Your (Fearful) Pregnancy, Week by Week

Consider yourself warned.

If you want to witness fear-based obstetrics at its finest, check out this book.

Seriously, one reader commented that it was the "most fear-based book I've ever read...it's the only book I've ever put into the trash in my whole life."

Wow. Was it really that bad? I wondered at first. I checked it out from the library and decided to find out for myself.

The first thing that really struck me was the little callout box on the cover: "The Only Best-Selling Guide Written by a Doctor - Millions of Copies Sold!" I was immediately skeptical. To the unsuspecting pregnant woman, that's supposed to mean, "Everything written in this book is true, because it was written by a doctor."

There was also a nifty quote featured from Dr. Elizabeth Warren (should I know who that is??):

"The primary book I recommend...I know I can trust it. It's organized, up to date,  and provides women with terrific information."

Surely you're joking.

As far as being up-to-date, that's only as good as the copyright date, so there's not much I can say about that. I had a good chuckle when she said it was "organized" - in that case, I think either Dr. Curtis (the author) or his editors were smoking something, because that's one thing I noticed about this book: it seemed very willy-nilly and strange in that respect. In one paragraph we're talking about testing and procedures to baby's presentation to bug spray and its bad side effects. Then we jump from TB and lupus (even Mad Cow disease! As if you didn't have enough to worry about while pregnant!) to "How much does having a baby cost?" I thought my head was going to fall off.

I don't want to sound crazy or all conspiracy theorist, but I think this book is full of lies. (Lies! They're all lies, I tell you!) Or at the very least, it's lying by omission.

Why do I think that?

Lie #1: When it comes to the biggies, like VBACs and cesareans, Dr. Curtis (who's first name is Glade, which makes me automatically think of a stinky bathroom and a can of air freshener) spends little time discussing the risks of repeat cesareans. He also spends blessed little time emphasizing how those risks can essentially be mitigated by having a VBAC. Not surprisingly, he prefaces elective cesarean as "patient choice," but most of us realize that the mother agreeing to a cesarean simply because her doctor made it sound like she was going to spontaneously explode without one doesn't exactly equal "choice." At the end of the day, we know that many women have little, if any, choice in the matter at all.

Dr. Curtis makes a glaring discrepancy by not really mentioning how repeat cesareans can impact future pregnancies, which is probably why conditions like placenta accreta are on the rise. Curiously he mentions a product called ON-Q, a system of medication delivery that administers pain medicine to just the incision, rather than the entire body. While it sounds interesting, I wonder how many hospitals use it -and the words "Ask your doctor about it at one of your prenatal visits" makes me think of a drug commercial (shameless product plug here!). Is he basically saying, "Just in case you have to have a cesarean - and many women do! - you should be preparing yourself for it. You know ... just in case."

One thing I can't stand is the assumption that just because you want a natural birth/VBAC/something other than the "norm," it "might" fail. It's like tearing you down before you even begin. Conversely, I also don't really like the idea of saying "I will have a vaginal birth!" because really, you don't know that either. It's important to have confidence in yourself, yes; but we can't be too presumptive, either.

Lie #2: He sets you up for more pessimism and failure later: "but you might need another c-section anyway" (with regards to a diagnosis of CPD). You might as well add, "So you should just skip your stupid, lofty plans for VBAC and just have another section." Again, we hear "Not all hospitals permit VBAC nor are they equipped for it." If they're not equipped to handle a VBAC, then why are they delivering babies at all?

Lie #3: You can't eat anything more than ice chips in labor. I think even the recent studies were published by the time this edition came out (2008), yet they're still promoting starving a laboring woman. If your hospital insists on nothing by mouth, know that they're basing their findings on a very outdated study done in the 1940s that suggest women who have food and drink in their stomachs *might* aspirate it should they need anesthetic. I'm hoping, as I'm sure you are, too, that methods of anesthesia administration have improved dramatically since that time, and that your risk of aspirating is even lower than it probably already was then. Should you experience a long labor, light food and fluids (notice I didn't say turkey dinner with dressing and four gallons of pop) is going to give you essential energy to stay strong throughout. Dr. Curtis doesn't mention any studies (or anything else, for that matter) other than hospitals won't let you eat and drink (and really, some do, by the way) except that "it's for your own safety." (So don't worry your pretty little head over it, okay?)

