ROBERT SIEGEL, host:
This is ALL THINGS CONSIDERED from NPR News. Im Robert Siegel.
Childbirth should be painful, painless; completely forgotten, fully remembered; natural, surgical; experienced at home and experienced in a hospital. At one time or another each of those has been regarded as true and that spectrum of truisms gives Randi Hutter Epstein plenty to write about in her new book on the subject. Its called Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank. Randi Hutter Epstein is a journalist and an MD, and she joins us from New York. Welcome, to the program.
Dr. RANDI HUTTER EPSTEIN (Author, Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank): Thank you. Thank you for having me.
SIEGEL: Is it fair to say that the overarching theme of "Get Me Out" is that the process of facilitating childbirth has been one generally of displacement of women by men and midwives by doctors?
Dr. EPSTEIN: No, actually, I look at it as, well, two things. One is I thought when I started the book that driving ourselves crazy over conflicting advice is something that just baby boomers do, but, actually, weve driven ourselves crazy and been bombarded with conflicting advice for hundreds and hundreds of years. And I think the other theme is weve always driven ourselves crazy to try to figure out how to have this perfect baby. Were trying to control the uncontrollable. And in terms of doctors and midwives, I think we women have a history of being a feisty bunch, so weve actually pushed and asked for lots of things too - some good, some bad.
SIEGEL: Now, there are people in this story who made great advances and yet are still very hard to admire for a variety of reasons starting with the Chamberlen's who made a great advance and then managed to keep it secret from the rest of the world.
Dr. EPSTEIN: Yes, the Chamberlen family came to England from France in the late 1500s with a forceps. Now, there were forceps before, but they kind of ripped the baby out and did all sorts of gruesome things. The Chamberlens claimed to have a forcep that could help get the baby out - the ones that were stuck -gently without harming the mother or the baby. But they wanted to capture that market. So they hid their forceps from anyone, even from the woman giving birth as if she was going to be taking notes and trying to figure out what that forcep was and make her own afterwards.
SIEGEL: So they wanted to make childbirth safer for their patients only. They didnt care about anyone else.
Dr. EPSTEIN: And they wanted to be the doctors of royalty, too, and they won -they got that.
SIEGEL: Another, at best, questionable character is Dr. J. Marion Sims.
Dr. EPSTEIN: Oh, yes. He's actually a much more controversial figure among historians today. What the Chamberlens did sounds really appalling to us now, but, really, thats what all doctors did. They were competitive. They had new things. They didnt share information. Sims is the doctor who is renowned for figuring out how to cure vaginal fistulas, tears in the vaginal wall, which is absolutely wonderful, you know, thousands and thousands of lives have been saved. The part of the story that he always liked to bury when he came 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.
SIEGEL: Using them as lab subjects.
Dr. EPSTEIN: Guinea pigs.
SIEGEL: Guinea pigs, yes. Another dubious contribution to the history of childbirth - the development of twilight sleep.
Dr. EPSTEIN: Oh, yes. And thats where women come into play. Thats where we can say this was not doctors saying you have to have this concoction of drugs. This was a group of wealthy women who read in the magazine that there were women in the 1910s in Europe that went into the hospital and the next thing they knew, the doctor was handing them their baby. They were knocked out. They didnt remember. They say a whit about the experience and isnt that wonderful.
What the articles that were in womens magazine forgot to include or intentionally admitted was that the way these drugs worked, you became a little delirious and more kicking and screaming. So you had to be strapped down and gagged and tied to the bed so you wouldnt roll out, but you didnt remember any of that.
SIEGEL: Yeah. This raises, as you know, the interesting philosophical question: If you dont remember the pain at all, what then is pain?
Dr. EPSTEIN: Well, thats exactly that I write in the book. I mean, doctors who knew better were saying this is not pain-free birth. And the women were saying, well, I dont remember the pain, so, to me it was pain free. So it is this philosophical question.
SIEGEL: Class has much to do with this.
Dr. EPSTEIN: Has everything to do with it.
SIEGEL: When youre writing about the advent of the C-section as not just a medical necessity, its all summed up in the title of a paper that you cite in 1908 by Dr. Franklin Newell of Harvard. The title of his article advocating more Cesareans for women was The Effect of Overcivilization on Maternity.
(Soundbite of laughter)
SIEGEL: Who are the over civilized?
Dr. EPSTEIN: The overcivilized were wealthy women who spent their time indoors stressing out over their children, dragging them from one activity to another. Im not talking now, Im talking about the early 1900s. And he felt that they just were not as sturdy and hardy as those poor women in the fields who were able to get out and have exercise and give birth easily. So he just felt we ruined our bodies.
SIEGEL: Yeah, the argument was that poor women, working women, rural women might be able to give childbirth the old fashion way, but over-civilized women, educated, urban, upper middle class women urged to fragile to push.
Dr. EPSTEIN: Right. And they had scientists saying and not only was their lifestyle, but the more bookish they became, the more those reproductive energies were being sucked up into their brain. So they just didnt have the energy to do it all.
SIEGEL: I assume these studies for you as an MD imbue you with some modesty about medical wisdom down through the years.
Dr. EPSTEIN: Oh, and you can look at things. I mean, we can laugh about what they said then, but its not that long ago that when we were picking sperm and egg for IVF, that we said, gosh, that sperm, hes swimming fast and straight, hes the one. And now there are studies emerging saying, no, the kind of loser-ish crooked ones might be the ones that are best to make the baby. So, you know, someones going to be laughing at us probably 50 years from now.
SIEGEL: Where we are right now, by the way? What is the in approach to childbirth? Are we post-Lamaze? What are
Dr. EPSTEIN: Oh gosh, I like to call today the era of extremism because I think where were now is and Ive interviewed, oh, gosh, it feels like Ive interviewed hundreds of women. But Ive spoken to women who will say: Because of everything we know and Im 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. And Ive spoken to an equal amount of women who have said, you know what were perfect the drugs. Were beyond twilight sleep. Get me in a hospital, get me as many drugs, I really look forward to motherhood, but I dont really need this childbirth experience. So, I think among informed women, were really at polar extremes.
SIEGEL: Randi Hutter Epstein, author of Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank. Thanks a lot for talking with us today.
Dr. EPSTEIN: Thank you so much for inviting me.
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