Author Reveals Flaws In The History Of Childbirth In her book Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank, Randi Hutter Epstein describes doctors who made great medical advances, but who had surprising flaws. Dr. J. Marion Sims, who is credited with curing vaginal fistulas, practiced on slave women, "stitching them up over and over and over again."

Author Reveals Flaws In The History Of Childbirth

Author Reveals Flaws In The History Of Childbirth

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Randi Hutter Epstein, a medical doctor and journalist, says that people have driven themselves crazy over childbirth over "hundreds and hundreds of years." And that while we've made advances, "someone is going to be laughing at us probably 50 years from now." Nina Berman hide caption

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Nina Berman

Randi Hutter Epstein, a medical doctor and journalist, says that people have driven themselves crazy over childbirth over "hundreds and hundreds of years." And that while we've made advances, "someone is going to be laughing at us probably 50 years from now."

Nina Berman

At one time or another, people regarded childbirth as something that should be painful, painless, completely forgotten, fully remembered, natural, surgical, experienced at home or experienced in a hospital.

Randi Hutter Epstein has written about that spectrum of truisms in her new book, Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank.

Epstein, a journalist and a medical doctor who teaches at the journalism school at Columbia University, says that people have driven themselves crazy over childbirth for "hundreds and hundreds of years."

"We're trying to control the uncontrollable," she tells NPR's Robert Siegel. "In terms of doctors and midwives, I think we women have a history of being a feisty bunch, so we've pushed and asked for things — some good, some bad."

Her book describes people who have made great advances in the history of childbirth — but it also unveils some characteristics that are hard to admire.

The Chamberlen family came to England from France in the 1500s with forceps — a safe way to extract babies — but they wanted to capture the market and be doctors of royalty, so they hid the forceps, Epstein says.

Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank
By Randi Hutter Epstein
Hardcover, 302 pages
W.W. Norton and Co.
List price: $24.95
Read An Excerpt

They even hid them "from the woman giving birth, as if she was gonna be taking notes and trying to figure out what that forceps was and make her own afterwards," Epstein says.

Another controversial figure is Dr. J. Marion Sims, who is credited with figuring out how to cure vaginal fistulas, or tears in the vaginal walls.

Epstein says this advancement saved "thousands and thousands of lives" — but Sims had a secret.

"The part of the story that he always liked to bury when he came to the North from the South, was that he figured out his remedy by practicing on slave women that he bought, and stitching them up over and over and over again," Epstein says.

And then, in 1908, with the advent of the cesarean section, Dr. Franklin Newell of Harvard wrote an article advocating more C-sections, called "The Effect of Overcivilization on Maternity."

The "overcivilized" were wealthy women who spent all of their time indoors and needed C-sections, Newell wrote, because they weren't sturdy and hardy like the poor women who worked in the fields, who were able to get out and exercise, and give birth easily.

"He just felt we ruined our bodies," Epstein says. "Not only was it their lifestyle, but the more bookish they became, the more those reproductive energies were sucked up into their brain so they just didn't have the energy to do it all."

Epstein says childbirth is still evolving.

"We can laugh about what they said then, but it's not that long ago that, when we were picking sperm and egg for in vitro fertilization, that we said, 'Gosh, that sperm, he's swimming fast and straight, he's the one.' And now there's studies emerging saying, 'No, the kind of loser-ish crooked ones might be the ones that are the best to make a baby.' So someone is going to be laughing at us probably 50 years from now.

"I like to call today the 'era of extremism,' " she says. "I've interviewed hundreds of women. I've spoken to women who will say, 'Because of everything we know — and I'm so informed — I want all-natural, I want to be at home or in a hospital that looks like a home, and this is going to be a wonderful, cherishable experience.' I've spoken to an equal amount of women who have said, ... 'Get me in a hospital, get me as many drugs, I really look forward to motherhood, but I don't really need this childbirth experience.' Among informed women, we're really at polar extremes."

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Excerpt: 'Get Me Out'

Get Me Out
Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank
By Randi Hutter Epstein
Hardcover, 302 pages
W. W. Norton & Company
List price: $24.95

ADVISORY: This excerpt includes subject matter of a sexual nature.

Eve's Doing: Birth from Antiquity through the Middle Ages

Eve, the first woman to become pregnant, suffered from excruciating pain during the delivery because she cheated on her diet. God told her to not eat an apple, but she was tempted by the serpent's claim that the forbidden fruit would endow her and Adam with worldly knowledge. In God's fury, he transformed the serpent into a belly-crawling creature. Then he turned to Eve and said, "I greatly multiply your pain in childbearing; in pain you shall bring forth children."

