A Book Review Pt 1-Pushed by Jennifer Block

I find myself at a loss for words. Not because i have nothing to say, but because there was so much information in this book that made its way into my brain. My brain digested it and as I allowed it to process, I debated if I should she most of it, but then I realized, this book is literally for sale and anyone can pick it up and read it for themselves. It is not for birth workers only. It is not for public health or maternal health professionals only. This book is for you if you have even the slightest curiosity about the maternity care system. This is for you if you are planning to give birth at any point in your life or if you’re currently pregnant. This book will equip you with digestible knowledge and can provide tools in the box to help make decision all the way from what interventions you would be planning to include or not include in your care. More importantly, it can help you make a highly educated decision about where you birth and who you birth with. Let’s get into it.

In all seriousness I would venture to call this a candid expose of the maternity care system, I mean even into the healthcare system as a whole. The author takes the reader through various accounts and conversations with Obstetricians, health care administrators, organization leaders, and midwives to help unpack a well rounded take on where out maternity care system stands today. It is a very refreshing, eye opening, and radically honest, and quite frankly I found little to no bias throughout the entire book as it raises very raw questions that leaves the reader with no choice but to question the current state of the birthing industry. I say industry because this medical speciality has quite simply been founded on many disillusions to incite trust from a community. So here’s my takeaways.

This was a great eye opener as a birth worker serving both the hospital setting and the community birth setting. It gave me a comprehensive understanding of what very few practices that work in a hospital setting to the ones that blatantly don’t yet are still part of standard practice. I was left with the thought, the more you know, the less you can justify.

Realizations of success without technology:

She begins by telling the account of a nurse working for Florida Hospital under the consequences of a hurricane that had completely shut down all technology. This particular nurse happened to quit 1 year after.

“Safety protocols seemed to have no bearing on actual practice; she saw too many women induced or heeled to the operating room, she felt, because the floor needed a bed free or because the physician had to be somewhere; and she blamed the hospitals concern over the bottom line fo supplying the ward with too few nurses, which hampered their ability to give quality care.” -Jennifer Block

After this hurricane, the nurses looked at the records of the patients that had no access to any technology. The nurses had no access to monitoring, to managing, if you will. Yet somehow, the data they collected from the successful births that night of the hurricane were difficult to argue with. Within the next year, four out of the five nurses on that same time left Florida Hospital.

This was just one example that this book left me with an unsettling and quite helpless feeling yet at the same time inspired to drive change. The over use of technology has led us to a detrimental place. We want assurance. We want to prevent and yes we should where we can, however, over preventing can possibly be causing the cascade of intervention. We seem to lose control, seeking control.

She makes a point of “support vs. stabilize”. Supporting birth is what we need to be doing vs stabilizing or viewing birth as something to be managed. Medicine over time changes. As new information and new data come about it is mostly due to new findings that are deemed “worth studying”. For example, Block discusses the fear of weight gain between 1920 and about 1975. Babies post the baby boom were being born bigger because mothers were well fed, but unfortunately considered obese. So we had 3 generations of women starving themselves with severe caloric restriction to not exceed the 20lb maximum that was being fed to mothers. This caused an influx of low-birth weight babies and some neonatal deaths. By 1970-1980s the trend reversed. Why? Because we saw adverse results. Do you see the ebbs and flows?

These points through the book give the dire need for individualized care.

Liabilities and Decision Making:

This topic was really heavy. Everyone is human. Therefore judgement at any point can be off and when risk of losing a profession, money, career, credibility, is all on the line, the finding is that judgement can be skewed. The risk aversion discussed int hge book sheds light on the way that decisions are made on the labor and delivery floors. I learned something new when Block discusses the risk management departments and software dedicated to spitting out risk assessments which has the ability to either reduce or increase surgical birth.

“The minute you see a deceleration on the heart monitor, you say maybe it’s fetal distress, better to do a cesarean. You see the ultrasound and think maybe it’s too big, maybe we’ll have a shoulder dystocia, better to do a cesarean. A lot of that is driven by fear of liability” -Physician interviewed

The worries and concerns on the providers end is completely valid. In fact, it is my personal opinion that they should not be placed under the microscope and management of insurance agencies, including malpractice. While yes they should be held accountable for preventable adverse outcomes, it shouldn’t be to a point where they fear allowing birth to unfold the way it’s supposed vs over preventing out of fear.