Interview with Jennifer Block, Author of “Pushed”


Jennifer Block, a former editor at Ms. Magazine as well as an editor of the revised Our Bodies, Ourselves, has clearly devoted herself to uncovering the obstacles to ensuring women's health and health care access in this country. Block's first book, "Pushed: The Painful Truth About Childbirth and Modern Maternity Care," takes you on a sincere truth-seeking expedition to discover why childbirth has become "medicalized" around the United States. As you wind your way through hospital halls and birth centers, listening in on interviews with midwives, OB/GYNs and childbirth advocates, Block uses meticulous research to paint a picture of a world where women are encouraged to disconnect themselves from their own bodies, rely on "modern" medical intervention for labor and delivery, and where hospital personnel are pushed to advocate for speed and profit over maternal and baby health.

AN: Why did you write this book?

JB: I get that question a lot—you've never given birth, why a book about childbirth? I've always been interested in women's health, in how we experience our bodies, the healthcare system, and in how politics so often affects our health and our healthcare. Childbirth never struck me as a political issue, but it turns out that it very much is. And I think it's important to know just how it affects the kind of care women receive, and what birth options they have or don't have. So I wrote the book to shed light on the reality of the U.S. maternity care system, which is not serving women and babies as best it could.

AN: What do you see are some of the root causes for, according to you, "overusing medical technology at the expense of maternal and infant health"? Have we (women) become less comfortable with and confident about our own bodies and our ability to birth naturally?

JB: I would agree that there has been a collective loss of confidence in the female body's ability to give birth, and a quiet acceptance of surgical birth as the solution. Having said that, however, I think we still have to ask how much of this system women are choosing, and how much is beyond their control. The women I've talked to overwhelmingly just want what's best for themselves and their babies.

When women agree to, say, induce labor because they're "overdue," or to schedule a cesarean because they're told the baby has grown too big (both are common reasons) those might be considered "patient choice" procedures, but we need to ask what kind of information they were given about the risks and benefits. The fear of a lawsuit and the financial pressures exerted by malpractice premiums drive physicians to intervene more. Many doctors told me that they are moving to cesareans more quickly because "you don't get sued for doing a cesarean."

At the same time, women are just bombarded by messages that our bodies don't work, that physiological childbirth isn't important. And the cesarean trend feeds this doubt, because women begin to think that if one-third of their sisters can't do it, then maybe they can't either. The fact is, we know from studies of healthy women who labor and give birth in supportive environments, with care providers who are trained to support the physiological process, 95% can birth vaginally. And that's optimal, for both mother and baby. The cesarean trend does not represent necessary cesareans.

AN: You address the issue of women seeking a vaginal birth after a cesarean (VBAC) in your book. Can you tell us a little bit about why VBACs are controversial? And why you believe this to be a reproductive "choice" issue?

JB: VBACs are controversial because they put doctors at risk of a lawsuit they can't defend, and because the American College of Obstetricians and Gynecologists has set a standard of care that is nearly impossible for physicians to meet. I explain more in the book, but the result has been that hundreds of hospitals have banned VBACs, and many doctors are refusing to attend them altogether.

The best data we have say that 1 in 2000 VBACs will result in the death or severe brain damage of the baby. That's an outcome that nobody wants, of course. But the reality is that the chance of a baby not making it through a first-time vaginal birth is about the same. One prominent OB/ethicist calls the VBAC hype a "distortion of risk."

So the decision of whether to plan a vaginal birth or a repeat cesarean is one that women need to make with full, unbiased information. But for many women, there is no choice. A recent survey found that more than half of women seeking a VBAC were denied it by their provider or hospital. Many, many women are being told they must have surgery – a clear violation of their constitutional rights.

AN: You tell the story of a man in Seattle who handcuffed himself to his wife's maternity bed so that he could be with her during the birth of their child. Washington State has been on the forefront of licensed midwifery. However, in Seattle, where I live, our second longest-running independent midwifery practice is only seven years old. Many have been forced to close—or have chosen to close—because of rising malpractice rates or are being "pushed" out by the mainstream medical movement. Can you elaborate on the "midwifery strain" and the discrepancy you uncovered in the ways in which midwifery is treated in this country from state to state?

JB: Midwives are a vital part of maternity care around the world. The World Health Organization has called them the most appropriate care providers for women experiencing normal pregnancies and births. They provide the bulk of care throughout Europe, and yet here in the U.S., Certified Nurse-Midwives are constantly fighting for coverage from Medicaid and private insurance while battling sky-high malpractice rates. At the same time, Certified Professional Midwives, who attend births out of the hospital—in birthing centers or in women's homes—find that in about ten states their job is illegal. For consumers it is a terribly confusing system. In New Mexico, for instance, you can choose a home birth with a midwife and Medicaid will cover it; in Illinois, you have to go "underground" and find an illegal provider. Midwifery care both in and out of hospital has been studied extensively and shown not only to be safe, but more likely to result in a healthy, vaginal birth. And yet in the U.S., we are driving midwives out of practice and underground.

