I loved that she had so many quotes from doctors and nurses saying that birth at home is safe, and that if you want to give birth naturally without interventions, you should be at home. I feel like I get a lot of my info from one side - the homebirth midwife side, although I read plenty of CNM and nurse blogs too - so it's nice to see that other side backing up what I'm hearing. And, honestly, midwifery does need support from medicine, doctors, and hospitals; a woman's giving birth shouldn't need to be legitimized by this whole medico-legal system, but it does.
I did think that the book got bogged down a bit in the middle during the section about outlaw midwives. There was one happy birth story and one problematic one with a baby needing resuscitation from the midwest midwives, as well as the death of one of Cynthia Caillagh's patients. I thought that those stories felt unbalanced: there was so much focus on birth mishaps, midwives evading the law, and the stress of the "outlaw" life that... well, the spotlight was so much on the negative aspects and the bad things that could happen in these illegal homebirths that I don't think it made the case for legalization as well as I would have liked.
I mean, it's important to show that making midwifery illegal causes big problems. That it can cause a certain recklessness, and that the great fear of the law can interfere with giving the best possible care. I do think it's great that the author didn't shy away from the less-rosy side of the picture. However, I think it was easy to come away from those chapters focused on how problematic these reckless/radical/outlaw/whatever midwives were, and not think as much about how their legal status shaped them.
I did love the chapter about Cynthia Caillagh, who was an illegal midwife in Virgina trained by a traditional Native American midwife. I think that most people would consider her views radical but she had very good points. She expressed great concern about the fact that modern midwifery relies so much on licensing and begs for the blessing of the medical establishment. Midwifery isn't medicine but it must get folded into medicine to get any kind of legitimacy. Caillagh feels like midwifery loses out there, that traditional midwifery is very special but impossible in a medical context. I don't think that there's any way around this, and until reading her point of view I saw no problem with it. I was happy to have the chance to hear a "radical" point of view expressed very reasonably, and to get a chance to really understand it and hear it.
Some miscellaneous points from the book that really struck me as important:
- Liked her use of the phrase "physiological birth." Because, you know, what is "normal" birth? What is "natural" birth? These are very fuzzy terms. Instead, she uses "physiological birth," defined (more or less) as the body doing its own thing: initiating labor, pushing the baby out under its own power, etc. Going through all the physiological steps.
- Shocking how many obstetric interventions started with male OBs just doing whatever the heck they wanted to women's bodies. Things like 90%+ episiotomy rates for decades without anyone doing a study of whether they actually did more good than harm, or any good at all. And the fact that maternal mortality first increased when birth moved to hospitals? Wow.
- Important point: The problem is not medical interventions. Medical interventions save lives in emergency situations. The problem is taking emergency interventions and applying them to every single birth.
- Really important pont #1: On doctors claiming that C-sections are just as safe as, if not safer than, vaginal birth: "... if the trauma of the cesarean section - cutting a birth canal in the abdomen - might be equal to or less than the trauma of a modern vaginal birth, then vaginal birth, as practiced in most U.S. hospitals, is so harmful that it rivals the injury of major abdominal surgery." That is powerful. Because either (a) these doctors are so clueless that they think that giving birth the way we're designed to = abdominal surgery, or (b) interventions in hospitals today are so harmful that they are not very different from major surgery.
- Really important point #2: You can't compel someone to take medical risks to save someone else's life. It's not ethical. This is something that's ironclad. If you have a man dying of kidney failure, and his mother's kidney is a match, there is no way to legally compel that mother to give her son a kidney. Not even though he'll die without it and she'll probably survive the surgery fine. You can't do it. Her body, her kidney. And yet, some people want to say that that woman's right to turn down procedures that would hurt her does not apply when that child is still within her body. She only has rights when that child is outside of her body. How does that make any sense? It doesn't.
- Really important point #3: Doctors can refuse to "provide" VBACs because any doctor can refuse to provide a medical procedure that they deem unsafe. Isn't it amazing, this framing? That birth is something that a doctor does to a woman, not something that a woman does? Because last time I checked, a VBAC involved a woman and her uterus pushing a baby out. No need for a doctor to do any procedure there!