| Title | : | Pushed: The Painful Truth About Childbirth and Modern Maternity Care |
| Author | : | |
| Rating | : | |
| ISBN | : | 0738210730 |
| ISBN-10 | : | 9780738210735 |
| Language | : | English |
| Format Type | : | Hardcover |
| Number of Pages | : | 316 |
| Publication | : | First published June 1, 2007 |
Pushed: The Painful Truth About Childbirth and Modern Maternity Care Reviews
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Pushed is a shocking documentation of medically managed childbirth in the United States. The first four chapters detail the standard practices and current trends (a la 2007) and the effect these have upon the women giving birth. Jennifer Block challenges the sacred cow of an idea that the definition of a successful birth is simply a live baby and live mother. She makes the case that the trauma incurred during the birthing process through unnecessary medical intervention and surgery, artificial time limits, and practices that hinder and harm the natural working of a mother's body should be factors in declaring a birth "a success."
Block also delves into how procedures, instruments, and drugs that were developed to combat certain complications and particular potentially deadly situations suddenly became standard practice for all pregnancies regardless of whether they were low risk and showed no signs of complications. She also describes the potential side effects, increased risks for further interventions, and complications of common and standard practice medications, surgeries, and practices -- information that is usually omitted or downplayed because it might make women less likely to blindly submit to them.
Interestingly enough, the author doesn't take the opportunity to discuss the naive American mindset that everything a doctor does is in the patient's best interest rather than because it is in the best interest of a drug company or hospital or convenience-driven in general. Fun fact: a cesarean takes a doctor 45 minutes while a woman delivering vaginally can labor for over 24 hours creating over a day's worth of intermittent updates.
There is a lot of very good information about vaginal birth after cesarean sections, and the authors does include a defense of doctors who refuse to allow VBAC in that she explains the cost of malpractice insurance and hospitals' general unwillingness to take up the time and resources while risking a potential lawsuit to provide this option. Of course, she doesn't explain why hospitals don't simply allow women seeking VBAC to sign a waiver relinquishing their right to sue in the event of a negative outcome. There is also no suggestion of a nationwide initiative to push for at least one centralized hospital in each of the 50 states that would allow VBAC.
I wished that she would have gone into more detail about alternatives to the standard lithotomy (flat-on-back) birthing position. It's simply taken for granted that because this is the most convenient position for the doctor that there's no hope of changing hospital procedure even if it's the worst position for a woman's body and could end the practice of giving routine episiotomies.
I also wished that she would have spent more than half a page on the detrimental effects of "coached/directed pushing" in the lithotomy position. She explains that this practice originated with the advent of early pain medication when women were totally numbed from the waist down and had to be told when to push and for how long since they had been rendered medically helpless. And she mentions that it is now standard practice and can cause severe pelvic floor damage, but beyond adding that this is not insisted upon by hospitals considered "baby friendly" by UNICEF and that having a doula can help you avoid this, she lets the subject drop.
In just about every single, television, birth documentary filmed in hospital setting, the nurses have the woman begin directed pushing in the flat-on-back position as soon as she reaches 10 cm, but not once in all my TV viewing did I ever witness a member of the hospital staff ask the woman if she wanted to wait until she began to feel the urge to push as pushing before the baby was in a good position could result in lasting pelvic floor damage.
Pushed provided the statistical data to support my anecdotal evidence. From what I've witnessed, the norm for women in the United States is horrible impersonal care dominated by medical intervention as if birth were an emergency on par with a heart attack. Over the last 10 to 15 years, I have not known one woman among all my friends, acquaintances, and co-workers who has been allowed to go into labor naturally. Not one. Three had complications/high risk pregnancies that warranted inductions and scheduled cesarean sections, but the majority had the "big baby" card played on them. Now it is always possible that every pregnant woman of my acquaintance over the past decade fell into the 5 to 10% of all pregnancies that develop macrosomia (baby too large to deliver). But the statistical odds are against this.
These women were all told at or before 37 weeks that they needed to be induced in order to prevent complications such as shoulder dystocia, an event that the medical literature states is impossible predict and occurs 50% of the time in babies smaller than the macrosomic weight of 8 lbs, 13 oz. Their doctors also insisted on inductions out of fear for a big baby despite the fact that fetal macrosomia can only be diagnosed after the child is born and that the guidelines issued by the American Congress of Obstetricians and Gynecologists recommended against elective inductions in cases of suspected fetal macrosomia because labor inductions only raised the odds of having cesarean sections without changing the fetal or maternal outcomes. -
Finally! An expose of the birthing system in the United States. It's absolutely a fascinating read, tracing the history of managed birth and outlining the various factors that scare and push expectant moms into unnecessary interventions. Ms. Block points out numerous statistics that support how out of whack interventions are in North America. In the countries where there are the best birthing outcomes, the c-section rate hovers around 15%, which is also the rate set by the World Health Organization where the risks of a section outweigh the benefits. The 2005 section rate in the US was 30.5% and in some states, topped 45%.
This is not a book that gives specific guidance in planning a non-interventionist hospital birth nor does the author promote a medication free birth. Instead, she is curious why a physiological birth is something that women have to fight for in the US. This book gives all the information necessary to understand what is going on with your doctor and your hospital when suddenly, in your most vulnerable moments, you find yourself sliding down the slippery path to a hospital managed birth and c-section. If you are planning a non-interventionist hospital birth, this background information is essential. Based on my own experiences (with both induced birth and 100% intervention/drug free hospital birth) Ms. Block's stated facts and observations are completely accurate. The book, which in general, is balanced in tone, seems to advocate midwife-assisted birth (but not unassisted birthing) over hospital birth. This is not surprising, given the level of vigilance one must have to achieve a low-intervention birth in the hospital. Also favorable are the outcomes achieved by midwives.
How is it, Ms. Block wonders, that such an overwhelming percentage of hospital births become an emergency instead of an emergence (when the true level of emergency births should be in the low single digits)? The protocols established by the medical staff are a huge factor, since so much of what they do and prescribe lead directly to more interventions and ultimately, either insanely medicalized/assisted vaginal birth or c-section.
