Book report: The Woman in the Body

Martin, Emily (2001).  The Woman in the Body: A Cultural Analysis of Reproduction.  Beacon Press, 1987, revised 2001.

My score
7/10

My review
The Woman in the Body was recommended to me by one of my committee members.  Emily Martin attempts to find truth with a capital T in how women perceive themselves and their life changes, and how pervasive medical explanations are in our society.  She investigates women's experiences with menstruation, childbirth, and menopause (not reviewed here), starting with the medical model and working through interviews with women of different ages and socioeconomic classes.  As this was the first real anthropological text I have ever read, and as I have never really discussed any of these issues (other than childbirth) with other women, I was fascinated, cover to cover.  The book and its accounts describe a culture similar to my own, with women's experiences that, when averaged, are like mine.  How weird is that?

Расцвела сирень, акация...

В мире нет счастливее меня!

У меня сегодня менструация:

Значит, не беременная я!

(Loose translation: Lilacs and acacias are in bloom / There is none in the world happier than me / Today I have menstruation / Meaning I am not pregnant!)

First, Martin attacks menstruation.  The medical texts describe the monthly flow in overtly negative medical terms, which Martin dubs the failed production model: it is when the egg fails to be fertilized; the tissue dies; the outer uterine layer is shed and expelled.  But many women come to anticipate menstruation gladly as a sign both of fertility and of the lack of a pregnancy.  Interviewing women on their own feelings, she finds two different mental models.  Unsurprisingly, given sex education in school and the bombardment with the all-too-familiar medical model in popular media, middle-class women recite the failed production model as their understanding of menstruation.  But working-class women instead explain the logistical implications, saying that menstruation is when your body changes, that it lasts this many days and requires these modifications in routine and these tools to help you deal with it.  Working-class women were unable to regurgitate the failed production model entirely.

Next, Martin attacks PMS, or premenstrual syndrome, the term associated with the days just before a woman's period during which she may act out, be angry, be clumsy, and be moody.  Women report feeling more sensitive and unhappy with their lives, which makes them lash out at their children and spouses, the latter of which complain of an imperfect wife but brush it off as PMS.  Martin examines the cause of this anger and contrasts American standards (basically, that we all work like robots without regard to our natural ebbs and flows of creativity and productivity) with certain indigenous African cultures, in which menstruating women are considered "unclean" and are given a week off from their usual duties.  In this week, women enter a menstruation hut with other menstruating women, and they relax in making a slow-cooking meal for each other and focus on --- I don't know, I guess becoming cleaner people.  Of course, the menstruation hut is an impossibility in our society given our norms, but the idea is poignant: shedding endometrial tissue is taxing on the body, it affects the mind, and we need a break --- especially in a world that fails to value the work women do in the home.

The failed production model carries over from menstruation to childbirth (and these sentiments are echoed in Pushed (see my review).  Birth is the expelling of a perfect fetus from an imperfect incubator (i.e., the mother).  The mother is producing the fetus, and medicine focuses on this production  There is a timeline for what is considered "normal" (and, for statistical purposes, "normal" is fairly well defined) and any birth deviating from around normal is augmented.  From the moment a pregnant woman in labor enters the hospital, the clock is ticking, and the production of the fetus must happen in the appropriate time.  Martin points out Barbara Rothman's research showing that the time women labor in a hospital has been decreasing linearly since the 1940s [1].  The increasing prevalence of fetal monitors, both internal and external, wireless and wired, transmitting information to the nurses' station, means that medical personnel no longer need to attend to the woman in labor, but to the machine that monitors her.  The woman is becoming an annoying afterthought in the process of expelling the fetus.  Meanwhile, the leading obstetrical text, Williams Obstetrics, fails to mention the mother in the paragraphs about labor and childbirth altogether until the small section on "intra-abdominal pressure," and instead encourages doctors to ally with the fetus, small and innocent, rather than the mother, capable of introducing great harms to the fetus due to the pathological condition which is natural labor.  It is no wonder women in America are striking against the hospital, striking against institutionalized medicine, to take back birth and take back their rights to their bodies!

Then there is the matter of interventions, and especially C-sections.  It is no mystery that our national c-section rate is around 33%.  Is there a difference when you control for race and class?  Of course there is.  Martin poses two theories.

1. Higher C-section rates for middle-class white women because these women can pay for the privilege of the commodity which is higher health standards.
2. Higher C-section rates for working-class black women because these women are used as "guinea pigs" in medicine; where new procedures are tested, refined, and perfected.

