Your no guilt pregnancy plan

Rebecca Schiller, Penguin Life 2018


Rebecca Schiller, CEO of the organisation Birthrights, sets out to inform women about pregnancy and birth so they can make informed and empowering decisions. The book is quite long and mainly focuses on pregnancy and labour. The section dedicated to the postpartum is the smallest. 

Because the book is presented as revolutionary, I was expecting a great deal from it. Unfortunately, I was disappointed. The narrative was very similar to what I was told in my antenatal classes. If you stay calm and trust your body, all should be well: “Your body is getting your vagina and perineum super stretchy and expandable so that your baby can and will fit through.”; “It’s comforting to know that as we’ve evolved, our bodies have evolved with us to enable our babies to be born.” The author also keeps advising on breathing techniques to cope with all sorts of situations: labour pain, dealing with mental health issues or dealing with the postpartum. I found that unrealistic at best.

Like many others before, this pregnancy book bypasses the risks of vaginal delivery. Whether common or not, complications are called “The unexpected”, downplaying the reality that a vast number of women encounter complications during pregnancy and birth, small or big. Pelvic health is almost absent. If women are not presented with realistic expectations, how can they make truly informed decisions I wondered.

Rebecca claims her book is evidence based so I fail to understand the regular references to acupuncture. Whilst she does not seem to endorse it, why mention moxibustion for turning a breech baby?

This brings me to another problematic statement: “It was previously thought that caesarean sections were the safest way for breech babies to be born, but there is an increasing change in that thinking, and some of the evidence that caesarean recommendations were based on has been discredited.” A Cochrane review has found that at term, less babies died or suffered serious injuries when delivered by planned caesarean. Why not say this? And why not explain the pros and cons of each scenario as previously done on many topics?

Two concessions seem to be made compared to the more traditional natural childbirth ideology: choosing to have a planned caesarean or planning for the possibility of an emergency caesarean and asking for an epidural. However, why choose these options when breathing looks enough to get you through labour and your body has evolved to birth your baby? I’m not convinced these concessions are made full-heartedly.

 The book left me wonder if it is about informing women of their rights, which is essential, or more about pushing women to say no for the sake of asserting their rights but without really letting them consider what they might be saying no to. Would I recommend reading it? No. Even with some concessions, the narrative is in line with the pro natural childbirth movement and offers nothing new in my opinion.

Push Back: Guilt in the Age of Natural Parenting.  Dr. Amy Tuteur (2016)

Review by:  SH

In her book, Push Back: Guilt in the age of natural parenting, Dr Amy Tuteur, a Harvard educated Obstetrician and Gynaecologist, unpicks the myths and foundations on which the natural childbirth movement is based. By looking at the roots of this ideology, Tuteur puts forward an intelligent argument: suggesting that natural childbirth is not feminist or empowering. In fact, she argues, it is antifeminist and reduces the measure of success or failure in women’s lives to the performance of their reproductive organs, wondering if ‘the process of birth was more important than the baby itself’. Rather than providing empowerment, women who follow this mind-set are ultimately being limited in their life choices by unrealistic expectations in birth, infant feeding and bringing up children. She proposes that: ‘It seems like the classic ploy to control and judge women.’

Tuteur points out that most of the current natural childbirth movement was in fact created by elderly white men. Grantly Dick-Read for example, the founder of the natural childbirth movement in the 1940s, believed that western women felt pain during birth because they were too tense and that by learning special breathing techniques, women would relax and not feel pain. In Childbirth Without Fear, he states that certain women suffer from painful periods and PMS because they have been conditioned to do so by society. Since then science has clearly shown that these symptoms are physiological and hormonal, therefore could not be enforced on women by society. He believed that by ‘moulding’ women during their pregnancies, they can be ‘born again’ and ‘the way she bears her children enables us to estimate the potentialities that she has as a mother and a wife.’ Despite these claims, he had no scientific evidence for these assertions other than his observations of amoeba and other lifeforms.

This is the basis of the natural childbirth movement’s beliefs, that if you have the correct mind-set and learn to breathe in a controlled manner, birth without medical intervention is a natural process that can be experienced by all women and on which womanhood is measured. It is a mistake for us in the 21st century to continue to validate women’s birth experiences based on these misogynistic, outdated beliefs.

