Brought to Bed - book reflections

Today I finished reading Brought to Bed by Judith Walzer Leavitt. I am very glad I read it. Although written in the 1980's, the fact that it is a historical view of childbirth in the United States means that the information in it has remained pertinent. I have no interest in giving a book report, but I will say that it is definitely worth the read. I do want to get out some of what the book has made me think about.

I find it amazing that early hospitals did not make childbirth safer, even though that was the only reason women were going to the hospitals in the first place. It wasn't until the 1930's that it became safer to birth in hospitals than in homes, on average, and that was because of the availability of bood transfusions for hemmorhage and antibiotics for infection, for the most part. This means that the major changing factors for safety in childbirth did not come from obstetrics, but from medicine outside of maternity wards and schools.

Forceps deliveries, while better for situations in which babies and/or mothers would have died previously, were overused to the point of increasing maternal morbidity for the whole of women. Of course, women will choose a life of debility over a dead child, but when the debility was unnecessary to begin with, it is obvious that the "improvement" was not all that great.

I was amazed to realize that I have more knowledge and experience than most doctors had when they left medical school in the late 1800's.

I also found it very interesting to make general comparisons between the U.S. and Norway. In the U.S., it is incredibly rare (1%?) to have a homebirth, but in Norway, I think upwards of 30% of births are at home. The clencher is that Norway has lower maternal morbidity and mortality rates and lower neonatal morbidity and mortality rates than the U.S. It makes sense when you consider that Norway continued to utilize traditional midwifery models of maternity care, while adding science and medicine where it could help and maintaining the sense of normalcy in birth. The U.S., on the other hand, clung to "progress" and "science" to a destructive and dangerous extent, outlawing midwives and turning normal births into technological, doctor-driven anomalies.

I keep thinking that it's not obstetricians who have made birth safer, it's medicine outside of obstetrics, it's access to clean water, it's access to prenatal care regardless of financial ability, it's lower disease rates for rickets and tuberculosis, etc.

Of course, I need a disclaimer. Obstetrics has done some amazing things in the last hundred years. I do think that obstetricians are absolutely necessary under certain circumstances, and it is obstetrics which has helped determine what those circumstances are. Obstetricians are specialists, however, and it's unwise to see a specialist when you don't need one. If you don't want surgery, don't see a surgeon.

The book also made it clear that doctors really have always been pressed to take action, not to wait and allow things to happen naturally. Doctors were originally pressed by other arrangements and other women and families to care to, leaving them desiring to speed things along, to interfere, to make the women fit their schedules. This is still true, of course.

It also made it more apparent to me the position of nurses. So many people expect a nurse to be a support person during labor, but that's not their job. It has never been their job. When hospitals first began institutionalizing childbirth within their walls, most women were so drugged up that support for the woman wouldn't have been received. Not to mention that the environment was supposed to be "sterile" to the point that a nurse probably wouldn't have touched you unless necessary, let alone told you that you were doing a good job. Women were strapped down during normal deliveries through the 1950's. Who would think that a nurse would be supportive in such an environment? A nurse isn't support for the woman, a nurse is support for the doctor.

I feel like my blog entries are very anti-doctor/hospital/nurse and I keep feeling the need to back up and express the other end of the spectrum of my feelings. Perhaps I just need to clarify. I think that women should have homebirths or births at free-standing birth centers unless their health or the baby's health necessitates hospital birth. I think that women should be referred to midwives when they tell their gynecologists that they are pregnant and should only see an obstetrician if medically necessary. I think that the place held by each member of the birth support team should be explicit, with no false perceptions remaining at the birth. I think that women who want hospital births when they don't need them should be allowed to choose their birth environment, but should be given the risks involved, just like they would be for other choices in birth. I think the evidence and information should be freely given, regardless of who benefits from her choices.

I support women's choices. I just think that we all need to have a better idea of what meets our needs and expectations. I don't have all of the answers yet, of course. I hope, one day, to have enough information gathered that I can really wrap my head around a lot of this.