Pushed The Painful Truth About Childbirth and Modern

Pushed The Painful Truth About Childbirth and Modern Maternity Care In the United States than half the women who give birth are given drugs to induce or speed up labor; for nearly a third of mothers childbirth is major surgery the cesarean section For women who want an alternative choice is often unavailable Midwives are sometimes inaccessible; in eleven states they are illegal In one of those states even birthing centers are outlawedWhen did birth become an emergency instead of an emergence Since when is normal physiological birth a crime A groundbreaking journalistic narrative Pushed presents the complete picture of maternity care in America Crisscrossing the country to report what women really experience during childbirth Jennifer Block witnessed several births from a planned cesarean to an underground home birth Against this backdrop Block investigates whether routine C sections inductions and epidurals eual medical progress She examines childbirth as a reproductive rights issue Do women have the right to an optimal birth experience If so is that right being upheld Block's research and experience reveal in vivid detail that while emergency obstetric care is essential there is compelling evidence that we are overusing medical technology at the expense of maternal and infant health Either women's bodies are failing or the system is failing women


10 thoughts on “Pushed The Painful Truth About Childbirth and Modern Maternity Care

  1. Meredith Meredith says:

    Pushed is a shocking documentation of medically managed childbirth in the United States The first four chapters detail the standard practices and current trends a la 2007 and the effect these have upon the women giving birth Jennifer Block challenges the sacred cow of an idea that the definition of a successful birth is simply a live baby and live mother She makes the case that the trauma incurred during the birthing process through unnecessary medical intervention and surgery artificial time limits and practices that hinder and harm the natural working of a mother's body should be factors in declaring a birth a successBlock also delves into how procedures instruments and drugs that were developed to combat certain complications and particular potentially deadly situations suddenly became standard practice for all pregnancies regardless of whether they were low risk and showed no signs of complications She also describes the potential side effects increased risks for further interventions and complications of common and standard practice medications surgeries and practices information that is usually omitted or downplayed because it might make women less likely to blindly submit to them Interestingly enough the author doesn't take the opportunity to discuss the naive American mindset that everything a doctor does is in the patient's best interest rather than because it is in the best interest of a drug company or hospital or convenience driven in general Fun fact a cesarean takes a doctor 45 minutes while a woman delivering vaginally can labor for over 24 hours creating over a day's worth of intermittent updates There is a lot of very good information about vaginal birth after cesarean sections and the authors does include a defense of doctors who refuse to allow VBAC in that she explains the cost of malpractice insurance and hospitals' general unwillingness to take up the time and resources while risking a potential lawsuit to provide this option Of course she doesn't explain why hospitals don't simply allow women seeking VBAC to sign a waiver relinuishing their right to sue in the event of a negative outcome There is also no suggestion of a nationwide initiative to push for at least one centralized hospital in each of the 50 states that would allow VBAC I wished that she would have gone into detail about alternatives to the standard lithotomy flat on back birthing position It's simply taken for granted that because this is the most convenient position for the doctor that there's no hope of changing hospital procedure even if it's the worst position for a woman's body and could end the practice of giving routine episiotomies I also wished that she would have spent than half a page on the detrimental effects of coacheddirected pushing in the lithotomy position She explains that this practice originated with the advent of early pain medication when women were totally numbed from the waist down and had to be told when to push and for how long since they had been rendered medically helpless And she mentions that it is now standard practice and can cause severe pelvic floor damage but beyond adding that this is not insisted upon by hospitals considered baby friendly by UNICEF and that having a doula can help you avoid this she lets the subject drop In just about every single television birth documentary filmed in hospital setting the nurses have the woman begin directed pushing in the flat on back position as soon as she reaches 10 cm but not once in all my TV viewing did I ever witness a member of the hospital staff ask the woman if she wanted to wait until she began to feel the urge to push as pushing before the baby was in a good position could result in lasting pelvic floor damage Pushed provided the statistical data to support my anecdotal evidence From what I've witnessed the norm for women in the United States is horrible impersonal care dominated by medical intervention as if birth were an emergency on par with a heart attack Over the last 10 to 15 years I have not known one woman among all my friends acuaintances and co workers who has been allowed to go into labor naturally Not one Three had complicationshigh risk pregnancies that warranted inductions and scheduled cesarean sections but the majority had the big baby card played on them Now it is always possible that every pregnant woman of my acuaintance over the past decade fell into the 5 to 10% of all pregnancies that develop macrosomia baby too large to deliver But the statistical odds are against thisThese women were all told at or before 37 weeks that they needed to be induced in order to prevent complications such as shoulder dystocia an event that the medical literature states is impossible predict and occurs 50% of the time in babies smaller than the macrosomic weight of 8 lbs 13 oz Their doctors also insisted on inductions out of fear for a big baby despite the fact that fetal macrosomia can only be diagnosed after the child is born and that the guidelines issued by the American Congress of Obstetricians and Gynecologists recommended against elective inductions in cases of suspected fetal macrosomia because labor inductions only raised the odds of having cesarean sections without changing the fetal or maternal outcomes