At a time when there is worldwide concern for a reduction in the Caesarean rate, Tuteur’s book provides clear, non-emotive reasons as to why we do not need to be concerned about the rate itself. She provides rational answers as to why the Caesarean birth rate has risen. One such factor being that women are having children later in life or that both women and their babies have become larger, making physiological birth less likely and more dangerous to both mother and baby. While women should be free to have the birth of their choice, women should ignore the dogma associated with a natural birth without pain relief and intervention and focus on giving appropriate pain relief, intervening when necessary, without women feeling guilty for the experience they have.

Tuteur reminds us that it is not always possible to know whether a baby would have survived a physiological birth if doctors had not intervened. Obstetric practice is about identifying the women whose labour is not going well and avoiding mortality and morbidity. The delivery of a healthy baby to a healthy mother is the most important measure. By discouraging intervention, babies and mothers are at risk, not only from the damage of non-intervention, but afterwards feeling that somehow they have failed and that they as women were simply not up to it. The way that women give birth should be a personal choice and one that women should not be made to feel guilty for, or burdened by the so-called specialists, pressuring unrealistic standards upon them.

This is a brilliantly researched, highly recommended book which will allow countless mothers to breathe a sigh of relief; that it’s OK to be the sort of mother that you want to be; that women should not be pressured into the ideology of having the ‘perfect’ birth or to bring up their child in a certain way; that there is not one right way of doing this and that we should allow women to work out for themselves what feels right. Mode of delivery should involve choice: a positive birth experience and a healthy baby and mother are the most important factors.


The Informed Parent: A Science-Based Resource for Your Child’s First Four Years

Tara Haelle & Emily Willingham (Tarcherperigee, 2016)


Haelle and Willingham are mothers, both have undergraduate degrees in English. Haelle has a Masters in Photojournalism and is a science writer with no scientific training or background. Willingham is a scientist with a PhD in Biology (thesis involved a species of turtle).  Neither have obstetric or gynecology training or background, nor did they interview or involve anyone with that expertise for this book.  They do not cite references.  Readers are unable to check the studies they give limited descriptions of, to determine if the science is good.  [Note: Birth Trauma Canada has read enough bad research, particularly in obstetrics, to recognize some of the studies they use.] Publishers Weekly described Haelle & Willingham’s book as “an ambitious but uneven attempt”.  It is ambitious when considering the wide variety of topics they discuss.  It is not ambitious in terms of distinguishing between the vast quantity of published literature and credible evidence and then discarding anything that wasn’t credible evidence.  While wading through this morass of bad science would have been prohibitively ambitious they could have relied on the grading system used by both Cochrane and PubMed.  Doing so would have made this a better (and considerably shorter) book and limited the ‘Garbage In; Garbage Out’ aspect that permeates most parenting books.  They understand, and write about, the pitfalls endemic in bad science (confirmation bias, Dunning-Kruger effect, mistaking correlation for causation, poor data collection and analysis, ignoring confounding variables, etc.) and then use published research with what should be exclusionary flaws.  They profess to work hard to limit their biases with limited success.  Where the science is good but it doesn’t match their biases, their work is tortured.  Examples are their pro-breastfeeding bias (which admittedly isn’t as extreme as some), total abstinence of alcohol in pregnancy bias and their anti-cesarean bias.  When the science is good and it matches their biases, they do a great job (examples are vaccines, vitamin K, delayed cord clamping).  When the science is so so, they fill in the gaps with cherry picked studies to match their bias (SIDS and microbiomes as one example).  When the science is bad they use it anyways to bolster their biases.  The most extreme example of this involves their anti-cesarean stance, most evident in the section of the book entitled Baby’s Arrival: Cesarean and Vaginal Births. They use one sentence to acknowledge that research doesn’t separate planned cesareans from emergency cesareans and then to proceed to use research with that huge flaw to state that cesareans are more dangerous than vaginal births.  Women can’t choose a vaginal birth.  They can plan a vaginal birth or they can plan a cesarean birth.  If Haelle and Willingham considered their approach from this position would their bias change?  In other words, the real question to ask is whether a planned vaginal birth is safer than a planned cesarean birth in healthy, term pregnancies.