Lie #4: "Avoid anxiety-inducing TV programs." Unless he's talking about Law & Order, I'm assuming he means all those insipid "reality birth" shows that are cropping up. I can't argue with him there, except for a different reason: I haven't seen one episode of "A Baby Story" that's even remotely realistic. Ditto on "One Born Every Minute" and all the others. So yeah, you'd be best to stay away, but not for the reasons he's thinking, I'm sure.

He also suggests "be careful of what you read on the Internet." You know, because those crazy bloggers that talk about natural childbirth all day (and give this book bad reviews) might give you some empowering information that might convince you that you can have a different experience than what Dr. Curtis thinks you should have. Seriously? I will admit, there's a lot of crap out there on the 'net about birth - both natural and medicated - that should be taken with a grain of salt. But there's also a lot of good information out there, and anyone who wants the trust and respect of their readers will provide reputable links that encourage you to read up on your own. Most blogs I read will have a blog roll of other birthy links for more info, and they come from some very well-respected, trusted midwives (and other sources). You're going to have a lot of pro- and anti- information thrown at you, but I really hate how he almost makes it sound like all the crapola and nonsense comes from pro-natural birth sources. 'Cause we all know there's some real shi!t-slinging going on from the other side too, don't we? (cough)

As far as natural birth philosophies, he does mention the big ones: Bradley, Lamaze, and hypnobirthing, to name a few. But it's almost like there's an invisible asterisk beside the paragraph that seems to say, "You can try these, but don't expect them to work." Some of them, according to Dr. Air Freshener, are best taken "before you get pregnant." Why? I'm completely puzzled over that one. So you'll be sure and forget everything you've learned by the time you give birth?

Lie #5: Diet is everything! Ok, it doesn't really say that, (actually, I think it says "Be vigilant about the foods you consume") but I swear - almost every time I flipped through this book my eyes fell on something about weight. Food. BMI. Desserts. Most of us realize that we shouldn't necessarily eat like there's no tomorrow when we're pregnant. But there's a hazy theory surrounding that: I'm not saying it's a good idea to eat with reckless abandon, but you need to enjoy yourself while pregnant, too. He actually says something like, 'At parties, you should avoid the dessert table if you think you're going to overeat.' You know, hide behind that big potted palm tree in the corner, you pregnant woman, because you don't deserve to have even one ounce of cake/cookies/or anything. If you sneak one hot dog or forget to microwave the cold cuts, it will go on your permanent record! (There's even a handy chart towards the back, so you can neurotically keep track of every ounce gained.)

We are not robots. Obviously cravings will overtake many of us while pregnant, and weight gain is just one of those things. Some women eat a reasonable amount of food and watch their diets and still gain a lot of weight. Others do not. Because if you're just harping on diet because of the "big baby" scare, well don't even go there, Dr. Curtis.

I'll admit - when I gave birth to my youngest, I was heavier than I'd ever been. And he was my largest baby, at 8 pounds 7 ounces. Woo. That's huge. Right? While you probably shouldn't be eating yourself into a food coma at every meal, neither should you feel like Dr. Curtis and the Pregnancy Food Police are going to come knocking on your door - with Heidi Murkoff bringing up the rear.

Lie #6: Vaginal exams are necessary. He goes on and on about how important they are to "assess" the pregnancy towards the end, such as baby's station and positioning, etc. etc. I will admit, during VE's two of my doctors were able to tell that my babies were not in the vertex position. (even with external palpitation, one doctor was also wrong) Aside from that, though, unless you're 35 weeks and in preterm labor, most people argue that they don't really tell your doctor anything. They sort of make him (and you) feel like he's doing something, and he is, all right: if you're not progressing, it gives him more of a reason to badger you into scheduling an induction because you're one day shy of your due date with no cervical changes whatsoever. You're already thinking about lupus and Mad Cow disease, who needs that on top of everything else??