  2. Jennifer Jennifer says:

    I've found fertility and childbirth were fascinating for a few years but now I'm pregnant and obsessed Luke calls it girlie parts science This book isn't so much about the science but does present surveys on the state of childbirth in the US today published 2007 It made me appreciate the tough situation obstetricians are in and want a health care system that treats low risk healthy pregnancies as life events but not illnessesIF YOU'RE EXPECTING while you read this please remind yourself freuently that your doctor has your best interests in mind and in all likelihood won't force you into anything It's good to be informed about the statistics and have your preferences; it's not good to view mothers and doctors as being on opposite teams The pendulum seems to have swung from the uninformed mother to be who depends upon and blindly trusts her obstetrician to the overbearing one armed with pages of birth plans I'd like to be in the middle somewhere


  3. Karen Karen says:

    Finally An expose of the birthing system in the United States It's absolutely a fascinating read tracing the history of managed birth and outlining the various factors that scare and push expectant moms into unnecessary interventions Ms Block points out numerous statistics that support how out of whack interventions are in North America In the countries where there are the best birthing outcomes the c section rate hovers around 15% which is also the rate set by the World Health Organization where the risks of a section outweigh the benefits The 2005 section rate in the US was 305% and in some states topped 45%This is not a book that gives specific guidance in planning a non interventionist hospital birth nor does the author promote a medication free birth Instead she is curious why a physiological birth is something that women have to fight for in the US This book gives all the information necessary to understand what is going on with your doctor and your hospital when suddenly in your most vulnerable moments you find yourself sliding down the slippery path to a hospital managed birth and c section If you are planning a non interventionist hospital birth this background information is essential Based on my own experiences with both induced birth and 100% interventiondrug free hospital birth Ms Block's stated facts and observations are completely accurate The book which in general is balanced in tone seems to advocate midwife assisted birth but not unassisted birthing over hospital birth This is not surprising given the level of vigilance one must have to achieve a low intervention birth in the hospital Also favorable are the outcomes achieved by midwivesHow is it Ms Block wonders that such an overwhelming percentage of hospital births become an emergency instead of an emergence when the true level of emergency births should be in the low single digits? The protocols established by the medical staff are a huge factor since so much of what they do and prescribe lead directly to interventions and ultimately either insanely medicalizedassisted vaginal birth or c sectionMs Block has collected interesting data from a variety of sources I particularly appreciated the anecdotes of a former LD nurse in FL who became disenfranchised after observing the wonderfully low key easy births that occurred during a hurricane when her hospital was conserving generated power and operating under different protocols The emergency c section rate was 6% The book has several chapters on midwives some working illegally devoted to bringing natural birth to their clients Many frightening incidents are depicted involving the violation of women's rights when literally forced into c sections and episiotomy without their consent or indeed against their express wishes In particular peril are women attempting VBACs which are rapidly growing out of favor She also notes the important contribution of American women to the growing trend of managed birth many of whom are strikingly uneducated about the risks of intervention and c section to both mother and baby or whose desire for a convenient birth outweigh common sense Somewhere along the line women have forgotten that a healthy mother and baby can achieve a remarkable empowering peaceful birth This book was fantastic a must read for the educated thinking mother who refuses to be pushed around by a system set up for everyone's benefit except her own and her baby


  4. Annie Annie says:

    After reading Pushed you will never watch “A Baby Story” the same way againBlock makes a convincing case that protocol on labor and delivery wards are driven not by what is best for individual women but by fear of litigation The stories that made me the saddest were those about women who expressly declined certain interventions and were given them anyway The worst was a woman who showed up at the hospital with her baby crowning Because she had had a previous cesarean the hospital called in a judge who granted custody of the baby to the hospital and she was forced to have a repeat c section The concept of “informed consent” is being eroded day after day by hospitals who view vaginal delivery as a “procedure” to be granted or withheld rather than as a natural normal biological processRead the rest here


