Pushed: The Painful Truth about Childbirth and Modern Maternity Care

Exactly 3 years ago I walked into one of the finest maternity hospitals in NJ to deliver my first baby. I was low risk - under 30, no complications - and was expected to have a smooth delivery. 11 hours later I was laying in a bed by myself staring at a ceiling, completely shell shocked, and without my baby, husband or family, I was immobilized in a recovery room with a gaping wound in my belly while my new daughter was off in the nursery. I had no idea what went wrong. It seemed that I had simply stopped dilating or "failed to progress." As I read Jennifer Block's book, I just nodded as it all became very clear - the insistence by the staff that we would just hurry things up a little by performing an amniotomy (breaking my water) when I was still in early labor. That was followed by pitocin (to "really" get things moving), stadol (a narcotic pain reliever), an epidural and finally, a c-section. My labor was simply one of many completely over-managed and over controlled labors in American hospitals. They finally decided that a c-section was the only way to end my labor. I was lead to believe my labor was a "problem" and a "complication" and surgery was the only answer. I wish this book could become mandatory reading for all women who are planning a hospital delivery. Contrary to recent reports (as discussed in this book), very few women are actually requesting a c-section on a completely voluntary basis. Years ago I was "pushed" by the obstetrical community into an unwanted delivery experience. Today I am pregnant with my second child. And I am pushing back.

Block's central thesis is this: "What's best for women is best for babies. And what's best for women and babies is minimally invasive births that are physically, emotionally, and socially supported. This is not the experience that most women have. In the age of evidence-based medicine, women need to know that standard American maternity care is not primarily driven by their health and well-being or by the health and well-being of their babies. Care is constrained and determined by liability and financial concerns, by a provider's licensing regulations and malpractice insurer. The evidence often has nothing to do with it." Block paints a depressingly grim picture of modern maternity care in which only a handful of women experience physiological childbirth. The rest give birth plugged into machines. Drugs and hormones course through their veins; scalpels and scissors cut them open, often after coercion and frequently despite the woman's expressed refusal. Almost everyone she interviews admits there's a problem, but no one seems to be able to change the system. Those who buck the system altogether--home birth midwives and unassisted birthers, for example--face legal harassment, imprisonment, fines, or loss of custody of their children. Block's book points out several captivating ironies that, if they weren't so depressing, would be laughable: 1) ACOG recently decided to support elective "maternal request" cesareans--surgery for no medical reason--as ethically justifiable (even though the medical evidence shows that cesarean sections for no medical indication lead to higher morbidity and mortality for mothers and babies, rising sharply with each successive surgery) yet refuses to allow women to choose out-of-hospital birth, direct-entry midwives, or, in many hospitals, VBACs (even though the medical evidence clearly shows that these choices are safe & reasonable). 2) Although physicians and midwives tout the importance of evidence-based medicine, less than 2% of American women received "optimal maternity care" that consists of these six basic aspects, all of which are well supported by the best evidence-based medicine: 1. Labor begins spontaneously 2. Women have freedom of movement during labor. 3. Interventions are medically justified rather than routine. 4. Women have continuous emotional and physical support. 5. Pushing occurs in any position but flat-on-back. 6. Mother and baby are not separated. In other words, 98% of women received sub-optimal care. Surprisingly, this book gave me a greater sympathy towards obstetricians (well, some of them at least). Many of the physicians Block interviewed held great respect for the natural, physiological birth process; bemoaned the current state of malpractice litigation, VBAC bans, and the dogma of automatic surgery for breeches; and secretly supported home birth midwives--often facing censure from their peers for their views. Pushed shows a maternity care system that has gone malignant. Instead of

Not only was this an amazing book packed full of easy-to-understand statistics and little-known information on what hospital birth is like in the US, but it is an absolute page-turner with plenty of gripping real-life stories from all types of people (physicians, nurses, midwives, mothers, lawyers, activists, etc.) with experience in this system. I used to have a vague idea, before this book, of some of the interventions I would absolutely not allow if I were to give birth in a hospital, but since reading this book and doing some additional research (via other books and internet) my eyes have really been opened. I could never watch TLC's "A Baby Story" the same way again! I think this book is a must-read for any woman contemplating childbirth. It is such a shame that SO FEW women know that there are options OUTSIDE of the hospital, and that they don't have to be forced by physicians to submit to procedures and interventions (e.g., episiotomies, continuous fetal monitors, cesareans) to which they DO NOT consent. Read this book (and others) to prepare yourself.

As a labor and delivery room nurse I applaud the writer of this book for getting this valuable information out there! I want to hand the book out to every pregnant woman, every obstetrician, and every labor and delivery room nurse. We have to stop the nonsense. I love what I do, but hate the technology that has taken the natural process of childbirth away from women. Women have to stop fearing the most incredible experience you can have and those in the medical fields have got to stop fostering the belief that if it can go wrong it will. This book is wonderful! Jennifer you rock! =)

This engaging journalistic expose was a real eye-opener, and a must-read not just for women, but for anyone considering becoming a parent, or really anyone concerned with the direction health care in the U.S. is headed. The cesarean rate in our country is over 30%, nearly three times that of some European countries. Are our bodies really that different? Somehow, I doubt it. Ms. Block explores the troubling trends that push doctors to perform often uncalled-for major abdominal surgery, and shows how this is harmful both to mothers and babies. With stylish, riveting prose, an exciting first-hand account of traveling "underground" with an illegal midwife, and tales from the operating table, Block skillfully takes stock of the current state of birth in America. Not to be missed.