Lie #7: Homebirth is dangerous. Dr. Curtis, bless his heart, devoted probably what amounts to an index card-sized space to tell you one thing: That home births are incredibly dangerous. (Actually, he prefaced it in the form of a question: "Are home births safe?" His answer: "NO!"in bold letters, just like that.)

I'm of the belief, like many people, that they are not safe for some. And perfectly safe for others. If you have access to good, quality care and are well-informed about the subject* then perhaps yes, home birth is safe for you. But for him to assert his opinion, essentially, as fact - well, that's just wrong. This book is more supposed to inform women about pregnancy and answer some of their questions, not start a firestorm of debate on whether you personally think it's safe, Doctor. Because there are many physicians who disagree with you on that one.

(*As for as being well-informed, I suppose that goes back to all that natural birth crap you read on the internet, right? Honestly, this is one of those murky areas that even the best natural birth/home birth advocates take issue with. This is your right as a childbirthing woman, and only you can discern whether you've gleaned enough - or the right - information in order to make that decision for yourself and your baby.)

Dr. Curtis goes on about how ACOG says this that and the other as far as the safety of homebirths, which is a dicey subject in and of itself. However, ACOG also says that it's safe for some women to have VBACs after two cesareans, but I don't see him jumping on that bandwagon. Know, ladies, that sometimes doctors like to pull out the ol' "ACOG says this!" about some things, yet completely ignore what they say about other stuff.

His pitiful, anemic take on home birth is probably the biggest stick-your-finger-in-someone's face judgmental BS ever, probably because it's written by a doctor who happens to think he's your boss, and that his opinion is the be-all-end-all on the subject. Let me tell you: whatever your stance, you deserve better than this!

At least he does suggest a birthing center, but you'd be hard-pressed to find one, depending on where you live. I live near an international border, 20 minutes from a major city, and there are no birthing centers where I live. That, in and of itself, severely limits your choices, and if you're also like me and live in a semi-rural area, you know that your choices are even more scarce. This is what Dr. Air Freshener, and many others like him, don't get.

This book is billed as "authoritative." Honestly, I'd call it more authoritarian than anything else.

Ina May's Guide to Childbirth (the *real* girlfriend's guide)

* Now, obviously I am a natural/normal birth advocate, so it's obvious that I'd be more likely to pan some books over others. I'll admit my bias and yet try not to get caught up in too much "woo." Just putting that out there. :)


In light of my last post on pregnancy/birth books, I decided this is the book a true girlfriend would give you if she really loved you. I first discovered this book when I was on the verge of delivering my second child. I was attempting a VBAC, and don't even remember where or how I heard about it - but once I started reading it I was immediately interested. Ina May Gaskin, much like The Navelgazing Midwife, Barbara Herrera, sounds like the kind of midwife you could trust to be open, loving, and more importantly - honest. Infallible and perfect; no - no midwife is. But someone you could trust to completely care for you to the best of her ability, yet call it as she sees it.

Before I even get into the book, take a look at Ina May's website - which has some impressive stats of the births she's attended while at The Farm, her "birth center" in Tennessee. Apparently she is well-esteemed within her local birthing community, even by obstetricians - which for a midwife is saying a lot. (I know there are lots of good doctor-midwife relationships in the medical world, but all things considered, most OB's will look at midwives disparagingly - even excluding them from their practices or at hospitals altogether.)

Ina May's stats - and her book - tell me that she must be doing something right, and has faith in the laboring woman! Among low-risk women over a thirty-year period, her rate of cesareans was ridiculously low. What hospital can say that? Obviously this is a picture that illustrates one thing: normal birth can work. It's clear that Ina May's insights into birth provide a glimpse that few other pregnancy and birth books outside the NCB circle provide - especially one that's not based on fear of birth.