AN: Did you research or uncover distinctions between upper-and middle-class women and their childbirth experiences and lower-income women's childbirth choices and experiences?

JB: The media often present obstetric trends as consumer trends, but the research (not mine, but large studies by CDC epidemiologists and public health researchers) actually shows that the rising cesarean and induction rates have little to do with women's bodies or choices, and more to do with changes in the way OBs practice. For a while there was a perception that high cesarean rates were specific to a white/wealthy demographic (one theory was that women with private insurance were more likely to be sectioned) but this isn't true today. Black women are generally more likely to give birth via cesarean. A recent survey actually found that almost half of first-time black mothers had given birth surgically.

One major difference between low-income women and high-income women, however, is that low-income women generally have fewer options to raise their standard of care. Doulas, who provide birth support and patient advocacy, cost between $500 and $2000 out of pocket. A home birth with a certified midwife can be anywhere from $1500 to $5000 [Editor's Note: in some states, as referenced above, midwifery care is covered by Medicaid for those who qualify]. So women who would otherwise choose a midwife often go with the care covered by their insurance because they can't afford otherwise.

AN: I know you spent a lot of time doing field research, watched many babies being born, and spent time with many laboring mothers. Was there one story or situation that particularly moved you?

JB: I did see a number of births, and I found them all moving in various ways. I like to tell the story of the very first birth I saw, because it was such a surprise. I was expecting to see what most of us think of as "normal" birth—woman lying flat on her back, people yelling "Push!", woman screaming, then baby screaming. I got quite a re-education. First of all, the woman gave birth standing up—I barely saw the baby coming out! The whole event was so much more peaceful than I'd imagined. The baby hardly cried, the mother was certainly experiencing pain, but the contractions looked more like hard work than anything else. There was hardly any medical intervention. Afterward, her family brought in a roast chicken and they had a party. Six hours later she went home. This is about as optimal as it gets, but this was in an independent birth center run by certified professional midwives. It's unfortunately not the norm.

AN: You say that this issue needs to be addressed as a significant women's rights issue. How can the women's movement/feminism address this issue more thoroughly? What do we need to do?

JB: Childbirth was an issue that feminists took up in the 70s and 80s, and some change happened. Even in the mid 1990s, a coalition of groups published a position paper calling for an overhaul of the maternity care system. But the issue has largely been dropped, and the focus is on preserving a woman's right to prevent pregnancy or terminate pregnancy, rather than on what happens when women choose to carry a pregnancy to term. In January, the National Advocates for Pregnant Women held a tremendous conference and challenged the pro-choice movement to advocate for pregnant women's rights, not just abortion rights. I strongly agree. I think the VBAC ban is the most salient issue, and women's health groups need to stand up and hold physicians, insurers, and hospitals accountable for effectively forcing women into unwanted surgery. But there's a much larger issue of women's access to optimal maternity care that feminists need to address. Some women are going to great lengths to access support for physiological birth, meanwhile most women are getting care that is not evidence-based and more likely to cause themselves or their babies harm. This should be of major concern to feminists. Women deserve better.

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  • invalid-0

    I’d like to imagine a world where every woman who has chosen to birth another human being is nurtured throughout her pregnancy, given sage advice from naturally relieving stretched skin and nausea to exercises before and during pregnancy that assist childbirth.

    I further imagine that every new mother is nurtured through lactation and wasting and becoming fully sexual with her partner again.

    I imagine this done with, of, for, and by women–a world just for us where we don’t feel like we’re taking up space in this man’s world–not in a way that excludes them, but in a way that women are in control of this magical process that happens not just to our bodies, but to our minds and spirits as well.

  • invalid-0

    I absolute agree. I think women have been conditioned to feel insecure in our bodies, and we have become disconnected to the experiences of our mothers and grandmothers. I hope that a renewed focus on childbirth as a political and “feminist” issue helps women to reconnect with ourselves in this way.

  • http://orgasmicbirth.com invalid-0

    Thank you.
    As an educator and doula for many years I could not agree more that women and their families deserve better. It is time to put birth on the femist agenda! To wake up young women and men to the issues at hand. Pushed, Childbirth Connection, CIMS, Lamaze, our many authors, and organizations, are creating an awareness of the issues. Now is the time to join together and start a movement.

