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Turning the page

Our Bodies, Ourselves: Pregnancy and Birth Book
An interview with OBOS director Judy Norsigian

By Judith Stadtman Tucker

For many mothers-to-be, searching out expert advice on childbirth preparation and how to have a healthy pregnancy is an affirming ritual that begins within weeks of conception. While putting accurate, unbiased information in the hands of pregnant women is always a good thing, an unfortunate number of mass-market pregnancy and birth guides also provide a crash course in the culture of intensive motherhood along with practical information on self-care and the biology of childbearing. In worst-case examples -- which include the best-selling "baby bible," What To Expect When You're Expecting -- the mother is relegated to the role of happy servant to the developing fetus, and any deviation from the author's sadistic prescriptions for averting risk are presented as reckless and potentially harmful. Did you succumb to the temptation to drink that sugary, caffeinated soda on your lunch break? Bad mommy! A sip of champagne on your birthday or anniversary? Don't even think about it. Women who follow the instructions to the letter also stand to lose, since they may wind up with a false sense of control over a physiological process which is utterly unpredictable (but normally culminates with a healthy baby). The underlying message of such "guidance" is familiar and unmistakable: mothers, and only mothers, are responsible for the optimal development of infants and children -- and pregnant and parenting women can (and must) micromanage their own cravings and behavior to minimize the odds of a less-than-perfect outcome.

As readers aware of its feminist heritage will anticipate, the new Our Bodies, Ourselves: Pregnancy and Birth Book (Boston Women's Health Book Collective, March 2008) offers a refreshing contrast to the "culture of doubt" cultivated by mainstream guides. While the OBOS book covers all the basics of prenatal care, prenatal testing, diet and exercise during pregnancy, potential concerns and complications, breastfeeding, and the physiological and psychological changes of childbearing, the volume also includes compassionate and informative chapters on childbearing loss and advocacy for pregnant and parenting women. In a significant departure from mass-market childbirth books that normalize physician-directed, high-intervention, low-support maternity care in hospital settings, the OBOS guide stresses options, including the importance of choosing a mother-friendly birth setting and having continuous support from a trained childbirth attendant during labor and delivery. Throughout the book, chapters benefit from the collaboration of a long list of contributing writers, while skillful work by the OBOS editorial team assures a consistent tone and a text that is accessible to all readers. (I contributed to the advocacy chapter; it was truly an honor to be involved in the project.)

The MMO interviewed BWHBC director and co-founder Judy Nosigian about the concept for the Pregnancy and Birth Book.

MMO: Can you share something about the origins and history of the Boston Women's Health Book Collective and the Our Bodies, Ourselves project?

Judy Norsigian: The Boston Women's Health Book Collective (doing business as Our Bodies Ourselves since 2001) had its origins in a 1969 conference held at Emmanuel College in Boston where women attending a workshop about "women and their bodies" decided to continue meeting. The ensuing discussions and collective writing process led to a 120-page newsprint booklet (initially titled Women and their Bodies, and subsequently Our Bodies, Ourselves) first published by the New England Free Press in 1970 and by Simon & Schuster from 1973 on. The Boston Women's Health Book Collective was officially incorporated as a 501(c)3 nonprofit organization in 1972. In the late 1970s, the book became a national bestseller. Several decades later, four million copies of Our Bodies, Ourselves have been sold and another 100,000 copies have been donated to women's groups, creating an estimated readership of more than twenty million worldwide. All royalty income from the sale of books (approximately $1.5 million over the years) has been allocated to support the work of OBOS and more than 50 other women's health projects globally.

Our Bodies, Ourselves has been translated and/or adapted into 23 languages. It also has been produced in Braille. From 2001 to 2007, Our Bodies Ourselves has provided technical support to women's groups that resulted in adaptations or books inspired by Our Bodies Ourselves in Albanian, Armenian, Bulgarian, French (for French-speaking Africa), Korean, Polish, Romanian, Russian (electronic edition), Serbian, and Tibetan. During this time, an English back-translation of the 2005 Tibetan edition and an English version of the 1991 Telegu edition were also published.

To quote historian Sandra Morgen: "Millions of copies later, this book has changed the landscape of women's healthcare in the United States and throughout the world," mobilizing the women's health movement and inspiring women to act together to improve their health and well-being.

MMO: This is the first time the Collective has published a separate book on pregnancy and birth. Why now?

