Rosemary Mander’s book brings together research evidence relating to the support available to childbearing women and the midwives who attend them.
She begins by focusing on the organisation of health care and how this may determine the interaction between women and their attendants, what is support and how does it work? She moves on to consider systems, both national and international, of the organisation of maternity and health care; the effects of stress in childhearing; the effects of support and an evaluations of supportive and innovative midwifery care, concluding with examining support for the carer, burn out and an analysis of the situation and the relevance of research.
The book examines who provides support and what is effective. While the main focus is on support for the woman Rosemary Mander also turns her attention to supporting the midwife, how this achieved and how effective it is.
Childbirth has become a battleground where the midwife and woman juggle the competing tensions between the social aspects of care, values, and medicalised interventions.
For example, I have been wary of the spread of doulas but had not examined why, Rosemary Mander’s analysis reveals how as midwifery has become more subjected to the requirements of medicalised birth so midwives have steadily been prevented from undertaking an essential part of their role - with women. This clear hole in their practice is now being filled by the ’non-threatening’ doula (or care assistants), women who have no authority, little training and no career path, and as a result are, therefore, not threatening and attractive to the medical model.
Anyone who is unsure about the relevance and role of the doula, as I am, should read this book.
Rosemary Mander’s well-reasoned analysis and deconstruction of the interlinking levels of personal behaviour, management issues, clinical practice, and policy making give women and midwives a valuable tool to enable them to understand and address many of the issues social and political that arise in childbirth today.
Beverley A Lawrence Beech
Chatto & Windus 2001
The publication of this book in September 2001 was heralded by much publicity including an interview with the author in the Guardian, followed by three extracts from the book (on hospital birth, natural birth and gender negotiations in motherhood) The hook received both acclaim and derision in various papers for either exposing the reality or self indulgent navel gazing.
At first I was disappointed: a quick look at the contents showed a different emphasis than the reviews. There were 104 pages on pregnancy, 60 on new motherhood but only 62 pages on birth.
It is indeed a book of three parts pulled together by the underlying aim to expose the myths of the ease and natural joy of becoming a mum, perpetuated by society and the medical profession.
The first part is divided into a chapter per month of pregnancy. It goes into issues such as antenatal screening, treatment by medical professionals, useless
antenatal classes. These are backed by some research findings but it is mostly
It also rambles into introspective tracts on her changing feelings. From the
start there is a marked difference in her experience in the US system compared
to the UK: she has 3 visits to an obstetrician in the first two months and hardly
sees a midwife; she is stripped to a gown for her ultrasound. Her antenatal classes consisted of lying supine while her partner timed her breathing patterns (a distortion of Lamaze). She felt the course was primarily to make women compliant to hospital procedures. A video showed interventions as 'part of
the natural standard of care'.
There was no help for using different positions or dealing with the pain in any other way than breathing or taking major drugs. A recurring theme is the difficulty in getting balanced information and advice that would be useful. Though I liked the reference to a rural Central American midwife whose approach was that women need to be warriors; they need to be told "Be brave, this will be tough and you can do it. Be brave."
The section on birth is different. It is punchy with one fact after another. Her research is recent, wide and plentiful, though not many British studies are quoted. She systematically debunks American birth assumptions and exposes the medical institutions vested interests in pushing them. She praises the British and Dutch systems. She details her own terrifying birth experience (from directed nipple stimulation to overhearing the
surgeon saying "I need to get this small intestine back in").
There are three further short birth stories including a British woman who avoided an early caesarean section by contacting AIMS (yes we get mentioned twice). The births myths cover the same issues that AIMS has highlighted over the years - routine episiotomies, the idea that hospital is the safest place to have a baby, and so on. One nurse-midwife is quoted as saying "Epidurals don't just give women birth without pain; they also give women birth without feeling."
There were some glaring omissions in this section: no discussion of relaxation, of the usefulness of breathing, little on home birth, and nothing at all on water birth, doulas or one-to-one midwifery. There is no mention of Entenox or pethidine - as if a woman's only choices were an epidural or nothing.
She does go on to look at completely natural births through the experience of Ina May Gaskin's community. It seems though this is the opposite extreme from the highly medicalised obstetrician controlled route and that American women do not have much in between. She does describe a free standing independent birth centre in New York (though how widely available this type of care is she doesn't say) which is much more what we would recognise as resembling a birthing centre or midwifery led unit.
The third section returns to the format of the first in that its main references are the experiences of the author and her friends but perhaps that is a reflection of the sparsity of research into the postnatal period. Again she covers a wide range of issues for new mothers from the change in roles and relationships to the low status of being a mother as illustrated by the poor facilities at parks.
This is an interesting book following one woman's experience of the American birth system illustrated by statistics, insights and anecdotes. Ms Wolf fully investigates and exposes the myth of the perfect mother' in both our attitudes to being pregnant and becoming a mum. She thoroughly examines the medicalisation of birth and the fact that the very interventions that women are told will make their birth safer and easier do the exactly the opposite.Throughout she calls for information to be shared with women. I was surprised however that such an intelligent, well read woman did not know much of this
before having her baby. Are there no organisations such as AIMS or the NCT in the US? I knew many of these issues from attending NCT antenatal classes.
My biggest complaint however is her negative conclusion on natural birth which she accuses of being romanticised. This is perhaps because of her own encounter with an extreme standpoint on natural birth where pain is to be denied and contractions are unhelpfully labelled 'baby hugs'.
As an advocate of natural birth myself, and with the birth of my third child three weeks ago still fresh in my mind, I think that no one would deny that giving birth is painful. But by having a natural birth you are helping your body cope with the pain and reducing
the risk of interventions. To achieve this women need to be empowered and indeed she does call for this. She concludes the section on birth with a call for a 'third way' between the two extremes with more midwives who should be 'honest brokers and true advocates' and for a birth culture that takes the needs of the individual woman into account. Aims that we are a little nearer achieving in this country
And then there was Jasmine is described as a 'simple guide to pregnancy and the first few months'.
In reality Suzanne Compton has written a detailed account of her first pregnancy, the birth of Jasmine and her first eight months, and had it printed privately. Not surprisingly, the book tends to generalise wildly from the author's personal experience and there are factual inaccuracies.
But the direct and honest approach does give a feel of what it's all about and parents expecting a first child could find it interesting as one woman's account, provided they regard it as such.
Suzanne's book is available from her via the internet (firstname.lastname@example.org) at £5.49 including postage.
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