Why Are Women Spending 2.6 Hours MORE in Labor Than Their Mothers Did? And Why Are So Many Developing PTSD After Childbirth?

Maternity care in the U.S. is a scandal in danger of being eclipsed by other health crises: the Covid-19 pandemic, the overturning of Roe vs. Wade, and the high cost of prescription drugs.

But growing number of bleak statistics show why the country shouldn’t ignore the problem, including that American women are three times more likely to die in childbirth than those in Canada and Britain. First-mothers also spend 2.6 hours more in labor than their own mothers did, and they are at risk of developing PTSD afterward.

I write about the grim realities in “7 Painful Truths About Childbirth in America” on Medium:

https://janiceharayda.medium.com/7-painful-truths-about-childbirth-in-america-d27ca30cc922

Heather Armstrong’s Memoir of Pregnancy, Childbirth and Motherhood — ‘It Sucked and Then I Cried’ – Shrieking All the Way to the Psych Ward

The creator of a popular blog tells how she found her way to a mental hospital and back

It Sucked and Then I Cried: How I Had a Baby, a Breakdown, and a Much Needed Margarita. By Heather B. Armstrong. Simon Spotlight, 258 pp., $24.

By Janice Harayda

Heather Armstrong warns on her blog, Dooce, that she “CANNOT RESIST THE CAPS-LOCK KEY.” The same caution applies to her unabashedly self-indulgent memoir of pregnancy, childbirth, and the infancy of her first child, which made her so anxious that she checked herself into a mental hospital after she got no relief from psychotherapy and drugs that included Risperdal, Ativan, Trazodone, Lamictal, Effexor, Abilify, Strattera, Klonopin, and Seroquel.

How did Armstrong like breastfeeding? “Everything I’d ever read about breastfeeding had to have been written by a man with no tits, because everything said that as long as the baby was in the right position it wouldn’t hurt to breast feed. THAT WAS A LIE.” What did she think when her daughter woke up at 2 a.m.? “Leta knew how to poop, she knew how to eat, SHE HAD TO KNOW WHAT TIME IT WAS, FOR CRYING OUT LOUD.” Would Armstrong consider having  another child? “‘HA! ANOTHER BABY? The logistics of more than one TOTALLY BOGGLED MY MIND.”

It Sucked and Then I Cried is intermittently funny but has a lot of bathroom humor and sometimes a nasty edge. Armstrong writes unkindly that when her stepfather raises his voice, she thinks: “Maybe if you SCREAMED A LITTLE LOUDER THE WINDOWS WOULD EXPLODE.” If she hates it when people shout at her, why does she spend so much time in this book doing what she calls “S.H.R.I.E.K.I.N.G.”?

Best line: No. 1: Utah stores sell soaps “in the shape of Joseph Smith’s head.” No. 2: “A few days after Leta turned four months old we took away Leta’s pacifier and it felt like we were running a division of the Betty Ford Clinic.”

Worst line: “But this time we couldn’t park in the special parking space because I was no longer pregnant (THANK THE LORD GOD JESUS!) and we had to park in the non-pregnant parking space and walk an extra twenty feet to the door. We found this inconvenience totally unacceptable as we were living in America and shouldn’t have to walk an extra twenty feet for anything. AM I RIGHT? AM I RIGHT? This is the best country on Earth! WE DON’T WALK NOWHERE FOR NUTHING. Damn straight.”

Editor: Patrick Price

Published: January 2009

About the author: Armstrong lives in Utah with her husband, Jon, and has had a second child since finishing It Sucked and Then I Cried. She has more than a million followers on Twitter at www.twitter.com/dooce.

© 2009 Janice Harayda. All rights reserved.
www.janiceharayda.com and www.twitter.com/janiceharayda

Maria Laurino Writes of Her Near-Death From Preeclampsia During Pregnancy in Her Memoir, ‘Old World Daughter, New World Mother’

Maria Laurino tells the chilling story of her near-death from preeclampsia in her new memoir, Old World Daughter, New World Mother: An Education in Love and Freedom (Norton, 224 pp., $23.95). The five-page incident is a small part of the book but worth reading by anyone who has or is at high risk for preeclampsia, the pregnancy disorder that used to be called toxemia.

www.twitter.com/janiceharayda

How Bad Is the Pain of Childbirth? A Possible Way to Tell If You’re Going to Want That Epidural, As Described in ‘Predictably Irrational’

Women, make your husbands try this before you head for the hospital

How bad is the pain of childbirth? Behavioral economist Dan Ariely offers a way to get a handle on the question in his new Predictably Irrational: The Hidden Forces That Shape Our Decisions (HarperCollins, 280 pp., $25.95) www.predictablyirrational.com.

Ariely says that before the birth of their first child, he and his wife spoke with a birth coach who swore that if Sumi plunged her hands into a bucket of ice for two minutes, the pain would resemble that childbirth. That test might help Sumi get a sense of whether she would want pain relief during the delivery. She tried it and, after two minutes, “clearly understood the appeal of an epidural.”

I have no children, but this idea sounded a little kinky to me. So I went to the Exxon station, bought a $1.99 bag of ice and lugged it home. Then I stuck my hands in it.

Yow!

I tried the test twice, repeating it in the interest of scientific accuracy, and it confirmed what I had long suspected: If I’d had children, I’d have asked for an epidural after 20 seconds. That was longest I could stand to have my hands in the ice.

Afterward, it occurred to me: What if all pregnant women made their husbands keep their hands in a bag of ice for the amount of time their labor might last — say, 36 hours? Even half an hour might be revealing.

