More About Pushed (& more about evidence based care)

In October, I was delighted to finally read Pushed by Jennifer Block. I wanted to add my thoughts and comments to those shared earlier by Susan Hodges. This book is seriously GOOD! Wow! Lots of weighty, meaty information, scathing critiques, astute observations, and clever commentary. She has plenty of scientific backup for her claims and the book is written in an engaging, fast paced style that skillfully weaves facts into descriptive commentary and personal, illuminating interviews. I checked this book out of the library, but after seeing all of the data contained within--she's pulled together vast quantities of data about effectiveness of "routine" practices, etc. and made it accessible to the average reader--I knew I had to put it at the top of my Amazon wish list.

Pushed is a thorough critique of obstetrics as an industry and how women and babies are being HURT by the systems ostensibly in place to "protect" them. Especially thought provoking is her descriptive exploration of the cesarean epidemic. She points out on one occasion when discussing uterine rupture as the common reason used to deny women VBACs, that a cesarean is a "controlled uterine rupture." Later, in a separate section regarding blood loss during birth, she mentions that average loss is 300-500 mil and over 500 is considered a hemorrhage. She then notes that during a cesarean the average loss is 1000 mil. Reading that, I was struck with the realization that essentially with a cesarean you have a 100% chance of a uterine rupture AND a 100% chance of a hemorrhage. Wow!

During the conclusion of the book after a discussion about the NAPW and whether childbirth is a reproductive right or not:

"To her [a doctor who thinks it is not], it is a medical issue, one that may need reform, but one that belongs under the purview of physicians. 'To my mind, I'm all for people having a pleasant and safe birth experience,' she says. 'But my highest priority would be for them to have a safe birth experience.' But what's considered safe is political. What's safe changes. Thirty years ago obstetricians said VBAC was dangerous. Then they said it was safe. Now they've gone back to saying it's dangerous. ACOG says out-of-hospital birth isn't safe, but the research has consistently suggested that for women with normal, uncomplicated pregnancies it is not just safe, but safer, because those women are far more likely to have a normal, spontaneous vaginal birth and far less likely to experience harmful, unnecessary interventions...."

"...The goal is to have a healthy baby. 'This phrase is used over and over and over to shut down women's requests,' she [Erica Lyon] says. 'The context needs to be that the goal is a healthy mom. Because mothers never make decisions without thinking about that healthy baby. And to suggest otherwise is insulting and degrading and disrespectful'...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 kind of 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 considerations, by a provider's licensing regulations and malpractice insurer. The evidence often has nothing to do with it." (emphasis mine)

The only critique I have of this book is one I echo from several other reviews. The book fires you up and has a lot of passion and energy, but provides no outlet or ideas for where to channel that energy. There is no "resources" section, no suggestion to join Citizens for Midwifery or your state midwifery advocates, no list of birth-positive organizations who are working diligently for birth change in our culture, etc.