Ms. Block has collected interesting data from a variety of sources. I particularly appreciated the anecdotes of a former L&D nurse in FL who became disenfranchised after observing the wonderfully low key, easy births that occurred during a hurricane when her hospital was conserving generated power and operating under different protocols. The emergency c-section rate was 6%.
The book has several chapters on midwives, some working illegally, devoted to bringing natural birth to their clients. Many frightening incidents are depicted involving the violation of women's rights when literally forced into c-sections and episiotomy without their consent, or indeed, against their express wishes. In particular peril are women attempting VBACs, which are rapidly growing out of favor.
She also notes the important contribution of American women to the growing trend of managed birth, many of whom are strikingly uneducated about the risks of intervention and c-section to both mother and baby or whose desire for a convenient birth outweigh common sense. Somewhere along the line, women have forgotten that a healthy mother and baby can achieve a remarkable, empowering, peaceful birth.
This book was fantastic - a must-read for the educated, thinking mother who refuses to be pushed around by a system set up for everyone's benefit except her own (and her baby). -
I've found fertility and childbirth were fascinating for a few years, but now I'm pregnant and obsessed. Luke calls it "girlie-parts science". This book isn't so much about the science but does present surveys on the state of childbirth in the US today (published 2007). It made me appreciate the tough situation obstetricians are in and want a health care system that treats low-risk, healthy pregnancies as life events, but not illnesses.
IF YOU'RE EXPECTING while you read this, please remind yourself frequently that your doctor has your best interests in mind and, in all likelihood, won't force you into anything. It's good to be informed about the statistics and have your preferences; it's not good to view mothers and doctors as being on opposite teams. The pendulum seems to have swung from the uninformed mother-to-be who depends upon and blindly trusts her obstetrician to the overbearing one armed with pages of birth plans -- I'd like to be in the middle somewhere. -
After reading Pushed, you will never watch “A Baby Story” the same way again.
Block makes a convincing case that protocol on labor and delivery wards are driven not by what is best for individual women, but by fear of litigation. The stories that made me the saddest were those about women who expressly declined certain interventions and were given them anyway. The worst was a woman who showed up at the hospital with her baby crowning. Because she had had a previous cesarean, the hospital called in a judge who granted custody of the baby to the hospital and she was forced to have a repeat c-section. The concept of “informed consent” is being eroded day after day by hospitals who view vaginal delivery as a “procedure” to be granted or withheld, rather than as a natural, normal, biological process.
Read the rest
here. -
This is the first book I have seen to tackle the issues of birth from a feminist perspective. It was a fascinating, gruesome, and eye-opening read that was extremely well researached and documented. Block's opinions on modern hospital birth come through loud and clear but are definitely evidence based. Especially interesting is the in-depth discussion of all aspects of the VBAC debate: emotional, public health, medical liability and legal ramifications are all covered. Also covered are the issues of breech births, and a candid look at the Unassisted Childbirth movement. While I'm sure true UC'ers won't appreciate her viewpoint and conclusions on the movement, it was the most balanced look I've seen in literature as of late.
This book does appear to be biased toward out-of-hospital birth, but Block does not shy away from looking at some of the risks of homebirth, especially in areas where lay midwifery is illegal and midwives difficult to come by. In the end the author implores people to do their own research, come up with their own conclusions and advocate for themselves as women. I think the most important thing women should come away from this knowing is that not all care providers, doctors OR midwives, necessarily have them or their baby's best interests at heart, so it's up to them to become informed consumers of the birth industry. -
Women deserve choice in pregnancy and delivery. If you are ever thinking about having a baby, I wholly recommend reading "Pushed", by Jennifer Block.
What's the difference between this book and the gazillion other books about childbirth out there? For one, it's the documentation. Jennifer Block meticulously references legitimate medical research and studies throughout her book. Instead of making an empassioned tug-at-your-heartstrings plea for her case, Ms. Block makes her case with statistics and data. For two (ha), she remains relatively unbiased throughout the book, and while her opinions on the matter aren't exactly absent, she makes a concerted effort to show the opposing side's argument and their reasons for their actions. If you're looking for an unbiased and research-driven book that delves into modern maternity care, I unequivocally recommend reading this one.
I strongly believe in the power of intuition. I think that we're all put on this Earth to have our own experiences and challenges, and that we each have a different mission or purpose in being here. Whether it's a matter of making life-changing decisions, raising children, or simply driving a different way because we feel prompted to, I think that the power of a person's intuition is not to be taken lightly. In some instances, I would argue that the Spirit speaks to us via our intuition. In all of these cases, I feel like the decisions we make for ourselves and our lives are always going to be deeply personal, and aren't necessarily universally good choices for everyone. So... that's my disclaimer.
For me, I've always felt passionately about childbirth. I've always felt that there's something more to it than simply going to the hospital and coming home with a child; I feel like it's meant to be a life-changing experience. It's a rite of passage during which the veil to the other world is briefly parted for a family to welcome life into the world. To quote a midwife who is quoted in the book, I've always thought that "a woman meets herself in childbirth."
For both of my kids, I chose a midwife for my prenatal care and birth. I always thought that they would be more respectful of the birth and my touchy-feely approach to it. And I had what I considered to be fantastic prenatal care. Both of my deliveries ended up as scheduled inductions, and I had epidurals with both of my kids. While giving birth is a holy experience, no matter the method, I'll be honest in saying that I don't feel like I've yet 'met myself' during childbirth. I haven't had the full-body spiritual experience that I've yearned for, and that I've heard others speak of.
Looking back, I wonder if there's anything that I could have done differently. Should I have waited longer to see if I would have gone into labor with my first child? Would things have been judged differently with a different provider? Were my inductions medically warranted, or was I rushed into the delivery room "just in case," so that my midwife could look minimally negligent in the case of a lawsuit?
