Tag: book reviews

Epidural Without Guilt: Childbirth Without Pain aims to offer the reader an alternative perspective on epidurals. It is also super short and has a free Kindle version, so I decided to give it a read. On the plus side, the author does a good job of describing what an epidural is and why they are not harmful to either mother or baby. On the other hand, he’s a bit overly enthusiastic by epidurals — he thinks that every laboring woman should get an epidural as soon as she gets to the hospital.

The thing is the author may be right, for the type of birth that he expects a woman to be having, but he assumes a fairly standardized hospital birth experience which does not involve a lot of movement on the part of the mother. He discusses how walking epidurals don’t completely immobilize the mother — depending on the strength of the epidural, the woman may still be able to walk around and, regardless, should be able to get to the bathroom, change positions occasionally, and feel herself push. However, many birth positions and intermediate coping techniques would be hindered by being attached to a bag on a pole. The author might claim that these coping techniques are unnecessary if the woman isn’t experiencing pain, but the author did not address the point directly.

The other weakness of the book is that the author equates pain and suffering. Unlike the author’s claims most of the materials I read don’t try to make women feel guilty about getting epidurals[1], but they do try to distinguish between the sensation of pain and the mental experience of suffering. If you are suffering, the general opinion seems to be, of course you should get an epidural. But if you’re not experiencing the pain as suffering, you can try these other techniques. Not because the epidural is bad, but because it changes the birth experience in a way that some women don’t want.

This is probably a good book to read if you worry about feeling guilty if you get an epidural. If what you want is a discussion to help you decide for yourself if and when you want an epidural, then this book, with it’s flat recommendations, is not for you.

[1] That said, I don’t read pregnancy forums and the like.

Pregnancy, Childbirth, and the Newborn: The Complete Guide by Penny Simkin, Janet Walley, April Bolding, Ann Keppler, Janelle Durham is the last of the general pregnancy books that I had on my list to read. I probably didn’t need to read it. Not because I didn’t learn anything — I did, and there were several areas where this book was better than the others I read — but I think three general pregnancy books reaches the points of diminishing returns. So now you know =)

But on to judging this book on its own merits! In many ways this was my favorite of the three books. I still prefer the tone of the Our Bodies, Ourselves pregnancy book, but I feel like in content this book combined the best of that book and the Mayo guide. This was, to some degree, at the expense of being about 30% longer than the other two (including appendices).

This book contained good information about alternatives, like the Our Bodies, Ourselves guide and detailed information about things like exercise like the Mayo guide. As far as I can recall, the chapters on breastfeeding and self comfort techniques during birth were more detailed than either.

The book did have a rather strong bias toward a lower intervention birth, so if that’s not of interest to you, the book may bug you. If that book is of interest, you’ll likely find it very supportive. I enjoyed it, but if you want a more balanced look at the alternatives, I recommend the Our Bodies, Ourselves guide; it’s attitude is more “we want you to know that the low intervention route is a viable option, but that it’s also perfectly OK to choose interventions. Either way, just make sure you know what you’re choosing.”

So my end recommendation of books for the pregnant or wanting to conceive couple?

• If you want more insight into how your menstrual cycle works and ways to track fertility, read Taking Charge of Your Fertility
• If you’re not sure how you feel about different birth options, read Our Bodies, Ourselves: Pregnancy and Birth for a balanced overview of options
• Read Expecting Better to understand the data behind many of the standard recommendations and get the data to decide for yourself which recommendations are more or less relevant to you.
• If you feel the Our Bodies, Ourselves guide didn’t give you enough info about pregnancy itself,
• If you decide you prefer the more standard hospital birth, read the Mayo Clinic Guide to a Healthy Pregnancy
  
• If you prefer the lower intervention approach (whatever setting), go with Pregnancy, Childbirth, and the Newborn (and, for the philosophical/emotional side of things, Ina May’s Guide to Childbirth)
• But note that either will give you lots of substantially different information, including about the alternatives. The difference is mainly a matter of tone.