The thought pattern was set. Women deserved pain. In 1591, Eufame Maclayne was burned at the stake for asking for pain relief during the birth of her twins. Attitudes did not change much when safer anesthetics were discovered in the middle of the nineteenth century. Most people thought they were fine for surgery but not childbirth. Devout men and women believed that the pain in childbirth was a heavenly duty. If you couldn't endure the agony of childbirth, how would you handle the ups and downs of motherhood? (Why no equivalent hazing process for fathers? Vasectomies without pain meds?) Pain relief became somewhat acceptable when Queen Victoria asked Dr. John Snow for a whiff of chloroform to ease her delivery during the birth of Prince Leopold on April 7, 1853. But only somewhat.

Eve, of course, had a lot more to think about than labor pains. She was the only woman in the history of the planet to go through pregnancy without any advice, solicited or otherwise. We don't know whether Adam was nagging her to eat certain things or avoid others, but given how easily she manipulated him into eating an apple, it doesn't seem like he was the one wearing the pants in the relationship. Eve had no one. No mother. No guidebook. No friends with their own birth stories. Instead, she suffered the punishment. Despite the dire consequences — having to squeeze babies through an impossibly teeny orifice — she populated the earth, launching one of the greatest traditions of womanhood: feminine determination. She got to have her apple and her babies, too.

As soon as her daughters and her daughters' daughters reached childbearing age, none of them would ever experience pregnancy without a bombardment of words of wisdom. We seek them. They seek us. Who did Eve's children turn to? Our ancestors did what women have been doing all along. They turned to each other and self-proclaimed birthing gurus. They turned to medical men, the presumed pillars of knowledge. The literate few could read guidebooks — rather, guide papyri. You may think life was easier for our great-great-great-grandmothers, given the narrow range of advice. But from their perspective, it was a dizzying whirligig of do-this-don't-do-that.

Birth from antiquity through the Middle Ages was an all-girls affair orchestrated by men who had never seen a baby born. It was considered obscene for a man to enter the delivery room, yet they wrote the guidebooks, doling out advice based on hunches handed down over generations. (In 1522, Dr. Wert, a German doctor, was sentenced to death when he was caught dressing like a woman and sneaking into a delivery room.) Their words of wisdom (or of ignorance) were a man-made concoction of myth, herbs, astrology, and superstition. Nearly everything was about good sex and good thoughts and eating and drinking the right things. It was not simple. As far back as 1500 BC, probably even earlier, women had access to all sorts of explicit information about sex, pregnancy tests, abortions, and contraceptives.

What women went through back then, the whole experience, must have been one big guilt trip. Should anything have gone wrong, there were so many reasons to blame your own behavior. Did I do something that deserved God's curse? Was I drinking too much wine? Did I harbor evil thoughts?

If you were lucky to be in a city, you may have been helped by a licensed midwife (European cities started educating and registering midwives around the fifteenth century); if you were in the rural outback, you may have had an uneducated but experienced midwife or a female family friend. In any event, you were surrounded by a gaggle of women. Oddly enough, expectant women were not supposed to be catered to, but to cater. You were expected to act as hostess and serve the aptly coined "groaning beer" and "groaning cakes." Friends of the laboring woman were called "gossips," as in God sibs, as in siblings of God. You can assume they did what all women would do under the circumstances — sit around and talk about other people. So what was once an epithet for "close-to- God" morphed into a term for "behind-the-back chatter."

For the first millennia or so, women relied on the same traditions written and rewritten, told and retold, with very little change. Centuries after Hippocrates, Aristotle, and Galen were long dead, doctors were rewriting their words of ancient wisdom with little thought to the fact that the wisdom may be outdated. Medical authors were scribes, not enlightened experts, and certainly not investigators. Pregnancy advice in antiquity was virtually the same as the advice doled out generations later to medieval women. Sometimes experienced midwives learned a thing or two to tweak the process, but the books did not change.

Women were told how to speed labor (a concoction of herbs), what to eat (nothing too spicy), what to drink (not too much wine), and what to think (no angry thoughts). Women were told how long to breast-feed and when to hand the baby to a wet nurse. They were told to have enough sex because a splash of sperm moistens the womb. They were also told not to have too much sex because it wears out the baby-making machinery. That's why "whores have so seldome children," one guide said, because "satiety gluts that womb." In France, pregnant women rarely left the house after dark because they were told that if they looked at the moon, the baby would become a lunatic or sleepwalker.

One guidebook prescribed his and hers cocktails to up the odds of having a boy: red wine tainted with pulverized rabbit's womb for him; red wine with desiccated rabbit's testicles for her. Were couples truly doing shots of this stuff? We'll never know. But couples who wanted children — or preferred one sex to another — were willing to try anything. Think about the hormones we're shooting ourselves up with today. Maybe dried testicles wasn't so weird after all.

