Thursday, August 11, 2011

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.

Friday, August 5, 2011

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.