Martin found both theories supported.  Middle-class white women received C-sections for real medical emergencies, such as prolapsed cord, bleeding, and high blood pressure.  Meanwhile, black working-class women received C-sections for the catch-all phrase "dystocia," which includes and is derived directly from running up against a time limit in labor.  On top of this, black working-class women are mistreated by the hospital staff, being denied pain medication, comfort techniques, and presence of their loved ones.  Martin summarizes how these two groups of women can and, those that feel they must, must resist the hospital environment, to strike and protect their bodies and their rights, in their own ways: 

For a white middle-class woman, the salient issue may be to stall going to the hospital so the clock cannot be started or to organize and demand that all hospitals in the region install birthing rooms; for a white working-class woman, stalling may be an issue, but behind it lurks the larger issue of finding a way to pay for prenatal, obstetrical, or infant care; for a black working-class woman, the issues of stalling and paying may be crucial, but even if she contends with them, she still may have to find a way to avoid downright mistreatment or to manage to have matters explained to her at all.

Conclusion

What is my interpretation of the result of this critical look at women's perception of their own menstruation and childbirth?  Women's experiences with, understanding of, and ways of communicating the details of menstruation and childbirth varies by socioeconomic class and race.  As women progress up the socioeconomic ladder, they become unquestioningly accepting of the medical models from textbooks, by which doctors abide.  As they accept, they are indoctrinated into the system and become part of it, even despite significant research showing the system to be flawed.  There is a silent war between working class and middle-class women: between women that fight the flawed system and are fought by it, and women that have become part of the system, contributing to its flaws.

References

[1] Barbara Katz Rothman (1983).  Midwives in Transition: The Structure of a Clinical Revolution.  Social Problems, Vol. 30, No. 3, Thematic Issue: Technique and the Conduct of Life (Feb., 1983), pp. 262-271.  University of California Press on behalf of the Society for the Study of Social Problems.

Stable URL: http://www.jstor.org/stable/800352

Book report: Soviet Women

Du Plessix Gray, Francine. Soviet Women: Walking the Tightrope. 1991.

Stereotypically cold, characteristically large, disgusting, unmovable, and inhuman, these Soviet women pass, from mother to daughter, from woman to woman, from teacher to pupil, the self-destructive loathing which defines them and which they have grown to hate.  Overburdened, they deny help from anyone, especially their spouses; unhelped, they become bitter; embittered, they scorn men and purge them from society.  Stiffly, they are proud of their proudness, yet inside, they yearn for tenderness, which they can only obtain from their daughters.  Men are disposable; women are emotionally destroyed.  How can one survive in such a society?

Of particular interest to me was the chapter about reproductive issues.  Due to a lack of education about reproduction, contraception, and options, in her lifetime, a woman averages nine abortions.  Only two of them are performed legally, in a clinic, under dire third-world conditions.  The others are performed in underground clinics in even worse conditions.  Abortion is considered a ritual cleansing, meant to be embraced and anticipated like a well-needed shower after a long hike in the wilderness.  Childbirth is worse.  Women labor with no support, on their backs, in rooms of three women or more, as rats scuttle along the walls and a drill-sergeant-nurse walks up and down the squalid room, exclaiming: "On your backs, girls. Quit your yelping. You sexed your filthy selves into this mess, now own up and take it like a woman."  Men are nonexistent; women are painfully undervalued.  How can one be born in such a society?

Book report: The Milk Memos

Colburn-Smith, Cate and Serrette, Andrea. The Milk Memos: How Real Moms Learned to Mix Business with Babies --- and How You Can, Too


My score
6/10

My review
From the first page, it was a bit of a tear-jerker.  How did all these women, from different backgrounds and careers and interests, know exactly how I feel every day I leave my son to go work?  This book is based on a series of interactive notebooks started by Cate in the employee lactation room at IBM.  Nursing mommas enter with pump and pen, and exit with milk and thoughts scrawled across pages of these shared notebooks.  These mommas balance work and family, but are they happy?  How does the momma that leaves her infant in the arms of another --- be it daycare, nanny, or even spouse --- answer to herself that she's doing the right thing, when every inch of her being wants, with incredible force, to be reunited with her child?  How does the momma that's at home with her child advance her career?  What can a mom whose boss just doesn't get it do?  From Cara's first day to Andrea's learning to love breastfeeding, and eventual weaning, this tale is a good glimpse, albeit too condensed, of emotional roller-coaster of a working mom's first year.

