Quickie book reviews

The Birth Partner by Penny Simkin:

• Lots of very practical information for helping a woman in labor. For example, I'd heard of doulas doing "take charge routines," but I didn't completely understand what it was until I read the description in this book. Lots of great tips on positioning and many ways to support a woman in labor.
• I felt like this book was aimed mainly at birth partners like dads, co-parents, friends who would be at the birth, etc. It's not just for doulas. It's very accessible to someone who just wants to help their wife/friend/partner give birth.
• Talks about pregnancy discomforts and how labor and birth go so you can be informed as a birth partner. It's quite comprehensive and really covers all you need to know if you're the dad supporting your wife, for example.
• Very helpful for doulas, too.

HypnoBirthing by Marie Mongan:

• Gotta be honest, I had to return this one to the library before I could finish it. 
• Enjoyed reading the history of HypnoBirthing - what a cool lady she was to fight for her right to be awake at her birth and have her husband present! Contains some lovely, positive birth stories.
• Good overview of what self-hypnosis is; nice focus on positive language; etc. Has some nice relaxation and visualization exercises.
• The book is clearly designed to be used with a course; sometimes there are notes about exercises that "you'll learn during your course." Because of that, I certainly wouldn't say that I "know" HypnoBabies just from reading this book. If I'd listened to the CD I'd probably know it a little better. As it is I'd say I'm at least more familiar with it now, especially with the positive language and how the relaxations work. 
• I'd say that you can probably learn a lot and get pretty good at it just from reading the book, doing the CD, and practice your relaxation a lot. Not having access to a course shouldn't be a barrier to doing HypnoBabies, but the author clearly thinks that you should be doing a HypnoBabies course if at all possible. 

Born in the USA by Marsden Wagner.

• A book about the flaws in the modern American maternity care system, sort of in the same vein as Pushed. The big difference is that this one was written by an OB, not by a journalist. It has a lot of great "insider" information coming from an OB, but is, I think, less balanced; he's not a journalist and he doesn't work quite as hard to include the "other side's" view. Pros and cons. I appreciate having a book like this from an "insider," though, and I think that value helps to balance out the flaws.
• The main point of the book is that our current system really puts doctors first. I'm paraphrasing here, but he notes that  ACOG is a trade organization, like a labor union. They have two main priorities: protecting the interests of their members, and producing a better product (in this case, health babies primarily, also healthy mothers). However, if there’s any conflict between those two goals, the interests of the members always come first. (ca. p. 32)
• His argument (it's the subtitle of the book, in fact) is that our maternity care system must be changed to put women and babies first, not doctors and hospitals.
• Makes some good points about how loyalty to the ACOG party line is strictly enforced, as OBs who try to do things differently from their colleagues are often ostracized: fired, hospital privileges revoked, unable to work and forced out of town, etc. This makes it very difficult for reform to come from within that community.
• He actually seems to be a fan of lawsuits because it's a way for non-doctors to force change. He also makes a good point about capping damages: if you cap damages at $250,000, but medical negligence disables your child to the tune of a million dollars in lifetime care and medical bills, is that right? Should that family go bankrupt for the sake of a doctor's malpractice premiums?
• He talks a lot about Cervidil, and rare but disastrous consequences from other interventions.
• Makes some very good points about how universally accessible prenatal care would prevent many, many premature births and neonatal deaths, and also save a lot of money on NICU care.
• I did find the book to be quite biased in some cases exaggerated to the point that it does hurt the message a little.
• Overall, though, I found it to be quite thought-provoking and mainly pretty reasonable. I think it's valuable to have an OB speaking about the problems he sees in obstetrics and arguing for more midwives and the evidence is good. The book is very well-cited with an extensive list of sources at the back.

Book review: Birth as an American Rite of Passage

Today's book review: Birth as an American Rite of Passage by Robbie Davis-Floyd.

I read this book at least two months ago, honestly. I think I had a hard time writing about it because it was so amazing. It was hard to think of just writing a few paragraphs about it when I just want to basically reproduce the book, I had so much to say about it.