  5. Lindsey Lindsey says:

    I felt pushed into being induced when I was pregnant with my second child My doctors induced me and several other women who attended the same practice on the same morning so the doctor's schedule wasn't affected We were told that by the nurse I have never felt good about my labor experience As I started to read this book I felt vindicated and realized I am not aloneWomen need to take back their bodies and control of their births Too many women are being pushed to be induced and have unnecessary C sections and have way too much medical intervention in a completely natural processI would recommend this book to any woman who is pregnant is considering becoming pregnant or is interested in women's healthIt's an eye opening interesting read And yes it is very one sided but it is a side we don't hear too often


  6. Sarah Sarah says:

    This was the central text for a short course I took on the history and current practice of childbirth in the US I think this book would scare any rational person into a celibate life And that's my problem Block's attitude is very clear OBGYN's Hospitals BAD Midwives home births and birth centers THE ONLY OPTION AND YOU ARE A BRAINWASHED COW IF YOU DON'T RECOGNIZE THATThe caps are deliberate Because this is popular non fiction she can be less rigourous in her sourcing and citing no bibliography or chapter endnotes Tricky as she relies heavily on numerous articles from journals like JAMA NEJofM etc Well she relies on them as whipping posts Anecdotal information from midwives women who've given birth doulas and alternative doctors are her golden children Her focus is on practice in the mid west and east coast but writes as if specific practices in specific regions speak to the entire practice OBGYN's hospitals midwives home births birth centers ALL are legitmate options as long as women continue to take charge of their health care their bodies and their rights as consumersNot to mention she's writing as if the only feminism is cultural feminism it's not and there's a post colonial critiue just waiting to be done Or Marxism And it's not going to come out in her favor


  7. Amie Amie says:

    This is the first book I have seen to tackle the issues of birth from a feminist perspective It was a fascinating gruesome and eye opening read that was extremely well researached and documented Block's opinions on modern hospital birth come through loud and clear but are definitely evidence based Especially interesting is the in depth discussion of all aspects of the VBAC debate emotional public health medical liability and legal ramifications are all covered Also covered are the issues of breech births and a candid look at the Unassisted Childbirth movement While I'm sure true UC'ers won't appreciate her viewpoint and conclusions on the movement it was the most balanced look I've seen in literature as of lateThis book does appear to be biased toward out of hospital birth but Block does not shy away from looking at some of the risks of homebirth especially in areas where lay midwifery is illegal and midwives difficult to come by In the end the author implores people to do their own research come up with their own conclusions and advocate for themselves as women I think the most important thing women should come away from this knowing is that not all care providers doctors OR midwives necessarily have them or their baby's best interests at heart so it's up to them to become informed consumers of the birth industry


