Sunday, September 21, 2008

Book Review: "From Here to Maternity"

"From Here to Maternity"
Connie Marshall, RN
1994, rev. 2002, 291 pages

I found this book randomly at Goodwill a couple of months ago (along with four other pregnancy books - someone was cleaning house, hurray!) and picked it up to read.

This is a nice little book. Really, I found myself with mixed feelings over it. It's great on the one hand and not so great on the other. The good part is that it is (except for various biases and inaccuracies) a great source of material. The bad part is that it is not a book that leans toward either natural pregnancy or natural birth. If you are already educated about natural birth, then it is probably a great book to read for information. If you're just starting out, make sure that you include a good selection of naturally-minded books along with this one.

I found a surprising number of inaccuracies in this book, along with some obvious bias for the medical (as opposed to holistic/midwifery) model of care. Let's look at some of these areas to start:

Let's start with the worst of the worst. This statement BLEW ME AWAY in its blatant falsehood:

"An epidural does not increase your chances of having a cesarean." (p. 86)

What???? People have the right to be in favor of epidurals (I sure was when I was in labor!), but they do not have the right to lie about them. Here is the truth of the issue: A laboring woman who has an epidural is roughly four times more likely to have a c-section than a woman laboring without one. Don't believe it? Here's the study:

Association of epidural analgesia with cesarean delivery in nulliparas

Why is this so? Many reasons. Hormone disruption, laboring on one's back, cascade of interventions (including pitocin augmentation to replace the uterine activity usually lost with an epidural, leading to fetal distress, etc.) - there are a number of reasons why things start to go wrong once a mother accepts an epidural. This is especially true of mothers who get epidurals early in labor - the earlier you get an epidural, the higher your chance of a c-section (see section in "Hey! Who's Having This Baby, Anyway?" by Breck Hawk for more information on this subject).

So anyway, that statement made me upset. It is blatant disinformation and should not be present in a well-researched pregnancy book.

Here's the second mind-blowing statement in this book (talk about unsubstantiated bias!):

"The decision for a home birth transcends economic and safety considerations because of a deep emotional commitment to a home birth experience." (p. 83)

Basically, "If you are having a home birth, you're a mindless fanatic who doesn't care about your safety or your baby's safety because of your illogical devotion to a cause." This is in spite of the fact that numerous reputable studies have repeatedly shown homebirth to be as safe or safer than hospital birth, with overwhelmingly more positive birth experiences for the mother and more gentle treatment for both mother and baby. Hmmm. Interesting.

However, following that degrading statement, Marshall does give some good guidelines on choosing a homebirth midwife. Kind of weird, but at least it's there!

Here are a couple more...

"If you and your doctor opt for inducing labor, skip to the induction section - your prayers have been answered." (p. 122)

Considering the myriad of problems for both mom and baby that are started by unnecessary labor induction (and with our induction rate at about 40%, you can bet that most of them are unnecessary), a good pregnancy book should never encourage or make light of this subject.

The following is another mind-blower - it is filled with so much falsehood that it was hard to read:

"Before electronic fetal monitoring, the labor nurse listened to the baby's heartbeat once an hour for 15 seconds; it didn't provide a wealth of information. As a result, some cesareans were done for fetal distress that wasn't there. Some babies who were distressed were missed because a stethoscope couldn't pick up subtle clues the electronic monitor can. More than a few cesareans have been avoided because the heart rate pattern was reassuring. Overall, the fetal monitor has had little impact on the cesarean birthrate... In many cases, fetal monitoring heads off disaster by detecting early signs of fetal distress." (p. 146)

Now, for the actual truth of the matter:

- Intermittent monitoring with a fetoscope, stethoscope or handheld Doppler has been proven to be as effective in monitoring fetal well-being as is continuous electronic monitoring.

Why Are We Using Electronic Fetal Monitoring?

- Continuous electronic monitoring has had absolutely no positive effect on the fetal mortality rate or on rates of birth-related damages to babies. On the contrary, it has been linked to an astronomical increase in the rate of cesarean births.

Association of electronic fetal monitoring during labor with cesarean section rate and with neonatal morbidity and mortality.

- Continuous electronic monitoring is infamous for both false positive readings (looks like something's wrong when it's not) and false negatives (everything looks fine when it's not)
- Continuous electronic monitoring is also a tool used by many unscrupulous caregivers to influence reluctant mothers into unnecessary cesareans

Moving on....

On episiotomy:

"It all boils down to being flexible and trusting your doctor to make the appropriate decision at the time. Most women who have a regular midline episiotomy agree that it's no big deal. The incision heals rapidly and the discomfort is minimal - you don't need pillows to sit." (p. 174)

Point #1 - I think there might possibly be some women out there who would disagree with that. Just possibly.

Point #2 - If I make it clear to my care provider that I do not want an episiotomy, then I expect my wishes to be honored. If an episiotomy is really necessary, then he/she can ask for and receive my permission. But I'm certainly not going to sit there and say, "Do whatever! I don't need to know, just feel free to cut without consulting me!"

Regarding internal fetal monitoring, in which an electrode is screwed into the baby's scalp:

"The procedure is probably no more uncomfortable for the baby than the contractions." (p. 177)

Hmmm. Hmmm. Hmmm.

No one is going to deny that internal fetal monitoring is sometimes necessary and beneficial. But to write off the baby's pain from the procedure (which is a highly unnatural pain) by comparing it to pain from contractions (which may or may not exist for the baby!) really seems like a cop-out.

Those are just a few of the inaccuracies I found.... But I won't go on.

Despite having started with the negative, I really did like this book. The author has a clear, concise writing style, a well-organized text, and a great sense of humor. Here's a great one:

"The herpes virus is the Greta Garbo of sexually transmitted diseases - elusive and mysterious." (p. 108)

This book is thorough (not too detailed, but still thorough) and covers all the usual topics very well.

One thing I love about this book is the diagrams, illustrations and charts - they are super-informative and very helpful.

This book also covers a surprising amount of alternative health care options - therapeutic touch, herbs, reflexology, pressure points, and more. I learned quite a bit that I didn't know!

I really liked this book. The only thing that keeps me from giving it unqualified recommendation is the fact that it is definitely within the medical model (rather than holistic), and is hostile to homebirth, midwifery care models and anything that swerves from mainstream pregnancy care. Thus, although I can't recommend it completely, I do recommend it - just make sure that you are reading other good-quality natural childbirth books at the same time.

1 comment:

  1. Oh, DEAR! Not a biased book at all! [giggle-snort]



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