I understand that not all labors go perfectly, and that access to emergency obstetric care is a privilege that I should not take for granted. The reality is that many women and children have been saved by medical interventions, and I am grateful to live in a time when that is available. Also, I understand that in our modern litigious climate, care providers and hospitals need to watch their backs and do their part to avoid a potentially career-ending lawsuit. And I understand that, in court, showing that you did "everything possible" to avoid the detrimental outcome is important in winning your case.
But I also believe that birth is a physiological process, not a procedure. Unlike cancer or transplant surgery or other typically medical events, optimal outcomes for birth occur when labor is not actively managed, but instead watched, supported, and protected with the least medical intervention necessary. Overwhelmingly, research supports this theory. And so I believe that the majority of the time, a woman can birth a baby safely without any type of medical intervention. And I feel like the majority of women are pushed into being treated like the minority (who justifiably require more medical attention), and are being treated as though their bodies are unable to birth the babies they so perfectly created and nourished for nine months, despite all indications to the contrary.
I am not arguing that every woman should think that hospitals are the childbirth devil and thus plan to have a home birth. I just wish there were more options out there. Current hospital policies tend to be more litigation-friendly than birth-friendly. For example, many hospitals require continuous fetal monitoring, which restricts movement during labor. Most hospitals require a woman to give birth within 24 hours of her water breaking, despite several research studies showing that this arbitrary deadline does not decrease the incidence of infection. Most hospitals augment (or induce) labor with pitocin, despite research showing that it markedly increases the incidence of fetal distress. Many hospitals require a woman to give birth within 24 hours of being admitted, whether vaginally or by c-section. Unfortunately, not all bodies work within these time limits.
And so women are basically given the option to either acquiesce to the hospital's litigation-driven policies, or to birth in an alternative environment (home or birthing center). And I understand wanting to have access to emergency obstetric care - it makes perfect sense to me to want to have somebody there in case something does happen. So I am militantly frustrated at the lack of options out there for a woman who wants to have a minimally invasive birth with access to emergency obstetric care... it seems like you get one or the other these days.
Why are we so quick to induce labor (40% of all labors are induced)? Why does our great nation lag behind virtually every other developed country in maternal and infant mortality rates? Why are 1/3 of our women giving birth via c-section, when overwhelming research shows that this number shouldn't be above 10% or 15%? Why don't we trust our bodies to go into labor on their own? Quite frankly, I have a hard time believing that God created women to create and carry babies and then disabled most of them from being able to give birth normally. Why don't we trust our bodies to give us the cues? Why is there no divinity in birth anymore? Why is it considered to be a medical event rather than a natural one?
To lift a paragraph from the book (page 140):
"In the womb, the lungs are filled with fluid, and the fetus receives oxygen through the umbilical cord. The remarkable process by which the fetus adapts in seconds from water to air is still unclear, but the current understanding is that it begins purging its lungs of fluid in the days prior to birth. 'Somehow, the fetus comes to know that it is about to be born," is how Lucky Jain, MD, professor of pediatrics at Emory University, puts it. Jain has studied the transition from one respiratory medium to another and has found that the process continues during spontaneous labor and birth. Hormones are released that prime the lungs for air, and the squeezing effect of the birth canal helps purge the lungs of excess fluid. Cesarean babies often must be heavily suctioned or intubated to facilitate breathing; Jain says that a significant number of those admitted to NICUs are in fact term or near-term respiratory cases, and cesarean birth has been linked with childhood asthma in a number of studies.... Jain estimates that for every 1 million cesareans, there will be 25,000 cases of respiratory distress and 5,000 cases of outright respiratory failure."
Why aren't we allowing our bodies to give us the signal, rather than giving the signal to our bodies? Is it possible that our modern medical system, while amazing in its advances and technology, is not as good at birth as our bodies are?
For example, in the 1940's, common medical practice was something known as "twilight sleep," where a woman was given morphine and scopolamine, which sedated a woman enough to give birth but not remember any of the pain. However, after almost two decades of routine use, studies showed that it had the unfortunate side effect of decreased attachment between mother and baby, difficulty breastfeeding, a depressed central nervous system in the infant, which caused babies to have decreased breathing capacity. Then heralded a landmark achievement for women and obstetrics, today, the era of twilight sleep is considered to be a dark time in obstetric history. Sometimes, I wonder if we'll look back at today's birth practices with the same regret.
There is so much more to this book than my rant details, but if you're looking for more information about it, you can check out the author's website, and I highly recommend reading my friend Bridget's (much more intelligent and less rambly) review of the book at
http://myadventuresintucson.blogspot.....
To close, I'm not saying that you should agree with me on the "ideal birth experience." In fact, I don't expect you to at all. But I do think that you should be able to choose your ideal birth experience without the constraints of hospital policies and practices. Just as you should give "informed consent" for any procedure in your care, you should also have the option to give "informed refusal" for anything you don't want. Your doctor is an advisor to your care, but you should be the one making the final decision, and you should be allowed to do so.
Ultimately, I agree with one of Ms. Block's closing statements:
"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."
Women of earth, trust your intuition, and take back your birth. -
This was a fascinating, meticulously researched, information-packed book that I thoroughly enjoyed. Block makes the case that modern maternity care in the U.S. is seriously flawed. The average woman laboring in a hospital can expect to be hooked up to a vast array of machines and to have her labor chemically induced if she's not progressing fast enough according to certain timelines - often resulting in a C-section. Block argues that most of this is unnecessary for women with otherwise uncomplicated pregnancies and childbirths. Many American women are denied the right to make fundamental choices about their pregnancy and childbirth process, choices that are guaranteed to them by the Constitution and legal precedent. This book is a convincing expose on the ways in which the medical community has made the process of natural low-risk birth a "pathology," or a condition that needs to be treated in a hospital. By allowing liability concerns and the malpractice insurance industry to dominate obstetrics, doctors have now standardized or mandated many procedures that were once reserved for only rare, high-risk emergencies (i.e., episiotomies, caesarean sections, artificial labor induction). The reader will be shocked by some of the cases in which women's rights have been violated in the name of medicine - court-ordered caesareans enforced by judges and police, midwives sent to prison for assisting in home births, women laboring just outside hospitals to avoid being forced into a C-section...crazy stuff. I would recommend this book to anyone who is considering having children or who would just like to read a very interesting piece of investigative journalism.