Planned vaginal births include operative assisted deliveries with either vacuum extractors or forceps, emergency cesareans, episiotomies, injuries to the bladder, urethra, anal sphincters, rectum, pelvic floor and vagina caused by the extreme forces and pressure involved in pushing a big head through a small opening,  widespread use of continuous fetal monitoring, many hours (or days) in labour and pushing, chorioamnionitis, uterine atony, inductions/augmentations, post traumatic stress, a high chance of being denied effective pain relief for labour and/or delivery, not being referred upwards to better trained and skilled professionals in a timely manner if emergencies happen and surgery to correct the damage caused by vaginal births (or attempts at them) both right after birth and throughout a woman’s lifetime.  Do not, even for a moment, think these surgeries are ‘minor’.  Neither is the pelvic floor physiotherapy oft touted after damage from a vaginal birth.  It is bloody awful, is often painful, requires a great deal of a mother’s time and needs to be sustained to see what limited success it can attain.  Medical device and incontinence product suppliers count on damage caused by planned vaginal births for profit.  Pelvic floor disorders are overwhelmingly caused by vaginal births or attempts at them that end as late stage emergency cesareans.  The high cost of obstetrical litigation involves planned vaginal births. These risks are not associated with competently handled planned cesarean births.  The risks of a planned cesarean are not zero but, done in a quality hospital with a competent surgical team, pale in comparison to planned vaginal birth.   The authors’ assertion that ‘There is no difference in urinary incontinence 2 years after birth’ is complete rubbish.  All they had to do is talk briefly to a urogynecologist (who could have provided credible evidence) to have that bias corrected.   Any competent obstetrician or midwife could tell them the same thing.

The section on postpartum emotional health ignores both partial and full PTSD and tends to blame ‘female hormones’ for trauma symptoms most women have after childbirth.  There is no credible evidence to support ‘female hormones’ as the cause of any postpartum stress, depression or anxiety a woman feels after giving birth (which they acknowledge yet pontificate as if that wasn’t reality).  Indeed, if low estrogen/progesterone caused or prolonged these issues you wouldn’t see men with postpartum depression and PTSD. 


There is a need to separate the wheat from the chaff in published obstetric, public health and parenting information. Kudos to the authors for the attempt and I think they wanted to make an attempt to counteract the overwhelming, judgemental and often conflicting ‘expert’ advice mothers get from all corners.  Correct the problems with this book and they may have a winner the next time.



And then My Uterus Fell Out:  A Memoir on life with pelvic organ prolapse

P.R. Newton - 2013

P. R. Newton’s heartbreaking and stoic story lifts the veil of secrecy surrounding the negative consequences of planned vaginal births.  Women are not really told what to expect when they are expecting.  These costs command a lion’s share of health care and litigation spending and attempts to mitigate the high rate of maternal morbidity associated with planned vaginal births are the bulk of a huge gynecological industry.  Those enormous costs reflect only a small portion of the actual costs of pelvic floor damage.  Most affected women suffer in silence, isolation and shame without seeking medical help.    Her ordeal could have been prevented with a planned cesarean but Canada remains a country bent on keeping that option from women.  I hope Ms. Newton’s altruistic desire to save other women from pelvic floor damage is realized. Read this book to get an understanding of life with permanent maternal morbidity.  


Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong - and What You Really Need To Know (How To Fight The Pregnancy Establishment With Facts)

