Sunday, May 1, 2011

Book review: Birth Matters by Ina May Gaskin

I liked Birth Matters quite a lot. A lot of the facts about modern obstetrics were quite similar to those presented in Pushed, but Birth Matters felt much more personal and less clinical. That's not to disparage Pushed - I really liked its journalistic tone. Birth Matters isn't just a book about modern obstetrics; it delves much more into the author's personal experiences, and into midwifery.

I really enjoyed reading some of Ina May Gaskin's story of becoming a midwife. It's really quite amazing! Women in a hippie caravan, just delivering each other's babies, learning from doctors when they had the opportunity. And that became the Farm, which has some truly impressive statistics, presented in the back of the book. Like: a single fourth-degree tear out of something around four thousand mothers. A neonatal mortality rate around 1.7% - much less than the U.S. average, probably about right for low-risk deliveries. No maternal deaths. A handful of forceps deliveries. Such an amazing testament to the safety of out-of-hospital birth.

There are several really lovely, positive birth stories in the book. So nice! I felt like this book was really positive. Hopeful, optimistic, showing how good birth can be, giving hope that doctors and midwives can come together to improve birth and maternity care.

I appreciated that this book addressed the "why birth matters/why should you care" part, and took care to explicitly speak to even people without children. As a pretty young feminist, I can confirm what she's seeing, that birth is not a thing that young feminists talk or really care about. I think there's a big stigma there, this feeling that young, career-minded women shouldn't care too much about birth, in the same way that we shouldn't care too much about laundry detergent or girdles. Why we should care about birth, why reproductive choice should including how we do reproduce and not just freedom from reproduction, is so big and interesting that I think that will have to be its own post.

There's a chapter about the historical forces in the U.S. that led to the near-extinction of midwifery. Again, lots in common with Pushed here, but with some info that was new to me. For example, the point that women of the late 1800s, who were so modest, had a big problem with male birth attendants - so immodest! Doctors consciously, explicitly mounted a scare campaign to convince women that birth was terribly dangerous so that they would choose doctors. This danger was not self-evident: it had to be manufactured and demonstrated by doctors. And, of course, we know now that maternal and infant mortality rose at first when the shift from doctors to midwives happened.

She also has some good points about modern midwifery. Legislation that requires midwives to be supervised by an OB means that OBs can prevent midwifery from being practiced, even if it's technically legal. The midwife's license becomes meaningless. There's also the point about how U.S. doctors tend to see midwives as "competitors instead of members of the same team" (p. 87), which really has to change. So many other countries manage to get doctors and midwives on the same team, but it's such a struggle in the U.S.

Some fun facts:
  • The US has seven times as many births as the UK, but one-fifth of the midwives. 
  • “It’s a national disgrace that the CDC’s statistics now show that more C-sections are performed between 5:00 and 6:00 PM than at any other time of day.” (Wish I'd looked up the citation for this. This is on p. 196 of the book.)
  • (p. 212) “It’s hard to think of a profession other than obstetrics in which members must risk being punished in order to maintain a high standard of practice." (Referring to the fact that it is really hard for an OB in the USA today to support a non-interventive, physiological birth. Hospital policies want pitocin to move things along and turn over beds faster, and they want continuous EFM [external fetal monitoring] for liability reasons even though EFM has been shown to increase interventions without improving outcomes. An OB who doesn't want to routinely give pit and EFM may get in trouble with their hospital, shunned by their colleagues, and even fired.)
  • (p. 214) “When a baby dies during or after a hospital birth, that death is overlooked. No one will be punished. If, however, a baby died when the mother labored at home, it will often be the case that the midwife or the doctor or even the parents will be punished - as if their choice caused the death, regardless of what happened.” I think she's right about this. The story of Cynthia Caillagh in Pushed is a glaring example - switch "mom" for "baby" in that quote and it describes that situation perfectly. 

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