Book report: Baby Catcher

Vincent, Peggy. Baby Catcher: Chronicles of a Modern Midwife

My score

6/10

My review

Peggy was a Berkeley midwife for nearly three decades. In these memoirs, she picks out the funniest, saddest, and most memorable births she has had the privilege of catching. Wittily written (sometimes too much so), this book is light-hearted and engaging. Peggy reminisces about her early days as a L&D nurse, about her carpool rides to midwifery school with a "real hippie," about the cat that attacked her all through her delivery of a particular baby, about the goose she kicked in rage.

Peggy's career hit an untimely end. There was an unfortunate incident with a prolapsed cord and insurance settlement that put her out of business. (Yet another testament to the faulty insurance practices here in the US).

Nonetheless, Peggy's positive attitude prevails. She never loses her sense of humor and her ability to laugh at herself. It seems like Berkeley has really turned the midwestern gal in her Zen.

Book report: Motherwit

Onnie Lee Logan (as told to Katherine Clark). Motherwit: An Alabama Midwife's Story, 1991

My score

2/10

My review

This is not an inspirational book. This is a book that seeds a few ugly, shocking birth stories, while attempting at some history. It is hard to read, anticlimactic, and lacking useful information.

Imagine a hot summer day, humidity in the high-nineties. You are on the front porch of a hand-built house in the middle of rural Alabama. There are 14 or so children running around -- all borne from the same mother. On the porch swing sits Onnie, a large black woman in her sixties, sipping sweet iced tea with fresh mint, the ice cubes ringing gaily in her glass. Onnie's slow, southern drawl is telling you her life story. Slowly. Meanwhile, mosquitoes as big as your fist are buzzing around your head, and you have a nagging feeling you have to be somewhere else.

The tone of Motherwit is just that: Onnie Lee Logan dictating her memoirs. The southern drawl, the slang, and the verbal self-corrections are all immaculately captured. I literally had to read the book aloud to myself on several occasions to see what on earth some words were supposed to be. Pick'n some co'n -- oh!

Onnie portrays a black-hating, rural, poverty-ridden world in Alabama. She introduces her large family (her mother spent almost all her adult life pregnant), and talks about her early days as first a home-care, and, later, midwife assistant.

In the second half of the book, however, the tone takes a turn for the worse. Since when did "memoirs" become synonymous with "here, let me describe to you the things that were so awful, so terrible, so heart-wrenching, that I cannot get them out of my mind -- and you should suffer with me?" That which has been read, cannot be unread.

Unlike Ina May's guides, which are full of information for anyone interested in how midwives function, or in labor, or in labor customs, Onnie's memoirs have virtually no useful information. I was hoping to discover the labor techniques for poor women living in squalor, or read some inspiring or heartening birth stories told from a black midwife's perspective, but alas. The setting was a background on which to paint an ugly canvas and dig up painful memories that just will not die.

I hate posting bad reviews of books, and I was hesitant to post this one. But there you go.

Book report: Spiritual Midwifery

Gaskin, Ina May, Spiritual Midwifery, Fourth Edition

My score

7/10

My review

Oh, Ina May... If you only pick up this book to flip through and look at all the photos of laboring hippies, do it. Even after four editions of the book, she still talks about feeling telepathic with all laboring mothers ever, how childbirth is so heavy, and uses her own terminology, such as "butt-hole" for anus, "taint" for perineum -- because "'taint what's above and 'taint what's below", or "cootchie" (what is that?). Spiritual Midwifery will teach you how to be a midwife in the astral sense of the word, using your inner peace to deliver the baby not only in the physical plane but energetically as well.

As with Ina May's Guide to Childbirth (see my review), the first half of Spiritual Midwifery is birth stories, including the story of Ina May's own tragic first birth. This section of the book is a history lesson on how The Farm came into being and how the hundreds of people traveled across the country in school busses, birthing babies along the way and picking up the knowledge they would need to become the birthing community they are today. Some birth stories are long, some are short; some end beautifully while others end tragically. All are inspirational.

The second half of Spiritual Midwifery focuses on the medical side of giving birth: how to conduct prenatal exams, how to turn a breech baby, how to sew up a tear, how to revive an asphyxiated baby, and so on. The figures are numerous and informative. After reading Ina May's descriptions, I feel intimately familiar with the procedures that go on in a delivery room.