This book looks at birth in the USA from an anthropologist's point of view. Specifically, it uses anthropology's observations about the construction and function of ritual in society to analyze birth as a set of rituals. The main argument is that (1) rituals perform a function in communicating the values of society to the person/people taking part in the ritual, and (2) birth as it as set up today functions as a ritual. The concepts come from academia, but Davis-Floyd takes care to explain the academic concepts in everyday terms. The book does have a bit of an academic tone but it's set up to be accessible to any reader. I've never taken any sort of anthropology or sociology class and I didn't have a hard time with it.

I found the analysis very powerful and very illuminating. It's not hard to see how modern hospital birth has many elements of ritual to it. These days, many women have the experience where they come in, they put on the hospital gown, they get their IV, they get their fetal monitor, the bag of waters is broken, etc. These things, when does as part of the routine of arriving at the hospital, are not done because they are necessary, but they feel like things that must be done. There's this whole ritual to getting set up for birth, a whole ritual to labor.

Additionally, modern hospital birth has many elements in common with rite-of-passage ceremonies throughout the ages: the "initiate" (being initiated into motherhood, in this case) is put in unfamiliar circumstances, put in strange clothes, often made to do things that she doesn't fully understand - "made strange to herself," and put into circumstances where she is vulnerable and unsure, making her very receptive to the messages that the ritual is sending.

Now here's where the book really blew my mind. Often, when I read about interventions in labor and birth that are proven to be unhelpful or harmful except for rare cases (episiotomy, augmentation with Pitocin, confinement to bed, etc.), I ask myself, "How on Earth can so many doctors do this when we know that this performs no useful function?"

This book, at last, answers that question. The answer: they do these things because they do perform a function. They help communicate the message of the ritual. The messages of the ritual include:

• that a woman's body is defective and can't be expected to work properly without help.
• that technology is always good, and adding in technology always makes things better. 
• that nature is subordinate to humankind and its technology. (This is communicated by the relentless speeding of labor, the near-compulsory Pitocin augmentation, etc. The natural rhythm of the mother's body and labor must be made to fit into the rhythm of the hospital schedule.)
• that society has a certain ownership of and interest in the baby. (Hence, taking the baby away from the mother for a time, asserting that the hospital's right to the baby trumps the mother's. Also, court-ordered C-sections and such things symbolically show that society has the right to override the mother's wishes because the baby belongs to society, not just to the mother.)

What an eye-opener for me. Why does a doctor perform an episiotomy? It shows that the doctor (and society and technology) is the savior, saving the woman both from tearing and from the inadequacy of her body to stretch properly and let the baby out. And it shows the woman that her body cannot birth without the help of the doctor, society, and technology. 

To readers who are unfamiliar with this kind of analysis, I want to emphasize that, no, this doesn't necessarily happen consciously. Doctors don't sit down together and say, We want women to really get the impression that their bodies are bad, and we really want to communicate how technology is paramount and way better than nature. How are we going to do this? Let's strategize! That's not how it happens. 

Rather, the doctors started out already with the belief that women's bodies were defective - that belief goes back a very long way, to the Greeks and Romans and beyond - and that technology was better than nature. That certainly came about in the Enlightenment, but the Christian belief in man's superiority to nature goes back farther than that, too. So we have doctors, we have men and women at the turn of the century, totally steeped in these beliefs. These beliefs then shape their actions: Women's bodies are weird and defective, so we need to intervene in birth. Technology is better than nature, so if we use technology, things will happen better. From that line of thinking, these practices emerge. And they become entrenched, they become part of the ritual. 

Once a ritual is established, you feel like it must be performed that way in order to make things turn out well. And when you perform that ritual right and things turn out well, you get the feeling that everything turned out well because you performed the ritual well.

Imagine a wedding where they didn't exchange rings, or where the bride just showed up without walking down the aisle to great ceremony, or where they just exchanged rings without saying any vows. You'd get a bad feeling about it, wouldn't you? You might think that the marriage probably isn't going to turn out very well, because if they didn't even care enough to go through the whole marriage ritual, well, what does that say about how seriously they're taking this? 

Now that doesn't even have the weight of scientific studies, or the word of thousands of doctors; that's pure ritual. Imagine how much harder it is to shake off the childbirth ritual that is supported by these doctors who we respect so much! And so you get the situation of, well, I've done thousands of births with Pitocin and episiotomies, and I've got lots of healthy moms and babies. What's going to happen if I stop?!

