Pregnancy and Birth: The Best Evidence

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by Joyce Barrett, MD, and Teresa Pitman

By Anne Rochon Ford

When I was pregnant with my son eleven years ago, my bedside table was piled high with all sorts of books on pregnancy and childbirth. I found no book alone that really answered everything for me, so I turned to different books for different questions.

This is how I was able to get a sense of the whole picture. More or less.

If I were pregnant today, Pregnancy and Birth: The Best Evidence would be the only book I would need next to my bed.

Joyce Barrett, a recently retired family doctor, practiced obstetrics and pediatrics for more than twenty-five years. Teresa Pitman is a childbirth educator, a doula and a writer. In a style that is reassuring and compassionate, the two authors examine each of the key decisions most women and couples will face and provide them with the information they
need to make the choices that are best for them.

What makes this book different from all the others that fill the shelves of bookstores and libraries is the authority and knowledge with which they cover the topic.

In 1989, the Oxford University Press published Effective Care in Pregnancy and Childbirth, a two-volume goldmine of information about pregnancy and childbirth based on a review of studies conducted worldwide since the 1950s. The authors of Effective Care (one of whom, retired Hamilton obstetrician, Dr. Murray Enkin, gets a special thanks from Barrett and Pitman) reviewed and analyzed all the studies on the vast range of pregnancy and birth-related topics and made recommendations for effective care based on the best evidence.

The two-volume resource, and a continually updated database (called the Cochrane Library, available on CD rom) is now considered the bible of many a nurse, midwife and physician the world over.

Pitman and Barrett have taken the wealth of information available in Effective Care and the updated Cochrane Library and translated it into friendly, readable language for a broader public; more specifically for pregnant women and their partners.

Beginning with the time when a woman first discovers she is pregnant and carrying through to the first few days after birth, the authors walk the reader through the range of questions they may have at each phase.

These include: choice of birthplace and caregiver, the use of ultrasound and other prenatal diagnostic techniques, problems during pregnancy, labour induction, medications for labour, options for different kinds of deliveries, and routine procedures done on newborns.

In addition, they point out where research contradicts many common practices, such as the use of fetal monitors, episiotomies and shaving the mother's pubic hair. While procedures such as these have become common practice in North American labour and delivery rooms, a body of recognized research shows that these may not be the best practice after all. Since they became routine before the full evidence was in, it is often hard to break from this routine.

There is no question that Barrett and Pitman view birth as a normal process. While leaning towards a minimum of intervention unless necessary, they are very careful to back up their reasons with the best evidence available. Using case studies, the authors help the reader to see how other couples worked through difficult decisions.

If I have one complaint about this book and it is a very minor one it would be that subsequent editions might include more illustrations. The few that are included (by Karen Visser) are beautifully rendered and thoughtfully chosen. Photographs are also used where they are more appropriate (e.g. showing the face of a woman in labour). Nothing beats a good illustration for explaining certain aspects of pregnancy and childbirth most fully.

This is a very small quibble with an otherwise highly readable and strongly recommended book, not only for expecting mothers and their partners but for all involved in the world of pregnancy and childbirth.

Anne Rochon Ford is a full-time writer and founding member of the Canadian Women's Health Network.

Pregnancy and Birth: The Best Evidence
by Joyce Barrett, MD, and Teresa Pitman
Published by Key Porter Books, 1999
70 The Esplanade

Toronto ON M5E 1R2 Canada