Ina May's Guide has some amazing, empowering birth stories, which are always a fascinating read. Many of the mothers, I feel, give accounts that seem to show how inwardly focused they are, concentrating on their births and the process that is happening within them. It's often said that when a woman gets into the "zone" of labor that she should not be bothered, and yet some books seem to categorize this phase of labor as negative and a sign of the laboring mother losing control. Much like people who have witnessed animal births know that animal mothers don't like to be touched, moved or approached in any way, I think of it in kind of the same way with some laboring women: they need to be left alone, unless they request something else, to just go inside themselves and focus on getting the baby out, a process that ideally shouldn't be met with cries of "Push! Push!" and idle talk and chatter from attendants.

Interestingly enough, in probably every story, the women mention vaginal exams from the midwives. Not excessive ones, but one or two during the course of labor to determine progress. But obviously nothing about it suggests repeat checks every hour on the hour, and no harshness or disrespect that sometimes accompany a hospital birth. Many of the women mention the loving, caring atmosphere from the birth attendants, and being in strong, capable hands of people they knew they could trust implicitly.

Some of Ina May's ideas greatly impressed me when I first read this book, namely how much our fear (or lack thereof) can sometimes dictate our actions in childbirth. I thought back to my first birth, and how I knew I was going to have a cesarean anyway, but was scared something would happen before then (my baby was breech). I was breathing uncontrollably and my husband was busying himself at the monitor by telling me "that was a big one!" when the contractions showed up, which didn't help in the slightest. I was letting the pain and fear take over.

Ina May recounts the story of a woman laboring in a hospital under the care of a resident, who is horrified when her baby presents face-first:

"...[the resident] was not good at hiding his horrified expression when her baby's head parted the lips of her vulva. It seems that the baby was coming face-first, and it was the first time the resident had seen this (usually the top of the baby's head comes first). He imagined that he was seeing some horrible defect. His facial expression terrified the mother, who instantly felt her baby retract inside her body with such force that one of her ribs cracked."

I don't doubt it. When most of us are trained to see doctors as bastions of calm and collectiveness, it can be unsettling to see through their body language that something might be wrong (even when it isn't).

Ina May's Sphincter Law is a popular theme in the book, explaining how some women can literally clam up when a rough care provider is examining them. Not only are the frequent hospital examinations excessive, but are often done in a less-than-gentle way, especially if mom is already uncomfortable with the idea of a strange doctor delivering her.

She mentions this in relation to directed pushing, when the mother is literally ordered to start bearing down simply because she is dilated. If there is one thing I wish I could change about my VBAC delivery, this would be it: I would push when I was ready to, not when they are.

"Those who have never felt what it is like to give birth while being shouted at can better understand how this can interfere when they try to imagine what it might be like to poop while a stranger stationed a few feet away yells at them how to do it."

Kind of puts that whole thing in perspective: no, pushing out a baby is not like having a bowel movement. You know what's going to happen when you try to go and don't have the urge, right? Why should this be any different?

Ina May also mentions something very important: that a rough exam performed by someone with a less-than-pleasant demeanor (say, an OB who is ready to go home for dinner or is impatient to catch his flight) can actually cause reverse dilation of the cervix. Ina May recounts the story of a patient who was transferred to the hospital because of a bladder infection that was keeping her cervix from dilating past seven centimeters. Upon a rough examination by "an obstetrician who was rather sullen and unfriendly in his manner," he noted that the patient was only four centimeters. Ina May noted that after that encounter, the mother's labor "never reestablished itself after this obstetrician's rude internal examination, so this mother's baby was born by cesarean."

There is a very informative section on pushing positions, as well as illustrations that depict women of various cultures in different positions while birthing. Not surprisingly, few, if any, of the other books I've read so far mention anything about changes in position to either aid in the baby's descent or birth the child. In fact, as far as alternatives to the typical lithotomy position, I don't think they mention it at all. (With one exception: What to Expect does mention changes in positioning, but doesn't really elaborate much on them, that I remember.)

