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Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood

2003; Wiley; Volume: 30; Issue: 3 Linguagem: Inglês

10.1046/j.1523-536x.2003.00249.x

1523-536X

Debra Pascali‐Bonaro,

Grief, Bereavement, and Mental Health

Naomi Wolf Doubleday, New York, 2001 326 pp, $24.95, hb Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood is both Naomi Wolf's personal journey through pregnancy, birth, and parenting combined with her interviews with other women. As the feminist author of the Beauty Myth (1991), Wolf shares her perceptions and feelings about the maternity system in the United States, the research she finds, and her discovery of how becoming a mother affects her. The book is divided into three sections: Part 1, Pregnancy, with a chapter corresponding to each month of gestation; Part II, Birth; and Part III, New Life. “Discovery,” the first chapter, begins with Wolf's discovery of being pregnant. She feels the medicalization of childbirth immediately: “I soon lost the quiet confidence I had briefly felt, newly pregnant on a bench in the Italian sun. Being home meant that I was inducted into a medical system that had very clear expectations of me—but little room for me to negotiate my expectations of it” (p 16). Wolf is just a few weeks pregnant and already aware of the gap between what women are told about pregnancy and childbirth and the realities they face as they experience it for themselves. “Second Month, Experts” examines the discrepancy between high rates of cesarean birth and the information presented in current pregnancy books. In this chapter and indeed, throughout the entire book, Wolf relates the information and myths in the popular book, What to Expect When You're Expecting. “Third Month, Baby Values” negotiates the maze and ethics involved in prenatal testing. Citing Barbara Katz Rothman's Tentative Pregnancy, Wolf relates the “unspoken agenda” of prenatal care—the money and politics of prenatal screening tests and amniocentesis. She shares powerful infertility and insemination stories of several women. The bliss of pregnancy is shattered. Wolf, here, is true to her feminist reputation. Her stories urge caregivers to keep the woman at the center of all they do. In “Fourth Month, Losses,” describing the morning sickness and weight gain that accompanies her growing pregnancy, Wolf struggles with the feelings that her expanding figure is equated with a decline in her social status: “My self-image had gotten skinned on the fast slide down” (p 67). Wolf's fears of death arise in “Fifth Month, Mortality,” as she explores the “taboo” American culture has placed on death. She points out that the word “death” does not appear in the index of many common pregnancy books, yet maternal mortality is a real issue. “Sixth Month, Birth Classes and Hospital Tour” raises the questions that expectant families need to ponder in making decisions about childbirth education classes and their place of birth. Wolf explores the politics and power inherent in hospital-based childbirth classes. She asks some good questions: Can educators who are employed by institutions provide informed choice on all procedures and techniques? Do childbirth classes prepare women and their husbands for the “medicalized environment and crisis atmosphere in the hospital''? Do hospital-based childbirth videos show natural labors as well as medicated births? Do women have realistic expectations about what they can expect? To all of these, Wolf concludes that caregivers do not adequately prepare women for these important decisions. She suggests questions women should ask hospitals and practitioners about their rates of interventions and urges readers to ask: “Why do only two states require this disclosure?” Wolf examines the hospital alternative birth centers as a model for midwife and physician collaborative teams to provide optimal care. She argues that the complex power and hierarchy dynamics of the midwife-obstetrician relationship may explain why such centers have not, in her opinion, lived up to expectations. “Seventh Month Mysteries” takes the reader through Wolf's inward journey as she submerges herself in her pregnancy and the miracle of life within. With her new awareness of the interconnectedness of mother and baby and its effect on the mother's emotional state, she says (pp 113–114): OB/GYNs and birth class teachers told us to eat green leafy vegetables and breathe. They did not tell our close and extended families, let alone advocate to society at large, that women carrying babies must be nurtured and supported intensively. How much more revolutionary and transformative it would be for the guides and gatekeepers to pregnancy to tell fathers-to-be, and grandparents-to-be, policy makers and employers, and the culture as a whole that it is as important to nurture and value pregnant women and new mothers as it is to ensure that they are properly fed, weighed, and medicated. In “Eighth Month Powerlessness,” Wolf makes the provocative observation that with peaking estrogen levels, a woman is more “female” than she has ever been before. This made her question her belief system about the so-called “social construction of gender” (p 115). When put this way, it is interesting to consider if and how pregnant women are affected by this special female time. The final chapter of Part I, “Ninth Month, Waiting,” discusses pregnancy dreams, increasing body size, aches, pains, and anticipation of birth. Some observations are a little gratuitous, if not disturbing. Of herself, Wolf observes, “THE BABY NOW BEGAN TO WHOMP inside me like someone cleaning out a closet before a move.” And she “felt the baby could come at any moment, but also that the baby would never come, that I would be pregnant forever” (p 132). Part II, Birth, is packed full of information, quotations from many sources, and Wolf's own birth experience (pp 135–137): When I finally gave birth, nothing happened the way I had imagined….I had now been flat on my side, scared, for an hour or so, without ‘making progress,’ as they put it. (They kept saying the words, ‘no progress’ or ‘failure to progress’ and ‘fetal distress,’ a terrifying combination. No medical staffer that I can remember said ‘You can do this.’ I learned later the powerful physical effect words can have on laboring women.) She describes receiving Pitocin and her epidural: “ In my delivery, I was an adjunct; I had almost no role. There was nothing I could do to contribute to the birthing process…” (p 137). After 24 hours Wolf has a cesarean section. “I am wheeled into the surgery room. I am anesthetized and strapped down as if on a crucifix…” (p 138). “Drugged and pinned, that is what I remember of the birth” (p 141). In a chapter that shows the helplessness and hopelessness women can feel in today's high-tech birthing world, I saw this faint glimmer of light as Wolf described the baby's “breast crawl” (pp 141–142): As I looked at her, my drugged-out emotions distant and uncertain, she began her preordained journey and, hand after tiny foot, crawled up my chest, just as in my dream. By the time she had found my breast and clung to me like a shipwrecked traveler, I was entirely hers. Though I did not yet recognize that she was mine, neither did I want anyone ever, ever, to take her away. In “Behind the Birthing Room,” Wolf realizes that her story is not unique. Many women share this empty, traumatized view of their births. She calls them “ordinary bad births.”Misconceptions looks at the history of birth: “Midwifery is a millennia—old tradition.” Comparing the high infant and maternal mortality rates in the United States with those of Holland and Denmark, she writes, “Midwives operate independently of medical institutions. One in three children in these countries is born at home, under a midwife's care. Yet these nations have the highest percentage of normal childbirths and the lowest percentages of infant and maternal deaths of all the industrialized countries” (p 151). Wolf continues in this chapter to explore the typical misconceptions that women encounter during labor and birth (p 153): The obstetrical culture trains doctors not to wait and nurture, but rather to act. Each of the landmarks of intervention—even the culture of the typical hospital birthing room—has a profound downside that is rarely revealed to the couple involved. These interventions create a domino effect that can actually increase the odds of medical complications and result in the less than fulfilling, even soulless birth experiences that so many women I heard from described. Here, Wolf goes in depth about birth options and practices. She examines the place of birth—hospital, home, and freestanding birth center—the use of electronic fetal monitors and cesarean sections; the influence of malpractice concerns; traditional hospital birth positions; the Friedman labor curve; Pitocin; epidurals; episiotomy; and research on doulas. The book's use of quotations from leading authors and researchers demonstrates the vast literature that Wolf and all American women have to sort through to make informed choices about their pregnancy and childbirth care. In discussing the history of natural childbirth, referring to Grantly Dick-Read and Frederick Leboyer, she writes, “Unfortunately the ‘natural childbirth movement’ too, has its own ideological slant” (p 182). Part III, New Life; Joys and ‘Blues’, examines American women's lack of social support during childbearing and the postpartum period (p 217): In a culture without mandated or paid parental leave…the combination of the husband returning to work, the sleepless nights, the lingering effect of hormonal plunge, the aching body, and demand to single-handedly care for a new baby can send many women into downward spiral. For Wolf this “biochemical crash” she describes lasted for 6 months. She shares her research and feelings about her postpartum depression and its causes. In describing the social isolation many new mothers feel in the United States, Wolf does an excellent job of pointing out how, by comparison, other countries and cultures value, honor, and support postpartum women and their families. “Calling it Fair” describes Wolf's and friends’ insights into changes—in relationships, in roles, and in their own definitions of motherhood (p 262): I saw what mother love was like in relationships in which the pressures of workplace, tradition, and male expectation were slowly making choices seem less and less equal. It made me think of two paving stones set side by side in a jointly built foundation, at first coequal, perfectly aligned. Then a burden is placed more upon one than the other. It sinks a bit, then adjusts and pulls away. Mother love is what hangs in there; mother love, and perhaps wifely love in a world not yet changed enough, seemed all around me to decide at last to trade in equality for certainty. It was like a root or creeper that reaches out to hold that foundation together, to cover the gap, to refuse at length even to dignify the gap, to make a virtue of imbalance. That love was, I saw, forging women with babies into mothers. It was strong, tenacious, resourceful, without shame. In “Making Mothers,” as Wolf's grief lifted, her joy in breastfeeding her daughter grew. With descriptions and sometimes poor information about breastfeeding, mixed with the reasons why women don't or can't breastfeed, she concludes with the final stories of the women we have heard from throughout the book as they journeyed through pregnancy and birth into motherhood and beyond. In the Epilogue Wolf tells us a brief story of her second birth. Should I keep you guessing about this outcome? Yes, It was another cesarean section. Misconceptions ends with “A Mother's Manifesto”—Wolf's vision for change in America for pregnancy, childbirth, parenting, day care, and our communities (p 287): It will be a revolution when we don't just say that mothers are important. It will be a revolution when we finally start treating motherhood and caring for children in general as if it were truly the most important tasks of all. Misconceptions took me on my own journey of mixed emotions. At times I said, “Yes, women and their partners need to hear this!” Then, a few pages later I felt my heart sink, wishing Wolf had gone deeper to uncover the research or put her knowledge to use. In several places her research into evidence-based practices and midwifery care is a great vehicle to initiate the reader into the importance of educating herself and making informed choices about her care. In other places Wolf's evidence is lacking, and she sometimes relies on books that are not evidence based.. As an educator and doula, I wish that her research and knowledge had influenced her care, her decisions, and ultimately her feelings about her birth. Childbirth educator Penny Simkin stated (1, p 252): We can be sure that the personal experience of childbirth for each woman and her family will, as always in some way reflect her society's current values. We also can be sure that it will, as always, carry the potential for immense positive or negative impact on her development as a woman and mother and on the future of the children she brings into our world. Naomi Wolf poignantly shows us what birth means to a woman. I hope that all childbirth practitioners will read this book, and learn to listen to women and really hear what birthing in America means to them and to their babies and families. It is time for all educators and practitioners to ask Penny Simkin's question: How will the mother remember this? No other book has collected so much birth information and controversy into a story format for the public. Naomi Wolf achieves her goal of reaching a broad audience and arousing both positive and negative feelings about her views and demand for change. Misconceptions has, in my opinion, done its job well in making us think, question, and debate many of the urgent issues facing maternity care today.