Book Excerpt: Pushed

Jan. 8, 2008 — -- Author Jennifer Block wrote a book about childbearing and pregnancy called "Pushed: The Painful Truth About Childbirth and Modern Maternity Care." In the book, Block writes about how hospitals have transformed childbirth into a business for no other reason than speeding up an unpredictable process.

For more from the book, check out the excerpt below.

On the last day of the breech conference, as organizers packed up leftover juice bottles and tossed stale bagels, a dozen or so stragglers stood in a cluster in the lobby. They were peering over the shoulders of two Toronto midwives, who were sitting on a couch with a laptop, a blue light cast across their foreheads.

I squeezed in between the rapt audience to see the image of a Snow White-featured woman with an enormously rotund, sagging belly sitting naked on her toilet in an unremarkable, windowless bathroom. "It's the porcelain birth stool," a midwife whispered in my ear. In the video, the woman has her hands on the seat, shoulder-length hair falling in her face, and she's moaning and moving through each contraction, sounds that are somewhere on the pleasure-pain continuum. In the interim her head is up, eyes wide, and she's talking to her partner or smiling at a blond toddler we see walk over in his pajamas and put his hands on the round belly. Another contraction, and as it subsides she reaches a hand down between her legs and mutters something about a head.

Someone finally tells me this is the video of a woman in California, Mindy Goorchenko, who gave birth to twins on her own, with only her husband present. This was Goorchenko's third pregnancy, but because she was having twins she had difficulty finding a home-birth attendant.

In the video, Goorchenko moves to the floor and kneels, towels spread out beneath her. She's moaning louder, breathing heavier, the phone rings, and we see the baby's face appear. Goorchenko touches the face, and before the ringing stops a boy slides out into her hands. She lifts him to her belly and greets him with singsong hellos. The baby lets out a few cries and kicks his limbs around, but he is mostly silent. "Hi honey, hi honey," she says, laying him down in front of her, cradling his head and touching his chest. "I felt his head descend quickly, got down on all fours, and let my uterus push him out into my hands," Goorchenko later wrote about the birth. "This was our first arrival, a little boy named Psalm Victor, who cried just enough to let us know he was okay, but otherwise settled into a deep calm. . . ." He weighed 7 lb, 10 oz.—average size for a singleton baby.

The video then fades briefly to black (husband Alex had put the camera down to help cut the cord and wrap the newborn in blankets), and next we see Goorchenko back on the toilet moaning and grunting, sipping water from a sports bottle, the phone ringing again in the background. Of the second birth, she writes:

My friend Kari thankfully arrived at this point to help Alex, who was now watching our 2-year-old, holding Psalm, and filming the birth, all at the same time! I reached inside me once again to check on my progress, and felt momentarily confused as to what body part was presenting itself. It felt like a hand, possibly, tucked up near the head, but then I realized it was our daughter's foot. . . . I wasn't afraid, just surprised. My husband asked what he could do and I responded, "Nothing. Just film." A foot and leg quickly came out, followed by a second foot and leg (I could feel her literally pushing her knee out of me). Next came her body, hands, and arms, as I supported her with my hands reaching under me. Her head popped out and our daughter Zoya Olga was born, with spurts of blood coming with her and a train roaring by outside. . . . After 10 or 15 minutes, I clamped the cord with shoelaces, gave her to my husband, and birthed the placenta into a big glass bowl. Their two placentas had fused into one big butterfly with two cords emerging from it. (The girl was 8 lb, 11 oz.)

Goorchenko didn't set out to have an unassisted birth, at least not initially. She'd gone back to the midwifery practice that had attended her second pregnancy, but when her belly started measuring suspiciously large and an ultrasound confirmed twins, she was "risked out" of their practice in accordance with California licensing regulations. By law, the midwives had to refer her to an obstetrician.

"They gave me a couple names of OBs," says Goorchenko. "I remember looking at them and thinking, this isn't an option. Because in California, a twin pregnancy pretty much means you're going to have a cesarean section and a NICU stay for your babies even if they don't need it. That was really painful for us to imagine. And I had very little interest in surgery for no good reason." Indeed, there is no evidence to suggest that routine cesarean delivery of twins improves outcomes.