Pushed: The Painful Truth About Childbirth and Modern Maternity Care

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On one episode of Friends, Chandler blissfully pops a birthing video into his VCR thinking it’s a porn tape. He describes his viewing experience as, ‘Well, let’s just say it’s ironic how footage of someone being born can make you want to kill yourself.’ That about sums up Jennifer Block’s polemic against obstetric practices, Pushed: The Painful Truth About Childbirth and Modern Maternity Care.

For reasons unfathomable to Block and a growing legion of women, informed consent does not apply to women giving birth in an American hospital. Physiological births (Block eschews the term ‘natural birth’ as being synonymous with vaginal birth, which can be rendered unnatural with excessive medical interference) are not offered to most women, regardless of their risk level. Additionally, many commonplace obstetric procedures, such as electronic fetal monitoring and episiotomy, have not been proven to be advantageous by any credible scientific studies even though they are given routinely and not always with women’s consent.

Malpractice insurers for most hospitals mandate that every laboring woman wear an electronic fetal monitor to allay legal fears (the readouts produced by the monitors are admissible as court evidence). Being strapped to a monitor means that a laboring woman can’t walk around, change positions, or otherwise manage her pain with movement. A woman who can’t manage her pain is more likely to request an epidural, which in turn can result in slowed labor. In order to speed labor up she will be given Pitocin, a synthetic form of oxytocin, ‘the love hormone’ that powers contractions. The accelerated labor doesn’t give her body enough time to stretch and loosen on its own, prompting many physicians to perform an episiotomy.

And so one of the many routes to the ‘cascade of intervention’ goes. Once one procedure is initiated, many more tend to follow until a laboring woman looks more like an electronic science kit than a human undergoing a normal physiological process. Women who get inundated with interventions are relatively lucky. Nearly a third of American births are via cesarean section. Doctors prefer cesareans because they’re quicker, can be scheduled (alleviating those middle of the night calls that The Cosby Show‘s Cliff Huxtable used to get), and are easier to defend in malpractice suits than botched vaginal births.
However, cesareans come with greater maternal risk and result in prolonged separation of mothers and infants, hindering breast-feeding and bonding. Block describes a surgical birth in excruciating detail, perhaps putting too fine of a point on the fact that it is a major abdominal operation. Nevertheless, she is right to ask if it’s true that 30% of American women can’t give birth vaginally.

She includes stories from several angry women who feel that a physician-forced cesarean cast a pall on their birth experiences. While these women stories aren’t to be diminished, Block doesn’t speak with women whose lives, or babies’ lives, were saved by the procedure, which leaves the door open for happy cesarean moms to feel like their birth experience is being slighted by Pushed.

Block spends a great deal of ink addressing the question of ‘cesarean delivery by maternal request,’ as the NIH calls it. Clearly, doctors are happy to scapegoat women for the rise in cesarean deliveries over the last 30 years. Block, in turn, is quick to condemn doctors for allowing women to choose a probably unnecessary surgery—an argument that sits awkwardly with pro-choice rhetoric.

Few doctors will now participate in a vaginal birth after cesarean (VBAC) because of an alleged increased risk of uterine rupture (it’s as bad as it sounds) on the basis of one hotly debated study. Most malpractice insurers also forbid midwives to attempt VBACs. This leaves women who don’t want a repeat cesarean with a few, ridiculously crappy options: 1) labor in the parking lot of the hospital and don’t check into the maternity ward until ready to birth; or 2) have an unassisted home birth.

Interestingly, the home birth movement intersects abortion activists at both extremes. Joining the lefties that wanted to make birth ‘an emergence, not an emergency,’ are devout women that believe birth to be a private process or otherwise object to a bunch of doctors and nurses shaving and fondling their lady bits.

Block’s arguments are sound, but her sometimes sensationalistic reporting detracts from how plainly terrifying the facts are. A pregnant woman checking into the hospital today cannot be guaranteed that she won’t get unnecessary drugs, incisions, or surgery. That alone, without garnish, should justify a fight for maternity care. Pushed pushes its agenda relentlessly, and sometimes repetitively, but by the end dropping a kid in a newspaper-lined cardboard box like a kitty-cat seems safer than a maternity ward. Point taken.