For quite some time, breastfeeding advocates have been working to change the language of infant feeding to reflect that breastfeeding is the biological norm (and formula feeding is the replacement/substitute). This includes sharing about the “risks of formula feeding” rather than the “benefits of breastfeeding” as well as encouraging research that no longer uses formula-fed babies as the control group or considers formula to be a benign variable (i.e. the babies in the breastfed group of many research projects also received some formula, but since our culture views formula as the “norm,” this was not seen as a conflict). I love Diane Wiessinger‘s example—would we ever see a research project titled “Clear air and the incidence of lung cancer.” No! Problem behavior is linked to problem outcomes in other areas of research, so it would be “Smoking and the incidence of lung cancer.” However, we routinely see research titles like “Breastfeeding and the rate of diabetes” rather than linking problem to outcome–“Infant formula and the rate of diabetes.”

Similarly, “intactivists” (people who oppose circumcision) have pointed out that there should be no need to refer to some boys as “uncircumcised”—being uncircumcised is the biological norm, it is “circumcised” boys that should received the special word/label. (On a related side note, I have written about “pleonasms”–words that contain unnecessary repetition–and birth and breastfeeding in a previous post.)

So, this brings me to another need for a change in the common language–correctly identifying whether we are really talking about “Health Care” or “Medical Care.” This was originally brought to my attention by Jody McLaughlin the publisher of Compleat Mother magazine. We have a tendency to refer to “health care” and to “health care reform” and “health insurance” and and “health care providers” and “health care centers,” when it reality what we are truly referring to is “medical care”—medical care reform, medical insurance, medical care providers, and medical care centers. As Jody says (paraphrasing), “we do not have a HEALTH care system in this country, we have a MEDICAL care system.” She also makes an interesting point about a trend to re-name medical care systems with names that use the word “health” instead:

This is what I have observed: Our local facility was called Trinity HOSPITAL, later re-named Trinity MEDICAL CENTER, and now it is Trinity HEALTH.

In the late 70’s and early 80’s the discussions centered around the MEDICAL crisis, MEDICAL reform, MEDICAL insurance and MEDICAL care cost containment.

MEDICAL insurance morphed into HEALTH CARE insurance. MEDICAL reform morphed into HEALTHCARE reform.

This is a difference with a distinction.

Health care includes clean air and safe water, enough good food to eat, exercise, rest, shelter and a safe environment as well as healing arts and the availability of and appropriate utilization of medical care services.

Medical care is surgery, pharmaceuticals, invasive tests and procedures. Malpractice tort reform is on the agenda too but no one is talking about reducing the incidence of malpractice, or alleviating the malpractice crisis by improving outcomes.

Why does this discussion belong here? First, I wanted to address it because I have a special interest in our use of language surrounding birth and how that language can impact our birth experiences. Secondly, if we emphasize that birth is a normal bodily process, a normal life function, and not an illness, we need to make sure that we are focused on health care services for birth, rather than medical care services. Personally, I think the midwives model of care can truly be described as health care, whereas standard maternity care in the U.S. can much more aptly be described as medical care.

Maternal-Fetal Conflict?

Aug1

“You will have ideas, options and paths to ponder, but you will also have a sense of possible directions to take as you consider midwifery, childbirth education, or being a doula or an activist. Your path may be circular or straight, but meanwhile you can serve motherbaby while on the path, with a destination clearly in mind.” She also says, “I use the word midwife to refer to all birth practitioners. Whether you are a mother, doula, educator, or understanding doctor or nurse you are doing midwifery when you care for motherbaby.” —Midwifery Today editorial by Jan Tritten

Mamatoto is a Swahili word meaning “motherbaby”–reflecting the concept that mother and infant are not two separate people, but an interrelated dyad. What impacts one impacts the other and what is good for one is good for the other. The midwifery and birth communities have used this concept for quite some time and more recently some maternal health researchers have also referenced the idea of the “maternal nest”–that even following birth, the mother is the baby’s “habitat.”

Critiques of homebirth sometimes rest on a (flawed) assumption of maternal-fetal conflict (which is also invoked to describe situations with substance abuse or other risky behavior). In the Fall 2007 issue of CfM News, Willa Powell wrote about maternal-fetal conflict in response to an ABC segment on unassisted birth. She wrote:

[quoting the expert physician interviewed for the segment] “The few hours of labor are the most dangerous time during the entire lifetime of that soon to be born child. Because of this, I would argue, all soon to be born children have a right to access to immediate cesarean delivery, and women who insist on denying this right are irresponsible.”

