Block, Jennifer, Pushed: The Painful Truth About Childbirth And Modern Maternity Care, 2007
"The painful truth" indeed. Starting out as a lesson in current events and history, the book takes a heartbreaking turn somewhere mid-way through. Near the end, the book is a depressing commentary on the dismal childbirth system, with no hope for the future.
Maybe the author sought out the most extreme cases for her examples of unassisted home birth, maternal mortality, newborn resuscitation, and forced c-sections. But the more I read, the sicker I felt about our national maternity and childbirth system.
The biggest problem for maternity care is the insurance. Insurance companies can choose who and what to cover. If an insurer refuses to serve midwives, or refuses to cover vaginal delivery after cesarian (VBAC), in the end, it's the expectant parents (and mothers in particular) that face the brunt of the decision. Mothers that are forced into having procedures that are arguably riskier than the uncovered alternative; procedures they do not want.
It is clear by research that the average low-risk woman with a low-risk pregnancy is better off with a midwife than an obstetrician. Maternal and infant mortality rates are lower with midwifery care, and maternal morbidity rates are much, much lower for women that choose midwives. However, midwives are few and far between, and only 8% of women deliver with a midwife nationally.
The final chapter of the book discusses the legal implications of fetal rights. The author reframes the age-old question of when does a fetus become a human, with human rights, as follows: When does the expectant mother cease having rights -- when is it OK to disregard a woman's health and livelihood to exctract her unborn child? I think this is a question for the rabbis.
My opinion on the matter of the state of the childbirth system? The expectant parents should have access to information and the freedom to make their own informed decisions. Their doctor or midwife should discuss with them the pros and cons and offer their professional, legal, and personal opinions (which could all be different). Then, for a low-risk, healthy pregnancy, it is the doctor's duty to follow through with what the parents have decided. A doctor is a hired professional. If he or she cannot or will not, for whatever reason, do the job, the parents should be free to find someone who shall.
As a doula (in training), it is my duty to give to the parent(s) the birth experience they desire. All things being equal (that is, having made safe decisions, and having been informed), why should a doctor's duty be any different?