I recently finished the Mayo Clinic Guide to a Healthy Pregnancy. Of the books I’ve read, it is most comparable to Our Bodies, Ourselves: Pregnancy and Birth. I’m not sure which I like better. The Mayo Clinic guide contains more details about pregnancy, including more information about the development of the fetus itself and useful information on gentle exercises to perform during pregnancy.

However, it is missing the key things I appreciated from the Our Bodies, Ourselves book: the sense of educating the reader about the various options available to her and empowering the reader to make the choices that are best for her situation. The Mayo Clinic guide is much more prescriptive, and it spends a lot less detail helping women decide why they might want to follow or deviate from standard practices.

I’m glad I read the Mayo Clinic guide; I did learn some things. But if I had to recommend just one or two books, I’d still go with Out Bodies, Ourselves: Pregnancy and Birth, and Expecting Better combined with an app like I’m Expecting (Android) to provide more details about the week by week development of the baby.

It was just as I finished reading A Baby at Last!: The Couple’s Complete Guide to Getting Pregnant–from Cutting-Edge Treatments to Commonsense Wisdom by Zev Rosenwaks, M.D., Marc Goldstein, M.D. and Mark L. Fuerst that we discovered we were pregnant. However, before that point, I was thinking that background in dealing with infertility might be something very valuable for us.

Generally, doctors say that a couple is infertile if they have been trying to get pregnant for a year and have not yet succeeded. We’d been trying for nearly a year and a half, and during that time, we had observed that I had extremely irregular menstrual cycles — the shortest were about 40 days and the longest over 100 [1]. Even though we weren’t planning jumping straight from there to high tech fertility treatments, we did want to understand what the different options were before we started talking to our doctor about fertility issues.

A Baby At Last seems quite thorough. It is generally optimistic about a couple’s chances of conceiving through fertility treatments, but it is also realistic about the risk factors involved, especially age. The book is rather technical at times, but that’s overall a good thing, since it helps the reader understand when different options are applicable. The book also has a number of chapters on specialized subjects — e.g., fertility issues for cancer patients — which I just skimmed but which seem like they would be valuable for those in the specific situation.

The book contained a chapter on alternative medicine techniques. The authors managed to say, in a way that wasn’t too condescending toward those considering such techniques, that there is little evidence that they work and that when they do show some positive effect, it seems like it’s more or less due to general stress reduction. This seems much more useful than the insulting and condescending attitudes adopted by many folks speaking up against alternate techniques. Yes, they are pseudoscience, but rudeness isn’t going to convince the people who don’t realize that.

Although I don’t have other books to compare this too, overall, this seems like a good resource for a couple who wants to understand their options for fertility treatments.

[1] As an aside, one thing that was frustrating on our journey to pregnancy was that our doctor encouraged us to wait a year before coming back and talking about fertility, even though, at that point, I had only had one period in the six months since I went off the pill, and I probably (based on temperatures) hadn’t ovulated. Statistics are hard to come by, but such a pattern generally indicates some sort of issue.

Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong-and What YouReally Need to Know by Emily Oster is the result of an economist (Oster) wanting to understand the actual risks behind the common advice given to pregnant women during her pregnancy. She doesn’t just present to the reader her own view of the various recommendations, she presents the data so that the reader can decide on the risks and trade-offs on her own.

The largest take away theme is that many of the common recommendations to pregnant women are based on sparse or inconsistent data, often because it is difficult or unethical to do true randomized studies during pregnancy. Because Oster is exploring the data herself and because she does not take recommendations at face value, this book provides the reader with a framework for deciding which advice to take at face value and which to take with a grain of salt.