So these beliefs shape what doctors do, which becomes ritual. And the ritual shapes what women believe, because those original beliefs are encoded in the ritual, and they send those messages to laboring women. 

Of course, how successful the ritual is at communicating those beliefs varies. There's a whole chapter on it in Davis-Floyd's book where she analyzes the messages that women got from their births and whether they internalized or resisted those messages. It's quite fascinating.

I really can't recommend this book enough. The analysis is so powerful, and the understanding that it provides about the function of the modern birthing apparatus above and beyond producing healthy babies is terrific and invaluable.

For what it's worth, although it's kind of an expensive book, I found it at my local library.

Another thought on Spritual Midwifery

Why do I keep breaking these things into two posts lately? Mainly because I forget to include some point, and I write such long posts as it is that it seems like a bad idea to just make the previous post even longer, I suppose.

Anyway, one thing I forgot to write about is the way that Spiritual Midwifery tries very hard to be as accessible as possible in the medical/technical chapters. It does this mainly by trying to avoid medical jargon as much as possible. So, she writes pee-hole instead of urethra, butthole instead of anus, taint instead of perineum, etc.

Personally, I found this quite off-putting. I'm a scientist. I like technical language. I prefer it. I'd much rather talk about urethras than pee-holes. And I've been a birth nerd for long enough to know very well what a perineum is.

But I just started reading Robbie Davis-Floyd's Birth as an American Rite of Passage, and she makes the point in Chapter 1 that "technical jargon... shouts 'off-limits to the unitiated" (p. 30). She also notes that one way that men historically created power over women was by creating "spheres of authoritative knowledge" to which they then denied women access. To put it more simply, using technical language can be way of asserting "I'm the expert, and you're not, so just listen to me." Technical language in writing can be a way of signalling to a reader, "If you're not comfortable with this language, you probably shouldn't be reading this. You don't have a right to this knowledge if you don't understand this vocabulary."

By using language that is very common, sometimes vulgar but always comprehensible, Gaskin is asserting that the knowledge she puts down in her book is for everyone. It's knowledge that is available to someone who doesn't know the difference between a urethra and a ureter. Gaskin is saying that it doesn't matter if you know what a urethra is; you don't need fancy vocabulary to understand your body. You know where your pee comes out, and that's what you need to know to understand your body!

So, although it may not be my preferred language, I acknowledge that Gaskin may be doing a great service to the average woman by using such plain and easy-to-understand language.

I also find it interesting to think about what sort of language I should use with clients, someday, when I'm a midwife. In my ideal of midwifery, the midwife should not be an authority figure who has power over the birthing woman. She should be a source of knowledge and skills who offers up that knowledge in service, and works with the woman to communicate that knowledge and assist the woman in making her own choices. In my mind, I imagined that this would include educating the woman on technical terms for anatomy, but now I wonder, how important is very technical language? Does it not in some ways go against the ideals of midwifery to use technical language that functions to set up the midwife as the expert, the authority figure, the guardian and sole holder of knowledge? We know that many doctors use knowledge to give themselves control: some doctors say that their great knowledge gives them the right to command and control the birthing woman. If a midwife uses technical language that sets up her client as an outsider, unitiated, does it set up the expectation in the woman that she ought to be obedient and is not the one in control?

Book Review: The Thinking Woman's Guide to a Better Birth

Whew, getting back on track! I've been reading, but updating. Whoops.

I recently read The Thinking Woman's Guide to a Better Birth by Henci Goer. This book seems to be very well-regarded, and for good reason. Goer does a great job of laying out the findings of a whole lot of research in a way that's easily readable and accessible to someone without a medical background.

She does have a strong bias towards natural birth, as she explains in the introduction. I appreciate that she acknowledges her biases and she is honest about them with the reader. This sometimes translates into a bit of bias that is a bit... not anti-OB, I don't want to say, and not quite hostile, but certainly suspicious.

However, this book is really well-researched, and written very clearly. I think that people who come into reading this, feeling pretty down with medicalized hospital birth but curious about the other side, can overlook the occasional anti-OB comment and appreciate the really solid research in this book. There's a ton of tremendously useful and educational stats in here.

