Please accept my apologies for letting this blog go so long without an update. I promise I have a very exciting post in the works about Wooly Mammoth physiology, which I will post later this week. In the meantime, enjoy this book review from earlier this year:
This is a slightly revised version of a post at Field of Science on April 22, 2011.
Earlier this year I received Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank by Dr. Randi Hutter Epstein through a Science Online 2011 giveaway contest on Twitter. It took me a while to get around to reading it, partially because I was busy churning out my thesis at the time, but also because it wasn't a topic I found entirely interesting. I am not interested in being pregnant at this point in my life, so a book about childbirth isn't on my radar right now. However, I decided to keep it around because you never really know what the future may bring. As it turns out, last week I had a very disturbing nightmare about being pregnant and being forced to have an abortion. The dream continued to disturb me a few days after the fact, so I grabbed the book off my bookshelf and started to read, thinking that it might help displace the "bad taste" of the dream.
Epstein has a nice light touch to her writing, so what could easily have been a dense and difficult book was actually very smooth and palatable. I banged it out in two days and it definitely achieved the desired effect of getting my mind off of the nightmare. The book is organized into five parts:
The first part covers the history of childbirth up to the 20th century. The focus is mainly on the invention of forceps and the contributions of Dr. Marion Sims, who is lauded for developing a surgical method to fix vaginal fistulas (a painful complication of childbirth where the vaginal wall tears and opens into the bladder or rectum) and simultaneously abhorred for developing his method through what essentially amounts to the torture of slave women.
The second part covers the move from bedroom to hospitals. Puerperal fever was a leading cause of post-partum death among mothers before the discovery of germs, which doctors transmitted freely between women in hospitals. This led to the bizarre practice of letting women's genitals "air out" on the roof of hospitals for days after giving birth, thinking that this would keep the mother from getting sick. After the establishment of sanitation came more drugs, and a chapter is devoted to "twilight sleep", the first attempt to use drugs to ease childbirth.
The third part explores the role of psychology in conception, the natural childbirth movement, and the devastating consequences of certain fertility drugs. The fourth part covers C-sections, freebirthers (an even more radical take on natural childbirth), and sonograms, and the fifth part covers gamete donation and cryopreservation.
Running themes throughout this book include the battle against midwives by medical doctors, the battle against medical doctors by pregnant women, and the rapidly oscillating opinions on what role drugs should play in pregnancies and childbirth. It seems that throughout history, doctors have been attempting to discredit midwives (both out of concern for women's well-being, but also in order to take over their business), women have been at odds with doctors over what is best for their pregnancies, and women have been unable to agree with each other over whether or not to take drugs, and which types of drugs, and the reasons to use or not use a particular birthing method. There are millions of different ways to have a child, and nobody can agree on anything! No wonder mothers are so stressed out.
One thing about this book that bothered me is that the book claims to be a "history of childbirth", but it is more accurately described as a history of childbirth in the western world. The book is not without the occasional reference to things happening in the non-western world, but the book is clearly focused on Europe and America, and largely devoid of Asian or African history and practices. This is not necessarily a bad thing or a criticism of Epstein's work. The book is clearly marketed towards western women, so there's no shame in focusing on western history (and to include a worldwide picture of childbirth throughout the ages would have made the book much longer and probably not as easy a read). I just believe in being honest about the limitations of scope, that's all.
While Epstein strives to write a fair and balanced book, sometimes her biases do slip in to the narrative. This is particularly obvious in the chapter on freebirthers, who believe in giving birth without any medical help at all. Her language in this chapter tends towards the dismissive at times, but I suppose that's to be expected, given that she's a medical doctor. To be fair, even scientist women aren't in 100% agreement about the level of medical intervention that is best for a pregnancy and birth. See, for example, Dr. Isis and Kate Clancy's recent posts on the subject. On the whole, though, her stance is clear. There's no one way to have a baby; women should decide what is best for them based on the information available, and then stick to their guns. And, perhaps just as importantly, when a mother chooses one method, it does not inherently translate into her making a judgement against mothers who choose other methods. New mothers have enough to worry about without being paranoid about how others will judge them based on their choices.