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The American Way of Birth by Jessica Mitford

By fff | Posted Under Book Reviews | Comments (28)



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Jessica Mitford was a muck-raking journalist most famous for her book The American Way of Death, an expose of the funeral home industry and ways in which it exploits grieving families. In The American Way of Birth, she turned to the history of birthing in the United States, finding much to critique in the ways that doctors currently treat both pregnant women and non-doctor caregivers such as midwives.

Mitford begins Birth by relating her own experiences giving birth, showing through personal experience how medical standards have gradually evolved to allow the birthing woman less autonomy. She then moves on to a historical perspective, from barber surgeons of England in the 1500s to “granny midwives” in the south in the early 1900s, on to the highly medicalized births that are common today. The bulk of the book looks at current practices — including doctor vs. midwife care, how doctors and hospitals deal with midwives, and income and class disparities in care.

Mitford ends up on the side of the midwives, but her position is balanced and measured. She is not an advocate for at-home, natural births for everyone, but she appreciates the training and knowledge of midwives, and documents, then critiques, the ways in which midwives’ practice is restricted and devalued, and medical interventions planned when they are unnecessary. Mitford ultimately advocates for unrestricted choice for birthing women, and finds that our current system funnels almost everyone into the same type of care — care that uses medical interventions frequently, more often than is necessary and to aid the convenience of the doctor rather than serve the health of the mother and the child.

Mitford’s writing is a joy to read. She writes in a journalistic style — mostly relaying facts in a neutral manner, but she readily admits her biases when they come up. She is alternately funny, sarcastic, and skeptical, and builds a powerful argument within an enjoyable personal style. While her ultimate thesis — that medical providers should allow the maximum freedom for pregnant women to choose their plan of care, and simply treat them as autonomous human beings — is not so radical in and of itself, it is a proposition that seems radical in the current system. Mitford’s common sense journalism is simply a rational voice against a large and dominant bureaucracy.

This review is part of the Cannonball Read series. For more of fff’s reviews, check out the blog.









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Comments

The business of being born documentary covers a lot of this same subject matter. Interesting.

Posted by: blacksred at September 8, 2010 9:18 AM

I have a friend who is a midwife and the horror stories of what she and her patients have gone through at the hands of the medical establishment is enough to turn your hair gray. She's the first to say that not every birth should be a home birth...there are some situations where it's just too risky, and she will turn away clients and refer them to OBs instead. She always has an emergency plan in place in case medical intervention is needed, and in one recent case where labor took a turn for the worse, her patient was badgered and berated by a doctor WHO BROUGHT IN SECURITY GUARDS because he assumed that a woman who chose to try a home birth would resist any medical care. Even though she had voluntarily come to the hospital with her midwife at her side. Yeah, just what a woman in hard labor, afraid that her baby's in danger, needed to go through.

I am NOT some kind of anti-medical hippy (I was fucking glad for an epidural, believe me), but I wish I'd known more about alternatives to a typical hospital delivery, and that I'd been more assertive in sticking up for myself to my awful OB. I later discovered she was referred to by hospital employees as a raving bitch. I found out because she FRAMED the letter she wrote in response to multiple staff complaints and kept it in her waiting room.

Posted by: Wednesday at September 8, 2010 9:28 AM

The unfortunate thing about midwifes is that because they are not seriously considered part of the current medical establishment (read- less profit to be made), the medical business world has laid a stigma upon the practice up there with bloodletting, beads and rattles. They are also often quick to claim the practice as both dangerous and archaic when one could have modern medicine at their disposal. This is of course, pure bullshit.

The fact of the matter is that women have been perpetuating the human race since the beginning of time just fine without epidurals, sonograms and c-sections than you very much. I'm not saying there haven't been complications and a few tragedies alleviated by modern medicine, but if everyone stopped going to the hospitals to give birth, humanity would be in no danger of extinction. If giving birth at home was once again considered the norm and hospital interventions looked at only in an emergency, I think people would realize that you don't always need to use up valuable resources to do something that is quite literally an everyday (albeit amazing) occurrence.

Posted by: bleujayone at September 8, 2010 10:16 AM

bluejay,

Yeah, you wonder how the homesteaders on the prairie in the 1800s ever made it without an ER with a birthing room down the (wagon-wheel-rutted) road.

