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Conscious Empowered Birth
book review


Misconceptions by Naomi Wolf
Reviewed by Cristin Tighe


This book gives an honest account of the ups and down of pregnancy and birth for many American woman. Naomi is intelligently critical of the limitations imposed on women regarding birthing choices, cultural support and the reality for moms with a newborn baby. Her account of how women are disempowered around their choices regarding birth location, interventions, support and security are grounded in both personal experiences and in academic backing. The book is written as a story, so is easy to follow and entertaining, while also being packed with information and decisive, significant questions.

She describes typical mis-conceptions (p.113-135) that woman should be aware of: (1) the hospital approach is safest (not true for low-risk mothers because hospitals increase stress which can lead to high blood pressure, fetal stress, and delayed or problematic labor); (2) fetal monitors protect the baby (actually 40-60% of the time external monitoring is inadequate, and women unable to move around experience more pain, thus more likelihood of labor being induced, epidural use and c-sections); (3) “normal” birth position is conducive to labor and delivery (this position, introduced by voyeur Louis XIV who wanted to observe his mistress in labor, decreases the emotional and physical support available to women who can move freely, kneel to rotate the baby, squat to take advantage of gravity, feel support of being held from behind, receive massage, take showers, etc, so the position amounts to more pain and less easeful movement of the baby through the birth canal); (4) the Friedman curve determines a safe window for labor (this theory states that dilation of one centimeter should occur for every hour of labor), causing pressure on women to “perform” which may slow labor and defy what some perceive as a reality that labor starts and stops); (5) the doctor/hospital will offer adequate emotional support (often the physical contact that women crave to ease labor, is not seen as appropriate for medical staff, and varied nurses, doctors, residents coming in and out does not facilitate confidence, which is sad because emotional support leads to better contractions and less likelihood of interventions); (6) epidurals are necessary (labor and delivery pain can be managed if women are prepared, and epidurals take away not only pain but feeling, as well as requiring other interventions such as local anesthetic and pitocin for contractions which shifts the natural hormonal balance that helps with pain, etc.); (7) episiotomy should be part of standard care (time pressures usually creates the need for this procedure which actually cuts into deep-muscle tissue, has long-term associated risks of blood loss, infection, pain and emotional trauma) when, ironically, with time the natural hormones/processes can maintain the safety of the perineum and the baby’s birth with much less trauma); (8) you will require an emergency cesarean-section (this is not a routine procedure, but typically requires the uterus to be taken out of the body to be sutured up and involves risks like all major surgeries; also the rate of c-section has dramatically increased since the 1970s in the U.S. and many countires (in the U.S., was 6-10%, in the 1980s 40% and in 1990s 25%) because it is convenient and sometimes necessary after inducing labor and having an epidural); (9) you will be treated according to your medical needs, not your race of class (a disproportional induction of labor in women of color suggests that medical practitioners are less likely to wait around for non-white women).

Regarding women’s birthing options, Naomi describes the perceived “two doors” (p.110-113) that women chose– (1) high-technology hospital birth or (2) natural birth with a mid-wife (often taken to the extreme that women should birth without drugs or medical interventions and at home). In the U.S., hospital births are popular because of liability issues and profitability for obstetricians/medical institutions. The other option, that is not so seemingly available -- or even little known to mothers -- is a supportive birth center (p.140) associated with a hospital where women feel secure, make their own choices, but also know that if emergencies arise the opportunity exists to take advantage of technological resources. (Naomi gives an example of Ina May Gaskin, a well-known mid-wife with peer-reviewed, evidence-based proof of healthy babies/moms after natural birth.)  Regarding women’s options after birth, the book ends with some real stories of women (p.161-192) shifting into their new roles as mothers, while maintaining their relationships and trying not to lose themselves. She asks some tough questions (p.193-199) about American culture, feminism’s support of mothers, and how women are really left to struggle and sacrifice in a country which under-values the role of the mother and child caregivers in so many ways.

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