Parenting Book Review: Giving Birth

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Finally a book that tells the truth about what really happens when a woman has her baby in the hospital with a certified nurse-midwife, CNM. Ivy-league-educated author Catherine Taylor, writes about her own experience as a nurse-midwifery patient as well as stories of many births she attended as an observer or doula.

What is most amazing about the stories of birth that are retold is the author’s realization that the certified nurse-midwives that the pregnant women trust are agents of the medical institutions. In story after story, the CNM patients are mislead about what to expect of their birth experiences.

Taylor shadowed a number of CNM’s during their usual workdays at their hospitals. The CNM care frequently mirrored physician-nurse care as busy CNMs left their clients in very active labor. Claims one CNM, “We try to compensate by having a nurse attend them.” Yet while a number of CNMs expressed a longing to be more actively involved with the women they care for, none actually provided the women with hands-on, continuous care during their labors and births. Taylor points out hospital-based CNMs frequently provide inadequate midwifery care, failing to provide even a modicum of “human presence” which is a core competency of the ACNM (American College of Nurse Midwives).

In birth story after birth story the reader is made aware of the inability of the CNM to prepare women for a drug-free, empowering birth. Woman after woman believed the slick hospital promotions that shows the beaming new mom and dad holding their little one with the ever-present staff hovering nearby. The rude reality is that for most of the women, this was a fantasy.

The midwifery clients were unprepared for the pain of labor and what to do about it. The midwives were too busy running from patient to patient to do more than stick their head in a room long enough to don a glove and check dilation and make lame suggestions for dealing with pain. The nurses also had no time to provide one on one support–that left the women and their partners to go it alone, without having been educated about what to do.

One theme that is played out in many of these stories is the power the hospital has over the CNMs. Whatever their personal beliefs may have been, they inevitably acquiesced to the hospital administration or physicians if there was friction between what a client/patient wanted. A few of the examples given include handing out “goodie” bags loaded with formula while theoretically promoting breastfeeding; telling a woman she needs pitocin when it is actually being given to speed up labor for the staff’s benefit; and breaking a water bag for the physician’s convenience.

Many CNMs seem to relish their role as mini physicians. IVs, rupturing membranes, ordering antibiotics, pitocin and epidurals, cutting episiotomies and dragging babies out by suction vacuum are daily activities for hospital-based CNMs. Yet the ACNM claims that one of the primary characteristics of a midwife is as an advocate “of non-intervention in the absence of complications.” With the widespread use of routine interventions by CNMs, one has to wonder whether any of the ACNM publications can be trusted. Said one CNM to a VBAC client, “With the next baby, if the baby starts to look big, my preference is to induce a week early. You’re so tiny you might have to have a c-section for all your babies.”

Do CNMs educate their clients better than physicians so that when interventions are offered, they are able to make fully informed decisions? Taylor wonders about this too and asks, “Can parents in the middle of the unfamiliar and often disorienting experience of labor make good decisions?” Can parents really be fully informed when a CNM has to please her collaborating or supervising physician or comply with hospital protocol in order to keep her job? Too often it seems, they side with those who sign their paychecks.

Some women have been able to hire doulas to provide the emotional support and unbiased information about hospital interventions. Sadly this is not always what they thought they were getting either. As Taylor points out, doulas are trained to never be critical. This means that if a woman suddenly decides she wants drugs during her labor, the doula supports her. Like CNMs, doulas frequently find they must walk a fine line to be welcome in a hospital. Sometimes this may mean not advocating 100% for the woman but rather guiding her to comply with some unnecessary intervention that will soothe the staff and keep the doula in their good graces.

Taylor discovered that at one hospital, the majority of CNMs had homebirths. She attended a number of homebirths while researching this book as well as at Elizabeth Gilmore’s birth center in New Mexico. Taylor chose to have her second child born at home. After her less than satisfactory first birth, Taylor explains that at home the woman’s ability to birth is protected rather than controlled. This is what Taylor wants. This is, I believe, the primary reason women in America choose to have a homebirth.
Taylor’s emotional process of going from a hospital birth to a homebirth is somewhat detailed in this book. Those of us who have had home births know exactly what she is dealing with when explaining her homebirth decision to those who only believe in hospital birth. She writes, “I realized my friend’s viscerally negative reaction to homebirth was probably not based on some piece of knowledge or information, but rather on ungrounded fears.”

While an ideal arrangement for birth is to have supportive medical care at the ready in case of an emergency, most homebirth families and midwives find this very difficult to obtain. Unlike a great many American women, Taylor had insurance while pregnant with her second baby and utilized that insurance to buy back-up medical care her CNM was unable to provide. While physicians decry those who plan homebirths without medical back-up, these physicians increase the dangers of homebirth by refusing to provide the very care they believe is essential for safety. Like Taylor, who pretended to plan a hospital birth in order to have emergency medical care readily available, those with money can buy a safety net. The rest cross their fingers or pray.

Taylor’s praises Elizabeth Gilmore’s Taos, New Mexico free-standing birth center. The practice employs obstetricians who provide built-in back up for the midwifery clients. Clients can choose to birth at home or the birth center. Although seemingly idyllic, the birth center has been a labor of love for Gilmore who has worked ceaselessly to keep it viable. The politics of birth are everywhere an endless war.

This book was written because Catherine Taylor had to write about her birth experience. Like so many of The Complete Mother subscribers, her homebirth transformed her into a strong, self-assured mother and woman. Those of us who have been there and done that will smile that knowing smile while reading of her metamorphosis. It’s the secret knowledge that’s suddenly discovered that we had the power all along, but didn’t know it.

Taylor recognizes that the road to self-discovery is frequently full of pain and vomit and body fluids. “Yet it was one of the most vital and powerful moments of my life…my midwife did not just attend the birth of my baby; she attended the birth of a new, powerful, confident and loving part of myself.”