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I read this book quickly and with interest. It is a rather alarming look at obstetrics--for that reason I don't know whether to strongly recommend it to other expectant couples or whether to dis-recommend it. Once you read the book, it is hard not to be suspicious of your doctors and to push back against their decisions -- this may be for the best, but it is not a comfortable position to be in. It is hard to judge exactly to what degree this is a reasonable book and to what degree it is an alarmist book. After reading it (and doing a lot of research inspired by reading it), I think it is on the whole quite reasonable, which is quite frightening.
The book ends with a section on rights with a number of frightening cases -- cases of hospitals that got attorneys to represent the foetus of mothers who refused procedures and forced those procedures on women. The points the books make strike me as right on: that it is a violation of a woman's body to force a procedure on her without consent; that it is absurd to believe that women don't have the best interest of the foetus in mind when they make their decisions.
One of the most interesting points the book makes is that groups that push for "reproductive rights" have been slow to include among those rights women's right to choose how they have their babies. Which is to say, it seems strange that a woman's right to choose encompasses her right to abort a pregnancy but not her right to have her baby vaginally in any number of cases in which hospitals insist on C-Sections. In an absolute sense, it seems a woman should always have a right to refuse a C-Section, since it is a procedure which undoubtedly puts her at greater risk than a vaginal birth. In a more pressing sense, women have good reason to refuse many C-Sections, since there is compelling evidence that far too many are performed in the U.S.
The role of malpractice insurance is invoked as the main reason hospitals and obstetricians make decisions to operate or to induce when it is not in a woman's best interest (convenience is another, more cynical, reason, but one that I'm sure operates on a subconscious level--I can't imagine a doctor knowingly putting a patient at risk to free up a weekend). At first I was sceptical that malpractice insurers would push for something not backed up with data and would have such sway over hospitals, but conversations with our doctor seems to confirm that it is true: he confirms that malpractice insurers give "cut rates" to doctors or hospitals who won't do VBACs, for example (which our practice regularly "do").
I wonder in how many other places in the medical system malpractice insurance makes a big impact on care. If it does, it seems quite worrisome because it means that what plays well to a jury determines what is good care, and it's not hard for me to believe (or for me to believe that insurers believe) that juries don't think scientifically. My impression from taking classes with pre-med students in college was also that med students are not very good scientific thinkers, so the malpractice monster pushes things from bad to worse.
Thus, regardless of whether monitoring a baby's heartbeat is shown to help babies and mothers, monitoring is routine in hospitals so that doctors faced with a suit can say they did everything they can. And it goes similarly with other interventions.
Thus, a kind of hysteria sets in, and the results are decisions which individually may seem unassailable to jury and patient (we just want to make absolutely sure your baby is safe) but on a societal level clearly cause more harm than good (we have a 30%+ C-Section rate). -
While decidedly anti hospital and pro home-birth, this book is very well written and researched and has a lot of evidence to back up its position. It discusses in detail the ways in which augmentation can disrupt the physiological birth and what that can mean for mom and baby. It also details cesarean section and the many risks involved with such a major abdominal study. While the author’s bias may have led her to overstate some on the complications, I don’t think I fully understood the ramifications of having a cesarean until reading this book. Not only the physical and psychological effects of the surgery itself, but also the absolute lack of choice in many places to even attempt a VBAC for subsequent pregnancy. What makes an OB’s life a little easier and makes sure he get’s home in time to have dinner with his family has lifelong effects for the mother and strips her of her basic reproductive rights. I found myself getting very angry reading about how doctors and hospitals look at how a potential procedure could affect their malpractice liability instead of how it would or wouldn’t benefit the mother and baby. And baffled that so many women’s rights organizations don’t want to include mother/labor rights with reproductive rights.
Borrowed from the public library. -
I wish every woman would read this book.
I have been studying to be a doula so I've been learning about childbirth for a few months but this was still mind-blowing. It reinforced the message I think you get again and again when you start looking at birth from any kind of woman-centered perspective: If you have an uncomplicated labor and want a natural childbirth, keep away from the hospital and deliver at home.
By the end of the book, the author noted that many women are energized, politicized and informed about abortion but very few know much about their labor and delivery rights or lack thereof. The author points out that "a focus of the second-wave women's movement was shaking off motherhood as what solely defined womanhood. So perhaps there has been a reluctance to watch over the process that makes women mothers." After reading this book, a woman's right to VBAC, to deliver on the timeline set by the baby, to labor without being constrained to the bed seem as fundamental to me as the right to a safe abortion. -
Fascinating in-depth look at modern maternity care and birth in the United States (published in 2007). Block is curious as to why women have to fight for a physiological birth in the US. The reproductive rights of women seem to end at their right NOT to reproduce, but women who are giving birth are often coerced into taking inducement drugs or having unnecessary c-sections out of convenience for the doctor, and fear of liability for the hospitals. In some extreme cases, women have been forced into c-sections, a major abdominal surgery, against their expressed wishes with doctors and lawyers arguing the unborn child's rights over the rights of the mother. Women are denied physiological births at many hospitals for VBACs, twins, breech, big babies, etc., and sometimes have to drive hours away to see an OB who will attend a VBAC or vaginal twin birth. Women with means are paying out of pocket for birthing-center births and midwife-attended homebirths simply to avoid the trauma of many typical hospital births, where they are not respected as experts on their own bodies. In a few extreme cases, some women have decided to give birth at home completely unassisted.
Block even goes in-depth to look at midwives who have practiced illegally, why they made the choices they did, the women who choose to birth with them, and those who have been prosecuted for practicing without a license. She doesn't paint a rosy picture of the illegally-practicing homebirth midwives -- some are reckless and miss a lot of births. The focus of the book is on choice. Do women have a choice when it comes to birth? In many states and many hospitals, they do not.