I had a few little quibbles with the book. There were a few little inconsistencies - saying in one chapter that EFM is basically pointless, because it increases interventions without improving outcomes, but then saying in the VBAC chapter that EFM was recommended, without elaborating more on why that should be. I also disliked the style of citing sources. The main body of the text contains explanations for laypeople without citations. Then, there is an appendix at the end of the book for each chapter that summarizes the literature sources, so that you can link a specific assertion with its source. For me, as a scientist, it bothered me to not to be able to link a statement with a citation! But, maybe it is more comfortable for the general reader to read chapters uncluttered by citations and journal article titles, so maybe that is a strength of the book.

One interesting new medical thing I learned from this book - okay, two: (1) Women are given a big bolus of IV fluid, on the order of at least a liter (4 cups), when they get an epidural or before a C-section. This is to raise blood pressure, to counteract the blood pressure-lowering effect of an epidural. (2) That's a ton of water all at once, and it may be (at least partially) responsible for the problem of increased fluid in the lungs and respiratory issues in C-section babies.

Another post coming up soon on some more specific thoughts!

P.S. Can anyone tell me how to pronounce "Henci Goer"? I have no clue and it really bothers me. Hensy? Henchi? 'Ensy? Gore? Go-er?

Book Review: The Doula Guide to Birth

Today's book review: The Doula Guide to Birth: Secrets Every Pregnant Woman Should Know, by Ananda Lowe and Rachel Zimmerman.

First of all: hey, the first author, Ananda Lowe, is a doula without children! Woo! As someone who's planning to go into birthwork long before having children, I find it very encouraging to read a book by a doula who's clearly successful, loved by her clients, and respected.

Okay, onto the book. I really liked it and, I have to say, of the books I've read so far, this is probably the first one I'd recommend to a pregnant friend, because it seems like a really great starting point. Of course, it's a book about doulas, so it's fairly set in the hospital paradigm, but it's very pro-natural-birth.

Here's what I liked best about it:

• It gives the readers concrete tools to help them in finding the best care provider(s) and setting themselves up for a good birth. It has these nice little "Ask your doctor now!" boxes sprinkled throughout, clearly highlighted and set apart from the text, to signal "hey, if you read anything in this book, read this!" I thought that was terrific. Concrete directions for a woman who may be new to all this is surely helpful. I also liked how it wasn't one big list, it was little questions sprinkled throughout - so, a busy woman reading this over a few weeks would be able to bring up these questions as she went along in the book, instead of deluging her doctor with questions at week 30.
• The most open-minded book I've read so far in recognizing that not all birth is going to involve a coupled mother-father dyad. This book recognizes that a woman giving birth might have a female partner, no partner, an estranged partner, a partner who isn't the father of the baby, or might even be giving birth to a baby for someone else (surrogacy or adoption). And it doesn't just give one shout-out to those things at the beginning and then spend the rest of the book talking about mom and dad; those considerations are integrated throughout the book. Very thoughtful, very inclusive.
• It's pro-natural-birth, but in a gentle, accepting way. It's not all "omg, if you have epidural and pitocin, horrible things will happen!!" It's more, "hey, if you have an epidural and pitocin, you'll be at risk for more side effects and complications. Why not try going without them and seeing how that goes? We won't judge you if you end up getting the epidural, though. It's all good!" In that way, I think it may be very good reading for the woman who just assumes that she'll be getting an epidural. It gently says, hey, why not consider this instead?, and of course gives lots of great tips for coping with labor without an epidural, but without being too pushy or judgy.
• At the beginning of the book, they mention that there will be a chapter on how to deal with unexpected medical intervention. "Uh oh," I thought. "Is this going to be all about, yeah, haha, you might wish for a natural birth, but you're not gonna get it, so deal with it"? But actually, it was very good! The book was really strongly pro-natural-birth and strong on giving mothers the tools to achieve that, if they wanted it. The "dealing with medical interventions" chapter was just focused on giving mothers the tools to deal with medical interventions if they came up: how to negotiate with the doctor, how to choose treatments, and how to cope with the unexpected. I thought the chapter was realistic but still hopeful. I liked their suggestions to think about, for example, if you're having a homebirth, how will you feel if you have to transfer to a hospital? How will you cope with that? It's good to think of coping strategies in advance, and hope you don't have to use them. 

