Friday, May 8, 2009

Pushed and preoccupied

I finally finished Pushed today. I've read a lot of books about childbirth, but this is most definitely one of the best I've ever read. The funny thing is that when I initially heard about the book in '07 and saw it sitting on display with the other new books at my library, I was turned off by it. Being the birth junkie I am, you'd think I would have eaten it up. For whatever reason, I couldn't bring myself to read it. But then my cousin-in-law read it and raved about it. And another friend. And a fellow doula-in-training. And I said to the universe... alright, already! I'll read it!

Thank you, universe. Thank you, thank you, thank you. Or, rather, THANK YOU, Jennifer Block. Too bad we can't mandate that everyone on the planet read the book. ;-)

I can't tell you how many times I read a sentence, statistic, or statement from a doctor or midwife and wanted to write a blogpost about what I'd learned. I think I was stunned, thrilled, appalled, and/or enchanted by something on every single page. I can't wait to read it again. Definitely buying my own copy for future reference and lending purposes!

Alright, enough gushing...

There's no question I loved reading this book, but it certainly wasn't an easy read. There were many times I felt sad enough that I wondered if I could keep reading it. The book also raised some important questions for me... questions I hadn't ever really considered before. And they are tough questions. I don't have time to address all of them here, but I do want to touch upon one or two.

Jennifer Block spent a chapter discussing doulas and childbirth educators. I've dreamed for several years about becoming a doula. I've been trained, I've read the books, and I've felt certain I wanted to pursue this path. Until now. Yup... thanks to Jennifer Block, now I'm just not so sure it's for me. Reading the experiences of the doulas she interviewed, I had to ask myself... can I really do this?! Here's an excerpt that hit me hard:
"Many doulas are emotionally devastated by the treatment they're privy to. 'If you care about birth, doing hospital births is very hard on your psyche,' says Barbara Stratton. 'It's hard to watch what they do to women.' And yet part of the doula's mandate is to make the woman regard her experience as a positive one. The doula ultimately can't throw herself in front of the scalpel, but she can figuritively throw herself in front of the woman's psyche. . . .

"As doulas 'reframe' the birth experience for their clients, they are also shielding the hospital and its care providers from criticism and complaint. . . .

"'The unanswered, fundamental question is whether [doulas] are making birth better for women, or just making women feel better about their births,' write sociologists Bari Meltzer Norman and Barbara Katz Rothman. They raise a fair critique of the doula as an enabler. By supplementing the handholding and informed consent conversations that nurses and doctors should be doing, and by buffering the level of intervention, they are perpetuating the very system that they are in the business of changing. . . .

"'This is is the hidden story of what goes on in birth. We've got folks talking about it as medical rape. Doulas are witnessing these things, and it's eating them up inside'"
(p. 160-161).
This section caused me some serious self-reflection. Am I capable of throwing myself in front of the psyches of my clients? Could I really stay positive in the face of abuse? Can I allow myself to be an enabler of this horribly broken system? Can my own psyche handle the emotionally challenging task of witnessing "medical rape" on a regular basis? I really just don't know if I could do it... Maybe I'm better suited to prenatal education? I just don't know if I can handle working in the trenches.

But then I think of the enormous impact doulas have. I think of the women who desperately need a supportive presence as they give birth. Can I leave these women alone?

So many questions... and I'm still not really sure what the answers are.


Liz Johnson said...

Pushed was AMAZING. I loved that book. Definitely Top 3 favorite birth books.

I wonder the same thing about being a doula. I wonder if I'm really cut out for it, or whether I could best fill the role that a doula has... I feel like I'd be better as a "You don't have to do that! You can say no!!!!!!" type of person, rather than the enabler type. I dunno. This dilemma is why I keep postponing the monetary investment of certification.

Missy said...

Sounds like a great read! I will definitely pick that one up.
I was just at an ICAN meeting last night when a midwife said something very similar to that quote. She gave up being a doula because of how hard it was to witness these sort of things in the hospital. At the same time I feel that doulas that do assist women in hospital births have the ability to make such a huge impact.

Hilary said...