Posted by: , at September 8, 2010 10:47 AM

They couldn't have done it without the miscarriages and still births most women had, not to mention the fairly common result of dying in childbirth. Unless you are willing to lose one, I'd rather have the sonogram to make sure everything's okay. My sister homesteads, and she's had three home births, but you'd better believe she had all the pre-natal care to confirm that she didn't need a hospital.

Posted by: Phaeolus at September 8, 2010 10:53 AM

I had a terrible experience with a midwife and a perfect experience with an OB practice. I just put that out there because I heard a lot of negative stories about the medical model and a lot of praise for natural birth when I was expecting my first baby. I had an awesome birth experience and that was despite a really bad case of pre-eclampsia which led to an induction.

It's nice that there are options out there, but I find it kind of weird that the feminist choice seems to be the one that requires refusing pain management medications.

team epidural!

Posted by: Jennifer at September 8, 2010 11:13 AM

Phaeolus-neither I nor my baby would have survived without medical intervention and I am a healthy person otherwise. Pre-natal care saved our lives.

Posted by: Jennifer at September 8, 2010 11:18 AM

There is a difference between a lay midwife and a certified nurse midwife. My mechanic could call himself a lay midwife, and start up a business. Certified nurse midwives are mostly nurse practitioners with a medical education, who have to undergo rigorous testing and licensing. We have multiple certified nurse midwives working the in offices of OBs in my town. They deliver babies in the hospital - they have a more hands off, natural approach, but an OB is "in house" in case the shit hits the fan. We've also had a lay midwife in town who has the deaths of several neonates and one mother on her hands from delivering complicated cases in hotel rooms.

Yeah, women have been giving birth for centuries, but there also used to be a high neonatal and maternal mortality rate. Everyone has this perception that pregnancy is so happy and great, but it's also the most dangerous time in a women's life. Given the fact that a full term uterus has roughly two liters of blood flowing through it in one minute, and the mother has approximately eight liters of blood in her body total, a severe uterine bleed can kill the mother in ten minutes, so minutes count. That's not adding to the mix such fun issues as umbilical cord prolapses which cause fetal death. I'm totally down with certified nurse midwives (again, who have advanced training to identify these problems and know how to deal with them), but it's just safer for everyone if the birth takes place in a hospital in case something very bad happens.

Posted by: gothdoctor at September 8, 2010 11:43 AM

A lot of people don't realize that midwives also deliver in hospitals and birthing centers, not just at home. For example, my midwife will be delivering my little girl at the hospital because she does not do home births and there is not a birthing center in town.

My issue with physician care for pregnant women is that they treat pregnancy almost like an illness and perform all sorts of interventions to make the birth "easier" and not all women need nor want that shit. I am the sort of hippie that wants to give birth with no medication whatsoever. There is plenty of room for my Sprout to come out and my uterus can contract just fine and push her out. To me, pain and inconvenience are not reasons to medicate or cut. Not all women feel that way and that's fine. Every one has their own individual birthing experience, but this is mine and I don't need some OB scaring me into interventions that I don't need. I've had too many friends, including a friend who was a doctor ay the hospital where she gave birth and personally knew the OB, receive unnecessary interventions for me to trust an OB with my run-of-the-mill birth. Now, don't get me wrong, for a woman who is high risk or has some shit go down during delivery an OB is absolutely necessary. But for an average run-of-the-mill pregnant lady a midwife is really all she needs.

Plus, if we want to talk cutting health care costs, let's start at the beginning. My delivery bill and the cost to my insurance from my midwife will be literally half that of an OB bill.

Posted by: stardust at September 8, 2010 11:46 AM

I find it kind of weird that the feminist choice seems to be the one that requires refusing pain management medications.

Jennifer -- I'm with you. My experiences with OB/hospital care to have 2 children were just fine. Regular births without complication, but WITH an epidural. In fact, I actually told the nurses, "Just because you do it without drugs doesn't mean you get an extra special baby." That got a bit of a laugh out of them.

(Then there's the case with my mom, who got the drugs with me, and they didn't work. And then she was in labor for over 24 hours. Good thing she likes me still... ;))

Homebirth wouldn't be for me, just as toughing it out in a hospital wouldn't be for me, but I certainly don't fault any woman who would want to do it otherwise.

To get back to the original point of the book -- it would be nice if EVERYONE from doctors to super hippies could just STEP OFF and not judge, you know?

