Helpful Resources for Childbirth Educators and Parents

Abstract

In this column, reviewers offer perspectives and comments on a variety of books and DVDs that address topics related to maternity care in the United States, health and childbearing experiences of women in third-world countries, traumatic birth, and pregnancy massage.

BLOCK WILL LIGHT YOUR FIRE

Pushed: The Painful Truth About Childbirth and Modern Maternity Care

Author: Jennifer Block

Publisher: De Capo Press (2007)

Hardcover: 316 pages

Cost: $26

Where to order: Available at various booksellers and Amazon.com

Don't pick up this book unless you have a free afternoon or two, because it is hard to stop once you start reading. Pushed should be read by every woman, pregnant or not, and should be in every childbirth educator's hand.

In contrast to Marsden Wagner, MD, who also writes on this subject, Jennifer Block is not an insider, but she has done her homework. Her work as editor of the revised Our Bodies, Ourselves and as former editor of Ms. magazine indicates that she is no stranger to women's issues, and she approaches Pushed having read and analyzed the research. I was impressed that she prepared by spending time with midwives across the United States and in hospital maternity units, observing births that included both a planned cesarean and a home birth with an underground midwife and interviewing all of the players in this controversy, including committee chairs of the American College of Obstetricians and Gynecologists.

Block does an excellent job of identifying the issues that prevent American women in the 21st century from experiencing physiologic birth. The eight chapters in Pushed detail the research, discuss the issues, and relate stories about what Block saw and heard during her research, creating a rich texture.

In the book's introduction, Block describes normal, spontaneous birth and then contrasts that with the common hospital-birth experience in the United States. She asks, “Is technology being overused at the expense of women and babies?”

Chapter 1, titled “Arranged Birth,” discusses the issue of induction. Block tells the story of a Florida hospital that lost power due to Hurricane Charley and had to cancel planned inductions. The staff was amazed that women went into labor on their own and birthed healthy babies without interventions, including three fourths of the women who had been scheduled for induction. Block cites statistics from a variety of sources, details the evidence, and provides a stroll down memory lane on Pitocin, the effect of active management of labor, episiotomy, and electronic fetal monitoring. She also discusses the business aspect of birth and its effect on current practice.

Chapter 2, titled “The Short Cut,” is about cesarean section, detailing the rise in the number of cesareans and the reasons for the increase. Additionally, the issue of “patient choice” is discussed. There is reference to the “business aspect” of cesarean birth, along with liability and ethics.

In Chapter 3, “Denied Birth,” Block focuses on vaginal breech and issues concerning vaginal birth after cesarean (VBAC). She cites one study on vaginal breech that changed obstetrical practice around the world, and she reports on the challenges to that study. Block tracks the rise and fall of VBACs and explores the politics of the VBAC issue. She also reports that some women, when denied a trial of labor, either turn to midwives who will allow them to labor, or give birth at home unassisted.

Chapter 4, “Consequences,” examines the consequences and risks of increasing the number of cesarean sections. Block points out the expectation that maternal mortality rates will also rise, although we do not have good statistics identifying the current rate. She cites reports from women that many obstetricians do not discuss with their patients the risks involved in the surgery, noting that some physicians are quoted in the press stating that cesarean section is almost risk-free.

In Chapter 5, “Mother's Helpers,” Block traces the history of women helping women in birth, and discusses the role of doulas and their increasing use in the United States. She points out that on January 7, 2007, only one hospital in the entire United States could meet the Coalition for Improving Maternity Service's Ten Steps of Mother-Friendly Care. Block reports that, based on best evidence, six care practices characterize optimal maternity care. If so, based on the findings of the Listening to Mothers II survey, “just 2% had an optimal experience.”

Chapter 6, “Underground,” is about midwifery care in the United States. Block describes the difficulties for both women and independent midwives in determining the variety of licensure, rules, legislation, and restrictions under which they practice. Some midwives have gone underground to avoid restrictions on their practice.

Chapter 7 is titled “Criminalized.” Block states that “the United States is the only country to have made the modern home-birth midwife an outlaw.” She goes on to describe the history of midwifery in the United States and details several criminal actions against midwives.