It’s worth noting that there are a lot of negative reviews of this book on Amazon from people who are outraged at the suggestion that a very moderate amount of alcohol during pregnancy may not be harmful. I’ll just note that Oster does not advocate for drinking during pregnancy. Rather, she points out some weaknesses of some of the studies that have shown harm and points out other studies that showed no observable harm. She personally concludes that a small amount of alcohol during pregnancy is OK, but she agrees that there is also no reason to drink if you are worried about the risks.

For women drowning in a sea of inconsistent advice — or who just want to understand why they are told to do or not do certain things, Oster’s book is an incredibly valuable resource. While, of course, this should be paired with a book that is more detailed about pregnancy itself, I highly highly recommend this book as one to look at if you are pregnant or interested in the topic.

Cracked Open: Liberty, Fertility, and the Pursuit of High Tech Babies by Miriam Zoll is not my normal sort of book. In fact, I kind of disliked it. It’s in the genre of self discovery memoir, in this case centered around the author and her husband’s quest to have a child.

What I disliked about it is that while emotions are important in a book exploring the emotional roller coaster of excessive promises and failed expectations that are so common — and so rarely talked about — in the fertility industry, Zoll rather overdoes it. Do we really need the long diversions into the author’s childhood or her brother’s ongoing life as a deadbeat? Do we need to hear about her journey to find her animal totem? While some mention of the author’s background is necessary to understand the emotional process the author was going through, it seemed like every chapter was more than half general musing about the author’s past, family, and insecurities. The book could have been half the length and still have painted an effective, personal, and emotional picture of the author’s journey.

That said, the book contained a lot of information that is valuable to anyone who is curious about the fertility industry — and since my husband and I have been trying for a year and a half to become pregnant with no success, we certainly had curiosity.

The largest lesson is that the media and general societal attitudes have hugely misinformed women when it comes to their fertility. A woman’s fertility drops dramatically after her mid-thirties, precipitously after age 40, and even the best technology relies largely on luck for a woman whose body is just no longer going through the right physiological processes to support egg production and pregnancy. Birth is not impossible — not even uncommon — but it is much more difficult. The various fertility assistance techniques, in vitro fertilization (IVF) and donor eggs in particular, have a much lower success rate than our societal folklore would lead us to believe.

The second largest lesson is that the fertility industry is just that, an industry, and it does not — or at least did not for Zoll and her husband — do a good job of supporting the emotional experience of the couples involved.

Overall, this was a worthwhile read, although I suspect that there is a book out there — written or to be written — which can convey much of the same experience without being so annoying.

Although this book contains much factual information about pregnancy and childbirth, Ina May’s Guide to Childbirth by midwife Ina May Gaskin is just as much a book on childbirth philosophy as it is a book about the process of birthing a baby.

The heart of the book is a number of birth stories, sometimes in the words of the women who gave birth and sometimes in the words of Ina May. While some of the women further toward new age woo than I think is quite reasonable, for the most part, these are powerful stories of women finding in their bodies and minds the power to give birth in a way that doesn’t treat birth as a medical problem to be fixed. One thing I appreciate about these stories is that they don’t exclusively describe normal, uncomplicated births. A good handful of the stories contain births that were difficult.

One thing Gaskin does well is demonstrate how many of the birth interventions that are sold as conveniences can hamper birth and lead to further interventions that the woman did not originally want. For example, the labor inducing drug Pitocin (synthetic oxytocin) can force the body into labor before the pelvic region has finished preparing for birth which, in turn, leads to higher levels of cesarean sections. This isn’t to say cesarean sections are bad. The point is that a woman may choose one intervention — induced labor — and end up with another which she may not have personally wanted — a cesarean section. Another example is epidurals to kill the pain of birth can lead to higher levels of perineum tears because the woman giving birth is unable to feel when she is pushing too hard or too fast.

Because of this, Gaskin advocates letting women’s bodies do their work and turn to interventions only as needed. The medical interventions that doctors have available to them today are wonderful lifesavers, but by treating them as conveniences that can standardize birth, we start down a chain of interventions in way that are not always desirable.

