Nature Medicine | Spoonful of Medicine

Beach reading

I’m now a certified East-Coaster and so I did the only right thing for my holiday—went to Florida. But I haven’t quite caught on to the drill—since for beach reading I passed by numerous candy-colored books and Janet Evanovich mysteries.

Instead, I chose a topic I at times found disturbing: “Birth: The surprising history of how we are born,” by Boston Globe reporter Tina Cassidy.

The book, published this fall, introduces the reader to birth methods and fads through the centuries—such as fish bladder vacuum extractors, strange levers, and “twilight sleep,” a drug mixture that made women forget their memories of pain (as well as childbirth). In the middle ages women squatted over incense smoke and consumed fungal extracts to speed delivery. In mid-20th century, many women were routinely tied down during labor, their pubic hair shaved and newborns stashed in nurseries.

Cassidy examines the prestige of midwives in some communities and their persecution in medieval Europe. One witch-hunting guide proclaimed that “No one does more harm to the catholic faith than midwives.” Church leaders believed God intended women to suffer, and for centuries resisted attempts at pain relief.

Chronicling the rise of obstetrics as a medical profession, Cassidy describes harrowing rates of infant and child mortality in unsanitary city maternity wards. Even by 1932, 4.5 percent of women died from childbirth in New York City hospitals. Home delivery by midwives was generally safer; in regions of colonial America maternal death rates were 1 percent or lower.

Now, in the United States and many other countries a woman’s chances of dying in childbirth are less than 20 in 100,000 births.

But all is still not well. In Afghanistan, Angola, Niger and Sierra Leone women lack access to even basic care, and more than 1600 out of 100,000 women die.

Cassidy also questions whether some of today’s practices have a sound scientific basis. It was not until the 1950’s that a researcher even bothered to rigorously document the length of the stages of labor. That researcher laments that doctors often take these averages as a benchmark today, viewing women with longer labors as candidates for cesarean section. Even now, it seems to me that basic questions remain unanswered, such as the exact linkage between premature contractions and premature delivery.

Rates of cesarean section become more disturbing every year. In United States the rate is 29 percent, and it’s above 35 percent in Italy, Mexico and South Korea—soaring above levels regarded as acceptable by the World Health Organization, and above rates in countries with records of safer deliveries.

Cassidy relays these statistics along with breezy anecdotes of women giving birth on the Boston subway, of placentaphagy (eating the placenta), and male involvement in birth—such as tribes where the men flagellate themselves while their partner labors. I might not recommend it for the beach, but I’d give Cassidy’s book a higher page-turning rating than an Evanovich paperback—and I’m still thinking about it days later. I can’t help but be unsettled.

Obstetricians may have eliminated some of the more drastic methods of previous centuries, but it’s clear that something is still seriously amiss with how we are born.

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