Emily Oster, The Penguin Press, New York, 2013

Emily Oster has a fine critical mind, is good with statistics and she is pretty funny to boot.  She goes wading through the chaff that is obstetrical literature to find that rare kernel of wheat that is closest to the truth.  Her critical thinking exposes much of what is repressive and judgmental in obstetrical policy, particularly in the US.  (It is just as bad in Canada, maybe worse).  I loved the fact that she recognized that women are individuals who should be making decisions based on what they personally feel is right.  The current systemic cookie-cutter thinking that women are clones of the same meristem is just too wrong for words.  No one would think that all men or children are the same but it is more difficult to get society to recognize that all women don’t think or feel the same.   I also admire her for saying that a good deal of the bad in obstetrics isn’t the fault of those working in the field.  Pregnant women themselves can be their own worst enemy – for both themselves and other pregnant women.  She gives many odds ratios for risks but she tempers that with a look at the risks of some everyday experiences.  Perspective is a wonderful thing. She gives a great primer on the relationship between correlation and causation (some medical researchers and medical journals need to read this) as well as explains false positives and negatives.    She fires on all cylinders when that keen analytical mind is turned on.  Unfortunately she does turn that off once in a while and allows her biases to surface (she is ‘natural’ hospital) and makes some sudden unsubstantiated statements that are accompanied by zero evidence.  A good example of this is her anti-cesarean stance.  One of the most deeply flawed areas of obstetrical literature involves the denigration of planned cesareans as a legitimate birth option.  Most of the current voluminous amount of obstetrical literature dealing with cesareans throws emergency cesareans or those performed because of medical complications (for which there is no other option) in with those planned by healthy mothers at term (the majority of all pregnancies) who want to avoid the substantial risks involved in planned vaginal births.  There is very seldom any adjusting for substandard hospitals. They mix it all up to arrive at the conclusion that all cesareans are bad.  This really is a case where, in her words, poor quality studies can rapidly become conventional wisdom.   Maybe she will consider a sequel and we can benefit from a critical re-think of this area of obstetrical literature.  She calls a cesarean major surgery but major compared to what?  Endometrial ablation?  An appendectomy? Open heart surgery?  Semantics matter.  She states that “OBs generally agree, for good reason, that they are not the preferred mode of delivery? “   Yet many OBs (and nurses, pelvic floor physiotherapists, family physicians, etc.) choose a planned cesarean for their own birth(s) and those of partners and other loved ones specifically to avoid the substantial and common risks of planned vaginal births.   She talks about recovery being slower with a cesarean but doesn’t distinguish between cesareans after a trial of labour and those that are planned without that added ordeal.  Do some hospitals get paid more to keep you longer after a cesarean?  Could this be a mitigating factor in longer stays?  Her anecdotal story comparing her birth experience (relatively unscathed) with her friends emergency cesarean is tinged with a bit of gloating and an apparent lack of understanding that she is comparing two planned vaginal births.  Her anecdotal stories or her critical eye didn’t look at those many women who can’t walk after a vaginal birth or who take months or years to recover from their vaginal births or their attempts at them, often requiring additional surgery besides the reconstructive surgery they endured right after a vaginal birth (which, incidentally, can take as long and often longer than a planned cesarean).  Nor did she acknowledge the many women who never recover.  A critical look at obstetrical literature needs to also explore the permanent, irreversible maternal and neonatal morbidity caused by childbirth – the overwhelming majority of this caused by planned vaginal births.   

Despite these misgivings I would recommend this book to all those who are pregnant or thinking about getting pregnant.  It will ease a lot of anxiety associated with the long list of things denied to pregnant women.  Most have no logical basis and you will want to know about the ones that do. Carry it around with you so you have it handy when the pregnancy police show up (and they will).  You can point to the relevant section when the sanctimonious stuff gets too much to bear. 


Choosing Cesarean: A Natural Birth Plan

Dr. Magnus Murphy and Pauline McDonagh Hull

Prometheus Books, New York, 2012


A culture that values mothers is one where women have the right to decide how to plan their births and they have the right to have that choice respected.  That level of maternal autonomy requires access to honest, factual information based on scientifically credible evidence.  Canada fails badly at respecting this basic human right.

Let me be very clear.   A woman can plan a vaginal birth or she can plan a cesarean birth.  Those are the only available options if she chooses motherhood.   Each of those options come with their own set of risks.

