Saturday, May 30, 2009

Pushed: A must read

I just finished Pushed: The Painful Truth About Childbirth and Modern Maternity Care, by Jennifer Block.  It is an extremely well-researched book about maternity care in the U.S. and how it came to be.  This is a must-read for anyone who is a mother, who wants to be a mother someday, who loves a mother or who is interested in how our medical system is failing childbearing women.

This is a fascinating read.  I finished it in 3 days.  I know a lot of you have already heard me harp about our country's high rate of cesarean section (over 30% this year).  This book clearly articulates how childbirth in our country is seen as a pathology, instead of the natural end to a pregnancy.  The U.S. ranks 32 out of 33 in maternal mortality among industrialized nations.  Countries with the best infant and maternal outcomes have most of their births attended by midwives and have between a 14% and 18% cesarean rate.

Pushed also takes a close look at how mothers are treated during childbirth.  Statistics are hard to come by, but anecdotally, I know of several mothers who had procedures performed on them or their babies without their consent.  Block writes about women who had court orders forcing them to have cesareans.  Other women are trying to file assault charges for procedures they  expressly denied.  

Many hospitals require women to stay in bed.  Many hospitals have an official or defacto ban on VBAC (vaginal birth after cesarean), caused primarily because of malpractice insurance. I certainly don't think women should be forced to have a "natural" childbirth, if it's not what they want. I do, however, don't think that interventions are adequately explained to women.  Picotcin, a drug given to women to speed their labors often leads to an epidural.  Epidurals require catheters.  Epidurals and the use of pitocin are more likely to lead to cesarean sections.  The term "casade of interventions" is apt.  It's a term I had never heard before T was born, but one I wish I had known.

I walked into the hospital, my water broken, with contractions 5 minutes apart.  I was 3 centimeters dilated, and all indications were that I would likely continue to progress.  I was given an IV, hooked up to a fetal monitor and moved into a labor room.  The doctor (the head of OB/GYN at my practice) came in, introduced himself and said "we're going to start you on some pitocin."  Why?  To make sure that I didn't labor all day, only to have to have a cesarean, because he was concerned that T was too big to birth vaginally (T was born at 5 lb, 13 oz).  Immediately after getting the pitocin, my contractions went from manageable, to hard core, 2-3 minutes long contractions with only 10-15 seconds in between.  I could barely catch my breath before another one barrelled in.  Within 2 hours, I requested an epidural.  It took another 2 for the anesthesiologist to arrive.  What is normally a short procedure took over 30 minutes because I couldn't stop contracting long enough for the doctor to place the epidural catheter.  Luckily for me, the epidural blissfully worked, and I got some much-needed relief.  The doctor came in several more time, each time indicating that if I only said the word, he'd give me a cesarean.  Each time, I said no.  The doctor and nurses told me they weren't getting good heart tones and recommended an internal monitor (it screws into the baby's head).  Initially, I told them no, but finally submitted after being talked into it.  Finally, I was 10 centimeters.  I pushed for 2 hours.  20 minutes before T was born, the doctor was still pushing a cesarean.  T was born via vacuum extraction.  I was given an episiotomy I didn't consent to.

I had a beautiful, perfect little boy.  I was happy, but numb for days after.  I don't know if things could have gone differently, but I certainly would have liked the opportunity to try and have a non-intervention birth.  I can't regret anything, but it still makes me sad and a little angry.  I felt managed, pushed, dismissed.  It is the reason I started reading.  It is the reason I'm going to become a L&D nurse, and eventually, a midwife.  It is the reason I'm having this baby with a midwife.

Read the book, get informed, make your own decisions.


Becky said...

Even though this is outside my personal relevancy zone (at the moment), I think this subject is fascinating. Seriously, NO ONE talks about this. I'm so proud of you for going into a profession where you can have an impact on women/pregnancy. I definitely plan to read this; the Pasadena Library has a copy.

Cath said...

So, just so you know, you will have to be there when I get around to being in this situation so you can tell those pushy Docs what is what!

nana said...

Amen! I too believe our doctors are way to C-section happy. When ever I hear some one talking about their "scheduled" C-section, I always ask them why? The answers I get are unbelievable. The dr is going on vacation, I wanted his birthday to be on the 5th, we are going on vacation" Incredible. No thought to how this will impact them. I certainly want to read this.

Jenn said...

Statistically speaking, it's pretty rare for women to want to schedule their own c-section (about 1%). A far greater percentage are coerced into them because they've already had one, because their doctor thinks the baby "looks too big", or a myriad of other reasons. I don't think a lot of people know the risks of c-sections. Moms are 4 times more likely to die during a c-section than a vaginal birth. They are twice as likely to die even during a scheduled, planned, non-labor c-section.

@Cath -- I'd love to be your doula!

Cathy said...

Good! Plan on it in a few years!

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