Pushed

This in an excerpt from a book review I wrote for my doula certification course. The book is called Pushed and written by Jennifer Block.

So all you pregnant ladies, put down What to Expect When You Are Expecting and pick up Pushed. It will tell you much more acuratly what you should expect when you walk into a hospital to deliver your baby!

Pushed, Jennifer Block, 2007

This book is phenomenal on many different levels. It is packed with concrete statistical analysis of modern childbirth practices, a critical eye toward the ever increasing number of births via c-section, a close look at what constitutes, and doesn’t, evidence based care in obstetrics and a historical context to understand why and when vaginal birth became the over managed and over controlled process it is today. Block concludes her in depth analysis with several chapters focusing on various effects the change from expectant management of childbirth to active management have had on our culture, women and overall how these changes should have an influence in the ongoing fight for reproductive rights in this country.

The last four chapters are full of case studies and the author actually shadows an illegal midwife. This section of the book was for me literally impossible to put down. The stories Block shares are engaging, heartbreaking and inspirational all at the same time. No matter where one stands on the issue of other reproductive rights (i.e. abortion), the tie in Block makes to the current treatment of women by healthcare providers, hospitals and insurance companies to reproductive and womens rights in general is compelling and effective.

There is not much that I didn’t like about this book. There are a great deal of statistics in the first section of the book and stopping to comprehend each new statistic makes for a cumbersome read. However, I felt most every statistic and study she included were appropriate. Block also uses lots of names and refers back to these same people later in a chapter or even later in the book. At times trying to figure out who the person was that she was referring to could be difficult since the original mention of the name was several pages prior in that chapter.

I think the most significant thing I learned from this book is the completeness of evidence-based data that exists and confirms that the active management of labor is flawed. Sadly the other significant fact I learned is that nobody seems to care and nobody shares this evidence with women, including doctors, hospitals or even women’s rights groups. She uses the National Organization of Women as an example of a group that has an official platform concerning women’s rights during childbirth that includes the availability of legal midwifes and VBACs, but that NOW does not promote this agenda because it puts them in conflict with the powerful lobbies of pharmaceutical companies and ACOG (American Council of Obstetrics and Gynecologists). She also discusses how ACOG has been more interested in maintaining status quo rather than examining and adopting evidence based practices. This preservation of active management of labor is due to misinformation, the ease of OB’s work schedules when c-sections and inductions are common, and the perceived liability risks.

What Block does say is that at the grass root level this issue is bubbling. She uses the examples of Mothering.com, ICAN and other groups that are supporting women and connecting expectant mothers with healthcare, legal or not, that will fight one baby at a time to change the way we think of birth. She also is realistic in showing that putting women in a position without choices when it comes to their medical care creates situations where women do not seek any kind of care at all or are left driving hours during labor to a midwife in another state. While this situation is usually safe, it is still an irony that women now sometimes have to choose between unacceptable medical care and non at all. Block does a good job describing the rising numbers of unassisted births that are happening in the country due to restrictive VBAC laws and the narrowing definition of normal vaginal birth.

This book also puts what happens in actively managed births into a historical perspective. For those of us drawn to the natural birth process it can be hard to understand why something like an episiotomy or continual fetal monitoring is common practice. Pushed helps to explain that most of these practices were not originally designed to be used in the form they are used in today and how it is that they came to be used as they are currently. The book also goes into detail about the pressures that face doctors and hospitals in terms of technology and liability. Knowing this reality makes me more likely to understand and emphasize with an OB or hospital that uses these procedures despite the evidence against them..

Furthermore, the book is inspirational in showing that helping women in childbirth does matter in both a personal and a cultural way. I anticipate that being a doula can get frustrating sometimes, especially when working in hospitals and watching clients deal with interventions and pressure for these interventions. Remembering the stories in this book will provide encouragement.