The Society of Obstetricians and Gynecologists of Canada (SOGC) and the Canadian Association of Midwives (CAM) have a long history of anti-cesarean bias, without any credible evidence to support that stance for at least two decades.  They lag well behind more progressive countries in this respect.  Their lack of critical thinking and their steadfast refusal to adopt a genuine, scientifically literate, evidence-based model of medicine for obstetrics is responsible for obstetrics’ well-deserved reputation for poor quality research and negative short term and long term consequences for millions of Canadian mothers and their babies.  Their behaviour is rooted in misogyny and ideological bias in an era where other medical specialties have long since moved forward to embrace improvements in medical advancement and technologies.  Their position has affected every federal, provincial and independent medical association in this country to the point where it is near impossible to rise above the fortress of systemic anti-cesarean group-think without being metaphorically shot at, even if you are an obstetrician or a prospective mother (sadly, often because you are an obstetrician or a pregnant woman).  It is not the first time they have been wrong.  The crusade against planned cesareans as a legitimate birth option for healthy mothers at 39+ weeks, by the Canadian birthing industry, is a battle with modernity and the wounded in this battle are mothers.  This is an industry that believes that suffering and morbidity – when they happen to women– is normal.  I hope “Choosing Cesarean:  A Natural Birth Plan” is the impetus for long overdue transformational change.

This does not mean that all obstetrical caregivers in Canada listen to or care about the dictates of the SOGC or CAM.   There is an underground resistance in this country.  It is a calling made more difficult by the fact Canada does not have a privately funded medical system as many other developed nations do.  Most of these rebels operate quietly, working hard to serve the women they care deeply about, while quietly working within the system, staying under the radar with respect to maternal request planned cesarean.  Very rarely do you see an obstetrician or a mother with the courage to speak out publicly about this issue in Canada.  Dr. Magnus Murphy is one of those physicians.  Pauline McDonagh Hull is a former journalist with the BBC and a mother with the same integrity and courage.    

“Choosing Cesarean:  A Natural Birth Plan” is a frank, clearly written book outlining why planning a cesarean is a legitimate birth plan.  The authors expect controversy from natural birth crusaders (given my own experience advocating for maternal autonomy and honesty in obstetrics, they will get it). Every myth and outright lie about cesareans is addressed in a well-referenced, logical manner.  Women have long been denied informed consent in obstetrics in Canada.  They are not told about the serious and common risks associated with planning a vaginal delivery while the risks of planned cesareans are consistently overstated.  This book levels that playing field.  It is well past time that cesareans be respected as the most important medial advancement in obstetrics since the advent of hand washing before tending birthing women. This was championed by Semmelwies and Gordon in the 1800s (both vilified for that bit of common sense by a medical profession at the time that didn’t believe in germs).  It is worth noting that quality hospitals with qualified, skilled surgical personnel have been able to consistently, over many years, perform planned cesareans with very few, or no, adverse events (an impossible feat for planned vaginal births).  It is not a question of whether cesareans can be done safely.  Clearly they can.  We need to ask why some hospitals won’t. 

“Choosing Cesarean:  A Natural Birth Plan” covers the risks women take when they plan a vaginal delivery and the risks they take when they plan a cesarean.  They address human evolution as it applies to reproduction.  I particularly like the chapter on the politics of birth; the politics of which make all other politics seem tame by comparison.  Dr. Jennifer R. Berman calls this book ‘a must-read for all women’.  I could not agree more.  If you only read one childbirth book in your life, whether you are considering motherhood or if you are pregnant now, please let it be this one. 


WILLIAMS OBSTETRICS (Cunningham et al.  McGraw-Hill, Medical Publishing Division, )



These are medical textbooks that give a good overview of vaginal and cesarean deliveries and obstetric complications from a clinical standpoint.  They are written with little regard for maternal experience but, as a mother or prospective mother, you will have no problem filling in those blank spaces.  There is very little attention paid to the psychological ramifications of childbirth and, like textbooks everywhere, the information is usually outdated before the latest edition is published.  Recommended reading for women considering pregnancy or delivery options.


ATLAS OF TRANSVAGINAL SURGERY ( Shlomo Raz, W.B.Saunders Company, 2nd edition, 2002)

This is another medical textbook.  For anyone who thinks vaginal surgery isn't really surgery or is 'minimally invasive' this book will change your mind.  It includes step by step instructions and pictures of several types of vaginal surgery.  This book is not for the faint of heart and it may be too much informed consent for some.  Use your discretion.


Management of Labor and Delivery
Robert K Creasy
Blackwell Science 1997

This is another medical textbook.  Like all medical textbooks there is no mention of PTSD and the relationship between childbirth and trauma symptoms.  Recommended reading for anyone contemplating having a baby.