Ina May has shared with me natural birth as it is meant to happen, introduced me to many unlikely complications for moms and their fetuses (and what is normally done about it), and has given an in-depth, heartfelt tour of the midwife's maternity and birthing room.

The rating system

Here it is: the breakdown of my rating system for books.

• 10/10: A must-own book for a lay-professional in the field.
• 9/10: A desirable book for the bookshelf of a lay-professional.
• 8/10: Will certainly reread this book.
• 7/10: This book has some great information, and I will likely reread it.
• 6/10: This book was worth a once-through, but I would not reread it.
• 5/10: I would recommend skimming this book and/or looking at the pictures.
• 4/10: There were a couple of good points, but not more than a couple.
• 3/10: I can see the value of a book like this, but it is unreadable and/or terrible -- not even worth skimming.
• 2/10: Reading this book was a waste of time; it contributed nothing to the discussion and was poorly written and/or unreadable.
• 1/10: Even the cover was a waste of time.

Book report: Nighttime Parenting

Sears, W., Nighttime Parenting, 1985

My score

6/10

My review

It is a little old, but the lessons discussed in Nighttime Parenting are still valid today. In fact, I think this little book became an entire chapter in The Baby Book, part of the Sears library. Nighttime Parenting urges parents to try co-sleeping (that is, sleeping in the same bed with their children). Sears argues that babies and toddlers do not and should not be expected to sleep through the night; that nighttime nursing is essential for their emotional development; that parenting does not end with the setting of the sun, but continues into nighttime. Children should be "parented to sleep."

As a wholehearted supporter of co-sleeping, and of night nursing, I was amused to find among the pages of this book photographs depicting our exact sleeping arrangment throughout the last several months: first, a co-sleeper; usually, bed sharing; and finally, a crib attached to the queen-sized bed. I picked up this book (at a used book sale) for advice on how to handle constant nighttime nursing on night wakings, how to move the baby into the crib (which is attached to our highly-preferred bed), and tips on how to cut out some of the hourly (or less!) night nursings that had creeped into our nighttime routine. What I got was not answers, but instead support for whatever the baby decides is right for him, as long as it works for the parents.

So, does it work for the parents? It works, and it doesn't. There are nights that he wakes every two hours (which are the good nights) and nights in which he nurses nearly constantly. Although on average, we have found ways to deal with it, it could be better, and hence I am not over-eager to try other methods.

On the bad nights, nursing is punctuated with occasional yells. This book and others on the same topic suggest teething pain to be the culprit. Time heals all wounds, the books say. I guess we will wait it out and see what crumbles first: my steadfast support of co-sleeping, or the desire for daytime energy.

Book report: Mothering Your Nursing Toddler

Bumgarner and La Leche League International, Mothering Your Nursing Toddler, 2000

My score

8/10

Amazon link

Mothering Your Nursing Toddler

My review

A handy reference! This is like 300 pages of things to tell people when they question a mother that is nursing her child "too long." List of benefits of breastfeeding? Check. Historical evidence of late weaning? Check. Comparison to other large primates, and extrapolation of weaning age? Check. This is the book mothers under scrutiny should read for support. What it really comes down to is if the mother is enjoying it, the children are enjoying it, and it works for the family, then more power to ya. The author provides strategies to keep breastfeeding going as long as the children want -- child-led weaning is the main topic here. If you are looking for a book that encourage weaning, look elsewhere. The purpose of this book is to make you, the reader, feel good about your lengthy nursing relationship.

The American Association of Pediatrics (AAP) recommends breastfeeding for at least one year. The World Health Organization (WHO) recommends breastfeeding for at least two years. That should keep me covered for a while. After that, here are some comebacks I plan to employ.

• The Jewish Angle: In ancient Israel, prophets, merchants, and shepherds alike nursed for two years. Sarah and Abraham weaned Isaac at two, but Moses was nursed for three years.
• The Primate Angle: Large primates wean when the young has either tripled its birth weight or is a quarter of its adult weight (for humans, that translates to between 2 years and 6 years, respectively). Or, large primates nurse for around six times the length of gestation of their young (six times 9 months = 54 months, or over 5 years for humans). Or, weaning in primates can be predicted is when the first permanent molars come in (in humans, that happens around 6 years old).
• The Health Angle: A human child's immune system is mature around 6 years old. Until then, children continue to benefit from the antibodies present in breast milk.
• The Average Angle: A 1989-91 study of La Leche League conference participants in the United States reported an average weaning age of 3 years. That's the same as the minimum natural weaning age in cultures that allow self-weaning.