Posted by: Sara H at September 8, 2010 11:58 AM

To be honest, I got more judgement from staff when I said that religious preference was not applicable, in case something did go wrong. There was a cooling of attitude for sure.

And on a side note: My insurance wouldn't have covered a midwife, I don't think. Stupid "in-network" type crap.

Posted by: Sara H at September 8, 2010 12:05 PM

Yay team epidural! I don't understand the need to feel birth to it's fullest, but that's just me. I found labor and delivery to still be difficult even though I wasn't in excruciating pain for hours on end. Epidurals allowed me to fully be present in my birthing experience and enjoy it. Excluding the random pokes here and there, but even the prods aren't that bad when you can't feel them. I guess giving over my body for a total of 39 months of pregnancy and breast feeding, yet not feeling the pain of my labor and deliveries somehow makes me inferior. How about if instead of comparing notes now we do it in 18 years when it really counts?

Sorry, that's my little rant. This topic has been covered ad nauseam on all sorts of mom/baby forums and it starts to wear on me. I had two wonderful OBs, one who actively advocated for my successful VBAC, and another wonderful midwife who was at my side for my planned c-section. This topic does not have to be argued in black and white.

Posted by: katy at September 8, 2010 12:36 PM

To clarify, my midwife was a CNM working through one of the major hospital systems in my city.

Posted by: katy at September 8, 2010 12:38 PM

Also to clarify, my midwife is a Certified Nurse Midwife. There is a lay midwife here in town that allowed a baby to die during a home birth. I think I know which one it is and if it is that woman then SCARY. I've known her for a while before I found out she is a midwife and she is dumber than a box of rocks.

I too hate the judginess that comes from people when I tell them my birthing choice. Medicated or non-medicated, vaginal or scheduled c-section, fuck, we're all choosing to raise children and thats not an easy task. Stop starting out childrens' lives out with judgement!

Posted by: stardust at September 8, 2010 1:49 PM

"The fact of the matter is that women have been perpetuating the human race since the beginning of time just fine without epidurals, sonograms and c-sections than you very much."

I find this reasoning hilarious. First of all, learn some history: miscarriages, death in childbirth, death soon after childbirth (of mom and baby) was a hell of a lot more common back in the day than now. Period. Look at maternal death rates around the world: much, much higher in places with limited medical intervention.

Also, I remember thinking whilst in labor (pre-epidural stretch) "Wow. This is how women died in childbirth." There's no benefit to physical suffering in this context, ladies. It's a loooooooooooooong road ahead.

Posted by: samantha t at September 8, 2010 2:36 PM

As a side note, the US has the highest maternal mortality rate of any industrialized nation. The World Health Organizations recommends no more than a 12% Cesarean rate for an industrialized nation, and ours is at 32%(last time I saw the figure).
We are lucky to have more options here, but just because you are going to an OB does not mean you are having the safest birth possible.

Posted by: yazikus at September 8, 2010 7:40 PM

My bad experience with a midwife was with a CNM, she just wasn't a good match with me and missed the early signs of what became life threatening at the end. One of the ladies from my birthing class started out with the intention of not using pain medication. She was flexible which is good because her giant-headed baby got wedged in her pelvis and without a c-section she would have died. My accupuncturist experienced such serious post-partum bleeding that she had to be rushed from her birth center to the hospital for a four hour emergency surgery. All of us are fit healthy moms under 35. Birth is serious business and I think because it happens to people we know all the time, we get complacent about it.

If homebirth is your choice, then more power to you. Some people struggle to find their voice in a medical setting. But don't put your life at risk to do it. Have a plan to get to modern medical treatment quickly and have someone with some serious medical training present.

Dying to prove a point should be reserved for suicide bombers not new moms.

Posted by: Jennifer at September 8, 2010 8:06 PM

The US has a high Cesarean rate for multiple reasons.

We're a fat nation. A large number of obese women develop gestational diabetes during pregnancy. Babies of gestational (and adult onset) diabetics are super sized, and can develop shoulder dystocia during a vaginal delivery. That is something an obstetrician can be sued for, so away to the OR they go.

Nonmedical inductions. There are a lot of women who want to be induced prior to their due date for all sorts of reasons ranging from "I'm tired of being pregnant" to "I don't want to have my baby of Christmas day." Many are first time mothers. Inductions have their place, but failed inductions lead to the OR.

