Tom's review

Pushed: The Painful Truth About Childbirth and Modern Maternity Care
by Jennifer Block

[close]

blog this review

Copy/paste the text below into your blog.

<a href="http://www.goodreads.com/book/show/607901.Pushed_The_Painful_Truth_About_Childbirth_and_Modern_Maternity_Care?utm_medium=api&amp;utm_source=blog_review" style="float: left; padding-right: 20px"><img alt="Pushed: The Painful Truth About Childbirth and Modern Maternity Care" border="0" src="http://photo.goodreads.com/books/1176254297m/607901.jpg" /></a> <a href="http://www.goodreads.com/book/show/607901.Pushed_The_Painful_Truth_About_Childbirth_and_Modern_Maternity_Care?utm_medium=api&utm_source=blog_review">Pushed: The Painful Truth About Childbirth and Modern Maternity Care</a> by <a href="http://www.goodreads.com/author/show/329571.Jennifer_Block">Jennifer Block</a> 
 <a href="http://www.goodreads.com/review/show/8228734?utm_medium=api&utm_source=blog_review"><h3>My review</h3></a>
 rating: 3 of 5 stars 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).
 <a href="http://www.goodreads.com/review/list/108034?utm_medium=api&utm_source=blog_review">View all my reviews.</a>

Tom's review
rating:

bookshelves: non-fiction
status: 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 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 consen...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

Like this review? yes (3 people liked it) flag

comments (showing 0-0 of 0)

newest »

date

all Tom's books »