So here’s a suggestion for pregnant women and others: The next time you and your husband sit down to watch Jeopardy!, bring out a bag of ice. Ask him to keep his hands in it until the end of the show. If he wants to quit, yell encouraging things like “Pant! Pant!” or “You’re doing great, honey!” Or come out wearing a shower cap to help him get in the spirit of the test. The results could be interesting, don’t you think?

© 2008 Janice Harayda. All rights reserved. www.janiceharayda.com

Atul Gawande Tells What You Can REALLY Expect When You’re Expecting

A surgeon looks at the pros and cons of forceps, Cesarean sections, epidural anesthesia, fetal heart monitors and other fixtures of modern delivery rooms

Better: A Surgeon’s Notes on Performance. By Atul Gawande. Holt/Metropolitan, 273 pp., $24.95.

By Janice Harayda

Last year the New York Times published an article on a remarkable medical study that found that – contrary to a near-universal belief – pushing during labor helps neither the mother nor the baby. The study also found that women who were told to push may have more urinary problems after the delivery. One of the doctors who did the survey, published in the American Journal of Obstetrics and Gynecology, said that the research did not mean that women should never push. Instead, he said, they should do “what feels natural to do – and for some women that would be no pushing.”

I had two reactions to this news. First, if I were pregnant, I would ask my obstetrician if he or she planned to tell me to push and, if so, why, given there seems to be no benefit to doing this during every birth. Second, why didn’t we know this news sooner? Why have doctors for so long inflicted the needless agony of pushing on women? I had no idea what the answer to the second question might be until I came across a striking fact in the chapter on childbirth in Atul Gawande’s Better: Most doctors pay lip service to the idea that nothing should be used in medicine unless it has been properly tested and shown to be effective by a respected research center, preferably through a double-blind, randomized trial.

“But in a 1978 ranking of medical specialties according to their use of hard evidence from clinical trials, obstetrics came in last,” Gawande writes. “Obstetricians did few randomized trials, and when they did they largely ignored the results.”

That observation helps to explain why Gawande, a surgeon and writer for The New Yorker, may be our most important medical writer. Unlike many others working in the field, he doesn’t write mainly about the latest developments in medicine. He digs deeper, looking for the “why” behind the “what,” while taking on extraordinarily complex topics. But his writing is rarely harder to understand than in his lines about the 1978 survey of medical specialties. He seems to make a grail not just of accuracy but of clarity.

The chapter on childbirth in Better shows his work at its finest. It deals largely with why so many women have Cesarean deliveries, which account for about 30 percent of American births. Many people explain the statistic by saying that Cesareans are more convenient and lucrative for doctors than vaginal births. Gawande argues persuasively that there is a larger reason for the pattern. And part of it has to do with the virtual disappearance of forceps from delivery rooms.

In the 1960s fewer than 5 percent of deliveries were Cesareans and more than 40 percent involved forceps. And those numbers are related. Gawande makes a strong case that in the hands of experts, forceps are safe (according to some research, safer for mothers than Cesareans). But forceps are hard to learn to use properly – a process that can take two years. And if forceps are used by inexpert doctors, the results can be disastrous. Cesareans are easier to master. And this has led hospitals to phase out forceps and, in many cases, do C-sections instead. To discourage the inexpert from using forceps, Gawande says, “obstetrics had to discourage everyone from using them.” This change has come at a cost. Gawande notes that, as straightforward as Cesarean deliveries can be, they can go wrong. The baby can be lacerated. If the head doesn’t come free quickly, the child can asphyxiate. The mother also faces risks:

“As a surgeon, I have been called in to help repair bowel that was torn and wounds that split open. Bleeding can be severe. Wound infections are common. There are increased risks of blood clots and pneumonia. Even without any complication, the recovery is weeks longer and more painful than with vaginal delivery.”

With all of this, Gawande isn’t trying to frighten women away from having Cesareans or bring forceps back to every community hospital. He is instead trying to show the trade-offs that medicine involves. And this is only a small part of what he says in his chapter on childbirth, “The Score,” which also covers such delivery-room fixtures as fetal heart monitors, epidural anesthesia and the labor-inducing drug Pitocin. It is an even smaller part of what he has to say in the 11 chapters of Better that deal with subjects other than childbirth, including advances in military medicine and the need for doctors to wash their hands more often.

Women who are pregnant may reach for books like What to Expect When You’re Expecting and The Girlfriends’ Guide to Pregnancy. And patients who are facing surgery may turn to guides to their illnesses. But both groups could benefit from also reading this fine collection of essays. For some of them, Better may just be better.

Best line: Gawande writes about the Apgar score, which rates a newborn’s health: “In a sense, there is a tyranny to the score. While we rate the newborn child’s health, the mother’s pain and blood loss and length of recovery seem to count for little. We have no score for how the mother does, beyond asking whether she lived or not – no measure to prod us to improve results for her, too. Yet this imbalance, at least, can surely be righted. If the child’s well-being can be measured, why not the mother’s, too?”

Worst line: None.

Editor: Sara Bershtel

Published: April 2007

Furthermore: The New York Times article on pushing during labor, “Rethinking the Big Push During Contractions, appeared on Jan. 3, 2006, page F8. I can’t link directly to it, but here’s a link to a similar reprint in its sister publication, The International Herald Tribune. When you click on the following link, you will reach a page that says “Multiple Choices” and see another link that looks just like it (below the phrase “Available Documents”). You have to click on that one, too, to read the story (which appears below an article on “lazy eye”): www.iht.com/articles/2006/01/04/healthscience/snvital/php/php.

Links: Gawande has posted many of his articles on medicine at www.gawande.com.

© 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com