Review of Birth Books

 

OK.  So I like to be prepared.  I like to be geekily prepared.  In fact, I expected that I would read more about the process of giving birth than most people.  But I have come to the realization that I have read more books on labor and birthing than everyone I know.  If you have read as many books as I, then welcome to my geekazoid world.  If you haven’t but would like to know what these books say or to buy one or two of them to prepare for your own birth, then I hope this helps.

 

First things first:  I went into this process expecting many these books to be “high crunch”.  What does that mean?  I expected many of these books to be granola, tree hugging, earth mama, tied-dyed, etc.  Since I am reading these books, these names and emotions are not completely foreign to me and may actually have been applied to me at some point or another. 

 

However, it was also an important goal for me to find objective and non-judgmental information about why a natural (i.e., un-medicated) birth is preferable to a medicated birth.  Why not go for an epidural?  What is the advantage of going au natural for labor and delivery?  Is it really better?  Even What to Expect When You’re Expecting, a very mainstream pregnancy book, says medication should be “used only when the benefits outweigh the risks”  (Third Edition, p. 283).  But what does that really mean?    

 

So in that vein, I am going to review the four books I have read on labor and delivery.  Yes, you are correct:  I’m completely unexperienced in the birthing process.  I don’t know crap about what it’s really like.  However, this could be our only birth experience, so we want to know as much as we can going in to the big event so we can make the best decision we can to have a good birthing experience.  So here goes…

 

Book #1:  Henci Goer’s The Thinking Woman’s Guide to a Better Birth (1999)

 

I was very excited about this book.  It certainly appealed to my ideal of having an objective take of birthing information.  Besides who wouldn’t want to be “a thinking woman?”  

 

Well, the book doesn’t live up to its name.  In particular, there is a philosophy the author expresses which is not uncommon in these natural labor books:  OB-GYNs are surgeons and their first response is to cut the pregnant woman open.  “Obstetrician-gynecologists are surgical specialists in the pathology of women’s reproductive organs.  The typical obstetrician is trained to view pregnant and laboring women as a series of potential problems…” (p. 3).  “I am not antiobstetrician.  I know personally and by reputation many fine obstetricians.  I also believe that most doctors want to do well by their patients, although I have seen, experienced, and read enough about instances of arrogance, indifference, and even cruelty to have no illusions” (p. 7).  You know what bothers me so much about that last quote?  Replace “obstetrician” with any ethnic group or gender, and you’ll see just how prejudiced it is. 

 

I actually do like it when authors admit their prejudices at the beginning of their writing.  However, I’m used to the rest of the book being as objective as possible in light of these prejudices.  Not so in this case.  She seems to wallow in her belief that OB-GYNs want to cut you open and your job is to fight them tooth and nail to prevent it. 

 

I don’t buy it.  You may.  But I don’t. 

 

I do appreciate that Henci Goer has read an amazing amount of literature on the topic.  In fact, she probably knows more about current literature than many OB-GYNs.  However, just because she has read the literature does not mean that she can critically evaluate its research methodologies and its findings.  In fact one of the most frustrating parts of this book was that 1) she rarely listed rates of occurrence for all these bad things that she argues happen in a medicated birth and 2) she doesn’t list the year the research took place  (i.e., it could be outdated).  For example, there are a whole host of negative things that could happen from epidurals (p. 133-134):  fluid can overload the mother and baby’s lungs and disturb the mother’s blood chemistry; it can cause anemia, days long migraines, a drop in blood pressure, convulsions, respiratory paralysis and cardiac arrest.  Even getting the epidural shot can cause neurological and other complications.  YIKES!  

 

But here’s the rub:  how many women actually experience these problems?  She argues that 1 in 3000 people can have respiratory paralysis or cardiac arrest, but what does that mean, really?  (33 people in 100,000 could have one of these very serious problems)  She argues that drugs with adverse reactions in this range are withdrawn from the market, but she fails to point out that these horrible events are primarily due to anesthesiologist’s error; they are not a reaction to the epidural drug.  I have to believe that like the miscarriage rates of doctor’s performing CVS, an experienced anesthesiologist will have a lower error rate. 

 

Also, I could not find how many women overall actually have had adverse reactions of the sorts listed above.  So that’s the part I’d say that one should take with a grain of salt.  Tell me the rate in which this occurs so that I can make an informed decision.  There is a probability greater than 0 that a meteorite could land on this house in the next 10 minutes, but it’s highly unlikely.  I feel she could do with a bit more knowledge about research design, methods, and statistics when talking about these problems. 

 

So, those are the parts I think could use improvement.  That said, there are some very informative parts which I think are quite useful. 

 

Breech Births:  She lists some yoga-type positions for getting the baby out of breach (p. 35).  Although this doesn’t count as “real” data, I’ve heard more women discuss how this worked versus having a reaction to an epidural. 

 

Overdue:  She points out that at least some “overdue” pregnancies are not, in fact, overdue.  Due dates are often based on last menstrual period (LMP).  However, that may be an inaccurate method of calculation.  As long suffering readers may remember, I ovulated 3 weeks not 2 weeks after my LMP—so using my LMP for my due date would make me 1 week overdue when in fact, I was right on schedule.  Additionally, she argues that late pregnancy ultrasounds are not as good as early ultrasounds in predicting due dates.  Finally, some routine tests of fetal well-being in the latter stages of pregnancy have false positive rates of 30%; that means 30% of the time they say there’s a problem when in fact there is not.  Although she argues that women should “refuse” to take the test, I’d think that it’s better to “insist” on taking the test twice will help rule out a real problem.  It’s highly unlikely to get two false positive tests.  High Crunch Alert:  she’s a big advocate of nipple stimulation, sex, castor oil and enemas to start labor for an overdue pregnancy. 

 

No Food or Drink During Labor:  Originally, this rule came about when women were put under full anesthesia for labor; the doctors wanted to prevent aspiration while the woman was under anesthesia.  Now, even with epidurals, that rule just seems silly.  As a marathon runner, I cannot imagine “working out” (as I imagine labor to be) for 4 to 6 hours without some caloric intake.  For Pete’s sake, Gatorade or Gu has got to help keep energy up for labor without filling up one’s stomach and causing problems.   

 

So my overall view on this book:

 

Moderately crunchy (yes, there are crunchier books out there) with some useful information.  I think this might be a good supplemental book for someone who has the ability to be skeptical of what he or she reads and sort the wheat from the chaff.  However, I would not recommend this book as the end all be all of labor books.  In my opinion, it’s too biased to be reliable.

 

Tomorrow, Ina May’s Birth book. 

7:50:30 AM     Comments? []