While reading this book (2019), I had a friend who was about a week past her due-date and not dilated, and her hospital gave her Cytotec to soften her cervix and induce labor. It wasn't working. Out of curiosity, I googled Cytotec and went immediately to FDA.gov -- they had a HUGE warning in bold and all-caps about the dangers of the drug for inducement. It is not FDA-approved for use in birth or science-based, and can cause maternal and fetal death. Then I went on to NIH.gov to find the same warning in a published study on NCBI. Here is a good example of how hospitals are following their own convenience needs over scientific evidence. Cytotec is regularly administered to induce women, and many women are uninformed about it's dangers and trusting their doctors. It's been in the news a lot lately that the US is one of the most dangerous countries in the developed world to give birth -- particularly for women of color. With only 1% of births happening at home, those deaths are occurring in hospitals.
I would recommend this book to anyone who has an interest in women's rights, feminism, birth, or even just good reporting. Again, it's not anti-hospital (medically necessary c-sections are a wonderful thing!), it is looking at women's choice and the question of whether normal, low-risk, physiological birth should be treated as an emergency. -
Like one reviewer said, "Every page will surprise and outrage you." An impressive and absorbing review of childbirth-related research, as well as common obstetric practices - and the frequent inconsistencies between the two. Here are two of my favorite parts:
"As the sociologist Barbara Katz Rothman puts it, 'Have our uteri somehow lost the knack this generation? Or have our doctors speeded up the clocks on us?' Or is there a third possibility, that active management practices have inflicted complications of their own making?"
"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."
It might sound a little extreme. But when you look at the overwhelming scientific evidence that time and again condemns the use of routine IVs, C-sections for non-medical reasons (not least of which is "failure to progress,)" the EFM, directed pushing, routine episiotomy, and a million other things that we consider standard procedures, it's hard for me to come to any other conclusion. -
This is the book I wish I'd had when I was pregnant. I was interested in a drug-free birth, and read all the usual books. Most of them seemed to equate natural childbirth with some sort of moral stance or an ethereal connection to womanhood, and although I can't prove it statistically, they were shrill and biased.
Pushed is not a light read. It's not going to help you create a lilac-scented birthplan on pink paper. It's not going to help you do anything, except think. It's a fact-packed book, heavy on medical studies, footnotes, and legal cases. Although the author is clearly sympathetic toward non-interventionist births, it is so thorough, and draws upon such a range of information that it comes across as balanced and informative.
There's a lot to discuss here with women you know, with your partner, with your doctor, and perhaps even with your legislator. But to go through birth without reading this book is like going through with your eyes closed. -
Dude guys, dude. Dude. This book rocked and rocked and rocked.
So basically -- it's a really good takedown of obstetrics as it stands in hospitals today. As someone contemplating having children at some point in the next five to ten years, and as someone with a philosophical commitment to The Less Medicated The Better (not obsessively so, but I've been lucky in my life to be a pretty healthy person who can't remember the last time I had a prescription for anything) ... I've always really thought: hey, when the time comes, maybe I'll get the labor-helping drugs but no way epidurals and no way c-sections and ok that'll be fine. But the case this book made very well (and that I've seen made elsewhere -- in the New Yorker and in the film The Business of Being Born, but not in such strong statistical detail), is that once you say okay to one thing you are implicitly opening the door to a hell of a lot of other things that are upsetting at best and infuriating/arguably illegal at worst.
What are those things? Well -- labor drugs screw up your body's natural responses, and make epidurals(lower half numbing injections) more necessary, and if your body's not doing what it's supposed to be without the stuff it needs from you to do that (which it can't cuz it's full of drugs), you're way more prone to c-section. And then when you get a c-section you can't freaking nurse! Breech babies? Nope, not coming out the regular way, ever. Which they are usually completely capable of. Oh, and you're in the hospital so why not strap you up with a fetal monitor, an IV, a catheter, etc, etc. And loveliest of all, because a doctor can cut you but can't coax you (NSFW I guess?) -- episiotomies over perineum massage all the way! JESUS CHRIST.
Of course, it seems pretty logical that it is best for a woman to labor at her own pace, in whatever position feels right for her, and it's pretty obvs, with eons of evidence, that lying on your back is NOT the way to do that. And how nearly impossible, and strongly discouraged, mobile labor is in the hospital is really really depressing. And infuriating. And enough to make anyone (or me, at least) consider home birth and other viable alternatives.
Though there are things to take issue with in this book -- namely the lack of comprehensive information on positive moves that some hospitals/hospital systems/doctors are taking and why and how they are doing it, states that DO legally allow and support midwifery, why the way they do things in Europe is so totally different (midwives everywhere!), and a complete and understandable analysis of exactly why the way that labor+delivery is in tune with insurance liability rather than human need (perhaps that's not so different from the rest of the medical system.. but well... it's different, seeing as being a woman is not a disease).. but I think any one of these could easily take up a whole book of it's own. And probably some of them do. And I should read these books.
But the basic case-- that ACOG - the American Congress of Obstetricians and Gynecologists - sets the standard of care nationwide - and that they're really looking out for themselves and not their constituency, pregnant ladies, and that that's really not ok - is a great one. So: Curse you, the patriarchy, for reals.
And a side note: Block did a great job mentioning without really digging too hard into the fact that physiological (unmedicated) birth is the territory of both radical feminists and very religious people (Amish ladies need midwives!). And since I, in my heart of hearts, consider myself to be something of both, that made me happy and heartened.
So this book kinda changed my life, is what I'm saying, and made me realize that I want to get a lot more of this stuff figured out before I am with child -- which means reading up on a lot of the more How To-y stuff and talking to doctors and getting a lot of birth stories from a lot of great ladies I know -- because otherwise that's gonna be a heck of an crazy 9 months yo. It probably will be anyway, but, hey, the more you know. Off to learn everything I can about Ina May Gaskin. Kthx. -
Painful truth is right. This book was written really well. I felt like the author's goal was to bring clarity and alertness to the reader. One of the ways she did this was by offering multiple angles to the same subject. She interviewed doulas, childbirth educators, mothers, obstetricians, midwives, perinatologist, and more. The goal of the book is to illustrate that there are some really awful things done to mothers in labor, like inductions, episiotomies or cesarean surgeries being performed without the true desire of the mother. A lot of what is going on in maternal care is women being bullied into accepting procedures.
