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Book Review

‘A Good Birth’ by Anne Drapkin Lyerly

Connecting women more fully to the birthing process

In “A Good Birth,” author Anne Drapkin Lyerly relies on women’s voices and experiences to reclaim the birthing process from the bickering jaws of the “birth wars” — that polarizing debate between midwives and obstetricians that leaves many women feeling regret, self-doubt, and failure for not birthing their babies the “right” way.

The heart of the problem, Lyerly writes, is a deep confusion about the goals of birth — about what it is that makes a “good birth.” On one side is the midwifery view, that birth is normal and natural and not the proper place for medicine. On the other side is the medical view, that birth is complicated, potentially risky, and responsibly undertaken only in the context of medical care, in a hospital. From Lyerly’s perspective as a seasoned obstetrician and mother of four boys, neither side has it quite right, and so she looks to the wisdom of women who have experienced birth to inform us.

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She initiated the Good Birth Project at Duke University in 2006, conducting interviews with 101 women and 30 practitioners about what they believed constitutes a good birth. Over 10 years, she and her team discovered that the answer to this question is much more subjective, nuanced, and varied than they had assumed. Based on her research, the book is laced with heartfelt anecdotes and compelling stories from new mothers, “wise women” — mothers who have birthed more than once — and health care professionals. In assessing her findings, what struck Lyerly time and again “was not what distinguished one birth from another, but what about them was the same. I was moved by what they had in common despite their differences.”

Many of the women endured births that strayed considerably from what they had hoped for or expected. But what determined whether their birth was actually good had more to do with their “feelings of agency, security, connectedness, respect, and knowledge than whether their births unfolded according to plan.”

There are many lessons learned from the Good Birth Project, a primary one being that women’s memories of birth, even decades later, are strikingly accurate. In chapters titled “Control,” “Connectedness,” and “Respect,” what emerges is that the physical and clinical features of these women’s labors were less important than the way they remembered being treated by caregivers, and how these women and men related to them during their most fearful and vulnerable moments.

“What I heard from women time and time again,” writes Lyerly, “was that feeling emotionally connected to health care providers was an important part of a good birth . . . what made their birth good was how intimate it felt, partly because of how deeply connected they felt to their midwife or doctor.”

Acknowledging the pros and cons of both sides of the debates, Lyerly writes with candor and humility about the risks, uncertainties, and “loss of control” that defined her own caesarean deliveries, and the hundreds of labors she has attended as a physician. She implores women to look to themselves to craft a notion of a good birth. “What makes birth manageable and meaningful — indeed, what makes it good — will relate in a substantial way to the person or people who experience it.”

Throughout her book, Lyerly celebrates women’s intuition about this most intimate and sacred of acts, even during the rigors of labor when the tentacles of the birth wars may loom and derail a woman’s sense of trust in her self.

“A good birth,” she writes, “is one that we have a hand in shaping . . . a birth that’s informed by things we value, a birth in which we’ve been able to decide among options, a birth in which we feel involved and present.”

Miriam Zoll is the author of the new memoir, “Cracked Open: Liberty, Fertility and the Pursuit of High-Tech Babies.”
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