Although, at times, a little on the defensive side, the book does bring up good points about the benefits of continued nursing, especially for working mothers, and the practical implications thereof. In the end, there is a thorough discussion of weaning, as well as several gentle weaning strategies. A good support book, it has a very -- I don't know -- compassionate approach to childrearing in general and nursing in particular.

Book report: Cesarean Section

Moore, M. and de Costa, C., Cesarean Section: Understanding and Celebrating Your Baby's Birth, 2003

My score

5/10

My review

After reading Pushed (see review), I wanted to pick up a book specifically about c-sections. This book is written for the moms of nearly one-third of the babies born: by Cesarean. Unapologetically and reassuringly, the authors try to cover the medical side of c-sections: why they happen, and what the doctors do while performing a c-section. The book lightly discusses the risks and benefits of the options available during Cesarean section, such as the methods of anaesthesia and postpartum pain management. In each chapter there are several quotes from moms having undergone c-section and their thoughts and feelings on their birth experience.

Happily, the book is supportive; the authors repeatedly express that it is not the mother's fault that she had a c-section, that she did not fail in labor, and that Cesarean is just another way to birth a baby. In fact, a baby born by c-section, just like a baby born vaginally, is born head-first, followed by the shoulders and then the rest of the body. I am giving this book a high score for the supportive attitude alone. Women having undergone a c-section need all the emotional support they can get, especially if they were planning and preparing for a vaginal birth.

There is a brief chapter on vaginal delivery after c-section (VBAC), which may be a welcome read for some women having undergone a Cesarean.

Appendix A, Questions to Ask Your Doctor, includes a comprehensive list of questions as well as the reasoning behind each question. These questions are well thought-out and, though perhaps an unpleasant topic for an expectant parent going for a vaginal birth, hopefully elicit some truthful answers from the doctor.

My criticisms of the book are as follows.

The mothers' stories are unconnected; they do not flow with the rest of the chapter of passage in which they fall. Even in short, three-sentence-long birth stories, everyone has a name (half-way through the book, I feel as though they're running out of simple names to choose from), and the individuals are referenced later in the book -- but it's hard to remember everyone. "You remember Jan and Paul from the introduction?" the tenth chapter begins. No, not really.

The birth stories leave out the difficulty of coping with major abdominal surgery as well as an infant in the first weeks post-partum. One birth story relates a mom coming home with her third child (all three by c-section) as well as a torn bladder. After the catheter was removed ten days after the birth, her bladder and urinary tract were "good as new." And the catheter? Oh, it "saved [her] having to get up to pee at night." Score one for positive thinking, score zero for the reality of a torn bladder, third c-section, and infant at home.

The whole book reminds me of a short pamphlet, maybe with the name So You're Going To Have a C-Section. Or the transcript to a fifteen-minute informational film: "These mothers have one thing in common: they delivered their baby by c-section." Dum-dum-dahhh.

Ways to reduce the risk of c-section are not discussed. Several of the birth stories, ending in c-section, have the mom arrive at the hospital too early (before 3cm dilation) -- that is, right after her water breaks, just like in the movies -- and, after a Pitocin drip does not dilate her fast enough (she nearly always asks for an epidural after the Pitocin is started), she is wheeled to the OR. The book would be smart to encourage women, with the support of their doctor or midwife, labor at home until active labor.

The book leaves out (in my opinion) some important details. The doctor puts some medicine in the IV. He is trained in fixing the problem with a special tool. What medicine, what tool? Please don't dumb down the information I feel is required.

Finally, for all the pages spent on the actual operation, the book barely touches on the postpartum healing period. Hire a doula, eat well, exercise a little, and -- controversially -- put out for your partner even if you do not want to. Wow, really? The point is hammered in a subsequent, lengthy chapter on contraception.

Book report: Pushed

Block, Jennifer, Pushed: The Painful Truth About Childbirth And Modern Maternity Care, 2007

My score

7/10

My review

"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?