  8. Liz Liz says:

    Women deserve choice in pregnancy and delivery If you are ever thinking about having a baby I wholly recommend reading Pushed by Jennifer BlockWhat's the difference between this book and the gazillion other books about childbirth out there? For one it's the documentation Jennifer Block meticulously references legitimate medical research and studies throughout her book Instead of making an empassioned tug at your heartstrings plea for her case Ms Block makes her case with statistics and data For two ha she remains relatively unbiased throughout the book and while her opinions on the matter aren't exactly absent she makes a concerted effort to show the opposing side's argument and their reasons for their actions If you're looking for an unbiased and research driven book that delves into modern maternity care I uneuivocally recommend reading this one I strongly believe in the power of intuition I think that we're all put on this Earth to have our own experiences and challenges and that we each have a different mission or purpose in being here Whether it's a matter of making life changing decisions raising children or simply driving a different way because we feel prompted to I think that the power of a person's intuition is not to be taken lightly In some instances I would argue that the Spirit speaks to us via our intuition In all of these cases I feel like the decisions we make for ourselves and our lives are always going to be deeply personal and aren't necessarily universally good choices for everyone So that's my disclaimerFor me I've always felt passionately about childbirth I've always felt that there's something to it than simply going to the hospital and coming home with a child; I feel like it's meant to be a life changing experience It's a rite of passage during which the veil to the other world is briefly parted for a family to welcome life into the world To uote a midwife who is uoted in the book I've always thought that a woman meets herself in childbirth For both of my kids I chose a midwife for my prenatal care and birth I always thought that they would be respectful of the birth and my touchy feely approach to it And I had what I considered to be fantastic prenatal care Both of my deliveries ended up as scheduled inductions and I had epidurals with both of my kids While giving birth is a holy experience no matter the method I'll be honest in saying that I don't feel like I've yet 'met myself' during childbirth I haven't had the full body spiritual experience that I've yearned for and that I've heard others speak ofLooking back I wonder if there's anything that I could have done differently Should I have waited longer to see if I would have gone into labor with my first child? Would things have been judged differently with a different provider? Were my inductions medically warranted or was I rushed into the delivery room just in case so that my midwife could look minimally negligent in the case of a lawsuit? I understand that not all labors go perfectly and that access to emergency obstetric care is a privilege that I should not take for granted The reality is that many women and children have been saved by medical interventions and I am grateful to live in a time when that is available Also I understand that in our modern litigious climate care providers and hospitals need to watch their backs and do their part to avoid a potentially career ending lawsuit And I understand that in court showing that you did everything possible to avoid the detrimental outcome is important in winning your case But I also believe that birth is a physiological process not a procedure Unlike cancer or transplant surgery or other typically medical events optimal outcomes for birth occur when labor is not actively managed but instead watched supported and protected with the least medical intervention necessary Overwhelmingly research supports this theory And so I believe that the majority of the time a woman can birth a baby safely without any type of medical intervention And I feel like the majority of women are pushed into being treated like the minority who justifiably reuire medical attention and are being treated as though their bodies are unable to birth the babies they so perfectly created and nourished for nine months despite all indications to the contrary I am not arguing that every woman should think that hospitals are the childbirth devil and thus plan to have a home birth I just wish there were options out there Current hospital policies tend to be litigation friendly than birth friendly For example many hospitals reuire continuous fetal monitoring which restricts movement during labor Most hospitals reuire a woman to give birth within 24 hours of her water breaking despite several research studies showing that this arbitrary deadline does not decrease the incidence of infection Most hospitals augment or induce labor with pitocin despite research showing that it markedly increases the incidence of fetal distress Many hospitals reuire a woman to give birth within 24 hours of being admitted whether vaginally or by c section Unfortunately not all bodies work within these time limits And so women are basically given the option to either acuiesce to the hospital's litigation driven policies or to birth in an alternative environment home or birthing center And I understand wanting to have access to emergency obstetric care it makes perfect sense to me to want to have somebody there in case something does happen So I am militantly frustrated at the lack of options out there for a woman who wants to have a minimally invasive birth with access to emergency obstetric care it seems like you get one or the other these daysWhy are we so uick to induce labor 40% of all labors are induced? Why does our great nation lag behind virtually every other developed country in maternal and infant mortality rates? Why are 13 of our women giving birth via c section when overwhelming research shows that this number shouldn't be above 10% or 15%? Why don't we trust our bodies to go into labor on their own? uite frankly I have a hard time believing that God created women to create and carry babies and then disabled most of them from being able to give birth normally Why don't we trust our bodies to give us the cues? Why is there no divinity in birth any? Why is it considered to be a medical event rather than a natural one?To lift a paragraph from the book page 140In the womb the lungs are filled with fluid and the fetus receives oxygen through the umbilical cord The remarkable process by which the fetus adapts in seconds from water to air is still unclear but the current understanding is that it begins purging its lungs of fluid in the days prior to birth 'Somehow the fetus comes to know that it is about to be born is how Lucky Jain MD professor of pediatrics at Emory University puts it Jain has studied the transition from one respiratory medium to another and has found that the process continues during spontaneous labor and birth Hormones are released that prime the lungs for air and the sueezing effect of the birth canal helps purge the lungs of excess fluid Cesarean babies often must be heavily suctioned or intubated to facilitate breathing; Jain says that a significant number of those admitted to NICUs are in fact term or near term respiratory cases and cesarean birth has been linked with childhood asthma in a number of studies Jain estimates that for every 1 million cesareans there will be 25000 cases of respiratory distress and 5000 cases of outright respiratory failureWhy aren't we allowing our bodies to give us the signal rather than giving the signal to our bodies? Is it possible that our modern medical system while amazing in its advances and technology is not as good at birth as our bodies are? For example in the 1940's common medical practice was something known as twilight sleep where a woman was given morphine and scopolamine which sedated a woman enough to give birth but not remember any of the pain However after almost two decades of routine use studies showed that it had the unfortunate side effect of decreased attachment between mother and baby difficulty breastfeeding a depressed central nervous system in the infant which caused babies to have decreased breathing capacity Then heralded a landmark achievement for women and obstetrics today the era of twilight sleep is considered to be a dark time in obstetric history Sometimes I wonder if we'll look back at today's birth practices with the same regretThere is so much to this book than my rant details but if you're looking for information about it you can check out the author's website and I highly recommend reading my friend Bridget's much intelligent and less rambly review of the book at To close I'm not saying that you should agree with me on the ideal birth experience In fact I don't expect you to at all But I do think that you should be able to choose your ideal birth experience without the constraints of hospital policies and practices Just as you should give informed consent for any procedure in your care you should also have the option to give informed refusal for anything you don't want Your doctor is an advisor to your care but you should be the one making the final decision and you should be allowed to do soUltimately I agree with one of Ms Block's closing statementsWhat'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 itToday women have unprecedented access to the information they need to make the best decisions for themselves and therefore the best decisions for their babies They are in fact in a far better position to make evidence based decisions than their doctors They have a right to make those decisions and they should make those decisionsWomen of earth trust your intuition and take back your birth