This was the only professional opinion in the program on unassisted birth, and he set up a typical expression of an obstetric community belief: the “maternal-fetal conflict.” The notion is that there are two “patients”, where the mother’s desires are sometimes in conflict with the well-being of the baby, and that the obstetrician has a moral/professional obligation to abandon the mother in favor of the baby.

I have to remind myself that Dr. Chervenak is setting up a false choice. In fact, this scenario is a “doctor-patient conflict”. The mother wants what’s best for herself and her child, but she disagrees with her doctor about what is, in fact, best. Women are making choices they believe are best for themselves and best for their babies, but those choices are often at odds with what doctors consider best for both, and certainly at odds with what is best for the obstetrician!

In the book Birth Tides, the author discusses maternal-fetal conflict:

According to obstetricians, the infant’s need to be born in what they have defined as a safe environment, i.e. an obstetric unit, takes precedence over the mother’s desire to give birth in what doctors have described as the comfort of her own home. It is a perspective that pits the baby’s needs against those of the mother, setting ‘overriding’ physical needs against ‘mere’ psychological ones. It is rooted in the perception that the baby is a passenger in the carriage of its mother’s body–the ‘hard and soft passages,’ as they are called. It is also rooted in the notion of the mind-body split, in the idea that the two are separate and function, somehow, independently of each other, just like the passenger and the passages. While women may speak about ‘carrying’ babies, they do not see themselves as ‘carriers,’ any more than they regard their babies as ‘parasites’ in the ‘maternal environment.’ If you see your baby as a part of you, there can be no conflicts on interests between you.

I previously linked to a book review that explores this concept of the more aptly described “obstetric conflict” in even more depth.

I think it is fitting to remember that mother and baby dyads are NOT independent of each other. With a mamatoto—or, motherbaby—mother and baby are a single psychobiological organism whose needs are in harmony (what’s good for one is good for the other).

As Willa concluded in her CfM News article, “...we must reject the language that portrays a mother as hostile to her baby, just because she disagrees with her doctor.”

An example of a mamatoto 🙂

Guest Post: Overcoming Stigma: A Film Story of Stillbirth, Miscarriage

Jul8

This post is republished from the blog of the Bill & Melinda Gates Foundation:

Overcoming Stigma: A Film Story of Stillbirth, Miscarriage

by Jhene Erwin

In 2007, with one two and half-year-old child, my husband and I decided it was time to have another baby. My first miscarriage occurred at six weeks. My second was at almost eleven weeks. The grief was alarming but I did what many women do – my best to quietly “carry on.”

Simple tasks became challenging. I’d stand in the cereal aisle frozen by the choice between honey-nut and plain. The question, “Paper or plastic?” should not make a person cry. Maintaining this external “everything-is-ok” façade was agonizing.

It was the tension – between façade and grief – which inspired my short film about miscarriage, stillbirth and early infant loss. “The House I Keep” is a story of transformation during one woman’s struggle to come to terms with the loss of her child.

My hope is that this film frees people to talk more openly about what remains stubbornly taboo. When people hear about my film total strangers let loose regardless of location: be it the gym or in a grocery store. Their stories are always deeply moving and I am honored by their candor.

What do they say?

They tell me there is no appropriate place to mourn this loss. While family and community are powerful sources of comfort, the silence on this subject prevents women from accessing that healing power. Consequently, the mental health of not only mothers but also their children suffers.

Consider this stigma magnified around the globe. In some developing countries, superstitious beliefs lead women to be blamed for a stillbirth or miscarriage. Some communities feel more people will die if the bereaved mother is in contact with other women and children. Subsequently, access to the healing power of family and community becomes greatly restricted. As we move forward with the important work of improving global maternal and newborn health, the long term effects of stigma on the mental health of women and their surviving children cannot be over looked or marginalized.

Talking heals. Women want to feel reassured that their child’s too-short life had a place in the world and that the world is different because of that child’s absence. You can help mark that life by just being willing to talk and listen. The landmark Lancet Stillbirth Series released in April is already impacting the worldwide perception of stillbirth.

In my own community of Seattle, Washington, in the United States, nonprofits that counsel women postpartum will be using my film as a starting place for open discussions. The ripple effect of community efforts, combined with the work of organizations including PATH, UNICEF, Save the Children, and the Bill & Melinda Gates Foundation, will undoubtedly lessen the stigma of a tragedy for which no woman should ever be held accountable.

By letting women talk openly, and by listening, our communities around the world can help women – including me – begin to heal.

More to Explore

Jhene Erwin is an actor and filmmaker. She lives in Seattle, Washington with her husband and six year old daughter.