Pushing in the lithotomy position, or flat on your back, has been in fashion for probably a few centuries, at least in Western cultures. While most people think it's necessary, really the only reason it's used is for the convenience of the physician. "By the end of the nineteenth century," Ina May notes, "birth chairs were rarely used any longer." She adds that squatting in labor, which actually helps to open the pelvic outlet, was something considered "low-class."

She includes a passage from physician George Engelmann, written in 1882:

"At every pain she made violent efforts, and would bring her chest forward. I had determined to use the forceps, but just then, in one of the violent pains, she raised herself up in bed and assumed a squatting position, when the most magic effect was produced. It seemed to aid in completing the delivery in the most remarkable manner..."

It sounds like this lady was prompted by sheer instinct. As Ina May says about a patient who flipped to the all-fours position while laboring, "women often make this choice spontaneously." If they're allowed to.

Even Engelmann realized this, in his now-obsolete book Labor Among primitive Peoples. He, too, realized the importance of positioning during a mother's labor:

"If we wish to obtain an idea of the natural position we must look to the woman who is governed by instinct, not by prudery." 

(He does go on to mention women of "savage races," who we can assume are too uneducated or "tribal" to be worried about how their hair looks or if they look "lady-like." While it sounds blatantly discriminatory, I've often thought poorer, less educated laboring women I've read about in birth cultures were luckier than they realized: they were left alone to labor, and often chose medication less often because of physician distrust. Because of their lack of social standing and inadherence to societal customs of the day, they probably had easier labors than their elite counterparts.)

If you're interested in normal birth - not even completely "natural" birth, which can be defined in many, many ways - you need to read this book. Not only to see that yes, it is possible, but that there is definitely something different out there that's worth exploring. So much of the innately beautiful physiological aspects of birth are ignored, covered up with medication and interventions, when they don't even need to be.

The Girlfriend's (misguided) Guide to Pregnancy

"Or everything your
doctor won't tell you."
(Oh, if only that
were true.)

I vaguely remember when I first heard about this book - that and Jenny McCarthy's Belly Laughs were pretty popular, and I figured it would be a nice alternative to those books that depicted pregnancy as all flowers and sunshine.

What I wasn't prepared for was the tone (of either book) to be the verbal equivalent of a cheese grater. I read a few passages of Jenny's book and thought, Ok, this is going a little too far in the opposite direction. (She obviously has never been known for her grace or demure behavior.) While not necessarily that bad, Vicki's book struck an uneasy chord with me on much the same level. 

This book is probably one of the biggest reasons I would hesitate to rely on  something written from the author's perspective. (Unless she's like Robin Elise Weiss, who is on like her eighth child: that alone gives her a bit more leeway in that department.) Iovine rubbed me the wrong way on several topics, namely:

• Home birth. Her perspective on it is somewhat sad, and reflects the notion that only doctors are capable of handling a birth. Not only that, but it sounds like she did little - if any - research on it, and relates the story of her friend Kathy, who transferred from a home birth to the hospital.

"....[Kathy's] midwife did everything from make her herb teas to walk with her in the hills ... to bring on regular contractions. The nurturing and reassurance were extraordinary... Unfortunately, Kathy found labor longer, more painful, and more frightening than she had anticipated..."

I'm not exactly sure how to interpret this passage. What is she saying? Have a plan? Be prepared for it to fail? The way she describes it, the midwife must not have been that reassuring.

Iovine says she "gleaned three lessons" from her friend's experience: you can never get to the hospital too early, (oh yes, Vicki, you certainly can!), save the "homebirths, midwives and underwater deliveries for the second, third and fourth babies" (because you have no idea what to expect or how to manage labor when it's your first child), and "never elect to have a child where you have no access to medication, or God forbid, real doctors."

(I think here is where Vicki just figuratively smacked the collective group of home- and waterbirthing women across the face with her book. Ouch.)

I don't really get the mention of water birth - which can be done in the "safety" of a hospital with "real doctors! Gasp!"

