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Sunday, July 29th, 2007
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Pushed: The Painful Truth about Childbirth and Modern Maternity Care

by Jennifer Block

Baby Monitor

A review by Jessica Jernigan

In March of 2006, the National Institutes of Health convened a panel of obstetricians, pediatricians, midwives, and other experts to compile a state-of-the-science report on cesarean section, and to suggest avenues for future study surgical childbirth. The NIH decided to call this conference "Cesarean Delivery on Maternal Request." If you're someone who reads Us Weekly or the Sunday Styles section of the New York Times, the phrase "maternal request" probably conjures up certain images: Britney Spears, Posh Spice, and upmarket control freaks. In their June 2006 article on the conference's findings, U.S. News & World Report suggests that "some women are sensitive to the less glamorous aspects of pushing," and, echoing comments by some of obstetricians and other experts assembled by the NIH, concludes by stating that, whether or not the c-section is safer and better than vaginal birth, it's a woman's choice.

Thus the popular portrayal of the current state of childbirth: Powerful, beautiful women would rather go under the knife than deal with chaos, pain, and a slack coochie; and the difference between physiological delivery and surgery is no more important than the difference between a Bugaboo Frog and a MacLaren Triumph. Women -- not doctors, not hospital administrators, not medical insurers -- are responsible for the normalization of the cesarean section, and that's just as it should be in a consumer culture.

This image is not, however, without its critics, and Jennifer Block talked to a number of them. The result is an eye-opening, distressing, and ultimately empowering look at the very sorry state of contemporary maternity care. While the book is not solely about the rise of the cesarean section, Block's critique of the NIH conference and her analysis of the myths and realities of surgical childbirth are representative of her larger project. Citing a response to the conference issued by Childbirth Connection -- a venerable not-for-profit organization dedicated to promoting "safe, effective and satisfying maternity care" -- Block notes that there are no reliable data suggesting a surge in "maternal requests" for c-sections; the "too posh to push" phenomenon might be an breezily bitchy hook for journalists, but it's just not supported by the numbers.

The typical birth in an American hospital today involves induction or "augmentation" of labor, constant fetal monitoring, and powerful pain killers. Each of these interventions creates restrictions on the laboring woman, and each intervention invites further intervention. There is a growing body of evidence to suggest that a woman who undergoes these procedures is more likely -- not less likely -- to end up having an emergency c-section. Block found a few examples of the optimal experience -- the sort of experience expectant mothers probably have in mind when they put together a birth plan -- at birth centers and a handful of hospitals, but she also found that it simply isn't available to most American women.

This is not to say that Block's book is a romantic argument for "nature" over medicine. She found a number of nurses and doctors who are frustrated and disheartened by the current state of childbirth, and a section on doulas contains the provocative suggestion that these caregivers actually impede childbirth reform by helping their clients reshape negative experiences into pleasant memories. But Block reserves the bulk of her criticism for a medical establishment that has pathologized and circumvented physiological childbirth without first understanding it. More than just a collection of statistics and anecdotes, Pushed is ultimately a call to action, and its message is that a woman's right to choose shouldn't end when she decides not to terminate a pregnancy.

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