In the final chapter, “Rights,” Block asks some tough questions that, on the surface, might seem to have a quick, easy answer: for example, “Do women have the right to give birth vaginally?” After reading Pushed, you will see how complex that question really is in our society. The chapter on rights may put off some readers, because the discussion about the broad application of women's rights includes the topic of abortion.

Appendix A in Pushed, labeled “Effective Care,” provides a partial list of the categories presented in A Guide to Effective Care in Pregnancy and Childbirth. Appendix B graphs the total cesarean, primary cesarean, and VBAC rates in the United States, from 1970 to 2004. In the “Notes” section, Blocks lists comprehensive and up-to-date references for each chapter.

If you are concerned about maternity care in the United States, Pushed will light your fire.

Reviewer:

Joyce Thomas DiFranco, RN, BSN, LCCE, FAACE

Rancho Palos Verdes, CA

ONE WOMAN'S POWERFUL IMPACT ON PROMOTING NORMAL BIRTH

Monique and the Mango Rains

Author: Kris Holloway

Publisher: Waveland Press (2007)

Softcover: 212 pages

Cost: $17.95

Where to order: Available at most bookstores and retail outlets

Monique and the Mango Rains is a beautifully written, true, personal account of author Kris Holloway's friendship with Monique Dembele, a midwife in The Republic of Mali located in Western Africa. Holloway describes in vivid detail her experiences working side-by-side with Monique in her clinic and midwifery practice during Holloway's 2-year service as a Peace Corps volunteer in the village of Nampossela, Mali.

Intended for a general audience, the narrative focuses mainly on the growing friendship between Monique and the author. Through Monique's life and untimely death giving birth to her fifth child, Holloway sensitively explores issues affecting the health and childbearing experiences of women in many third-world countries, including poverty, social inequality, female genital cutting, lack of birth control, malnourishment, and lack of education. The beautiful black-and-white photography brings Monique, the birthing house, and the other characters to life.

Monique and the Mango Rains became for me an inspiring statement on the potential of women to influence birth in their own communities. Despite shockingly high maternal and infant mortality rates in Mali (approximately 1 in 12 women die in childbirth), Monique made a real difference in simple ways for thousands of birthing women. Her skill as a midwife, her tender and constant care of women in labor and beyond, and her belief in the power of women to give birth normally impacted Holloway so powerfully that, several years later, she chose to give birth in her own home with a midwife.

Childbirth educators and normal-birth advocates will find this book empowering and useful for discussions of how birth is influenced by culture in their own communities. Holloway contrasts the U.S. model of birth, where technology and interventions are the norm, to birth in Nampossela, where birth is a family and community event—although hindered by the unavailability of emergency medical care. Women's book groups would be wonderful places to discuss Holloway's hope that “giving birth didn't have to happen at one extreme or the other—that a happy medium existed between the two.” Leaders may also find the online reading guide (www.moniquemangorains.com) helpful in conducting a discussion of the book's main themes.

Proceeds from sales of Monique and the Mango Rains will benefit the “Clinique Monique”—a rural health clinic in Mali established in honor of Monique Dembele—and provide school-tuition assistance and health care for Monique's children.

Reviewer:

Elizabeth H. Day, BA, CD(DONA), LCCE

Bentonville, AR

HELPING VICTIMS OF TRAUMATIC BIRTH

Birth Crisis

Author: Sheila Kitzinger

Publisher: Routledge 2006

Softcover: Pages 160 plus notes

Cost: $23.95

Where to order: Available at most bookstores and at www.routledge.com

Currently, several books are on the market addressing the practice of maternity care in the world, but Sheila Kitzinger's book should be on your reading list. It not only targets birth professionals and those who work with postpartum women but is also recommended for use with women experiencing posttraumatic stress disorder (PTSD) because of a birth experience. Kitzinger's practical advice is helpful for those who listen to women's birth stories or find themselves in a position to frequently hear them. Birth Crisis focuses on identifying the crisis, showing how we know it exists and why it exists, and learning how to respond to women who are victims of traumatic birth.