One teensy-tiny criticism I might have would be that this book is very focused on first-time mothers. I suppose that's fairly reasonable: all woman who have children will have a first child, after all, but not all of them will have a second child! I also imagine that the first pregnancy tends to involve the most reading and research. (With the exception, perhaps, of woman who go for the I-trust-my-OB route the first time, have a traumatic birth experience, and then the second pregnancy is the research-intensive one - this is a story I've heard quite a few times.)

It did make me laugh a little bit, though, when the book assumed that only was it the reader's first child, but that it was also the reader's parents' first grandchild! I imagine giving this to my aunt when she was pregnant with her first child, but her mother's sixth grandchild... heh.

I felt like this book was somewhat research-lite. It definitely talked about a lot of different birth interventions and their pros and cons, but not in nearly as much detail as some other books. There were a few sections where they would mention interventions, and kinda say, well, you can do more research on this if it matters to you, but we're not going to talk about it too much here.

I thought that that was okay, though. Like I said, this book is a great starting point. It gives a broad overview of birth, birth-related issues, and how a doula helps, but doesn't go too deep. I wouldn't tell a woman to read only this book, for sure, but it's a nice place to start. Written in a very warm, friendly tone, very optimistic, and full of plenty of tools and recommendations for talking with care providers and digging deeper, I think this is a very valuable book for pregnant women.

Book review: The Doula Book

My most recent completed book was The Doula Book by Marshall H. Klaus, John H. Kennel, and Phyllis H. Klaus. (Did anyone else notice that all the authors have the same middle initial?)

It's a slim, reader-friendly book, weighing in at just about 190 pages, plus some helpful appendices. The writing style is a bit clinical but accessible.

This book makes a strong case for doulas, and it does so in large part by presenting a wealth of data. If you want to cite a figure for the concrete good that doulas do, this is the book for it. They bring together an impressive amount of studies and make a compelling case for doulas decreasing the need for pain medication, medical intervention, and Cesarean sections, not to mention increasing satisfaction with the birth experience, and even helping to improve mother-baby bonding so much that it leads to a decrease in child abandonment and abuse! Wow!

The book also explains what a doula is in quite some detail, and really goes into the details of exactly what a doula does. That seems like it's sure to be very helpful to someone who's curious but really has no clue about doulas. All the talk of techniques that doulas use was very interesting to me, too, as I'm looking into becoming a doula.

They have a special chapter for talking about the role of the father in birthing. First of all, the language of this book isn't very inclusive - as it always seems to assume that there is a partner in the picture, and that that partner is male. (They give a nod to this book being for all kinds of families somewhere early on, but it's all about "mother and father" from that point on. Admittedly, most families will fit that description, but just a heads-up to others.) Anyway, I thought that this book was sort of discouraging about how much a father can really do for the birthing mother in labor. On the other hand, it was a very fair point that it is a big burden to put on a partner's shoulders, to expect them to be labor experts and great labor support people, with no training, possibly no experience, and a great deal of anxiety for their partner! So that was an interesting point.

I also found Chapter 9 to be very interesting. This chapter focused on a hospital in Dublin where every laboring woman got one-to-one care from a doula/midwife (actually, nurses who were training to be midwives). I was rather amazed by the amount of intensive coaching that was described, and a little bit disappointed by how strictly they seemed to coach pushing. I guess I can't fault their methods too much: the vast majority of first-time mothers delivering spontaneously and naturally within ~8 hours of being admitted to the hospital? Impressive!

Bottom line: Great book for someone who doesn't know much about doulas, or who is skeptical about them, to learn how great doulas can be. Great for someone who wants cold hard facts without "woo." Overall, I feel like this book is really aimed at people who want to know exactly what a doula does and exactly what the benefits are. It feels a little bit like a book for doctors, nurses, hospitals, medical providers, etc. Maybe not as useful for expectant parents as some of the other books are there, but again, good for expectant parents who want "just the facts!"

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. 

Blocks

I just realized that, contrary to my previous assumptions, the Jennifer Block who wrote Pushed is not the Jenny Block who wrote Open, a book about open relationships. Things somehow make a little more sense now that I know that these two books are written by two different people!

Now, of course, there's nothing wrong with the idea of a polyamorous woman going on to write a book about childbirth - I'm pretty sure that Jenny Block has a child, so it made sense in that way - but it seemed like such a big, odd change of topics that I was a bit puzzled.