When I happened to see Pushed: The Painful Truth about Childbirth and Modern Maternity Care on a featured shelf at the library, I admit that my first thought was something like, "what, again? Haven't we been there already? What could Pushed possibly have to say that hasn't already been said in books like Birth, Misconceptions, Giving Birth, etc. etc. etc.?"
The answer is: quite a bit, as a matter of fact. I'm glad I decided to take the book home and give it a chance. I won't go so far as to say that this is a book about childbirth that men could actually get into (does any such book exist?), but it's probably about as close as you're going to get. In large part, that's because Pushed, unlike any of those other books, does not appear to have been motivated by the author's own negative birth experience. In fact, the author, Jennifer Block, mostly keeps her feelings to herself and lets statistics, and to a lesser degree, anecdotes and interviews, tell the story for her. It's not until the final chapter, a treatise on mother/fetus rights (or sometimes mother vs. fetus rights) that we really get the full force of her personal opinion on some of the major issues affecting women's choices in childbirth.
This book holds particular interest for me at this time for a few reasons. First, as you know, I recently gave birth to my second child and had a birth experience as different from my first one as day is from night. So the choices and procedures involved in maternity care are still very fresh in my mind. Second, I have a sister-in-law who is pregnant right now and who (as far as I know) is hoping for a VBAC (Vaginal Birth After Cesarean). And wow, does this book ever have lots to say about that issue.
Out of respect for my sister-in-law, I'll keep my analysis of what Pushed has to say about VBAC very general.
I knew VBAC was "controversial" in the sense that not every woman was interested in trying it, or that not all physicians were willing to take on such cases. But I had no idea that it is probably the most divisive issue confronting the obstetric community (and, thus, pregnant women) at this time. Perhaps this is because the concept of VBAC touches just about every nerve possible: was the first cesarean necessary or not? If not, was it elective? If necessary, has that assessment changed in either direction in hindsight? Are the circumstances that led to the cesarean likely to present themselves in a future birth? Most of all, VBAC starts a firestorm when you start comparing the risks of a VBAC versus a second (or third, or fourth) C-section. Essentially, and I am leaving out chapters and chapters of analysis and commentary, Block makes a very convincing case for the side that contends that VBAC is at best safer than, and at worse, as safe as, a second C-section. In doing so, she goes against the current position of the American College of Obstetricians and Gynocologists, which is that VBAC is not a recommended course of action. However, that has not always been the case. For several years during the 1990s, VBAC was sanctioned by ACOG.
You can see how navigating the arguments on both sides of the medical community spectrum is like walking through a minefield. Unfortunately, it is pregnant women who are caught in the crossfire. I didn't realize this until I read it in this book, but it is by no means guaranteed that a woman who wishes to try a VBAC will be allowed to do so. Depending on where she lives, she will face opposition from hospitals, doctors, and insurance companies. The book describes women who have been denied a trial of labor so desperate for a VBAC that they labor clandestinely in the parking lot of the hospital and go inside only when it's "too late" for a C-section. However, apparently it's almost never too late, since one woman who tried that was told she could start pushing as soon as she took in some oxygen. Except that the mask they gave her wasn't supplying oxygen, it was general anesthesia, and she woke up having given birth by C-section, without her consent.
This, of course, brings up the issue of reproductive rights. When that term is mentioned, most people think of abortion, but birth is a reproductive right, too. One interviewee in the book describes maternity care as the last great frontier of feminism, and one that has not yet been taken on in full force. Somehow, the debate keeps getting re-directed to abortion, and meanwhile, women everywhere are being denied choice in the manner in which they birth their babies. The stark incongruity in the way these two closely related issues are addressed is shocking.
Lesser issues than VBAC are also addressed in the book, such as why the C-section rate in general is so high (almost one-third of births these days) and getting higher, and why birth has become so rife with interventions.
That latter issue is one I took particular interest in, having given birth so recently. According to the author's research, only 2% of mothers have had an "optimal" birth experience. Obviously, some women have risk factors or other complications that will keep them from being able to avoid some interventions. But Block cites lots of research that calls into question the increasingly entrenched methods of intervention such as routine IVs, continuous blood pressure readings, electronic fetal monitoring, epidurals, Pitocin, forceps, episiotomies, and flat-on-your-back pushing.
The 2% statistic is slightly misleading, of course, because honestly, some women don't care if they're hooked up to an IV, or receive an epidural, or are induced, or are confined to a bed during labor. "Optimal" should of course be defined by each individual woman. Who is Ms. Block, or Ricki Lake, or anyone to tell a woman that she shouldn't be satisfied with what she thought was an OK birth experience?
The good news is, Ms. Block seems to realize that. And that's what separates Pushed from other books in this genre. The anger and indignation just aren't there. Or they are, but they just sort of simmer below the surface, manifesting themselves largely in anecdotal interviews or statistics, instead of being in your face, demanding that you feel disenfranchised.
That being said, the book's thesis, as indicated by one of its closing paragraphs, is (p. 271):
"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."
I completely agree. However, I would add the caveat that if a woman, having accessed the pertinent information, makes the decision to be induced or send her baby to the nursery or not breastfeed or, heaven forbid, elect for a C-section, then they're allowed to create their own "optimal."
As long as they allow me the same and let me have my ginger ale and Gladiator music.