Book report: The Breastfeeding Answer Book

Mohrbacher and La Leche League International, The Breastfeeding Answer Book, Third Revised Edition, 2003

My score

10/10

Amazon link

The Breastfeeding Answer Book

My review

This is a hard-core reference book. This is the book our local lactation consultants use. It is the single most complete, amazing breastfeeding resource I have found. Of particular note are the first few chapters, which discuss changes in our knowledge of breast anatomy, and what we know now. Understanding how the breast works puts so many other breastfeeding problems into perspective. Written with the lactation consultant or other support person in mind, the book first addresses active listening and how to ask questions without prying

This reference really does answer most breastfeeding questions, from nursing in the early days to teething, from nursing strikes to weaning, to the practical issues of nursing a toddler. Answers are comprehensive and supported by cited, peer-reviewed papers. Each paragraph in the book has a one-sentence summary in the margin.

Anyone taking breastfeeding seriously, as an art as well as a science, should get this book. You wouldn't take a circuit design class without buying a circuits textbook... similarly, you wouldn't consult a woman on breastfeeding without this book.

Book report: The Doula Advantage

Gurevich, The Doula Advantage, 2003.

My score

9/10

Amazon link

The Doula Advantage

My review

Why this book wasn't recommended instead of The Doula Book, I don't know. This fabulous paperback introduces the idea of a labor companion, and spends a chapter discussing the importance of touch and support in labor, citing many of the same statistics. Unlike The Doula Book, however, The Doula Advantage refrains from getting all hippie on the reader. Instead, the book discusses the practical implications of having a doula: what a doula actually does for a woman; how a doula supports a woman who chooses to or must have pain medication; how a doula supports a woman with a c-section; what a doula does for a birth partner; and how to hire a doula, including examples of interview questions, how much doulas charge, and how to cut doula costs by bartering and hiring doulas in training (like me!).

The Doula Advantage goes on to talks about postpartum doulas and what they do, and how they differ from lactation consultants, babysitters or nannies, and maids. The purpose of a postpartum doula is, just as a birth doula, to support the new mother. The postpartum doula does whatever is necessary for the mother or around the house to make the mother calm, content, relaxed, and focused on her new task at hand: taking good care of her newborn. Sometimes the task is to help with lactation; sometimes, she must help with older siblings or hold the new baby while mom takes a long shower; sometimes the mother's stress level is proportionate with the mess in the house or the number of dishes in the sink. Then, the doula will pick up the house, clean the kitchen, and prepare a healthy meal.

Another type of doula discussed is the antepartum doula. Slowly gaining popularity and recognition, the antepartum doula serves the mother-to-be before the onset of labor (although such a doula may stay and support the mother during the birth). Women on bedrest or with particularly difficult pregnancies benefit from antepartum doula support, as do single mothers and teens. An antepartum doula will meet the emotional needs of the mother-to-be, coming over to talk, cook some meals, and help prepare for the baby. She may hold a one-on-one childbirth class with the new mom.

I am a big fan of Rachel Gurevich's book as a practical overview of the benefits of having a trained labor companion and how to obtain one. If I were to teach a childbirth class, I would put this book on the reading list... and recommend it to all my clients.

Book report: Attachment Parenting

Ganju and Kennedy, Attachment Parenting, 1999

My score

3/10

Amazon link

Attachment Parenting

My review

Just read Sears' book, The Baby Book, or The Attachment Parenting Book instead. Sears is quoted liberally in this little large-fonted paperback. Shock value is used throughout to push the attachment parenting agenda. The book is missing a conclusion, and just abruptly ends after a half-hearted discussion of tandem nursing. The main topics covered by Attachment Parenting are as follows.

• Baby-wearing, or otherwise touching and carrying the infant and toddler
• Co-sleeping, sleeping near the child(ren), or sharing a family bed
• Nursing rather than breastfeeding - that is, "mindful parenting" (a term not mentioned here)
• Allowing the child to lead in - or, at least being respectful of - independence milestones such as sleeping alone and weaning
• Listening to the baby's cues and being respectful of the child

However, I was left with several questions and concerns.

• For child-led (or "child-respected") weaning, which occurs over a period of months, what happens to the milk supply?
• If a child eventually nurses only once every several weeks, does the mother pump in the interim, or allow the milk to dry and let the child nurse for comfort only?
• The book does not address how to properly feed an infant while an older child is nursing - in particular, the infant must be fed first, every time, before an older sibling is allowed to eat at the breast.
• How one balances parental need for space with a child's need for attachment.