France's sixteenth century queen Catherine de Medici had the money and wherewithal to get all kinds of medical advice and treatment when she could not get pregnant. She chose first her folk healer, who told her to drink mare's urine and to soak her "source of life" (vagina?) in a sack of cow manure mixed with ground stag's antlers. The king was never sexually attracted to his wife. The dung diaper could not have helped the situation. Eventually, de Medici went to a doctor who diagnosed the teenage royals with physically defective reproductive organs. He had a different cure in mind. No one knows what it was, but it worked. They went on to have nine children. In between the folk and medical wisdom, she tried her own tactic: she commanded her servants to drill a hole in a floor so she could watch her husband have sex with his mistress and learn a thing or two about baby making. Maybe that did the trick.

Despite the collection of advice manuals, we really have no idea whether our great-great-great-grandmothers followed advice doled out by mothers, midwives, or medical men. Did they second guess their doctors when their mothers told them something else? Did they read the pregnancy books or just let them collect dust on a shelf ? If Eve is supposed to be a female representative, a role model of sorts, then perhaps there is something innately feminine to questioning authority. You have to assume that we have always balanced experts' suggestions with the advice given by friends and mothers, not to mention our own gut instincts. What was written in the books, then, may not tell the story of birth in antiquity, but it expresses what was important to women and caregivers about the birthing process.

The great thing about consistent medical knowledge is that doctors could reprint their books forever. Today's medical textbooks are outdated by the time they go to press. Soranus was a famous Greek physician who wrote the definitive book on gynecology in the second century. It was the leading text for the next thousand years. Not a bad run. The first part was matchmaking advice. He told men how to choose a fertile partner. Here's what to look for: a cheerful woman who is not mannish or flabby; a woman who digests food easily; a woman who does not have chronic diarrhea. Constipation, according to the book, suffocated the fetus. Diarrhea washed it away. Or, as he put it, women with chronic bowel issues would never be able to "lay hold of the seed injected into them." It's a wonder how men approached the subject of bowel movements on the first date. Soranus also told men to date a normal woman with a normal uterus. No further advice about how you figured out who had the normal uterus or what constituted a normal uterus in the first place — or, for that matter, what constituted a normal woman.

Soranus thought moderate drinking a good thing, but too much was dangerous. He believed that your thoughts molded the growing baby, so if you got drunk and had oddball fantasies, you would have weird children. There was proof. He said one women thought about monkeys during a drunken sexual escapade and her kids turned out hairy. On the other hand, an ugly man from Cyprus made his plain-Jane spouse stare at a beautiful statue during sex. Wouldn't you know it? They had gorgeous children.

Sex during pregnancy was considered dangerous to the growing fetus because it drained a woman's vital juices that should flow to the baby. Too much intercourse caused children who would be "defective in vital and other qualities, ill tempered, sickly, and short-lived." Smart parents made smart children, but again, only if they did not have too much sex. Otherwise their little ones, though born with higher than normal intelligence, would be weaklings and die before the age of 10. As always, moderation was key, but no one said what was the normal amount of sex.

Soranus wrote about positions and maneuvers to up the odds of conception. He also gave birth control advice, that is, how to have sex without conceiving: After your partner ejaculates inside of you, hold your breath, forcefully sneeze and then drink ice-cold water. If that failed, he recommended Hippocrates' abortion remedy: kick your heels into your buttocks until the seed drops out.

He also promoted do-it-yourself home pregnancy tests. Many tests relied on urine chemicals, much like today. He told women to urinate on a bouquet of wheat, barley, dates, and sand. If the grains sprouted, you were pregnant. If wheat grew, it was a boy; if barley, a girl. The sex selection may have been nonsense — maybe not — but perhaps the surge of the pregnancy hormones fertilized the sprouts.

Many of the earliest women's health books were written by monks, the very people who had the least use for the information. One book instructed men to get women in the mood by rubbing her between vulva and anus. What good this did monks is anybody's guess. One of the most popular monk guides, Women's Secrets, or De Secretis Mulierum, has been translated from the original text into modern language by Helen Rodnite Lemay, a medieval scholar. As she sees it, the book not only doled out health advice, but showed what some of the great thinkers, including Hippocrates, Aristotle, Soranus, and Galen, thought about women. In a nutshell, not much. She also showed that while health care was a combination of philosophy and medicine, philosophers and doctors perceived the human body and the cures in vastly different ways.

Reprinted from Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank by Randi Hutter Epstein. Copyright 2010 by Randi Hutter Epstein. Used with permission of the publisher, W.W. Norton & Company, Inc.

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