    It is time to use the power of the media to provide positive images of birth.
    We are in the final stages of editing Orgasmic Birth, a documentary that examines the sacred and sensual nature of birth and its powerful role in the lives of women who are permitted to experience it fully. People who see this film will reexamine everything they thought they knew about the act of giving birth and its life-affirming potential for both parents and baby.
    How women are cared for as they give birth and how their babies enter the world have profound effects—not just immediately, for the families involved, but also later, on all of society.

    thank you for helping to raise awareness of the importance of birth in a woman, babies and families lives and how out of control our current maternity care system is in protecting and addressing women’s safety and well being.

  • http://www.ourbodiesourselves.org/ invalid-0

    Thanks for this great book, Jennifer– it’s much needed. Many women think medicalized birth is the safest birth for them and their babies, but an increasing amount of research is showing that this isn’t true. The widespread routine use of medical interventions during labor and birth has not only failed to improve the safety of childbirth for women who are at low risk for medical complications, but can disrupt the natural rhythms of labor, undermine women’s confidence in our capacity to give birth, and decrease our satisfaction with our birth experiences.

    We at the Boston Women’s Health Book Collective have been working on a book on pregnancy and childbirth that will be published next March. We hope it will help women understand the range of birth options available to them and will contribute to the ongoing discussion of the politics of birth. For more info, see the website of Our Bodies Ourselves.

  • invalid-0

    Thank you for this interview. I think it was very good and this is a topic that still needs lots of attention. However, I wanted to point out that many women have felt betrayed and bullied by midwives as well as doctors. I had a homebirth midwife for my first pregnancy, yet I still ended up being bullied into the hospital, into induction, and ultimately into a c-section. My birth could not have gone more “wrong” and further away from what I had envisioned and planned on.

    My experience with this midwife, as well as my experiences in trying to find a midwife who will even consider taking me as a VBAC client have taught me that many midwives are failing women in much the same way that doctors are. I don’t feel that this problem gets enough attention. There are many articles and books praising midwives as the solution to America’s over-medicalized and interventionist birth culture, but I have found that many midwives are susceptible to falling into the same traps of fear–fear that something will go wrong, and fear of litigation. It is unfortunate that I have encountered so many midwives who only give lip service to the idea that birth is normal and that they trust in the mother’s ability to give birth. It is one thing to say it, it is another to truly live it, and such confident and trusting midwives are sadly too few and far between.

  • invalid-0

    Thank you for speaking up. Yes, your story is proof that there are certainly midwives out there who do not advocate on behalf of their patients as much as one could in relation to intervention and over-medicalization of birth. I had a certified nurse midwife for my first birth who, as I discovered during labor, was not an ally in my quest for a natural birth free from intervention. Though I ultimately did birth “naturally” I could not rely on her to advocate on my behalf. It was disappointing to say the least.

    But though there are certainly cases of individual midwives not “living up” to patient’s expectations, I still strongly believe that midwifery does much more good than harm and should be the norm for the care of all healthy pregnant and laboring women! Thanks for commenting!

  • http://www.unassistedchildbirth.com invalid-0

    I bought Jennifer’s book the minute it was released and I wasn’t disappointed! I was amazed to learn that it is possible for a woman in the hospital to be hooked up to 16 different machines when she gives birth. Most people look back in horror to the days when women in labor were strapped to tables (a common proceedure in the first half of the 20th century) yet how far have we really come? When a woman is hooked up to 16 different machines, she might as well be strapped to the table, for her freedom to move is gone. Too many women are “birthing in captivity.”

    I am also thankful to Jennifer for being one of the few authors that has been willing to deal with intentional unassisted childbirth. I was interviewed for the book and felt she accurately conveyed my thoughts on the subject. Jennifer devoted several pages to the UC (unassisted childbirth) movement. As the woman above stated, a midwife-attended birth is not always the solution, as most midwives have their own set of rules they must adhere to. Many women prefer to give birth alone or with friends and family. This is an option that must remain legal in a free society.

    Thanks for posting this great interview, Amie! I hope Jennifer gets lots of positive press!
    Laura

  • http://www.alittleredhen.com invalid-0

    important interview. i’d encourage jennifer block to consider that one way we could get more leverage, more support from women of different ages/situations would be to be more inclusive–beyond birth and abortion. all of our health issues have been medicalized, at every age.

    came here through the blog, doulicia, which opens my 70+ world to the concerns of women younger: we ourselves can decide to move past ageist boundaries! -naomi

  • invalid-0

    I just finished “Pushed” and was truly impressed. I have also been a childbirth and lactation educator for years, and recently came off of my self-imposed “break” because I couldn’t stand what was happening to birthing women and how they were so “brain-washed” into thinking it was all normal.
    It is time to push this issue into the “birthing rights” arena.
    I also foudn her comments on doulas to be informative and something I have been pondering on for a few years.
    Great book, just on time!