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Parenting Book Review: Giving Birth

Finally a book that tells the truth about what really happens when a woman delivers 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-midwife and patient, as well as stories from the many births she attended as an observer or doula.

What is most surprising about the retold childbirth stories is that the author realizes that the certified nurse midwives trusted by pregnant women are agents of medical institutions. In story after story, CNM patients are misled about what to expect from their childbirth experiences.

Taylor followed several CNMs during their regular work days at their hospitals. CNM care often mirrored the care of doctors and nurses, as busy CNMs left their clients in very active labor. He states a CNM: “We try to compensate by having a nurse attend to them.” However, while several CNMs expressed a desire to be more actively involved with the women they care for, none provided women with hands-on, ongoing care during their labors and births. Taylor points out that CNMs in hospitals often 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 story after childbirth story, the reader becomes aware of CNM’s inability to prepare women for drug-free, empowering childbirth. Woman after woman bought into the hospital’s clever promos showing radiant new moms and dads holding their little one with the ever-present staff hovering nearby. The harsh reality is that for most women this was a fantasy.

Midwife clients were unprepared for the pain of labor and what to do about it. Midwives were too busy rushing from patient to patient to do more than stick their heads in a room long enough to put on a glove and check for dilation and make silly suggestions for pain management. Nurses also did not have time to provide one-on-one support, leaving women and their partners on their own, uneducated on what to do.

A theme that runs through many of these stories is the power the hospital has over MNCs. Whatever their personal beliefs may have been, they inevitably acquiesced to hospital administration or physicians if there was friction between what a client/patient wanted. Some of the examples given include giving out bags of “treats” loaded with formula while, in theory, promoting breastfeeding; telling a woman that she needs pitocin when in fact it is being administered to speed up labor for the benefit of the staff; and break a bag of water for the convenience of the doctor.

Many CNMs seem to enjoy their role as mini doctors. IV lines, rupture of membranes, ordering antibiotics, pitocin, and epidurals, cutting episiotomies, and vacuum suction pulling babies are daily activities for CNMs in hospitals. However, the ACNM states that one of the main characteristics of a midwife is that of an advocate “of non-intervention in the absence of complications”. With the widespread use of routine interventions by CNMs, one must wonder if any of the ACNM publications can be trusted. One CNM told 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 small you may have to have a C-section for all your babies.”

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

Some women have been able to hire doulas to provide emotional support and unbiased information about hospital interventions. Unfortunately, this isn’t always what they thought they were getting either. As Taylor points out, doulas are trained never to be judgmental. This means that if a woman suddenly decides that she wants drugs during labor, the doula supports her. Like CNMs, doulas often find that they must walk a fine line to be welcomed in a hospital. Sometimes this may mean not 100% defending the woman, but rather guiding her to comply with some unnecessary intervention that reassures the staff and keeps the doula in good condition.

Taylor found that in a hospital, most CNMs had home births. She attended several home births while researching this book, as well as at Elizabeth Gilmore’s birthing center in New Mexico. Taylor’s thing is that her second child was born at home. After her first less than satisfactory delivery, Taylor explains that at home a woman’s ability to give birth is protected rather than controlled. This is what Taylor wants. This is, I think, the main reason women in America choose to have a home birth.

Taylor’s emotional process of moving from a hospital birth to a home birth is detailed in some detail in this book. Those of us who have had home births know exactly what you are dealing with when you explain your home birth decision to those who only believe in hospital birth. She writes, “I realized that my friend’s viscerally negative reaction to home birth was probably not based on any knowledge or information, but rather unfounded fears.”

While an ideal delivery arrangement is to have supportive medical care ready in case of an emergency, most home birth families and midwives find this very difficult to obtain. Unlike many American women, Taylor had insurance while she was pregnant with her second child, and she used that insurance to purchase backup care that her CNM was unable to provide. While doctors criticize those who plan home births without medical support, these doctors increase the dangers of home births by refusing to provide care they believe is essential to safety. Like Taylor, who pretended to plan a hospital birth to have emergency medical care available, those with money can buy a safety net. The rest cross their fingers or pray.

Taylor’s praises Elizabeth Gilmore’s freestanding birthing center in Taos, New Mexico. The practice employs obstetricians who provide integrated support for midwifery clients. Clients can choose to deliver at home or at the birthing center. Though seemingly idyllic, the birthing center has been a labor of love for Gilmore, who has worked tirelessly to keep it viable. Birth policies are everywhere an endless war.

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

Taylor acknowledges that the road to self-discovery is often filled with pain, vomiting and bodily fluids. “Yet it was one of the most vital and powerful moments of my life… my midwife not only attended the birth of my baby, she attended the birth of a new, powerful, confident and loving part of me.”

Amen.

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