One story that I really liked was told in the beginning: Hurricane Charley hit the Florida Hospital Heartland Medical center in Autumn of 2004. Before the hurricane hit he hospital delivered 951 babies, 29.41% by cesarean section. . . Induced labor would have accounted for about half of all births. Under Charley's spell, between September 13 and September 20, seventeen women gave birth: one was induced, two had scheduled repeat cesareans, and just one had a cesarean for "failure to progress." That works out to a cesarean rate of 17%; excluding the repeat cesareans, it was 6%." It wasn't that the women delivering at the Florida Heartland hospital were magically able to give birth without interventions. Because of the decreased technology available, the hospital only admitted women who were in active labor, and if they weren't, they were sent back home. The nurses spent more time supporting the laboring women and therefore they saw decreased interventions. (p1-5)
The author, Jennifer Block goes in depth to learn about what really goes on in the birthing community. She attended some cesarean procedures where the surgeons listened to "Dancing Queen" while performing surgery and a homebirth with a 300 pound mother making jokes about having an "orgasmic birth." She interviews mothers who had positive hospital experiences because of their doula, and women who had less than positive experiences with homebirths.
Block interviews several obstetricians and nurses who say that the a lot of the reason the hospital situation is the way it is because of insurance and the politics of that. Doctors aren't being trained to handle breech or multiples vaginal birth. They are acting with the thought the birth is a disease rather than a normal and healthy experience.
"There's a tendency to look upon labor intervention, such as induction, in isolation, when it should be regarded as more of a package deal. With Pitocin comes amniotomy, internal fetal monitoring, immobilization, epidural, and urine catheter. Intervention leads to intervention." (p139)
"The current media buzz is over a woman's 'right to choose' a scheduled cesarean. At the same time, however, there are limits on a woman's right to choose a normal birth. Due dates are increasingly tantamount to deadlines. Women who've had a previous cesarean are in many cases being denied vaginal birth altogether. . . Today, what's normal is being redefined: from vaginal birth to surgical birth, from "My water broke" to "Let's break your water." from "It's time" to "It's time for induction." (xix) Non-intervention childbirth shouldn't be done because it's an "experience" (although it is, and is a powerful one), it is healthy for mom and baby.
Today's current obstetricians (with few exceptions) are no longer the experts of normal, non-physiological childbirth and labor. They are the experts of induction, epidurals and cesareans. Our focus shouldn't be "at least there's a healthy baby", our focus should be in supporting the creation of a healthy family. -
I loved “Pushed: The Painful Truth about Childbirth and Modern Maternity Care.”
Initially, I just checked the book out from my library because it looked interesting. I thought, “Hey, I think I’ll read that book for fun.”
I’ve since ordered a copy of the book from Amazon so I can keep it with me always and use it as reference material. I’m also thinking about joining some kind of a women’s rights advocacy group now.
I have weird feelings for the book’s author, Jennifer Block. I think I love her. Her book spoke to my soul. It was brilliantly researched, fun to read, and empowering.
I really think maternity care is a feminist issue. I am also aware it appears to be a hot button issue as well. For example, a woman at work saw my copy of “Pushed” lying on the desk and confronted me about it, demanding to know why I would read something so ‘horrible.’
I just stood there and I was like, “What the f**k are you talking about?”
Long story short, I got really condescending and told her she should try getting her information from somewhere other then TV.
I was like, “It would behoove you to stop being such a lemming and read a book some time, you ignorant sl*t.”
Don’t mess with me and my books. I’ll read what I want to. No one tells me what I can and cannot read. No one.
I’ll also research my health situation, if I ever have any kids (or not), and make my own informed choices. Why? Because, I’m an American and I have rights—and you can’t strip me of those rights just because I’m female.
I have a right to “bodily integrity, to self-determination, to liberty, and to privacy.” If anyone ever tried to mess with me, I’d beat them to death with my copy of “Pushed,” because ignorance is destroyed by knowledge and some people need a beat down. -
I have mixed feelings about this book. I am glad I read it. I found it informative, interesting, and I am glad Block wrote it. I do think some of the issues in this book need to be addressed. I completely agree with the author that choice is a paramount issue in giving birth today and I agree that women should be educated about all aspects of birth and pain and be allowed to choose how they want to deliver.
However, I read this when I was 6 months pregnant and it made me afraid of my doctor and the hospital. I was terrified to give birth in a hospital b/c I thought my feelings would be totally brushed aside and it would be a traumatic and miserable experience. I felt foolish for choosing a family practitioner instead of a midwife and I hadn't even given birth yet!! Although those feelings are the legitimate birth experience of some women and those decisions are right for some, they were not for me. In the end, I did get an epidural, I did give birth with a doctor in a hospital, and I was very pleased with my birth experience. I think this book was very one sided and did not give voice to those doctors and hospital personnel who do care, are there to help, and allow women choices during birth. Having an epidural does not make you less of a women or a less loving mom, but after reading this book, that's how I felt. It is a good choice for some women and can make them feel more in control over the experience. -
The topic of this book is interesting and important and I think all pregnant women (and perhaps even their partners) should educate themselves on the topic: that is, the degree to which the medical profession has embraced drugs and surgical intervention over natural childbirth, overplaying the safety of the former and the dangers of the latter. So this book is one way to educate oneself on that topic. But it is not the best way....the book is just not that good. I preferred Ina May's book much more. The problem with Pushed is that is an overwhelming assault of statistics and facts. It is not fun to read. And the book is so lacking in a clear narrative, that I kept feeling like I was reading the same thing over and over again. The book also seemed to read like one giant argument. I understand that many books on this topic will have a bias, but Block's was sort of relentless. Again, I much preferred Ian May's book. She hits the many points about the dangers of medical intervention during labor without an assault of facts and figures. Yet she also provides a lovely narrative and a message of empowerment about how to tackle natural birth. So read that instead!
