In the pursuit of learning, every day something is acquired.
In the pursuit of Tao, every day something is dropped.

Less and less is done.
Until non-action is achieved.
When nothing is done, nothing is left undone.

The world is ruled by letting things take their course.
It cannot be ruled by interfering.

Tao Te Ching

Monday, March 14, 2011

Get Me Out - Book Review

A History of Childbirth by Randi Hutter Epstein

One of the most interesting birth-related books I've read yet,
Get Me Out is about the cultural history of childbirth, from ancient times up to today. Each chapter takes a subject through its evolution- the one about cesarean today some women request the surgery for convenience!
Quite a change.

Other parts of the book explore the advancement of birthing tools (like forceps), how women have moved from birthing at home to using hospitals (and back into the home again), the use of drugs (whether for pain relief or supposed prenatal sections begins in the 1400's when they were done only after both mother and child had died in childbirth, in order to baptize the baby before burial; eventually the operations became more successful (at least the baby lived) but were done only in extrememe emergencies; benefits- often going awry), the first use of x-rays and then later ultrasound, and sperm banking. Some of the stories from the past can be quite horrific- as when a doctor in the 1800's did repeated experimental surgeries.

Lots of things in the book opened my eyes but probably the most surprising was when I read about twilight sleep. For some reason I had assumed that twilight sleep was pressed upon women by doctors who wanted complete control over unconscious patients during birth (from something I read before?) but this book tells the opposite: doctors were reluctant to use a drug they didn't know all the side-effects of, and feminists of the day demanded a pain-free birth when they saw it was possible.

There's a lot to learn in
Get Me Out, not only about how medical science has advanced over the decades but also how societal attitidues towards birth have changed, often drastically so!

There's enough disturbing details about what women suffered in childbirth in times past that I'm not sure I would recommend this for pregnant women to read (I probably shouldn't have read it at the time, myself!) but otherwise, it's pretty intriguing.

Though it purports to be a history of childbirth, Get Me Out is more a history of the science and sociology of reproduction in a broader sense—from conception to birth—and it is an “examination of how ideas about pregnancy and birth shed light, directly and obliquely, on contemporary society.” Hutter Epstein organizes the book both chronologically (it really does begin with the Garden of Eden and end with the sperm bank) and by topic (with chapters on the evolution of our understanding of reproduction, methods of childbirth, infertility, and reproductive technology), and she weaves a colorful narrative out of scientific facts and the larger-than-life characters who made history (and often achieved infamy) for advancing revolutionary (and/or really bizarre) ideas about babymaking.

The way we give birth is a story about our deepest desires and our fundamental concerns about life, death, and sex.

The bulk of Hutter Epstein’s book focuses on nineteenth- and twentieth-century practices because, as she puts it, that’s where most of the action is. From antiquity to the Middle Ages, not much changed. Pain and the possibility of death during childbirth were givens, and pain was either a woman’s curse (Eve was framed!) or her divine duty (to be delighted in and appreciated, natch), depending on whom you asked. And then in 1513, a brilliant chap named Eucharius Rosslin wrote the first book about pregnancy and childbirth, The Rose Garden for Pregnant Women and Midwives (doesn’t that sound warm and fuzzy?), and the thing was a bestseller for…wait for it….TWO HUNDRED YEARS.

While it may seem innocuous, the fact that the author of this first book about pregnancy and childbirth was a man is quite telling because as birth transitioned from being a natural state of affairs to a medical event requiring professional intervention, men began to play a larger role in defining, theorizing about, and overseeing the process. And these men didn’t necessarily want the women to know what they were up to. They sneaked forceps into the delivery room under the cover of large sheets (to prevent competitors from copying their designs, of course), blindfolded expectant mothers to keep them subdued and—literally—in the dark about the tools being used on them, and conducted experiments on slave women without the slightest concern for informed consent.

Hutter Epstein writes of Dr. J. Marion Sims, who invented the speculum (wow, thank you, Dr. Sims) and pioneered the field of gynecological surgery to heal fistulas but did so by experimenting on slave women who did not have the option to decline his requests, thereby negating his contributions to medicine with what we now think of as his unethical behavior. Sims is “no longer seen as an icon, but a poster child for patient abuse.”

Get Me Out also chronicles the evolution of maternity wards, from the seventeenth-century practice of having three to five women share a bed to the late-nineteenth-century belief that women suffering from “childbed fever” should be taken up to the roof to air out their genitals. As more women bought into the idea that birth was safer in hospitals than at home, they began to want more than just survival out of the previously life-threatening experience.

It was not only a move from home to hospital, it was a move from one culture to another.

Enter the phenomenon of twilight sleep—a condition induced by morphine and scopolamine—to reduce pain but not consciousness during childbirth (though women often reported not remembering anything about delivery) and the Twilight Sleep Association. Contemporary feminists may prickle at the notion that essentially being high while giving birth was a step toward liberation, but early twentieth-century feminists supported the movement because “they did not beleive they were relinquishing control…they were demanding the right to give birth the way they wanted to.”

Hutter Epstein tracks the long and complicated relationship between feminism and reproductive rights and reminds readers that pre-1970, natural childbirth wasn’t so much a political statement as just the way things were (that whole twilight sleep thing didn’t last very long). She also examines the ways in which “childbirth became like the modern factory,” often inspiring women to seek more independent, personalized, even “romantic” ways of giving birth, though the author contends that “getting pregnant can be romantic…getting the baby out is anything but.” She discusses C-sections, efficiently separating myth from fact, “freebirthers” who seek to avoid assistance of any kind, sperm banks, and in vitro fertilization, and she does it all with humor, warmth, and respect for her readers’ autonomy.

Hutter Epstein also briefly explores the rise of ultrasound technology in both medical and commercial settings (read: those boutiques in the mall that will charge you an arm and a leg for some 3-d photos of your baby-to-be) and notes that “sophisticated microscopes and imaging tools have given the fetus its own identity,” which has some interesting (and, if you ask this reader, frightening) implications for the abortion debate.

Get Me Out covers a lot of ground and provides a wealth of information in under 300 pages, and it seems that Hutter Epstein agrees with one of her sources that feminism is not about promoting one way of life–or childbirth, in this case—over another but “acquiring sufficient information to understand the medical choices and demand the one that suits you.” A great read for women and men—and parents and the childfree— alike.