EVER SINCE I HAD MY BABY:  Understanding, Treating and Preventing the Most Common Physical Aftereffects of Pregnancy and Childbirth (Roger Goldberg,Three Rivers Press, 2003)

 Dr. Goldberg gives a pretty honest assessment of the negative consequences of vaginal births and what is available to treat them.  He talks about obstetrical politics and what to expect during a urogynecology checkup.  Many books about pregnancy and childbirth have the bizarre and irritating habit of saying something truly awful and then making a joke about it or make light of it with the liberal use of exclamation marks.  Dr. Goldberg isn't immune to this but he keeps the chirpy dismissiveness to an acceptable level.  If you are looking for actual informed consent we highly recommend this book.


PELVIC HEALTH & CHILDBIRTH:  What Every Woman Needs to Know (Magnus Murphy and Carol L. Wasson,  Prometheus Books, 2003)

Like Dr. Goldberg, Dr. Murphy gives a no -nonsense and compassionate account of genital tract damage associated with vaginal deliveries and the various invasive and non - invasive methods used to treat associated problems.  This book is written in clear language with excellent illustrations.  Dr. Murphy is known as a pro-cesarean doctor (as most urogynecology specialists are and he is pretty white bread about this compared to other pro-cesarean proponents in other parts of the world) but we think he gives a balanced assessment of the situation.  I think there are only 4 exclamation marks in the whole book and he speaks from a Canadian perspective.  He also gives a good account of how difficult it is to be an obstetrician and we think it's important for people to know why Canada has a shortage of obstetricians and why this shortage is expected to get worse.  The field of obstetrics needs sea changes not just from a mothers perspective but from a doctor's as well.  Highly recommended.


The Birth That’s Right For You:  A Doctor and a Doula Help You Choose and Customize the Best Birth Option to Fit Your Needs  Amen Ness, Lisa Gould Rubin, Jackie Frederick-Berner; McGraw Hill, 2006

 This book is a welcome literary slap up-side the head to all those self-righteous, self important childbirth ‘experts’ who feel they know the best way for you to give birth and, damn it, it’s their way or the highway.  Eureka and good on these authors for stating what should have been obvious decades ago.  They recognize that each woman is different and, bless their hearts, they know that what makes sense to a woman before she goes into labour is exactly what is going to make sense to her when the birthing day(s) comes.  If that childbirth educator sounds like she is too stupid to even get herself dressed when she is talking to you about chanting, hee-hee-hoo-hoo breathing and whatever else she is on about she isn’t going to seem any smarter when you are in labour.  If that sort of thing relaxes you now (and it is to some, for sure) it will be useful to you then.  The authors recognize that the mother is the expert when deciding what is best for her.  This is a radical and revolutionary obstetrical attitude.  In 2008. Very sad. 

The authors are dismissive about some stuff, they completely ignore other stuff (like maternal morbidity)  and they aren’t completely honest about everything but they are honest about enough stuff that you will have a good idea about what to realistically expect, at least about vaginal deliveries, up to the point of placental expulsion.  It is a book primarily about labour and vaginal delivery but, bless their hearts again, they support and acknowledge the right of woman to a planned cesarean if a vaginal delivery is deemed objectionable to her based on both psychological and physical reasons.  They give good advice on how to get the type of birth you want. 

The book isn’t without bias (one example: it is written for married/partnered women and if you aren’t or if your partner isn’t a ‘he’ you are going to notice this discrimination) but we are so thrilled with the message that we still think it is well worth reading.  Just roll your eyes and move on when you come to any bias.  That won’t happen that often.


CESAREAN SECTION: Understanding and Celebrating Your Baby's Birth
(Michele Moore and Caroline Costa, John Hopkins Press, 2003)

This book is written by two doctors - both mothers.  They wrote it as a means of ending discrimination against women who have cesarean sections.  It is directed to women who had emergency sections and planned cesareans for currently acceptable reasons, although they do acknowledge cesareans as a means of protecting the pelvic floor.  They talk about why cesarean sections are necessary and give a description of what to expect.  They gloss over the placental removal part of cesarean surgery (most sources do and that is never informed consent in our mind) and they tend to overplay what to expect after a cesarean - especially a planned one.  We think this is a good primer for anyone considering a planned vaginal delivery or planned cesarean.  Prenatal classes don't adequately prepare women for this possibility but it happens frequently.