Several chapters are dedicated to the institution of birth; the stories referenced are primarily in the United Kingdom, but global enough to not matter. Kitzinger addresses the culture of birth, the social structure of the medical community, and the iatrogenic nature of interventions in ways that add to the thought process without being overbearing or inflammatory. Her ideas are consistent with Lamaze International's philosophies of pregnancy, birth, and parenting, including informed choice and no separation of mother and baby.

Chapters examining the symptoms of PTSD, how women and their partners try to deal with the symptoms, and the process of moving forward are all excellent resources to share with women experiencing PTSD. Kitzinger offers a window into the thought process that women with PTSD experience and, more wonderful, gives us the tools to listen and respond to women in helpful ways.

I recommend this book to women who are experiencing PTSD, but only if they are ready or able to read excerpts of birth stories of other women who had negative, perhaps even abusive, birth experiences.

Review by:

Tamara Kaufman, CLD, LCCE

Columbus, OH

MASSAGE TECHNIQUES FOR EXPECTANT MOTHERS, COUPLES

• Nurturing the Mother: A Body, Mind, Spirit Approach to Pregnancy Massage

• Nurturing the Pregnant Couple

Director: Claire Marie Miller (nationally certified AMTA Registered Massage Therapist)

Format:Nurturing the Mother – DVD (79 minutes) or VHS (45 minutes)

 Nurturing the Pregnant Couple – DVD (84 minutes)

Cost:Nurturing the Mother – DVD: $37.99; VHS: $25

 Nurturing the Pregnant Couple – DVD: $37.99

Where to order: Moonstone Products (www.moonstoneproducts.com or call toll-free 866-240-4488)

Touch during pregnancy and labor is without dispute a vital element to communicating with the pregnant mother and baby. Nurturing the Mother and Nurturing the Pregnant Couple provide specific instructions for both the professional massage therapist and pregnant couples. Emphasis is placed on the numerous ways to communicate love, support, and confidence to the new mother through touch and massage. Claire Marie Miller's gentle narrative and guidance throughout the videos exude confidence and nurturing while emphasizing the importance of thoughtful, meaningful touch for the pregnant mother.

Nurturing the Mother provides a slow, methodical demonstration of a complete body massage for the pregnant woman. Miller demonstrates the many massage techniques and stretches to benefit the pregnant woman and, at the same time, identifies cautions, contraindications, and different positions for various discomforts. Additionally, a separate demonstration on the proper mechanics for side-lying placement of the pregnant mother and pillows during the massage are discussed at the end of the video. Specific techniques for lymphatic drainage, foot reflexology points, and polarity are identified throughout the video.

Nurturing the Pregnant Couple is divided into four chapters: “Couples Prenatal Yoga,” “Dad's Simple Shiatsu,” “Simple Pregnancy Massage,” and “Labor Massage.” In each chapter, couples work together with Miller's guidance to learn how to nurture each other through yoga, shiatsu massage, and pregnancy massage for the mother. Miller also guides the partner with specific massage techniques and labor positions to help the laboring mother. Miller does an excellent job of encouraging a safe environment for couples to explore pregnancy massage techniques and yoga positions. Each chapter emphasizes the importance of building a foundation for working together as a couple during pregnancy, labor, and postpartum.

Many viewers will find the pace of these videos simple and easy enough to follow. Viewers could easily perform the described techniques while watching the videos. A thorough review of each video before trying the techniques is strongly encouraged. Although the target audience is the pregnant couple or the professional massage therapist, childbirth educators and doulas could easily incorporate many of the different massage, touch, and positions into their education and preparation of pregnant women and their partners.

Reviewer:

Stephanie Schaldenbrand, MA, LCCE

Ann Arbor, MI

NOTE TO READERS

All reviews appearing in this column are intended solely for the use of our readers. The statements and opinions presented here are solely those of the individual reviewers, do not represent the opinions or official position of Lamaze International or The Journal of Perinatal Education, and do not constitute an endorsement of the reviewed material. The reviews cannot be used in advertising or for any other commercial purpose without written consent from Lamaze International. Lamaze International will take all available measures to prevent the unauthorized commercial use of its materials, its name, or the name of The Journal of Perinatal Education. Readers interested in writing reviews should contact Teri Shilling at her e-mail address (teri@passionforbirth.com). She should also be informed of media materials and teaching aids relevant to this journal's readers.