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The Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. Safeguarding the health of mothers and young children is one of the world’s most urgent priorities and a core focus of the foundation’s work; especially in the developing world.

Abusive or Honest?

Jun20

I recently finished reading the book, Breakthrough: How the 10 Greatest Discoveries in Medicine Saved Millions and Saved the World, which I got for free on my Kindle. The section about germ theory talked about Ignaz Semmelweis, of course, and his conviction that it was an “invisible particle” carried by physician to woman that was causing “childbed fever” to be a rampant problem in hospitals. (I appreciated that the book noted that mortality rates for women attended by midwives or giving birth in their own homes were very low compared to hospital-based physicians.) During the latter part of his life, Semmelweis became very agitated by the failure of his colleagues to recognize the validity of his theory of the cause of childbed fever and began sending them, “vicious letters.” An example included in the book was the following:

Your teaching, Herr Hofrath, is based on the dead bodies of women slaughtered through ignorance…If, sir, you continue to teach your students and midwives that puerperal fever is an ordinary disease, I proclaim you before God and the world to be an assassin…

The author goes on to explain that Semmelweis later died in a mental institution and that, “Ironically, some contend that Semmelweis’ final vitriolic attacks against his colleagues constituted a third key milestone: His abusive letters may have helped raise awareness years later, as other evidence for germ theory began to accumulate.”

I find it fascinating that his frustration and anger towards his colleagues is described as “abusive” and “vitriolic,” when Semmelweis wrote a book, presented papers, and spoke with other professionals at length about the issue and was dismissed and even mocked for his ideas. When his (correct!) theory continued to be ignored and women continued to die, isn’t he a little entitled to be angry and express that?! I think he was being honest in his letters, not abusive. It made me think of how women are dismissed as being “drama queens” for being upset about unnecessary cesareans and that the terms “birthrape” or “birth trauma” are viewed by some as too “extreme” and how the medical profession all too often continues to NOT practice evidence based maternity care with regard to a variety of issues from restrictions on freedom of movement, to continuous fetal monitoring without indication, to risky induction of labor procedures, to cesareans for “failure to progress.” In the future, these experiences and women’s and birth advocates’ “vitriolic” reactions to them may be viewed through the same lens in which I view Semmelweis’ attempts to share his findings—they were trying to tell people something really important after all.

In another section of the book, the author says, “Scientific medicine has never been shy to dismiss if not denigrate any perceived threat to its values or power.” We continue to regularly see this in maternity care today!

Book Review: Arms Wide Open: A Midwife’s Journey

May22

Book Review: Arms Wide Open: A Midwife’s Journey
By Patricia Harman
Beacon Press, 2011
ISBN: 978-0807001387
324 pages, paperback, $16.47 (Amazon)
http://www.beacon.org

Reviewed by Molly Remer, MSW, ICCE, CCCE
https://talkbirth.wordpress.com

I very much enjoyed Patricia Harman’s first book, The Blue Cotton Gown, and was delighted to learn about her new memoir, Arms Wide Open which is, in a sense, both a prequel and sequel to her first memoir. The first half of Arms Wide Open chronicles Patsy’s experiences with homesteading and communal living as a young hippie mother in the 1970’s. It also explores her thoughts and experiences with peace activism and her passion for an eco-friendly life. During this time, she attends her first birth and dives into her midwifery journey and eventually becomes a CNM practicing with her hippie-farmer-turned-OB/GYN husband in West Virginia. Her experiences with their years in a joint women’s health practice are described in The Blue Cotton Gown. Readers who, like me, wondered what happened where The Blue Cotton Gown left off, can find out in the second half of Arms Wide Open, which is a narrative of Patsy’s ongoing work with women through 2009 and includes her emotional painful moments in her marriage, as her husband struggles with fears of another lawsuit as well as with chronic pelvic pain patients who abuse his trust (chronic pelvic pain is a specialty of their practice).

I did feel as if there was a large chunk of story missing as the book somewhat abruptly skips from 1978 to 2008. We miss learning about any of Patsy’s experiences in nurse-midwifery school, nor do we learn much about her practice when she was a CNM attending births. The book transitions from her years as a self-taught midwife considering going to school to become a CNM, straight to her present-day years as a CNM in a private women’s health practice.

Harman’s writing style is lyrical and engaging as well as candid. The book is based on personal journals and reading it feels like eavesdropping on someone’s very private thoughts and feelings. The book is much more of a look at a woman’s feelings about her life, than it is a “manifesto” about birth or about the practice of midwifery. In this manner, I feel like you receive a much more complete picture of a midwife’s life and journey, rather than reading a sequence of birth stories. Patsy has a lot of life in addition to birth. While definitely not a “feel good” book, Arms Wide Open is a deeply touching and very honest exploration of one woman’s personal journey in life, love, motherhood, and midwifery.

