Pushed: The Painful Truth about Childbirth and Modern Maternity Care by Jennifer Block

A muck-raking expose of what happens in labor and delivery wards across America.

Pushed upset me–so much so, that I considered not finishing the book. I have an innate mistrust of doctors and hospitals after some rough treatment I received during a miscarriage last year. where I was not informed of all my options and wound up in the ER with an infection. My quest to find a new care provider ultimately led me to choose home birth with a midwife for my low-risk, healthy pregnancy. It was a wonderful, peaceful experience.

Reading Pushed, you’d think that almost every hospital birth is rife with drama and that almost every OB would rather do a C-section than “allow” a woman to deliver vaginally. Since I don’t have a hospital experience of my own to draw upon, I can’t add to the conversation. However, among my friends, I have heard some horror stories. One woman I know delivered in a closet that was commonly used as a passage, so while she was pushing on her hands and knees there were hospital personnel constantly walking past. Another friend of mine was told at 39 weeks that her baby was “too small” and offered the choice of induction or a C-section–right then and there. Having heard horror stories about Pitocin, and because she had not even begun to dilate, she chose C-section. Her baby was 6lbs and she was unable to breastfeed (she chose to pump for 7 months and is my hero for that). On the flip side, I have several friends who chose the conventional epidural birth and had wonderful, easy experiences with no drama or chaos.

Block 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 process. Block writes:

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.

Today 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 decisions.

The goal is to have a healthy family.

The must-read chapters in this book concern the role of midwifery care in the US, care that is illegal in many states. Whenever I think about a midwife being prosecuted for assisting a birth, the image of a woman being tried as a witch comes to my mind. I love the concept that a midwife doesn’t deliver a baby, she assists at the birth of a family. I really felt that my midwife (and my chiropractor, but that’s another story) shepherded me into motherhood, because the care I got was so personal and intimate.

I am the first to say that I am glad that we have modern medical technology. The friend of mine who was issued the c-section ultimatum was a c-section herself. Her mother’s placenta peeled off, which is a genuine life-or-death situation for the baby. I am beyond glad that my friend is here today, thanks to the doctors who intervened. However, I believe it’s just as important that women who choose to refuse interventions are supported in their decisions, because most births are simply not emergencies.

After reading Pushed, you will never watch “A Baby Story” the same way again.

10 thoughts on “Pushed: The Painful Truth about Childbirth and Modern Maternity Care by Jennifer Block”

  1. My wife and I have three kids. She had health problems with each pregnancy, but all of our choices and questions were respected the whole way through. To the point that, after our third, they thought my wife needed surgery to stop bleeding (it’s ok to be graphic, right?!) ,but held off because my wife believed she was improving. It ended up that she didn’t need surgery, but the Doc and I were both sweating bullets by the time it was all over. Anyway, our hospital is at the boundary of a suburban and rural area. I wonder if the pace of life at the hospital influences the respect of patient choices and the number of horror stories.

    I have to ask, did the author provide any studies that show how the amount of social support for minimally invasive births influences the health of the babies? ‘Cuz that sounds iffy to me.

  2. Modern Western medicine is absolutely wonderful for trauma care and fighting disease. It is close to helpless before chronic conditions and has the wrong mindset altogether for pregnancy and delivery. My children were born in hospital (except for the one that just came too fast), because I had heard the horror stories of children born at home with their cords wrapped around their necks and such. I don’t really regret it, because I had reasonable doctors.

    I would recommend any woman going the epidural route to ask for a half dose. That’s what I did for the last one and it worked wonderfully. I could still feel the contractions to be able to work with them and yet not be overwhelmed by the pain. I don’t know why it isn’t standard procedure.

  3. My doctor was going on vacation about the time I would deliver, so one day, he mentioned casually that if I hadn’t gone into labor by Oct. 16th, he’d induce me. I wasn’t sure what all that meant, so I said OK then mentioned it at book group. All the women there were 5-10 years older, and they were livid and told me “DO NOT LET HIM INDUCE YOU!” I was only 22 at the time and didn’t have the nerve to go up against a doctor. Luckily, my son was born on the 15th, settling the question. Also, during my pregnancy, he told me I was gaining too much and I should be using the Herbalife diet (he was a distributor) I did what he said and felt weak and dizzy on this diet, so stopped it. He wasn’t a doctor too much longer; he lost his license because of insurance fraud. Last I heard he had become an airline pilot.

  4. Ben–I would imagine that pace of life has everything to do with it. It sounds like your doc had the time and inclination to truly be present with you and your wife. What a gift!

    I’m not sure what you mean by your last point, though. She did have a comprehensive appendix that I did not read, so I can’t speak to studies, but the book was well-researched. I think she would say that minimally invasive births are best for babies–certainly that’s what Erica Lyons says in The Big Book of Birth.

    Janet–that is great advice. Women owe it to themselves to be informed about the choices that they make like you were.

    Bybee–okay, that is a terrifying story!! What a nutjob–glad everybody turned out okay 🙁

  5. I’ve read this post several times trying to think what to comment. When I was pregnant I read many books on childbirth. I can’t remember if this one was in the stack, but it sounds like several that frightened me of conventional hospital births so much I went with a doula. Unfortunately my labor did not progress, there was meconium, and I was rushed to the hospital and had a painful time. I wish I had know you could get half an epidural dose, I would have asked for that!

  6. I’m sorry you ran into trouble, but good for you for doing the research and making an informed decision. I’m learning that motherhood is all about learning what you can and then taking a leap of faith.

  7. I note that you don’t give any indications of the authors background or what his/her biases might be. I think that is something to consider in reading a book like this. (I’m not saying that the case being made is invalid, just that it is an important aspect to factor in when making a judgment about the book itself.)

    As someone who did both a textbook “normal” pregnancy and a problematic pregnancy, the one thing I came away following the birth of my children was that the medical community is really rather stuck. They don’t have the scientific studies that they’d like (because no one can run medical tests on pregnant women due to the obvious risks of litigation) but without the studies and clinical data they’d like, they are just as likely to be put in a medically dubious position. We live in a litigious society and this is the price we pay for it. Unfortunately, only a certain percentage of the population pays for it!

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