Beyond the philosophy, this book also contains a lot of information about the birth process that emphasizes how to let the process of birth happen in its own way: let the birth take time; stand up and move around to help the baby into the right position and let gravity help you push it out; laugh or let your partner sexually stimulate you to relax you and help to loosen your muscles; etc. These aren’t magical incantations to make the birth process pain free and fast, but they are ways of working with the birth process rather than against it.

You shouldn’t read this book expecting a neutral presentation of non-medical birth, but you should read it if you want a book that focuses on birth as a normal process not something to be medicated away.

Our Bodies, Ourselves: Pregnancy and Birth was the first book about pregnancy I read so, of course, it is going to influence me more than books I read later. That said, it still stands out as a good book on the topic of pregnancy, labor, and the early postpartum period.

I appreciate the balance the authors of this book struck between being clear as to which choices they considered best but still discussing multiple options and the situations under which those alternatives might be best. One example prevalent throughout the book is the preference for vaginal, minimally medicated birth over more heavily medicated or cesarean births. The authors described both why they preferred less medicated vaginal births and discussed the situations under which other options were reasonable or necessary. With this background, I feel more confident in my ability to try to make the right decisions for myself without feeling guilty about not having the “perfect” birth experience.

Another aspect of this book that I liked was the clear focus on empowering and advocating for women. This book did not try to limit itself to just the birth process. The authors were not afraid to discuss policies they considered bad or advocate for change.

One aspect of this book that may be considered a weakness, depending on what you are looking for, is that it focused on breadth more than depth. The authors gave just enough detail to enable you to ask further questions. Thus, while it’s a great first book about pregnancy and birth, those who have read other books with similar scope will likely not encounter as much new material.

Before trying to get pregnant, it seemed appropriate to learn more about how female fertility works. For that, I chose to read Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health by Toni Weschler.

The first, and perhaps most important, thing to know about this book is that it is a book every woman should read. Whether you want to get pregnant or avoid pregnancy, whether you’re taking birth control pills or attempting more manual methods of contraception, if you’re a woman who cares about how her body actually works, you should read this book. (Note: I use “you” and “your” throughout this review because it’s more conversational. I acknowledge that this may a bit awkward for any men reading this. Consider it an exercise in what it’s like being in a situation whose “you” is not, in fact, you.)

It amazed me, when I started reading this book, how little I knew about my own fertility. While I think that birth control pills were the right contraceptive option for me during the years I wanted to avoid pregnancy — my ovulation cycle has always been much too irregular to depend on my physical signals — I am, in retrospect, sad that I spent a over a decade taking a drug without understanding the system it was regulating. Now that I am trying to become pregnant and having a hard time, I regret accepting the explanation from my doctor that the pill would “fix” my extremely irregular cycles. Yes, it suppressed the symptoms, but now that I actually want to get pregnant, I still have the same issues and no more knowledge of them than I did as a teen. (By the way, Weschler also wrote a book targeted at teens, which I haven’t read.)

Now to the book itself. This book is centered around the Fertility Awareness Method. This can be seen as a natural birth control method or a technique for helping achieve pregnancy. I see it as a way to understand how your own body works. Part one discusses these different perspectives and encourages women to take charge of their own fertility. Part two contains background on a women’s reproductive anatomy, menstrual cycle, primary fertility signs, and various types of irregular cycles. Parts three and four apply knowledge of the primary fertility signals to, respectively, birth control and pregnancy achievement. Part five discusses other practical benefits of charting your cycle, even if you don’t care about the other two.

In subsequent posts, I’ll cover some of the most important background for understanding the menstrual cycle.

As a final note, if avoiding pregnancy is absolutely vital for you, I cannot recommend the Fertility Awareness Method as a standalone method of birth control. Even if you’re extremely regular normally, stress, sickness, alcohol, and other life factors can make your signals less reliable. But I still recommend reading the book.