LIFE AFTER BIRTH:  What Even Your Friends Won't Tell You About Motherhood
Kate Figes with Jean Zimmerman
Penguin Group 1998

The title pretty much says it all.  This book was published nearly a decade ago and the studies cited are older than that so the medical information - particularly about cesareans- is outdated.  Many cultural attitudes have changed during that time as well, particularly with respect to marital status and motherhood.  Even considering this information this book is as relevant today as it was in 1998.  It is reassuring to any mother who has ever felt inadequate, guilty, isolated or alone.  Kate Figes gives a moving tribute to mother love but doesn't varnish the negative aspects of motherhood.  She criticizes the modern emphasis on the naturalness and healthiness of pregnancy and childbirth and acknowledges the conspiracy of silence that surrounds these issues.  She also feels - as we do - "that if we are not honest about the extremes then we perpetuate the myths and reinforce the taboo.  To deny the existence of the negative is to let women down badly.  Mothers shouldn't be considered a mere container for a more precious cargo."


Postpartum Mood & Anxiety Disorders: A Clinician's Guide
Cheryl Tantano Beck/Jeanne Watson Driscoll
James Bartlett Publishers 2006

Drs. Beck and Driscoll look at seven psychological problems caused by childbirth from a clinical nursing perspective.  They are:
  • maternity blues
  • psychosis
  • depression
  • bipolar disorder
  • panic disorder
  • obsessive compulsive disorder
  • post traumatic stress disorder
This book is a brief overview of their collective experience to date.
They define the maternity 'blues' as symptoms which can include, but are not limited to, sadness, irritability, anxiety, fatigue, worry, sleep problems, periods of mania and/or hypomania, grieving and a sense of loss over who you used to be, low self-confidence and sensitivity to stressors like bright lights, noise and visitors.  These symptoms last up to three weeks and they refer to them as 'normal' reactions to childbirth.  We would certainly agree with the term 'common' or 'understandable' but I don't think there are any women out there who would consider any of these normal - for them or other women they know.  These are trauma symptoms and in any other situation these symptoms would indicate severe distress, not normalcy.  Women contemplating motherhood should know that dismissiveness about these symptoms is ubiquitous among obstetrical caregivers and they should also know how common this form of psychological distress is.  Drs. Beck and Driscoll peg percentages from 50 to 75% of all mothers. 
    Each of the seven problems includes diagnostic criteria and a brief case study along with their assessment strategies and care protocols.  Women suffering from any of these problems will immediately relate.
    This book ends with some postpartum assessment questionnaires and an extensive list of pharmaceuticals used to treat each of the mood and anxiety disorders discussed.  Beck and Driscoll address postpartum problems with respect and empathy for mothers and, just as importantly, with an understanding that no two women are alike.  Each is a complex, unique individual.  It is a refreshing change from many cookie cutter obstetrical attitudes.  Their work is an important step forward and Birth Trauma Canada applauds their efforts to shine a light on problems that have been ignored, stigmatized and neglected for too long.


The following books have been helpful in assessing and understanding trauma and in self-directed healing from trauma.  They are available through our lending service.

The Body Remembers:  The Psychophysiology of Trauma and Trauma Treatment;  Babette Rothschild, Norton Publishers, 2000

I Can’t Get Over It: A Handbook for Trauma Survivors; Aphrodite Matsakis, New Harbinger Publications, 1996

Life After Trauma: A Workbook for Healing;  Dana Rosenbloom and Mary Beth Williams, Guilford Press, 1999

The Post Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery and Growth;  Glen R. Schiraldi, McGraw-Hill, 2000

The Body Bears the Burden:  Trauma, Dissociation, and Disease  Robert Scaer, Haworth Medical Press, Inc. 

An excellent primer on the role trauma plays in a myriad of different diseases.

Women’s Inhumanity to Women  Phyllis Chesler, Lawrence Hill Books, 2009

An intelligent, understanding book about this difficult reality.

The Empire of Trauma: An Inquiry into the Condition of Victimhood  Didier Fassin,  ….., 2009   under review.

