Early on, this became one of the books I saw recommended most on various LiveJournal communities, especially by those people who believed in informing themselves in depth about all possible procedures, and by those who often chose a different way and setting of birthing than the stock standard, and oft expected, hospital delivery. That said, this is definitely a book that I feel everyone should read, no matter what your plan is, or your philosophy on labour, birth and caregivers.

It's not a book that documents pregnancy and all the changes, nor a book that deals with labour and birth and their emotional and physical ramifications, so don't expect that if you get this book, plenty of other books cover those topics. It's sole purpose is to break down the information about procedures that might occur, and to provide information.

The author's qualifications are not strictly the ones you might expect (i.e. she's not a doctor/midwife), but pretty impressive nonetheless. She has a degree in biology, has been a Lamaze-certified instructor and a doula (labour support person) for over 20 years, and is an award-winning medical writer specialising in birth issues.

She also comes with an admitted bias, though she hopes not prejudice, that she states unequivocally at the beginning of the book. She believes that the "unconcious principles and resultant concious practices of obstetric management fail to meet the needs of women and babies and cause many of the problems they claim to prevent or cure". She does state though that she is not anti-technology, but is not a fan of routine use of intervention as opposed to indicated use. Nor is she anti-obstetrician, knowing many fine OBs herself, though in her years she's seen, experienced and read about plenty of not so fine OBs. By and large this just boils down to the fact that she doesn't consider any interventions lightly, as nobody should. But at least take that warning as you will.

She also points out though, that her views are based on medical literature, and it is this medical literature that she uses as a base for her book. She presents both pros and cons for each intervention and procedure.

The book itself is broken down into three parts. The first 280 pages deal with pretty much every intervention you might come into contact with during labour and birth. The next 100 pages are all summaries from the medical literature on which she's based her information including links to the titles/authors of the medical studies, so that you might look them up yourself if you wish. Then there's a 25 page bibliography listing studies, professional articles, policies and books on the subject.

The main chapters cover the following topics: caesarian sections; breech babies; labour induction; IV's; electronic fetal monitoring and caesarians for fetal distress; breaking the membranes; slow labour; epidurals and narcotics; episiotomies; elective repeat caesarian and VBAC (vaginal birth after caesarian); professional labour support; obstetricians, family practitioners and midwives; place of birth.

Each chapter is broken down into an explanation of the procedure, the reasonings for its use, the pros and cons and depending on the procedure, tips on how to avoid unnecessary application thereof.

The one thing that struck me the most in this book, and which is probably the key element, is how often common obstetric practise goes against published medical literature/studies/research and sometimes even professional guidelines. In a way that's kind of scary really, that you have people doing procedures that go against their own research and literature, or at the bare minimum that research has pointed out that the advantages are not what they're thought to be, or are not significant enough to warrant the added risks that doing the procedure will invite. Risks not only posed by the intervention itself, but also from other interventions you then become more at risk for, because most interventions can trigger situations that warrant more interventions. It works in a cascade/domino effect much of the time.

This is not a book that is going to tell you to just have a natural birth and to tough it out no matter what, and that you're some kind of failure if you can't hack it that way. Certainly though, this is not a book that advocates willingly going along with all decisions made by an OB and to just smile and listen to the good doctor without question. It does present you with information that you might not readily get from your OB, especially about the risks or downsides to the procedures, which is information you need if you're to make a really informed choice about whether or not to go ahead with something. It also gives you the tools to question (and possibly avoid) the routine use of certain procedures even when problems are not (yet) apparant. Procedures which might be completely unnecessary for you at that time, or at all. It certainly might surprise you that various procedures, which are commonly held as the greatest thing to be availible for labouring women, are not always what they're cracked up to be, being that often their risks are not mentioned as much, and the benefits glorified.

For what it's worth, bearing the author's own bias warning in mind, a lot of the topics that this book covers, and the resulting opinions of the author, were ones we also encountered in our birthing classes, and our classes weren't adherent to any one particular style/method or view of birth. They never made any comments on people's choice of care (veiled or otherwise), or espoused a "preferred" care choice but just presented information to us all, stating however that in a hospital you're much more likely to encounter most of these procedures than those at a birthing center or homebirth. This book was just much more indepth about the topics and research than our classes were, which of course focussed on more than just the labour/birth procedures.

Certainly this ranks as the "must buy" book for labour/birth as far as I'm concerned. While I've always leaned quite heavily towards the camp of not wanting any interventions if I could possibly avoid it (probably no surprise to most reading here), I do feel the information in it is vital to anyone to make informed decisions about their care, and with ample resources to continue researching the issues if so desired, with the inclusion of an extensive set of appendices, a bibliography and a resource section. Even if you do want the interventions, you should know all the information about them, not just the stuff that would make you consent or choose the procedure.