Friday, August 21, 2009

Commencement: Copyright 2009

I just finished a very enjoyable book, called Commencement, about the experience of four young women at Smith College and their "commencement" of life outside of Smith. I especially enjoyed it, I think, because I lived in Western Massachusetts at the time the novel was set in, and it was interesting to read about a place I passed on a regular basis.

There were a few things I didn't like about this book though. First, there was what felt to me like a big plot stretch to include lots of information about girls and very young women being forced into prostitution. It's not that this issue wasn't related to other issues explored in the book, around freedom and feminism and the choices women make, or aren't able to make and why... it's more that the plot felt driven by it in a way that didn't feel realistic.

What really annoyed me, though, was this scene, when one of the four central characters, Sally, is in the hospital giving birth:
"'Sally, we're having a little trouble getting the baby's shoulders out,' the doctor said. 'We're going to have to do a small episiotomy.'

'How small?' she said.

'Small,' the doctor said. 'I promise. Seven stitches, max.'

Stitches? Celia reminded herself to get on the waiting list for a couple of Romanian orphans as soon as she got home.

'No,' Sally said, shaking her head. 'I don't want it done.'

Celia was about to speak up, about to say that these damn people needed to listen to Sally, and really, hadn't the poor girl been through enough without slicing her open?

'Babe,' Jake said gently [Jake's her husband & the baby's father]. 'I know you didn't want one, but it will heal so much better than a jagged tear.'

Bree's eyes nearly popped out of her head.

The doctor grinned. 'I see Daddy here has been reading What to Expect When You're Expecting. He's right, I'm afraid.'

'Oh okay,' Sally said. 'Just get this thing out of me.' She put her head back, resigned.
Okay, maybe this scene infuriated me. I'll admit it.

I don't know where to start. The fact that the doctor promises the number of stitches it will take to close the episiotomy? How would he know?? Especially since from all the research I've seen many of the worst kinds of tears happen more frequently after an episiotomy.

In case you're wondering, this is what the very mainstream Babycenter.com says about perineal tears:
"A third-degree laceration is a tear in the vaginal tissue, perineal skin, and perineal muscles that extends into the anal sphincter (the muscle that surrounds your anus). A fourth-degree tear goes through the anal sphincter and the tissue underneath it." . . . and that "It's possible to tear even if you have an episiotomy. In fact, an episiotomy may raise your risk of getting more severe tears."
And here's a bit of what Henci Goer writes in Obstetric Myths Versus Research Realities about episiotomies, "The major argument for episiotomy is that it protects the perineum from injury, a protection accomplished by slicing through perineal skin, connective tissue, and muscle. Obstetricians presume spontaneous tears do worse damage, but now that researchers have finally done some studies, every one has found that deep tears are almost exclusively extensions of episiotomies. This makes sense, because as anyone who has tried to tear cloth [or paper] knows, intact material is extremely resistant until you snip it. Then it rips easily" (276).

I do that demo in class, with paper. When we talk about circumcision, almost always the dads turn a bit green. The episiotomy demo has the same effect on the moms.

This is an excerpt from Chapter 32 of A Guide to Effective Care in Pregnancy and Childbirth:
Although episiotomy has become one of the most commonly performed surgical procedures in the world, it was introduced without strong scientific procedures of its effectiveness. The suggested beneficial effects of episiotomy are: a reduction in the likelihood of third-degree tears; preservation of the pelvic floor and perineal muscle leading to improved sexual function and a reduced risk of fecal and/or urinary incontinence; reduced risk of shoulder dystocia; easier repair and better healing of a straight, clean incision rather than a laceration . . . On the other hand, a number of adverse effects of episiotomy have been suggested. These include: the cutting of, or extension into, the anal sphincter or rectum; unsatisfactory anatomic results such as skin tags, asymmetry, or excessive narrowing of the introitus; vaginal prolapse; rectovaginal or anal fistulas; increased blood loss and hematoma; pain and edema; infection and dehiscence; and sexual dysfunction.

Liberal use of an operation with the risks described above could only be justified by evidence that such use confers worthwhile benefits. There is no evidence to support the postulated benefits of liberal use of episiotomy. Controlled trials show that restricted use of episiotomy results in less risk of posterior perineal trauma, less need for suturing perineal trauma, fewer healing complications, and no differences in the risk of severe vaginal or perineal trauma..." (295)
Then, the fact that, in a book with a 2009 copyright date, full of thoughtful examination of women's independence and women's choices the author writes, with no evidence of criticism the passage quoted above... this passage that feels like the baby's dad and the doctor pull a paternalistic act of "reassuring" the "ignorant", "hysterical" laboring woman, with LIES, makes me feel a little crazed!

Where is the critique? Where is the "speak truth to power"?? Where is the sense of outrage???

Instead we get "She put her head back, resigned." We get one observer whose eyes nearly pop out of her head and another who is so traumatized and horrified that she wants to adopt children instead of give birth. We get What to Expect When You're Expecting.

There are 29 holds on this book from the Maine library system. People, probably mostly women, are reading it. And on the whole, it's a good book. Which makes the above passage all the more insulting, in my opinion. And all the more damaging.

What would possess an otherwise well-informed, sensitive, thoughtful author to write it? Any ideas?

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
Mamas & Muffins: New Moms Group

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