Sunday, May 15, 2011

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.

Wednesday, May 4, 2011

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!"

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.