A book review

Last night I read a very interesting book called Giving Birth: A Journey into the World of Mothers and Midwives by Catherine Taylor. It was so interesting that I read it all in one sitting, like a novel. The author started researching exactly what contemporary midwives are in America, how thir work settings influence their practice of midwifery, and why America rated pretty low for maternal and infant mortality rates among industrialized nations, even though we spend more per capita on birthing women than any other country. While writing the book, she became pregnant with her second child, so it was also a search for this "perfect' birth experience that she felt she had missed during her first labor (which was with a certified nurse-midwife in a hospital). She shadows several midwives in a hospital setting (in the southwest US), writing about many births, which I always find fascinating. She was surprised to find that although the midwifes seemed to be in charge, in many cases doctors were actually making decisions that the CNMs had to implement. Also, almost all women at this hospital gave birth sitting in a bed with feet out to the side, in stirrups, although they were encouraged to labor in different positions. And most midwifes were not really around much for the labors--just for the actual pushing and delivery. Catherine also visited a birthing center in Taos, NM where she observed more births and found a philosophy a little more to her liking, as far as the midwives really supporting the women and being there, and there being a lot of options for laboring comfort as well as delivery. This center had very low c-section and epidural rates, which the hospital midwives did not. Then she went to some home births, which she decided were the best of all worlds, and she gives a lot of statistics to bolster her case, such as how healthy the babies are, how less-stressed the moms are, etc. Catherine eventually decides this is the way for her, and she has a home birth for her second child. While she is following all these different midwives around, she becomes a doula so she can better assist women at birth, and also actually experience more births. Although the book tries to be pretty even-handed, she is clearly not a big fan of drugs or epidurals. None of the midwives, however, make a big deal of this--they all were very supportive of whatever choices the client made, and like I said, the hospital midwives ended up with a lot of epidurals. She muses about the causes of this--that American women simply are not used to any sort of pain, and will not tolerate it at all, even knowing it has an ending point. Also, that nurses and OBs would rather have thier patients have one so that they don't need to be so involved in the care. Interesting thoughts, but I would love for my sister-in-law to read the book and tell me what she thinks, since she actually IS a labor and delivery nurse! The author never interviewed or shadowed any nurses or OBs, so she was basically just making judgement calls.

Several of the author's points I think depended a lot on personality too. One reason she was dissatisfied with her first birth was that she felt like her midwife wasn't around for it, and she didn't have all the support she needed. I personally have never liked having too many people around me while in labor, so this absolutely was never an issue for me. I like the peace and quiet, and I just read and listen to music. I think it would drive me crazy to have someone hovering around me, offering me "sniffs of peppermint oil" or other things like that to distract me from my contractions! But I can understand that not everyone is as self-focused as I am during labor, and maybe they do need more of that. Also, she really hated it that she didn't have the midwife she saw for her prenatal care deliver her. Well, I have had 4 children now, and I never been delivered by anyone I met before they were peering at me from between my legs! I guess I never expected it or thought it very important who actually caught the baby (good thing, huh!), so I wasn't disappointed. Also, I rarely see the same person for appointments, so it's kind of hard to form any attachments, LOL! Catherine was also bugged when the hospital midwives would take the baby after just 5 minutes on the mother's chest to bath it and clean it up. Well, I don't really like goopy babies, so that was never a problem for me either. Let me deliver the placenta, then bring me back a nice, clean weighed baby! As far as home births go, I would NEVER want to do this--I would never want to deal with all the blood and gunk and dirty laundry! BLEH! Also, the author takes a hilarious set of birthing classes where everyone belly-dances around, then the instructor acts out the story of "the goddess Innanna descending in to the underworld, the tomb and womb of the earth, where she plants seeds of life by giving up her own". LOL! This intructor also makes everyone practice making loud pushing noises by pretending they are mama gorillas. I don't think so! They also have to draw a "landscape of their labor", which is supposed to be a metaphor. Catherine draws a river with rapids that flows through a narrow opening to a wide calm lake. Nice idea, but how exactly does that help? I've made it through 4 completely all-natural labors, and I didn't need any of that weird stuff to help me!

For my first 2 deliveries, in Colorado, I was delivered by certified nurse midwives that I am sure were very similar to the ones she shadowed in the book, although they would not have had all the stresses of dealing with HMOs and the whole managed care system. I was thrilled to not have episiotomies, to not have drugs pushed on me, and to be able to stay in the same room for labor and delivery! It also helped that I stayed home as long as possible before going in. One thing that always bothers me about my births is having to keep the contraction/heart rate monitor on at all times, even though they always said in classes that you could be free to move around. Again, going in late helps with this--you don't feel much like moving anywhere when you are already at least 6 cm dilated! It does make it harder to move into comfortable positions for transition, however, if every time you move, the alarm goes off because the monitor no longer can pick up anything. Grr. Also, I have become trapped in the "only push in a semi-sitting position" way of thinking. When I was in labor with Jonathan, I was laying on my left side when I felt a tremendous urge to push. I told everyone then scrambled to get sitting up while they took off the end of the bed in between contractions! As soon as I sat up, I never had such strong pushing urges again. He was a big baby (9 lb. 6 oz), and it was harder to get him under my pelvis. I think if I had stayed laying down (would they have even let me? No midwives at the big W-P teaching hospital!), I would have pushed in half the time (which was still only about 20 minutes, but that's a lot for #4!).

Well, this was a long review, but it was such an interesting book for anyone who is or ever has given birth, or who just wants to get some perspective on it. I didn't agree with all her conclusions, but the stories were great, and the book made me think. My conclusion was that everyone has such vastly different expectations for birth and ways for coping with pain and childbirth. I'm glad there is no one method forced on women like it used to be, and I am glad that more and more hospitals are becoming less and less invasive and forceful about managing labor, as if it were a disease to cure or something. Thanks for reading this far!!