She says that "childbirth is as messy as a pig slaughter," and wonders who would want to 'sacrifice' their beautiful sheets and other linens for such a thing. She recommends giving birth in a four-star hotel, where the maids can clean up afterwards. Seriously?! 

So much for a real, meaningful or educational dialogue on home birth. No wonder it gets so much flak!

• Regarding pain management and epidurals:

"You will tell yourself from now till labor begins that you intend to try delivering without an epidural, but I can't think of a Girlfriend who didn't take it when it was offered."

What the heck kind of thing is that to say?

So don't even bother, because no one else does, and you're weird if you think you can actually try to get through this without it. Just go ahead and try, because I bet you can't! Honey, I think you need different friends.

(One Amazon reviewer noticed this too, and said Vicki was "downright hostile" towards moms who don't have epidurals and "chastises women who are disappointed to end up with c-sections." While she emphasizes the 'natural' changes in your body such as weight gain, the reviewer notes, she "has no use for the natural process when it comes to birth," and "thinks everyone should induce labor at a convenient moment.")

As far as childbirth in general, she concludes that:

"A delivery that results in a healthy mother and baby is a gift from God, no matter how that delivery was achieved. Period. Childbirth is not like a visit to a spa: It is not designed for your personal enjoyment and fulfillment. It is not an opportunity to demonstrate your abilities or fitness....I think this feeling of being "gypped" by a birth experience that doesn't match our expectations is one more example of that yuppie self-centeredness that is none of our least attractive characteristics." 

This passage .... this part made me mad. Right after I thought my eyeballs were going to pop out of my head, I then felt like barfing. So, all you ladies who feel victimized, used, abused, betrayed or otherwise treated like crap by an OB, you better just get over it. Because all that matters is your baby was born healthy, okay? Your feelings don't really mean much, in the broad scope of things, now do they? (sarcasm off)

It's this kind of behavior that makes women feel like their thoughts, feelings and emotions surrounding childbirth are completely invalidated, and that is so not fair. Who are you to say another person has no right to feel the way she does?

As far as the whole "personal enjoyment and fulfillment," I bet there are loads of women - both of whom had epidurals and those who didn't - who would definitely beg to differ. For many of us, it definitely is about fulfillment - of your role as a mother, as the giver of life.

And as more women are realizing, sometimes those interventions that are supposed to help us have a "healthy baby" do more harm than good, and we would oftentimes be better off without.

Ironically, a few pages back she talks about her primary cesarean with a baby conceived through IVF, and how let down she was by the experience of not having a vaginal birth. So much so that she had her next three children by VBAC, because she says that she "felt so robbed of something my soul had yearned for." (At least one Amazon reviewer said Vicki frequently contradicts herself, and I guess this is one of those moments.) She goes to on to mention two of her friends and their husbands, who, at the time, were planning on all natural births. (emphasis mine)

Both of them labored for more than twenty hours. They were in the kind of pain that only fear and no end in sight can create....I call these husbands Golden Retrievers because they continue to act sweet, loyal, and dumb even when all evidence is making it abundantly clear that everyone in their little family had been unimaginative in how big and long and scary the pain of childbirth can be. 

Finally, it was the insistence of their doctors that got the laboring moms and their clueless husbands to surrender and release their stressed babies via the zipper. 

The babies were "scandalously healthy and robust," she adds. So maybe that means they weren't so stressed after all? I feel badly for her friends, who I bet aren't anymore after that one.

So basically it's okay for Vicki to feel "robbed of an experience," but no one else should be because she says so. "Period."

I don't know if I can go any further, honestly.

Ladies, you have every right to feel "robbed" of an experience if that's what happened to you. Taking into account that not every birth can always turn out the way we'd like, that "experience" can be very important in deciding the outcome. As the person giving birth to this child, it can be about you and your wishes too, without compromising the "healthy baby" part. It's important to realize that some of what is done and isn't done in labor - that can either add to or take away from the "experience" of birth - is key in the healthy baby equation. Don't let Vicky Iovine or anyone else tell you to just get over it and move on; a true girlfriend would never say that.