Recent Posts

Thursday, February 24, 2011

What to expect when you're reading What to Expect When You're Expecting

According to most women, when you
read this book you can expect to be
given a major guilt trip, anxiety about
every calorie you put into your mouth,
and the idea that while you should
enjoy your pregnancy, you should
also log every symptom that might
suggest spontaneous combustion.
I don't go to book stores very often, but when I do, I always manage to end up in the childbirth section. It's like there's a tractor beam pulling me in - I can't help it. It's interesting to see what's on the shelves and what people are reading; sometimes nauseating at the same time.

When leafing through pregnancy books I usually check out their opinions and "advice" on two things first: inductions and cesareans. Both are serious problems in American maternity care, and what they say about it will sway me to either think it's right on the money or absolute tripe. Lately some of the books I've seen would make better toilet paper or campfire starters than anything else.

If you gathered a crowd of 200 or so pregnant women into one room and asked them if they've been reading any pregnancy books lately, I bet nearly all of them would have read What to Expect When You're Expecting. I'll admit, I even read it. Somewhat religiously, at first. And while it might be good for basic information (like, "Why do I have funky discharge?!") there are so many other books out there that should be considered.

If it's any indication of this book's popularity, look on any bookstore shelf, even at Target. There's probably two dozen copies of WTE for every one copy of Ina May's Guide to Childbirth, which doesn't mean you were lucky enough to get the last copy. It means the 24 copies of WTE are much more popular, unfortunately. Why? Because most people don't realize that along with everything else, you're getting overdosed on the typical 'abnormal as normal' pregnancy fare. Time to change that!

Not to discredit Heidi Murkoff, (who, for some bizarre reason, I thought was a nurse at first) but perhaps her book is a reflection of how she and so many people are unwitting victims of the modern obstetrical "system." The biggest complaint I often hear about this book is how alarmist and fear-mongering it is (especially when it comes to the infamous "Best Odds Diet"), and yet in some ways, they de-emphasize the things that women should be concerned about.

I do have an older edition of this book (that I bought at a yard sale for a quarter - about all I was willing to spend), but I'm sure not much has changed. On the "What to Expect" website, I looked up Pitocin and labor inductions, just to see what came up. Things like 'being overdue' came up, blah blah blah. Of course she can't be a smartass (like me LOL) and add, "Just because your doctor wants you to..." to the list.
"The amount of Pitocin given will be carefully monitored; you'll get enough only to reinvigorate your contractions."
I don't want to go so far to call Ms. Murkoff a liar, but I know that countless women across the country could probably say that this statement is far from the truth. Especially this laboring mom, who recounted her testimony on a discussion board about the "Pit to Distress" phenomenon on
"...he did instruct the nurse to increase the pitocin until I “cried” so that I would “beg for an epidural” and “give up my stupid plans for a natural childbirth.”
(Unfortunately, but understandably, this doesn't appear anywhere in the book either.) And, as far as fetal distress is concerned, WTE cites the most common reasons for it being multiple pregnancies, high or low levels of amniotic fluid, uterine growth restriction, gestational diabetes and preeclampsia. The word "Pitocin" doesn't appear anywhere on the page.

Nowhere on the page does she mention the risks of induction, but this misleading little gem is offered up:
"Once your contractions are in full swing, your labor should progress just as a non-induced labor does."
About AROM (artificial rupture of membranes), she says that the patient might notice a gush of fluid and then hopefully labor will start. It's been my experience that a gush of fluid means the baby's head is not in position, and this can cause an increased risk of cord prolapse, which can be very dangerous to the infant. And neither does she mention that while cord prolapse is rare, it can be caused by having your water broken while in labor.

Another complication that's mentioned is shoulder dystocia. WTE prefaces it by saying:
Only one percent of babies weighing six pounds have shoulder dystocia; five to nine percent of babies weighing more than nine pounds have shoulder dystocia. 
This statement kind of scares me, simply because women are already falling in droves for the 'big baby' scare that usually sends them for an induction or c-section in the first place. And we also know that Pitocin can lead to shoulder dystocia, depending on the way it's given. But again, it's not mentioned.

She does go on to say that a change in mom's position might help the baby's positioning, and that you may want to get into the best position that allows your pelvis to be as open as possible. Unfortunately, in reality this isn't always possible, nor allowed, during labor - as most women are confined to bed and not allowed much freedom of movement, and often told to push while lying on their backs or in a "c" position , which is just about as bad.

To her credit, she does say that episiotomies are often unnecessary and not part of routine practice anymore; that IV lines are often not standard procedure and includes advice on what to do if you don't want one, and acknowledges that restricting fluids during labor is 'fortunately far less common these days.' I'm not sure if I believe that either: I still read accounts from lots of women who say their hospital would not allow anything but ice chips during labor. She adds that IV lines can make a woman feel tied down to the bed and disable her freedom of movement, and they make childbirth seem like an "illness (which it isn't)." Unfortunately, she doesn't mention on her site what to do when your care provider insists you do these things, even though they have dubious efficacy.

This book - and the fact that it's sold millions of copies since it was first introduced - is downright scary. If you're just looking for something to cover the basics, then maybe you might get something from it, but otherwise I'd put it down (or in the garbage, which is where I think my original copy went) and move on to something else. Quickly. As one mom once put it, "I saw this book really cheap somewhere and bought it, just to keep it out of the hands of some poor, unsuspecting victim."

Our ideas of birth are already dysfunctional and abnormal enough without this "pregnancy bible" doing more damage.


Erinn said...

As a public service, I collect copies of books (usually purchased used or donated to the cause) which are worth reading and offer them in trade for books which are not.

For example, if a mom received a copy of What to Dread While You're Expecting, I would offer her a copy Sheila Kitzinger's Complete Guide to Pregnancy and Childbirth.

Lots of moms get copies of the "official" ACOG birth guide form the biggest OB practice in town. They're usually quite happy to trade me, because the ACOG guide is a better used as a cure for insomnia or to prop up a short-legged end table.

The Deranged Housewife said...

What an excellent idea! :D

TracyKM said...

I didn't read this book until maybe, my second pregnancy. I had heard how horrible it was, how it'd make me feel guilty, etc. But it didn't. I somehow just didn't let A BOOK make me FEEL bad. They're just words written by a writer.
I know though that it is so popular, and I really noticed a lot of misimformation/left out info like you mention. It is a decent pregnancy book, but it's not a labour/delivery book. Perhaps that's the problem.

The Deranged Housewife said...

No wonder women are afraid of birth - if they are scared into following "The Best Odds Diet!" to the letter and yet don't, and they "grow a baby that's too big" they probably feel like it was their fault. Unfortunately, everyone's definition of "big" seems to vary widely!