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3.5 stars — compelling and intriguing, this deep dive into semi-modern (published in 2007, things have changed a lot in the past 14 years!) medically-managed obstetrics challenges a lot of the assumptions about childbirth in and out of the hospital setting. I love her feminist take on the birth experience that are greatly missing in this space!
I agreed with so many of the arguments made by Block (too many c-sections and scheduled inductions, the critical role midwives play in birthing experiences, way too many interventions in labor) but believe it is a little too heavy-handed with the fear mongering.
I think this is an excellent book to anyone working with birthing women, but hesitate to recommend it to expectant parents because of how biased the author can be about physicians and hospitals. I do not agree that home births should be the standard of care, but I agree that so much more could be done for women to promote choice and empowerment in the birthing space. -
Pushed is a well-researched and stunning look at modern modernity care and women’s lack of control over the way they give birth. The introduction is stunning and beautiful. It is short and carries through the rest of the book. The first chapter looks at women in hospitals, the machines and the procedures enforced on them. The second chapter looks at the history of Cesarean births and how they work and when they are used. The third chapter looks particularly at the type of births forced to have C-sections in hospitals – breech, twins, and after cesarean – vaginal birth after cesarean or VBAC is a big no-no to the hospitals. This leaves some women who don’t want a C-Section giving birth at home, unassisted. (Yep Mindy – this is the chapter where you appear). The book makes clear the role of malpractice insurance in dictating what procedures doctors were willing to attend. Yet as the extensive studies cited by Pushed show, these births are actual safer without the c-section in the majority of cases. The fourth chapter looks more at the dramatic rise in C-Sections (the current rate is more than double than what it should be). The fifth chapter looks at doulas, the demand for them and their role in the hospital. The sixth chapter looks at midwives and the question of licensing and unlicensed practice. Particularly she follows several unlicensed midwives in their work. The seventh chapter looks at the criminalization of midwives (so licensed midwives are legally forbidden from attending certain types of births in some areas, and in most places unlicensed midwives are forbidden from assisting with a birth at all). Midwives are on my list of heroes! The final chapter looks at women’s rights. In particular she talks about disturbing cases where c-sections and hospitalizations have been court ordered. The hospital finds out about a women giving birth at home and gets the court to put a protection order on her unborn fetus forcing her into the hospital.
Laura Pemberton was giving birth in 1996 at home, making good progress when sheriffs stormed her house forcing her to the hospital for a c-section. She was dilated 9 cm when the forced c-section was performed, the baby inches from birth. It shows some of the dangerous consequences of giving fetus’ rights, but more importantly the legal and cultural way we privileged the “rights” of fetuses above the rights of mothers. It is truly scary to reach a point where women literally cannot choose to give birth at home. Obviously this is rare, but horrifying. And it is part of a larger challenge. She won the case on appeal, so this particular legal precedent is helpful, but there is another case on trial now for a woman who gave birth to a stillborn and is on trial for first degree murder. If a baby or mom dies in the hospital, and a c-section was attempted, no one is to blame, even if the c-section might be the reason. If a baby or a mom dies outside of the hospital, the consensus by the mainstream seems to be that someone is to blame – even if maternal and “fetal morbidity” still happens. This is to say “the campaign for fetal rights, led by those intent on re-criminalizing and stigmatizing abortion, has been a detriment to women who decide to carry their pregnancies to term.” As Lynn Paltrow, the attorney and ED for the National Advocates for Pregnant Women states, “the question is not when do fetuses have rights, but at what point in pregnancy do women’s civil rights end?”
This book is stock full of the most recent statistics and studies (scientific and legal). It is a barrage of information that at times can slow the book down (particularly around the middle). The stories of real people though, also fill the book. Without the studies the stories would loose their impact. But we hear from many women about their experiences giving birth, having C-Sections, having home births, being forbidden from attending home births, attending hospital births, attending home births, etc.
The author is attentive to race and class, although never as attentive as I would like. For example, the author puts the framework of the right to reproduce alongside the framework of the right to avoid reproduction. While I agree with this move, there is a long history of women of color and poor women denied the right to reproduce whose rights were violated. The lack of control over when and how women gives birth belongs with discussions of forced sterilizations and other derogatory treatment women received at the hands of medical institutions.
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This book makes my blood boil and is responsible for keeping me up too late at night because I couldn't stop thinking about it. The second half of the book was the most interesting to me. You would not believe some of the stories in here. The ones that got me most worked up were the stories of women being forced -- literally, forced -- into surgery against their wishes.
One woman, (a lawyer, who knew her rights) attempting a VBAC said she constantly repeated "I do not consent to this! I do not consent to this!" as the on-call OB came in (while she was pushing!), told her "VBAC babies die," injected a drug into her IV to stop her contractions and started wheeling her to the OR. Luckily her VBAC-friendly doc arrived just in the nick of time and she was saved from surgery.
Another woman discovered her cancer (that she thought was in remission) had returned with a vengeance when she was 26 weeks pregnant. It was inoperable, but chemo was an option. She wanted chemo, but the hospital refused to give it to her because she was pregnant. Meanwhile, she was very sick and in the hospital and a neonatologist found out her situation and persuaded the hospital to order a c-section, because the neo doc was convinced she could save the 26 week old baby. Every OB in the hospital refused to do the c-section, knowing the woman was far too sick for surgery. The hospital order a staff surgeon to perform the c-section and both mother and baby died within 2 days.
That story may be extreme, but the point is, women all over the country, every single day, are being told how they are "allowed" to give birth. How did this happen, that in obstetrics, patients' rights can be so flatly ignored? Putting the more serious matter of unwanted c-sections aside, I've read countless stories of women being given episiotomies without their knowledge or consent. That is absolutely abhorrent to me. My one hospital birth was uneventful, with a doctor I liked, but I was still given Pitocin without my knowledge or consent. I remember looking over and seeing it being pumped into me and feeling shocked that they hadn't told me they were doing that. There was absolutely no indication for it. If I hadn't been so exhausted, I would have been furious.
I hate to sound anti-establishment, because I am actually really grateful for the art of modern medicine, but I feel like hospitals, and particularly L&D departments just can't be trusted as a whole. It's so important to research, question, and interview your provider and hospital to make sure your rights will be respected.