  9. Tom Tom says:

    I read this book uickly and with interest It is a rather alarming look at obstetrics for that reason I don't know whether to strongly recommend it to other expectant couples or whether to dis recommend it Once you read the book it is hard not to be suspicious of your doctors and to push back against their decisions this may be for the best but it is not a comfortable position to be in It is hard to judge exactly to what degree this is a reasonable book and to what degree it is an alarmist book After reading it and doing a lot of research inspired by reading it I think it is on the whole uite reasonable which is uite frighteningThe book ends with a section on rights with a number of frightening cases cases of hospitals that got attorneys to represent the foetus of mothers who refused procedures and forced those procedures on women The points the books make strike me as right on that it is a violation of a woman's body to force a procedure on her without consent; that it is absurd to believe that women don't have the best interest of the foetus in mind when they make their decisionsOne of the most interesting points the book makes is that groups that push for reproductive rights have been slow to include among those rights women's right to choose how they have their babies Which is to say it seems strange that a woman's right to choose encompasses her right to abort a pregnancy but not her right to have her baby vaginally in any number of cases in which hospitals insist on C Sections In an absolute sense it seems a woman should always have a right to refuse a C Section since it is a procedure which undoubtedly puts her at greater risk than a vaginal birth In a pressing sense women have good reason to refuse many C Sections since there is compelling evidence that far too many are performed in the USThe role of malpractice insurance is invoked as the main reason hospitals and obstetricians make decisions to operate or to induce when it is not in a woman's best interest convenience is another cynical reason but one that I'm sure operates on a subconscious level I can't imagine a doctor knowingly putting a patient at risk to free up a weekend At first I was sceptical that malpractice insurers would push for something not backed up with data and would have such sway over hospitals but conversations with our doctor seems to confirm that it is true he confirms that malpractice insurers give cut rates to doctors or hospitals who won't do VBACs for example which our practice regularly doI wonder in how many other places in the medical system malpractice insurance makes a big impact on care If it does it seems uite worrisome because it means that what plays well to a jury determines what is good care and it's not hard for me to believe or for me to believe that insurers believe that juries don't think scientifically My impression from taking classes with pre med students in college was also that med students are not very good scientific thinkers so the malpractice monster pushes things from bad to worseThus regardless of whether monitoring a baby's heartbeat is shown to help babies and mothers monitoring is routine in hospitals so that doctors faced with a suit can say they did everything they can And it goes similarly with other interventions Thus a kind of hysteria sets in and the results are decisions which individually may seem unassailable to jury and patient we just want to make absolutely sure your baby is safe but on a societal level clearly cause harm than good we have a 30% C Section rate


  10. Tierney Tierney says:

    This was a fascinating meticulously researched information packed book that I thoroughly enjoyed Block makes the case that modern maternity care in the US is seriously flawed The average woman laboring in a hospital can expect to be hooked up to a vast array of machines and to have her labor chemically induced if she's not progressing fast enough according to certain timelines often resulting in a C section Block argues that most of this is unnecessary for women with otherwise uncomplicated pregnancies and childbirths Many American women are denied the right to make fundamental choices about their pregnancy and childbirth process choices that are guaranteed to them by the Constitution and legal precedent This book is a convincing expose on the ways in which the medical community has made the process of natural low risk birth a pathology or a condition that needs to be treated in a hospital By allowing liability concerns and the malpractice insurance industry to dominate obstetrics doctors have now standardized or mandated many procedures that were once reserved for only rare high risk emergencies ie episiotomies caesarean sections artificial labor induction The reader will be shocked by some of the cases in which women's rights have been violated in the name of medicine court ordered caesareans enforced by judges and police midwives sent to prison for assisting in home births women laboring just outside hospitals to avoid being forced into a C sectioncrazy stuff I would recommend this book to anyone who is considering having children or who would just like to read a very interesting piece of investigative journalism


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