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Disclosure: I received a complimentary copy of this book for review purposes.

Review: A Book for Midwives

May18

Review: A Book for Midwives
Hesperian Foundation
CD-Rom, 2011
544 page pdf book in English and Spanish
by Susan Klein, Suellen Miller, and Fiona Thomson
ISBN13: 978-0942364-24-8, $16.00
www.hesperian.org

Reviewed by Molly Remer, MSW, ICCE
https://talkbirth.wordpress.com

As a child, I was fascinated by my father’s copy of the book, Where There is No Doctor. Fast forward twenty or so years and imagine my glee when as a birth activist adult, I then discovered A Book for Midwives, also published by the Hesperian Foundation. Hesperian’s goal “is to promote health and self-determination in poor communities throughout the world by making health information accessible. [They] work toward that goal by producing books and other educational resources for community-based health.” In keeping with this goal, A Book for Midwives is available for FREE download on the Hesperian site. (Personally, I appreciate the professionally printed version of the book I purchased, because I think it would cost more same in ink to print it myself, but without the nice cover!).

A Book for Midwives is excellent; a true community resource. It is also a very sobering look at the reality of women’s health and health care in other countries. It contains reminders such as “do not hit or slap a woman in labor,” and other things that can make you cringe. A Book for Midwives is basically a textbook for midwives, health care workers, or educators working in developing countries and/or with very limited resources. I appreciate how it makes information available that is sometimes “hidden” in other books–i.e. explicitly technical content and “how to’s” that are normally reserved only for “professional” people. It is simply written and extremely blunt. There is no fluff and nothing romanticized about pregnancy, labor, and birth. In a way, it was hard to read a book that makes it so very clear how very, very difficult things are for midwives and women in impoverished areas (living in the US, I am used to the “normal, healthy pregnant women” approach to midwifery care). The book covers a wide range of information from preventing infection, treating obstetrical emergencies, doing pelvic exams, and breastfeeding to HIV/AIDS, testing for STDs and cervical cancer, and IUD insertion. There is also a section in the back of the book about medications, medication administration, giving injections, and other topics. It is an extremely comprehensive resource. (Just a side note, in the section on contraceptives, the book is heavily in favor of hormonal methods such as pills as well as very positive about IUDs and sterilization.)

Recently, Hesperian made A Book for Midwives available for purchase on CD. The CD includes the 544 page book as a pdf file in both English and Spanish. Both high resolution and low resolution versions of the book (in both languages) are included on the disk. This format makes it easy for the book to travel with you via laptop for trainings or presentations. I was particularly excited to convert it for my Kindle, making it readily available for travel and reference.

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Disclosure: I received a complimentary copy of the CD for review purposes.

Blessingway Readings & Chants

Mar14

I’m looking through my files to choose a reading for a mother blessing this weekend as well as choosing readings for a women’s retreat this weekend. Anyway, I felt like sharing some of them here for people who might be googling around looking for something to share at a blessingway:

From the book Joyful Birth: A Spiritual Path to Motherhood by Susan Piver

The path of motherhood has a beginning, but no end. It’s constantly changing and constantly challenging. Along the way, we encounter our personal limits over and over. We fall in love over and over. We ride the sharp edge of hope and fear. On this path of discovery, as on any spiritual path, our pretensions are shattered, our minds are blown, and our hearts are opened. We cry, we laugh, we bumble around and make countless mistakes. Through it all, we are gently—or abruptly—poked into greater honesty, lovingkindness, and understanding. It is a truly joyful path.

The memory of [my child’s] birth has become a talisman that I hold in my heart as I journey deeper and deeper into motherhood. For these moments come again in every mother’s life—the times when we are asked to walk straight into our pain and fear, and in doing so, open up to a love that is greater than anything we ever could have imagined: all life’s beauty and wonder, as well as all the ways that things can break and go wrong…Again and again, motherhood demands that we break through our limitations, that we split our hearts open to make room for something that may be more than we thought we could bear. In that sense, the labor with which we give birth is simply a rehearsal for something we mothers must do over and over: turn ourselves inside out, and then let go.

This is the reading we often use for symbolically summoning the four directions. It is from the book Mother Rising: The Blessingway Journey into Motherhood:

Blessed be this gathering with the gifts of the East: communication of the heart, mind, and body; fresh beginnings with each rising of the sun; the knowledge of the growth found in sharing silences.

