Tuesday, July 2, 2013

What to Read Instead of "What to Expect"

What do pregnant women really need to do to prepare for childbirth?  Award-winning investigative journalist Jennifer Margulis, Ph.D. reflects on this question in her essay below.  Margulis is the author of The Business of Baby:  What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby BEFORE Their Bottom Line.  Her book is a well-referenced expose that takes on a list of what's wrong with our perinatal healthcare system: from the risky effects of ultrasound on developing fetal tissues, to the harmful chemicals added to prenatal vitamins (and their potential contribution to morning sickness), and the profit motive underlying everything from obstetrical procedures to vaccines to long-term diapering.  Here are Jennifer Margulis's recommendations for what to read, watch, eat, do, and yes--expect--as an empowered pregnant consumer in a difficult maternity care climate.

Aunt Joanie and I were watching PBS’s Call the Midwife the other day.

“That’s not right,” I grumped at the television screen as the mom-to-be was groaning in pain during the first contraction. “She wouldn’t be in that much pain so soon.”

“Shut up,” Auntie Joanie chided. “It’s fiction, Jenny, fiction!”

Uncle Shelly, who’s 80 and a Nobel-prize winning physicist, looks forward to the episodes as much as Aunt Joanie. I applaud Call the Midwife for turning the average Joe or Joanie into a veritable birth junkie and for normalizing birth, but most accounts of childbirth on television and in the movies give the impression that it is a terrifying emergency that happens at lightning speed and is excruciatingly painful.   

Here’s the truth:

1)     Most women don’t even know when labor begins. You can lose your mucus plug (without noticing) and not go into labor for days. Your water can break but labor may not start for days. In Europe, where birth and delivery outcomes are much better, the midwife will tell you to wait a few days to see if something happens and then call her back. In America, they put you on the clock when your water breaks, to avoid infection they fear will kill the baby in 24 hours. Some women are in active labor for four or five days. Others have their babies in four or five hours. As long as the baby and the mom are both tolerating contractions and exhibiting no signs of complications, labor doesn’t need to happen on anyone else’s timetable.

2)     Labor is fun. That’s right. It’s fun! It’s exciting. It’s interesting. It might just be the best day of your entire life. It took some loving to get the baby in there in the first place and with loving support from your partner and doula and friends and family, you can actually have a GOOD TIME.

3)     There are l-o-n-g periods of time when everything that’s going on is inside the woman’s body. So, um, there really isn’t ANYTHING to see or do. A mom in labor often goes deeply inward. Many moms want to be in darkened quiet rooms. This does not make for good television. It’s kind of boring. Except for the mom. But she’s too busy climbing Mount Everest to notice. Some laboring women put themselves in small spaces because that’s where they feel safest—very hard to do in the hospital.

4)     No one should scream at you to push. They often do but they shouldn’t. Contractions are so powerful your body knows what to do without any vocalizing from the Peanut Gallery.

5)     Birth is an emergence--not an emergency.

You want to have an enjoyable, mind-blowing, fun, and even funny birth (it is funny. Think about it. A baby comes out your yaya. What could be funnier than that)?

So what should you do to prepare besides not watching TV?

1)     Meditate every day. It’s not just for tree huggers. Honest. If you spend a few minutes at the end of the day sitting quietly (I meditated in the bathtub every night) and imagining the birth you want, it conditions your mind, floods your body with positive feelings, and helps you get in touch with your baby. If you aren’t good at meditating (I’m not) write some positive affirmations out for yourself: I will have a good birth. My body is strong. My baby is healthy. I am the daughter of my mother and the product of all the women who came before her.

2)     Exercise. You can’t climb Mount Everest without getting into shape. Labor is called labor for a reason. Exercise! Being on your feet at work all day does NOT count. You need to do the stuff like prenatal yoga and swim class and you need to do the harder exercise. Every day that you are up for it.

3)     Eat Well. My friend who teaches childbirth classes likes to tell her mamas that “you are what you ate three months ago.” That’s true. But it’s never too late to start eating better. Trade pickles and ice cream for cucumbers and whole milk. Eat lots of leafy greens, saut√© them in butter (yes, FAT is good for you in pregnancy). Throw away the processed foods, skip the sugar, and make sure you are getting enough high quality protein. Need a snack? Try nuts, carrots, and fruit. Looking for an easy quick meal? Scramble some steak and eggs and serve them over a fresh green salad. Eating well need not be a production but it does need to be a habit.

4)     Gather your friends. You need to have people around you during pregnancy who are positive, kind, giving, and understanding. Do not spend time with friends who want to share their birth nightmares with you, or who think scheduling a C-section is like scheduling a haircut. Those “friends” can take their negativity elsewhere.