I found this book so fascinating/scary . . . it's amazing what it points out about what's going on in the world of American births!

River Eden said...

"The doula ultimately can't throw herself in front of the scalpel, but she can figuritively throw herself in front of the woman's psyche."

Wow, what a powerful sentence. I don't think of myself as an enabler but I can see why some might think that. If a doctor wants to do an episiotomy, I always look to my client and say, "Dr. X is going to do an episiotomy, do you have any questions?" I think returning the focus and power to her is such a powerful thing we do as doulas.

Diana J. said...

"Pushed" is definitely one of my all-time favorite books - horrifying, but amazing!! I thought the same thing that you did about being a doula - I don't think I could take it. Who knows??? It's an interesting question to ponder.

Sarah said...

I haven't read the book but now I am really interested!
The whole Doula thing is interesting.

I am so grateful that with my last labor and delivery, I had a WONDERFUL nurse who got me through it with the least intervention possible. I had to be induced due to PPROM at 31 weeks and Group B Strep. I decided before I started that I was not getting an epidural and I was not getting pain meds while in labor. Because my baby was so early (9 weeks) and I was being induced they made me keep the monitor on. I told my nurse that I needed to be up and walking and moving as much as possible to do this the way I wanted. This nurse let me be up and moving and doing my thing and if the monitors came off she would move them, trying in the process, to bother me as little as possible and she was excellent at it. She helped me when I needed it by keeping me focused and left me alone when I needed to be. She also told the anesthesiologist where he could go when he came and asked her if I needed an epidural now. She told him that I wasn't getting one and he said "She'll be upset when she wants it later and it's too late." and the nurse told him I didn't need or want it and to leave me alone. I never saw him, for which I am grateful.
This nurse not only stayed after he half shift that she was filling in for someone to finish out my labor but she also stayed a couple of hours after everything was done to make sure I was ok and keep me company while my husband was up in the NICU with my very sick baby and I had not heard how my baby was doing!
My doctor (a family practice doc) was there for the last hour and a half of my labor as well. He helped me stay in control a few times too and was very supportive of what I was doing and how I was doing it.
To me, this nurse (and my doctor to an extent) are the type of people who are changing the system!

Faithful Lurker said...

This is on my "must buy" list already. I have heard great things about it. Thank you for the feedback and recommendation. I'll pick it up!

HollySteffen said...

I know what you mean. Its easy to put the blame on the hospital and say the interventions are abuse. And part of me wants to agree with that statement.... but I just was thinking more and more about it and this is what I came up with:

A Dr, Midwife, Hospital and even Doula cannot make a woman make a certain choice about her birth. So, what we need to do (and Doulas do a LOT of this) is educate our moms to educate themselves. We gotta put out the pros and cons and let them decide. We have to EMPOWER them to VISUALIZE how they want their birth and then make it happen.

Does this make sense? As a doula, you would be a prenatal educator and everything else that comes along with being a doula. =]

Liz-- I just read what you wrote- you CAN be that type of doula that says 'uh, you dont HAVE to do that'. My doula was JUST like that and i loved it. They wanted to start and IV and my doula was like 'cant she just drink to stay hydrated' bc she knew that was what i wanted.

Sarah H said...

I loved this book too. I've read it twice cover to cover and have re read parts of it 4 or 5 times. In fact, I have it here by my comptuer, and since my computer is soooo slow, I often read a couple of paragraphs while I'm waiting for it to load. I really want everyone to read it!

I think her coverage of a doula is very interesting and true. Right now I just feel gung-ho about being a doula because it means I get to be around birth and support women, but I can see how burn out would easily occur. The doula who trained me said she's mostly done with hospital births except for repeat clients, and instead wants to do mostly home births. She also said that you have to get together with other doulas to unload some of the things you see.
Anyway, I love your blog and all the great information you put out there. I think you would make a great childbirth educator and a doula if you decide to pursue that.

Anonymous said...

Wow. I really want to read Pushed now. I never thought about Doula's that way before. I can't even imagine what some doulas go through when watching the way some women are treated in the hospital. What an interesting thing to think about.