Judy Norsigian: Maternity care is in crisis in this country. The cesarean section rate has risen steadily since the turn of the century (now at about 1 in 3 births, with many hospitals reporting rates of more than 40 percent). Despite the documented safety of vaginal births after previous cesarean sections (VBACs), the rate of VBACs continues to drop, as hospitals increasingly deny women this option. The rate has fallen about 70 percent since 1996. In 2007, for the first time in many years the Centers for Disease Control reported a small increase in maternal mortality rates. The U.S. also has one of the highest infant mortality rates among industrialized countries.

There is also an enormous amount of misinformation in the media and on the internet that has created a poorly-informed public. In addition, some obstetricians who fail to keep up with the latest research misleadingly suggest to women that many routine medical interventions are completely without risks. The most extreme example of this is advice given to women indicating that elective cesarean section (major abdominal surgery with no medical indication) is as safe as an attempted vaginal birth (which might or might not ultimately require a cesarean procedure to be performed).

Current reimbursement mechanisms often offer perverse incentives that promote surgical deliveries rather than less medicalized approaches to supporting women in their birthing experiences. Certain interventions -- which can be lifesaving if needed -- also can cause harm. Thus, routine use is inadvisable for such procedures as inductions, continuous electronic fetal monitoring, episiotomies, epidurals, and cesarean sections.

These are some primary reasons why this book is so important right now.

MMO: What distinguishes the OBOS Pregnancy and Birth book from other popular pregnancy and childbirth guides?
Judy Norgsigian: The book creates a "climate of confidence" rather than a "climate of doubt" and is careful to present the best available information on all the topics covered. We also provide a complete picture of the benefits of the midwifery model of care, something missing from most pregnancy and birth books. As with all OBOS books, there is a comprehensive approach taken, where key social, economic, and political factors are addressed, and the stories and experiences of women included throughout the text.

MMO: The book stresses the importance of selecting a doctor or midwife and birth setting with low overall rates of intervention, but some mothers-to-be worry that too little intervention may jeopardize the health of their baby -- and others may feel they have a limited choice of care providers or birth settings. Can you discuss the health studies behind the book's support for minimal medical intervention?

Judy Norsigian: As I mentioned above, there are many studies that demonstrate how routine use of certain procedures is inadvisable. These include: inductions, continuous electronic fetal monitoring, episiotomies, epidurals, and cesarean sections. This does not mean that one should not utilize these procedures, but that there should be clear need demonstrated. We also note that there is a need to better explore alternative approaches to pain management (for example, the use of nitrous oxide, which has many advantages over epidurals for many women who find that they do need medication relief of some sort).

MMO: Another recommendation the book makes which departs from mainstream childbirth guides is the advice to make arrangements for continuous labor support from someone with experience, such as a doula. Is that just to increase the mother's satisfaction with the birth experience, or are there health reasons as well?

Judy Norsigian: Studies show that continuous support does reduce interventions and even improve outcomes. But this does not mean that EVERY woman who uses a doula will experience greater satisfaction, for example. The relationship between a woman and her caregiver is centrally important, whether the person is a doctor, midwife, or doula. Trust, good communication, and a sharing of basic values about how to approach birth are always key factors that influence both birth outcomes and a woman's overall sense of satisfaction.
MMO: Pain management during childbirth is a controversial topic in feminist circles -- some mothers who received childbirth instruction promoting drug-free delivery (as I did in the early '90s) may feel completely unprepared for the pain of labor and birth, while others want respect for their right to have a delivery that is as pain-free as possible. Where does the OBOS book stand on the issue of pain management?

Judy Norsigian: OBOS clearly leaves the choice about what to do regarding pain management in the hands of each woman, but provides accurate information about what the best available evidence shows.

MMO: The OBOS Pregnancy and Birth Book is the first pregnancy and childbirth guide to devote a separate chapter to advocating for the workplace rights of pregnant and parenting women. Why did the editors decide it was important to include that information?

Judy Norsigian: Most childbearing women are also wage earners who work outside the home. The United States is one of the least family-friendly countries in the world, and the need for more breastfeeding-friendly workplaces, employers who allow flex-time, paid family leave, safe and affordable childcare, and other support systems will require considerable organizing and political action. We included this chapter in part to demonstrate what some women and groups are doing to solve these problems.

mmo : march 2008

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