Sunday, April 17, 2011

Birth in sci-fi

I'm a lifelong fan of the fantasy genre, and a more recently-converted fan of science fiction novels. Since I haven't read so many, I don't have a great basis to draw from. That said, I find the topic of gestation and birth in science fiction very interesting. Often, science fiction consciously or unconsciously makes a statement about the present; it is always a product of the hopes, fears, and technologies of the time of writing.

One example that springs to mind is Lois McMaster Bujold's Vorkosigan Saga. In those books, the more advanced civilizations have created artificial wombs: the fetus is grown in a tank, and is decanted instead of being born. Everyone is very happy about this since, after all, it means no maternal mortality! When one character finds herself in the position of being pressured to actually get pregnant and carry a child in her own body, she's horrified. I won't say anything about what happens with that situation because it would be a big spoiler.

More recently, I read some books by Charles Stross, Accelerando and Glasshouse. I'm going to throw in a minor spoiler for Glasshouse in the next line - more a spoiler for the type of world it is, but also a bit of a plot hint, so if you're planning to read it and haven't yet, skip the next paragraph, I guess.

Ready? Spoiler ahead! Okay! So in one of these books, technology eventually reaches the point where they have these devices that are like the food replicators in Star Trek, only they can replicate anything. It's not stated explicitly, but based on (again) horrified reactions to the thought of pregnancy and physical childbearing, it's pretty clear that these replicators are where babies come from in this vision of the future.

I think that both of these examples are quite interesting. In a way, they're very optimistic: they imagine a world where not a single woman has to die in childbirth. They're the ultimate dream of medicalized childbirth: a world with no discomfort, pain, injury, or death at all associated with childbearing. It sounds pretty good! There is, at times, a poignant sense that something good has been lost, but there's also a powerful sense that something bad (barbaric, violent, backwards) has been happily done away with.

One could argue that books that portray childbirth this way imagine the future as a place where humans are not made to be the best that humans can be, but rather as a place where science and technology allow humans to become something better than humans. Those stories also express a deep fear of childbearing, I think, and a wish that women could be freed of that fear by science.

I wish that I had some good counter-examples. As it is, most sci-fi novels don't concern themselves much with these types of things! Also, I just haven't read enough sci-fi novels to be able to think of a lot of good examples. I can think of some sci-fi TV shows and movies that depict natural, physiological birth in a neutral or even positive way (a variety of Star Trek series and at last one movie; Farscape; Battlestar Galactica; etc.). However, I'm not sure that it's fair to compare novels and TV. Birth is great for big, dramatic TV moments; audiences are going to be much more entertained by a screaming woman in an escape shuttle than they are by a baby being mechanically replicated along with the morning coffee. Choices are being made there for entertainment value, not just for message. Of course, I think that the childbirth elements of Star Trek do fit with its message as a series, but still, not a fair comparison.

Friday, April 15, 2011

Book review: Pushed by Jennifer Block

I finished reading Pushed by Jennifer Block the other day. I thought it was excellent. Very well written; overall, I thought it put things together very well. Highly, highly recommended. Full of great info about the safety of birth and various procedures; the history of obstetrics and midwifery in the U.S. and how we got to where we are today; the legal status of midwifery throughout the U.S. and the problems that illegality causes; the terrible medical and legal abuses of women who want to make their own choices; and the incredible importance of choice and autonomy for birthing women. It was full of terrific information, extremely well-researched, lots of good citations. Block is an investigative journalist, and it really shows. I thought she did a great job of letting a lot of different voices speak and bringing together many sources.

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!
Sorry if this is a bit rough or rambling. This book was so wonderful and informative and thought provoking. I have so many thoughts swirling around in my mind now.

Saturday, April 9, 2011


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.

About the blog / Who am I?

Well, here's my first post on this new little blog.

First things first: Who am I?

I'm blogging anonymously, so I can't get too detailed on that question. So what can I tell you?

I'm a woman in my mid-20s. I'm a physical scientist. (Physical as opposed to biological. Think physics and chemistry, not biology and medicine.) I'm a U.S. American, and a west coaster for life. I'm a feminist. I'm pro-choice. I'm scared of climate change but I'm not scared of vaccines. I love my family. I don't have any children.

I've never seen a birth in person but I want to be a midwife. I've been fascinated by pregnancy and birth from a very young age. By the time I was 7, I could define a zygote and a blastocyst, and I had strong feelings about using the words "embryo" and "fetus" accurately. Adults always told me that I should be a doctor because I was so smart, but I never wanted to be a doctor. Still don't. The fact that I could work with pregnant and birthing women without being a doctor (or a nurse) only occurred to me in the last few years. Since that moment I haven't been able to get the thought of becoming a midwife out of my mind.

Okay, enough of that. I'm bored of talking about me.

So what's the point of this blog?

I'm not sure yet! To start with, it probably won't be terribly active. Right now I'm working on reading through lots of birth and midwifery-related books, so I'll be posting reviews of those. (Next up: Pushed by Jennifer Block. Loving it so far; I'm about 60 pages in.) I'll probably also post about my thoughts and research as I look into possibly becoming a midwife. I'm still trying to decide if I'm totally crazy or not. I do hope that this blog will become a record of my journey to becoming a midwife, but we'll see!

For now, if anyone stumbles across this blog, the most useful thing is probably the "My Blog List" section over on the right. Lots of great blogs there by homebirth midwives, nurse-midwives, nurses, and other people. I read a lot of blogs.