Evil obstetricians. You hear about them - they don't want to stay in the hospital past 5 pm, or they don't feel like coming back in at 2 am to deliver a baby. Younger obstetricians aren't like this yet, but some of these old guys treat women like cattle in the first place, have no bedside manner, and yeah, if things aren't moving on their timeline, they'll call it a "failure to progress" and head to the OR.

I only saw the evil OBs when I was in medical school. The ones I see now are more concerned with the well being of the mother and the baby, and, yeah, they practice defensive medicine, so more often than not, they don't take any chances. I don't think many other industrialized nations have the same legal issues that we do. Also, we have a high rate, but China has the highest rate of Cesareans in the world as they are limited to one child, and do not want anything to happen during the delivery. Also, Brazil has a higher rate than we do as well.

Just my observation.

Posted by: gothdoctor at September 8, 2010 8:22 PM

Couple of points from my two birth experiences. First, my midwife team was a part of the big OB/GYN practice I go to in my smallish Florida town. We were encouraged to go with them by the doctors if it looked like a routine pregnancy. Prenatal visits were set up so I got to know all three so I would know my delivery person no matter when I went into labor. My midwife, a certified nurse physician as already detailed, stayed with me from checkin to last stitch. She fought to get me the last bed in the hospital so I would not be diverted elsewhere. She reminded me that birth certificates do not come with a gold star if you avoid meds during delivery (meaning that I could have what I felt I needed - no more, no less). She kept my mom out of the delivery room.

Holy runon paragraph - point being that drug- free deliveries are neither encouraged nor discouraged by midwives. And the second point being that midwives are not always apart from regular OB practices. I really liked it because it gave me more options, and a backup plan in case anything went wrong.

Posted by: Kati at September 8, 2010 9:19 PM

I was going to rant, but gothdoctor and Samantha said it first. Just because something is 'natural' doesn't mean it won't kill you, after all, 90% of maternal deaths due to childbirth are in developing nations where 'natural' is about the only option.

yazikus The important difference between America and other western nations is actually access to health care. Among the middle and upper class, the mortality rate is no worse than any other western nation, despite the fact that these people are more likely to have a Cesarian. The Cesarians that kill are the 'emergency' measures taken in a vain attempt to save the life of a person who hasn't been able to afford the pre-birth health care and scans.
Sadly, this has become such an issue that scientists have started to claim it is a 'confounding factor' (ie something that will fuck up the outcome) in epidemiological studies performed on Americans.

Posted by: ScienceGeek at September 8, 2010 9:58 PM

"As a side note, the US has the highest maternal mortality rate of any industrialized nation."

Which says nothing about the link between mortality and access to hospitals. It's well-known that our mortality rate is higher than other PEER (meaning first-world, meaning hospital-based) countries because of prenatal care. The true comparison is between our peer countries and third-world countries with little access to hospital births, which have many, many times our mortality rate. Not to mention fistulae and all of the other horrific things that result from a difficult birth should mom (and/or baby) survive.

Posted by: samantha t at September 9, 2010 8:13 AM

Yay Jessica Mitford rocks! You should read Get Me Out, it's a more recent take on this topic with emphasis on the history of modern childbirth.

Posted by: FyreHaar at September 9, 2010 1:32 PM

Well...I am pregnant and I am planning on a home birth and I am TIRED of hearing people jabber on and on about how dangerous my choice is.

It's like people think a midwife just shows up to your house with a towel for you to bite on or something...sheesh! I am working with seriously experienced and trained professionals who bring a substantial amount of medical supplies with them.

Personally, I don't give a shit about how other women want to give birth. I just do not care. Want to go hospital and drugs all the way? Awesome for you.

But I find it hard to believe that people planning a more "normal" birth have encountered a fraction of the judgment I have.

Being in my final trimester and having some asshole try to tell me what they think about the manner in which I am going to push my child out of my cooter is really enough to drive me to violence.

Posted by: arr matey at September 9, 2010 4:46 PM

Well said, Samantha T and Gothdoctor.

Posted by: pyroplastique at September 9, 2010 10:48 PM

Arr: The problem is that the public face of your ilk are generally not as live-and-let-live as you are. Unfortunately, the publicity around homebirth (I'm sure you read that New York Magazine piece) has emphasized fringe homebirths and moms-to-be who believe breastfeeding is child abuse. You've been done a disservice on that front.

Godspeed when you have the little one.

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