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Conscious Empowered Birth
book review

The Thinking Woman’s Guide to a Better Birth by Henci Goer
Reviewed by Cristin Tighe

Henci Goer’s book is an excellent, thorough, comprehensive review of varied interventions as well as other significant considerations related to conscious birth choices. She does comprehensive overviews of the literature and summarizes pieces (p. 219-320) and includes a large bibliography (p. 321-341).  This offering alone was so needed when the book was published (and still is!), but in addition, she then writes the book in a user-friendly way, that is easy to follow and to reference later or for topic-specific information. The quality and thoroughness of her research is unique and superb for someone who is not officially an academician.  The biggest downfall of the book is that is now dated, and it would be amazing for her to write a revision with updated information on the last ten years of literature and research.

By laying out the distinction/extremes between the two models of birth – the medical model and the midwifery model - she helps women to understand the real importance of making informed choices. Her overview of Obstetric Management is clear and concise:
“The problem is that obstetric beliefs don’t fit the realities of pregnancy and childbirth.  Obstetricians-gynecologists are surgical specialists in the pathology of women’s reproductive organs.  The typical obstetrician is trained to view pregnant and laboring women as a series of potential problems, despite the fact that pregnancy and childbirth are normal physiological processes… Obstetric belief tends to become a self-fulfilling prophecy…. Obstetricians work within the medical model, a model that says drugs and procedures are the answer to whatever goes wrong.  However, labor difficulties usually resolve themselves with tincture of time or simple remedies…  Obstetricians are also influenced by the broader culture in that it is believed that technology is superior to nature and machines are more reliable then people.  This explains why they will not back off from technologies that have proven to be failures except to replace them with the next new and untested expensive technology… It also explains why not intervening has the burden of proving itself rather than the other way around.” (p. 3-4)
Her purpose in writing the book is also explained well:
“There is another model of care, that unlike obstetric management, fits the realities of pregnancy and childbirth.  The midwifery model of care is founded on the belief that pregnancy and labor can be trusted to go right most of the time… Emphasizing supportive rather than interventive care, the midwifery model demonstrably produces equally good and often better outcomes.” (p. 5)

Understanding there are two models is so important for women, as is clarity on the weaknesses of each. All of us in modern times are often blinded by the positivistic focus on technology as the best choice, but despite some benefits of technology, most people do not understand the scientific model and the economic and corporate pressure, as well as real liability issues that doctors and hospitals face… all of which are not congruent with giving babies and women time to birth and trusting the power of women to birth. Women today, living in a patriarchal world, have not likely been exposed to healthy, intervention-free pregnancy and birth, and maybe have never seen a baby be born to a conscious empowered mother, even on television.  Ricky Lake in the film “The Business of Being Born” interviews medical Interns in Gynecology who realize that despite experience with birth, they have never seen an intervention-free, pure birth… and they are surprised with this realization!  This book is very important, real contribution to empowering mothers around the realities and limitations of the more dominant model, and that they can choose more positive outcomes.

Henci Goer reviews the many interventions and clarifies there are real benefits, as well as real risks to each.  Her approach is interesting and non-repetitive, laying out “myths and realities” (p.12), asking, “What’s the problem…?” (p. 32), “Why not wait?” (p. 50), exploring “pros and cons” (p. 79), “How did we get into this mess?” (p. 90), “Why you don’t hear…?” (p. 126), “The odds of…” (p. 169), and “History reexamined…” (p. 202).  Each chapter explores a different intervention completely, including the history, why you would consider it, and the “bottom line” including ways to avoid it or to handle it, if it occurs.  She also has written in “Gleanings from the Medical Literature” to not only empower her view, but to allow the readers to make informed choice about what she is saying (thus, what to choose). Despite her stated bias toward the midwifery model, the book moves through the critical thinking needed to explore each intervention in depth, to be fully informed of the who, what, why, when, where and how of its emergence and its use. Simultaneously, with this depth, she provides breadth in explaining the history of interventions, the potential cascading effect of them, as well as how to make conscious choices (see last three chapters on professional labor support, choosing birth attendants, and the place of birth).  Her work is a critical contribution to the field and to new parents in choosing a conscious birth and all the benefits that follow.

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