Blessed be this gathering with the gifts of the South: warmth of hearth and home; the heat of the heart’s passion; the light to illuminate the darkest of times.

Blessed be this gathering with the gifts of the West: the lake’s deep commitments; the river’s swift excitement; the sea’s breadth of knowing.

Blessed be this gathering with the gifts of the North: firm foundation on which to build; fertile fields to enrich our lives; a stable home to which we may always return.

From previous posts here is:

After my blessingway with baby girl, January 2011

A birth blessing

Full moon poem

Courage reading

Fear release for birth

Birth warrior affirmation

Two birth poems

Birthing poem

And, finally, here is a handout of the chants we often use. It is formatted with the chants in two columns so it can be cut in half to distribute.

International Women’s Day, Birth Activism, and Feminism

Mar7

“The minute my child was born, I was reborn as a feminist. It’s so incredible what women can do…Birthing naturally, as most women do around the globe, is a superhuman act. You leave behind the comforts of being human and plunge back into being an animal. My friend’s partner said, ‘Birth is like going for a swim in the ocean. Will there be a riptide? A big storm? Or will it just be a beautiful, sunny little dip?’ Its indeterminate length, the mystery of its process, is so much a part of the nature of birth. The regimentation of a hospital birth that wants to make it happen and use their gizmos to maximum effect is counter to birth in general.” –Ani DiFranco interviewed in Mothering magazine, May/June 2008

“We were all held, touched, interrelated, in an invisible net of incarnation. I would scarcely think of it ordinarily; yet for each creature I saw, someone, a mother, had given birth….Motherhood was the gate. It was something that had always been invisible to me before, or so unvalued as to be beneath noticing: the motheredness of the world.” –Naomi Wolf, Misconceptions

Since tomorrow is International Women’s Day, I felt moved to share the above quotes. I also wanted to touch briefly on birth as a feminist issue, spurred by this thought-provoking post by my friend Summer (I have TONS more ideas about this topic, but limited time in which to share them!). Personally, I’ve identified as a feminist since I was a child—long before I became a birth activist. Identifying in this way was my first taste of the activist spirit that has fueled me for the rest of my life. For me, my birth activism is intimately and inextricably entwined with my larger interest in women’s rights. I have always been somewhat confused to hear any woman say she is not a feminist, it grieves me because when you dig a little deeper, it is usually because they are defining feminism according to a very skewed, simplified, inaccurate, media misportrayal of feminism (i.e. a man-hating caricature). I also like the term “womanist.” To me, being a feminist most simply means believing and acting as if women have value. All too often, those who mischaracterize feminism in the above ways believe EXACTLY the opposite.

In one of my many books about women’s issues, I found these awesome explanations of what feminism is—the source being of some surprise to me, the Roman Catholic Order of Sisters of Loretto:

Feminism: a world-wide social change movement which critically but lovingly rejects relationships and structures based on stereotyped roles of dominance (male) and submission (female).

Feminism: a life-affirming movement reorganizing institutions and relationships, so that women will have equal access to society’s goods, services, status, and power.

Feminism: the bonding of women discovering the joy of woman-identity.

Feminism: a process freeing women to work toward liberation for themselves and other oppressed persons.

And here is another definition: “Feminism is a conscious and continuous effort to improve the lives of all women, an effort which requires changing the system that defines success as making a lot of money.” –Jane O’Reilly

To me it also means defining all women’s work, paid or unpaid, as having real value (this includes the “invisible” work of mothering reflected in the second quote I chose to open this post).

I think all of these definitions can be well applied to our work with birth!

I also think some women who do not self-identify as feminist do not because they feel like, “feminists want women to be like men.” So, here is a feminist quote about that too 🙂 “A woman should not be a mirror image of man’s universe. A woman should not try to emulate men, thus taking on masculine traits, she should develop herself, realize herself, gain direct vision into her own being.” —Anais Nin

I love the final point especially—gain direct vision into her own being. I think empowered birth often triggers this for women.

Net of love in action!

And, then finally, bringing us back to International Women’s Day I have a final quote:

“I believe that these circles of women around us weave invisible nets of love that carry us when we’re weak and sing with us when we’re strong.” –SARK, Succulent Wild Woman

As I noted in my post for CfM this week, in honor of International Women’s Day—and every day—let us celebrate our bodies, honor our mothers, and trust in the nets of love woven around us by a multitude of remarkable, powerful, everyday women.

Pushed Thoughts

Feb23

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?!

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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.”

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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]

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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 🙂