The book uses guilt and shock to persuade the reader (who is already sold on the idea of attachment parenting, or else would not be reading a book called Attachment Parenting) that modern inventions, including but not limited to bouncers, swings, the "baby bucket" (removable, carry-able carseat), and strollers, are detrimental to a baby's development and only carrying or wearing the baby and co-sleeping are good for him or her.

A few interesting statistics were cited here.

• When looking at other primates to project a natural weaning age for humans, it seems like humans' natural weaning age is between 2.5 and 4 years of age. Some human cultures breastfeed their children to four years, but the mean American weaning age is four months. And that's with just over half of women even attempting breastfeeding in the first place.
• Korean children are held or touched 95% of the day. American children are held around 20%.

All in all - an incomplete book which I would not call a reference.

Book report: Ina May's Guide to Childbirth

Gaskin, Ina May, Ina May's Guide to Childbirth, 2003

My score

8/10

Amazon link

Ina May's Guide to Childbirth

My report

The book starts with some awesome birth stories - very inspiring and inspirational. The births are mostly set on The Farm, a birthing community deep in Tennessee, supporting natural midwife-driven childbirth. The following chapters aim to persuade the reader that "the body is not a lemon;" that in the vast majority of cases, natural childbirth is possible, and, moreover, preferable to childbirth with interventions. Ina May cites both The Farm and other natural birthing communities as well as European nations that have a high home-birth rate, low intervention rate, and maternal mortality rates drastically lower than that of the USA. In particular, she calls for greater accountability among medical professionals for maternal mortality rates - in the UK, for example, there is a complicated process of investigation into maternal deaths which results in a book called Why Women Die, which anyone can buy from the book store.

Ina May argues that labor need not be painful: that with relaxation techniques the "rushes" are felt more like intense pressure rather than pain. The Sphincter Law is that it's impossible to relax a sphincter under pressure.

Book report: The Thinking Women's Guide to a Better Birth

Goer, Henci, The Thinking Woman's Guide to a Better Birth, 1999.

My score

6/10

Amazon link

The Thinking Woman's Guide to a Better Birth

My report

Heavily biased towards natural childbirth, this book presents bulleted lists of pros and cons for interventions during labor and birth, and presents alternatives for undesirable interventions. If it weren't for the strong agenda, this book would be great. The book uses shock value by starting right off on the discussion of C-sections, then continues by discussing the interventions one by one in decreasing invasiveness. One of the main points in the book is that obstetrics is mismanaged, backed by overwhelming statistical evidence. I like the simple language and easy reading of the bulleted lists. If presented with an intervention, one can flip to the proper section and quickly research its pros, cons, and alternatives.

Book report: The Doula Book

Klaus, Kennell & Klaus, The Doula Book, 2nd edition, 2002

My score

5/10

Amazon link

The Doula Book

My review

This little paperback provides an overview of the duties, benefits, and experiences of a doula. The first four chapters take the reader on a touchy-feely journey on the good things about having a doula before and during labor. The following four chapters provide summaries of randomized trials regarding doula care. Every trial concludes that having an emotional support person (doula) present continuously throughout labor and delivery significantly reduces the chance of intervention, from epidural to C-section. The most shocking study is from Guatemala, in which the labor and delivery experience was half a dozen women in a single room, attended by one nurse that comes and goes, with no pain relief. It sounded like my mom's birth experience. In Guatemala, half of the women were assigned a doula that stayed with the women throughout labor; their success rates as far as minimal intervention were phenomenally higher. The Dublin Experience is a case study of a maternity hospital in Dublin, Ireland that assigns each mother a nurse midwife during labor; the intervention rates at this hospital are incredibly low and the maternal experience is rated incredibly highly. Moreover, the length of labor is decreased compared to the labor length at the same hospital prior to the introduction of the constant emotional support person. Finally, postpartum care is addressed from the point of view of a postpartum doula, who helps with breastfeeding, care of the newborn and the parents (who, it is pointed out, also need to be mothered during this delicate time), and household chores.

The appendices are arguably the most useful sections of the book as a reference (although the summaries of the trials were interesting as well). Appendix A discusses the training of a doula and how a doula prepares for her work. Additionally, the appendix discusses what happens to the laboring woman during the stages of labor, how a doula can help, and ways she can tell that it's time to seek medical attention. Methods of interacting with a woman that has undergone abuse are discussed. Appendix B lists in detail several self-hypnosis and relaxation meditations.

Many of the findings are summarized here, in Touch and Labor in Infancy.