5)     Get together a birth team. You may be in labor for a long time, so you need to have people there who can go the distance and also help each other out. A midwife confessed to my husband once that she was mostly at the birth for the husband, since the laboring mama and her baby were busy doing their thing. I thought I wanted my mom at my first birth—that was a mistake. Don’t let nostalgia for the happy childhood or a supportive family you did not have influence whom you invite onto your team.

6)     Have someone organize a meal train. You don’t need anything after the baby is born besides lots of healthy food and time to marvel at the warm miracle who is sleeping, floppy-headed, on your shoulder. Tell friends you don’t want gifts but you would very much appreciate healthy fresh meals. Get someone to spearhead this initiative and arrange to have a cooler on your porch so friends and family can leave the meals but you don’t have to socialize with them until you’re ready.

7)     Watch the right movies. There are some good ones out there. My three best recommendations are The Business of Being Born, Orgasmic Birth, and Birth Story.

8)     Read the right books. If you own a copy of the book that begins with the words “What to Expect,” throw it in the recycling. Despite its popularity, that book is full of outdated, misguided, and non-evidence-based information. (If you want a full critique of how toxic that book is, read Naomi Wolf’s Misconceptions. But I’d skip that until after your baby is born.) My favorite books about birth are short and sweet and inspiring: Jennifer Derryberry Mann’s Belly Button Bliss, Heather Cushman-Dowdee’s Simply Give Birth. You can also read Ina May Gaskin’s Spiritual Midwifery, Janet Balaskas’s Active Birth, and Suzanne Arms’s Immaculate Deception.


  1. Great recommendations! I am a new doula, and I will definitely be following your blog. :)

  2. I don't share my "birth nightmare" to bring pregnant women down - I share it because awareness saves lives. Preeclampsia happens to 5-8% of all pregnant women. And 1 in 8 babies (that's 12%) are born prematurely. Birth can be both an emergence and an emergency at the same time. So where do we include information about complications? I wouldn't recommend What to Expect, either - but there has to be some way to balance this push for natural, normal birth with the need for information about complications. None of the books or movies that you recommend give good information on complications.

    1. Thank you Jenn. Readers may want to see my book for the chapter called "When Epidurals and Cesareans are Unplanned." It is a guide to "preparing" for the unexpected, and healing from traumatic events should they happen during birth. A large body of research from all over the world shows that women are best able to cope with complications when fully included in decision-making (sounds simple enough, but often does not happen). Thank you again for your comment.

  3. Lovely blog post :).

    I hesitate to put emphasis on needing to be an athlete to have a successful, satisfying, low-intervention birth. As a doula and childbirth educator, women come to me with many shapes, sizes, and physical abilities. Birth is physical, yes, and one doesn't need to be a marathon runner or accomplished strength trainer to move through this normal, mammal process. I have seen great athletes fumble through birth, overwhelmed by the lack of control over their bodies, and I have seen cubicle-dwelling women easily glide through the process, giving into their bodies' demands of hard work. Just as we know smoking is not a wise choice while pregnant, we also know basic exercise is beneficial -- walking, swimming, yoga. When we frame birth by stating a mom should be physically-fit for pregnancy and labor, it is easy for the un-fit woman to feel defeated before she has even finished her first trimester. Focusing on how to easily exercise during pregnancy (for not only the sedentary woman, but also the athlete) is a positive push forward to a healthy mom, healthy baby, and healthy experience of birth. So much of birth is mental -- if one can't relax her mind to relax her body, her fitness level makes little difference.

    Books that weren't mentioned as resources, those "nightstand books," women like to keep close that I find useful are The Official Lamaze Guide, The Birth Partner, and anything by Sheila Kitzinger.

    1. Hi Stacie,

      Interesting -- the line about exercise was also the one that caught my eye the most in this article, but for the opposite reason! In my experience as a doula, healthcare providers rarely share the proven benefits of exercise with pregnant patients. Dr. James Clapp is the author of the book "Exercising Through Your Pregnancy" and he has dedicated his career to research on this topic. Fit mothers have shorter labors, report less pain, and are less likely to birth post-dates or be induced. When I teach childbirth classes, I agree that it is a sensitive issue to not make sedentary moms feel guilty, which I would never want to do. But I do exhort my students to get moving, and it is a real mind-shift for some of them. They may not be getting that encouragement from anyone else. It is fun to see them start to talk amongst themselves in class and encourage one another to become more active from week to week. Thanks so much for commenting!

    2. Perhaps it's anecdotal, but I have heard that some super-fit pregnant mamas can have difficulty with labor (possibly because of tight pelvic floor muscles--think ballet dancers). For most women, it's probably safe to say they need more exercise and activity, but for some, they may benefit more from working to relax some tense muscle patterns

  4. Thank you for this. It was fun!