Pushed: The Painful Truth About Childbirth and Modern Maternity Care

published	June 4th 2007 by Perseus Books Group
binding	Hardcover
isbn	0738210730 (isbn13: 9780738210735)
pages	400
description	A provocative and incisive analysis of childbirth in the age of machines, malpractice, and managed care. In the United States, more than half the...more [close] A provocative and incisive analysis of childbirth in the age of machines, malpractice, and managed care. In the United States, more than half the women who give birth are given drugs to induce or speed up labor; for nearly a third of mothers, childbirth is major surgery - the cesarean section. For women who want an alternative, choice is often unavailable: Midwives are sometimes inaccessible; in eleven states they are illegal. In one of those states, even birthing centers are outlawed. When did birth become an emergency instead of an emergence? Since when is normal, physiological birth a crime? A groundbreaking journalistic narrative, Pushed presents the complete picture of maternity care in America. Crisscrossing the country to report what women really experience during childbirth, Jennifer Block witnessed several births - from a planned cesarean to an underground home birth. Against this backdrop, Block investigates whether routine C-sections, inductions, and epidurals equal medical progress. She examines childbirth as a reproductive rights issue: Do women have the right to an optimal birth experience? If so, is that right being upheld? Block's research and experience reveal in vivid detail that while emergency obstetric care is essential, there is compelling evidence that we are overusing medical technology at the expense of maternal and infant health: Either women's bodies are failing, or the system is failing women. [close]
date added	04-10-07 edit book

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Sarahdorothy rated it:

02/23/08

bookshelves: notforschool, politics-of-reproduction

Read in February, 2008

recommended to Sarahdorothy by: Mindy
recommends it for: Everyone.

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 f...more 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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Tom rated it:

11/10/07

bookshelves: non-fiction

Read in November, 2007

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 alarm...more 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)....less

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