Our Bodies, Ourselves: Pregnancy and Birth

By Kiki Zeldes and Judy Norsigian

From the time the first edition of Our Bodies, Ourselves was published in 1970, it has provided indispensable information on women's health and sexuality. With each new edition, the authors and editors have struggled to include an ever-growing amount of health information without sacrificing the personal stories and social analysis of health care that are the hallmarks of the book. Looking for an opportunity to cover certain health concerns in greater depth, we recently produced two new “single topic” books: Our Bodies, Ourselves: Menopause, published in 2006, and Our Bodies, Ourselves: Pregnancy and Birth. This article is based on excerpts from the latter book, which came out in March, 2008.

Books about pregnancy and birth abound, so why did we write another one? Primarily because we believe that the maternity care many women receive does not always serve the best interests of women, babies, and families. Pregnancy and birth are normal, healthy processes for most women, the vast majority of whom have healthy pregnancies and babies. Yet childbirth is often seen as an unbearably painful, risky process to be “managed” in a hospital with the use of many tests, drugs, and procedures. The high-tech medical care that is essential for a small proportion of women and babies has become the norm for almost everyone.

Our Bodies, Ourselves: Pregnancy and Birth presents the best available evidence about the advantages and disadvantages of a range of practices, from epidurals to episiotomies. It includes the important warning that some common procedures are not consistently helpful to women in good health and might be better avoided in some cases, while other practices that have been shown to improve birth outcomes are not offered widely in U.S. When used appropriately, maternity care interventions such as artificial induction of labor, episiotomies (cutting the opening to the vagina), epidurals, and cesarean sections can improve health outcomes and even save lives. Yet far too often, these interventions are used routinely on healthy women, despite clear scientific evidence that they are unnecessary, ineffective, and/or can cause harm.

The widespread routine use of medical interventions during labor and birth has failed to improve the safety of childbirth for women who are at low risk for medical complications. In addition, these interventions can disrupt the natural rhythms of labor, undermine women’s confidence in our capacity to give birth, and decrease our satisfaction with our birth experiences. At the same time that such procedures are overused, others which have been shown to improve birth outcomes — as well as women’s satisfaction with the experience of giving birth — are widely underused. These include receiving continuous one-on-one support from a skilled, experienced caregiver during labor; being able to change positions, get out of bed, and walk during labor; and using comfort measures such as massage, warm baths, and birthing balls (these are large physiotherapy balls that women can sit on, rock on, or lean over and rest their arms on).

The book offers concrete advice and support for birthing women: The path to motherhood involves navigating through a health care system that can be complex and sometimes intimidating. While some aspects of maternity care are shaped by economic, social, and political forces beyond our individual control, there are things you can do to increase your chances of having a healthy and satisfying pregnancy, birth, and early postpartum period.

As much as possible, surround yourself with the kinds of supportive practices that have been proven effective but are sometimes underused, and avoid unnecessary medical interventions. Choosing a health care provider and birth setting that make judicious, conservative use of interventions, learning about the advantages and disadvantages of different medical procedures and treatments that are offered to you, and declining those procedures and treatments that you do not need can help you have a safer, more satisfying birth experience.

We hope that Our Bodies, Ourselves: Pregnancy and Birth, in addition to being a practical resource for individual women and their families, will also be useful as an advocacy tool. For example, a short sidebar in the book about reintroducing nitrous oxide into U.S. hospitals as one option for coping with pain during labor has generated interest in advocating for its use in several hospitals and health care systems. The book has already been useful in advocacy efforts to license and regulate Certified Professional Midwives (trained direct-entry midwives who practice primarily in the home setting).

The book also discusses the growing lack of access to vaginal birth after cesarean (VBAC) and how this lack of access contributes to the alarming rise in cesarean rates (about one mother in three has a cesarean birth today). It provides information and tools to fight against hospital VBAC bans, and includes the following story, about a woman who fought one such ban:

More than 300 hospitals in the U.S. do not allow women to choose to have a vaginal birth if they have previously had a cesarean section, despite the facts that the option is very low-risk and that cesareans carry their own set of dangers. As a woman with a previous cesarean myself, I feel strongly that all women should be given information on the risks and benefits of vaginal birth after cesarean (referred to as VBAC) and allowed to make their own decisions.

In Maryland, where I live, Frederick Memorial Hospital announced a ban on VBACs in August of 2004. My first reaction was, “Not in my state!” Birth activist Robin O’Brien and I quickly co-organized a rally that was held in November of that year. We began at a park near the hospital, then marched around the hospital itself while chanting and carrying signs. The event attracted a lot of local media attention. I contacted The New York Times, which published a front-page story on the nationwide problem of the bans. A day after that article hit, the chief obstetrician at Frederick Memorial was invited on the Today show to debate the president of the International Cesarean Awareness Network (known as ICAN). USA Today and The Washington Post eventually did lengthy stories on the issue as well. After the rally, I continued to apply pressure to the Frederick hospital through the media and government agencies. In August of 2006, Frederick Memorial Hospital reversed its ban, citing “community pressure” as the reason.

Our Bodies, Ourselves: Pregnancy and Birth is available in bookstores everywhere! For more information about the book and our organization, see www.ourbodiesourselves.org. OBOS Executive Director Judy Norsigian is available for speaking engagements and media interviews on a range of women's health topics. For more information, contact her at judy@bwhbc.org.

Kiki Zeldes and Judy Norsigian are the editors, along with Heather Stephenson, of Our Bodies, Ourselves: Pregnancy and Birth.