When the Body Says No   Gabor Maté

Dr. Maté’s underlying message is to learn to say ‘no’ to stress, trauma and unreasonable expectations – or your body will - and that this lesson is especially pertinent to women as women have more stressful lives.

Waking the Tiger: Healing Trauma;  Peter A. Levine, North Atlantic Books, 1997

Trauma and Recovery;  Judith L. Herman, Basic Books, 1997

Does Stress Damage The Brain?  Understanding Trauma-Related Disorders from a Mind-Body Perspective, J. Douglas Bremner 2005   (short answer is yes)

Dark Waters: Stress After Trauma Opal Rose, Author House, 2007


The best investment for the future?  A life-affirming choice?  The worst decision you will ever make? We often field questions from women deciding whether motherhood is the right choice for them.  It is a big decision, and like all life’s major decisions, it requires thought and honesty.  These books are helpful resources.  Each of these is available through our lending service. 

The Mask of Motherhood:  How Becoming a Mother Changes Our Lives, Susan Maushart, Penguin Books 2000

The Price of Motherhood: Why The Most Important Job in the World is Still the Least Valued, Ann Crittenden, Owl Books, 2002

No Kid: Quarante raisons de ne pas avoir d’enfant, Corinne Maier, Michalon, 2007 (This book is published in French.  We can mail (or email) English excerpts if you wish.)

A Suburban Mom: Notes From the Asylum, Meredith O’Brien, Wyatt-MacKenzie Publishing, 2007

What’s The Matter With Mommy: Rantings of a Reluctant Stay-at-Home Mother, Kelley Cunningham, Wyatt-MacKenzie Publishing, 2006

Great Expectations: Twenty Four True Stories About Childbirth, Editors Dede Crane and Lisa Moore, Anansi Press, 2008


Enjoy Your Labor: A New Approach to Pain Relief for Childbirth [The Only Book that Takes the Fear, Mystery and Guilt Out of Epidurals and Spinals] Gilbert J. Grant, Russell Hastings Press, 2005

Epidural Without Guilt:  Childbirth Without Pain Gilbert J. Grant, Russell Hastings Press, 2011

Dr. Grant is an anaesthesiologist specializing in obstetric anaesthesiology at New York University Medical Center.  These are the best books we’ve read about the safest and most effective ways to provide pain relief to women during labour, vaginal deliveries, cesarean deliveries and the postpartum.  He debunks myths and gives an honest account of the risks of regional and systemic pain relief methods, as well as the risks of not electing to choose pain relief.  We only wish all obstetrical caregivers and hospitals were as enlightened.  [They aren’t] It is required reading for anyone considering obstetrical pain relief.
The only problem we have is the title ‘Enjoy Your Labor’.  It still pumps up unrealistic expectations.  Even with a skilled and enlightened anesthesiologist and regional anesthesia there are likely going to be many other reasons why you shouldn’t order the party hats and bring in a mariachi band to wile away the hours or days you will be in labour.  Unresolved pain is only one reason (but a VERY big one) women develop post partum psychological trauma symptoms.  Loss of control –which will be lessened with timely and effective pain relief they can control– , a lack of respect for her privacy, dignity and choices and having to cope with life-altering negative health problems are all ways women are traumatized before, during and after childbirth.  Pain, loss of control and lack of respect, privacy and dignity (or any dehumanizing treatment) and serious health problems cause post traumatic stress in ANY human being - male or female.
The new approach Dr. Grant talks about isn’t epidurals and spinals.  They have been around for decades.  ‘Walking’ epidurals aren’t new either.  They are just regular epidurals that use a different combination of drugs and none of those drugs are new.  It isn’t that anesthesiologists aren’t trained to perform epidurals and spinals safely and aren’t aware of the best techniques for performing them.  They’ve known that for decades, too.  It is what anesthesiologists do and these techniques have been used in other medical specialties for decades. 
The new approach Dr. Grant is referring to is the attitude that women shouldn’t suffer because they are women.  They have the same right to effective pain relief as anyone else does in situations of extreme pain and they have the right to it before the pain happens.  His point is that it is inhumane and blatant misogyny to deliberately deny women pain relief during childbirth and the postpartum.  The new approach is that someone from the obstetrical community has the courage to publicly state what many already know and haven’t bothered to say.