Also, ACOG is vile and repulsive. Seriously, they are doing nothing to improve the safety of maternity care for women. All they care about is perpetuating a demand for their own field, so of course they are going to do everything they can (political lobbying, etc.) to falsely discredit midwives, birth centers, homebirth. I was just browsing their website and saw a few little bios of their top leaders. In answer to the question, "why did you choose ob/gyn?" 3 out of 5 of them said because they love surgery!!! They can't wait to cut your baby out. -
This book is awesome! I'm so glad my friends recommended it to me! Block really opened my eyes to the strengths and weaknesses of our modern maternity care.
With my first two pregnancies, I definitely took the approach that "Doc knows best" and never questioned or challenged anything about my maternity care. After reading this book and having discussions with my friends about this topic, its very clear that that was my loss. Just because a procedure or protocal is common practice, does not make it best practice. I've realized how important it is for women to educate and empower themselves to know the risks and potential long term effects of the various types of birth interventions.
I'm very grateful that we have so many modern medical technologies that save the lives of mothers and babies everyday. As Block points out, these interventions (pitocin, for example) are sometimes applied universally to otherwise healthy pregnancies and deliveries, and can cause unnecessary harm.
The book is a fascinating and sometimes troubling read. Her detailed description of a cesarean section was tough to get through. She definitely drove the point home that a c-section is a major abdominal surgery.
I also have a much greater sympathy and appreciation for great doctors. It was enlightening to learn about the mal-practice red tape that OBs have to tread through in order to practice good medicine.
Reading about Block's adventures as she shadows traveling midwives was very interesting. I didn't even know there were midwives practicing illegally. I definitely don't think they should be practicing medicine without a license, but after reading this book you can at least understand their motivations for doing so.
Overall, the book is worth reading if you are at all interested in advocating improvement in modern maternity care. Whether or not I agreed with every point, it definitely got me thinking. :) -
I finally finished this book!!! I really struggled with how many stars to give it, because I liked it but not because I liked reading it ... does that make sense? It is packed with so much information that some of it was hard to sort through and digest, but it's information that I wanted all the same. The book is about the pros and cons of modern maternity care (specifically in the U.S.) and the book itself has some pros and cons. I did not like Jennifer Block's writing style. She wasn't very good at weaving facts with anecdotes, which made for some boring reading, especially in the first half of the book. I also did not like her first-person references, which made her seem less professional and more irate. I do have to give Block credit for discrediting the medical community (in regards to childbirth) so well. She did not have to call it self-serving and hypocritical specifically, because the evidence is there, all she did was write it all down in one place. I am very glad that she did. The statistics alone are mindboggling, and scary. The contents of this book will make you angry, and they should. It's time for women to stand up for themselves and say, "NO MORE!" Block states that she is surprised that there is not a broader movement against the established childbirth protocol, and so am I. Where are the women that will challenge doctors to embrace childbirth for what it is ... a natural process, not a disease? Overall it is a great book. I would recommend it to anyone, although I know it would probably not be a favorite of women (parents) that are depending on the system, especially if they're not already just a little bit anti-intervention.
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I'm not certain how I missed reading this when it came out more than ten years ago. Unfortunately, the disheartening story of how the healthcare system is failing childbearing women hasn't changed all that much in many ways in the intervening decade.
Block lays out in eight well-researched chapters the state of birth in the United States today, which too often involves only the illusion of choice about how and where a woman will give birth. She outlines how we got here, starting with the shift from midwifery care to obstetric care that began in the nineteenth century. Some of the truly chilling information comes in the last chapter, "Rights," which discusses cases in which women were forced to undergo cesareans--literally strapped down and operated on without their consent at the order of a court. This chapter also looks at how the women's movement, with its focus on autonomy and choice around abortion, has largely ignored what might be thought of as the "childbirth movement."
This book was particularly interesting to me as I have worked with many women in my role as a birth doula who have experienced the system and its shortcomings first hand. But anyone interested in the intersection of healthcare, culture, medicine, and feminism will get a lot out of this incisive and well-researched book. -
This book opened my eyes, and made me really think about the options (or lack of) presented to women in American Hospitals for birth.
It is too often that women's bodies are hijacked by doctors, nurses, and hospitals because they want the woman to give birth on their schedule, and also they want to make money, and protect themselves from law suits.
Don't get me wrong, I am not against any women that get epidurals, or c-sections, or get induced at their own election. I am against Doctors pushing these procedures without letting women know the possible ramifications of these things to their health and their baby's.
Often times Women are not being given the options for a natural birth within a hospital, or if they are given the option - it is given falsely because the Dr's and staff induce them, or 'progress the labor'.
Even if you make the largest attempts to have a natural birth within a hospital there are a lot of things working against you.
After reading this book I am left with the question posed in the very beginning of the book- “Why are normal births treated like medical emergencies within Hospitals?” As if the idea of having a baby isn't scary enough.... -
I read this book while Roe v Wade was being overturned and while early in my own first pregnancy. I certainly don't recommend reading it while pregnant... that was not a good choice for my own anxiety. But I do recommend it.
I knew that America is known for having problematic obstetric care, but knowing the history and details helped me to not only understand my own choices, but to understand childbirth choices as a part of reproductive rights, which are usually only talked about in terms of abortion access. I read about the criminalization of midwifery, court-ordered cesareans, obstetric procedures performed in violation of consent. I also read about the hope of childbirth as an empowering and beautiful experience.
While informative, this book was extremely biases against obstetric care and towards homebirth. It is also somewhat dated -- a lot has changed since 2007. Read with a grain of salt.
To quote Block in her final pages: "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 have the right to make those decisions, and they should make those decisions." -
I read this book as part of my Doula training. But wow....if you are pregnant or going to be the helper of a pregnant momma even the father, I would recommend this book! So much information on how we've taken away the right of the mother and given over to the Dr and Hospitals convenience. Birthing is and should be a natural process. Kudos to Jennifer Block for writing this book!
