Birthing a Slave: Motherhood and Medicine in the Antebellum South (review)

Marie Jenkins Schwartz’s Birthing a Slave attempts to paint a comprehensive picture of women’s reproductive health in the slave quarters of the antebellum south. In pursuing this laudable, if difficult, task, Schwartz has been diligent in locating plantation records, WPA interviews with former slaves, case reports in contemporary medical journals, and other relevant primary source material. The result is an impressive bibliographic treasure trove for which future researchers will be thankful.

Having gathered this material together, however, Schwartz is uncertain what to do with it. She is a social, not a medical, historian, and her grasp of clinical obstetrics and gynecology is shallow and insecure. Because she does not understand the pathology and physiology that underlies the cases about which she writes, her comments are often little more than superficial glosses on the primary texts, and she is unable to set them within any meaningful clinical context. As a result, many of these cases lie lifeless on the pages of her book. For example, one gets no sense of the heart-stopping terror faced by a physician who unexpectedly encountered a placenta previa, a condition in which the placenta implants over the internal cervical os. Obstetrical writers since the eighteenth century referred to such cases as ones of “inevitable hemorrhage” because it was impossible to deliver the baby without disrupting the placenta and causing massive bleeding. Because the lower uterine segment is poorly contractile and because 20% of the total cardiac output is going through the placenta in a term pregnancy, cases of placenta previa produced what nineteenth-century obstetrical writers called “a flooding,” in which the unfortunate woman could exsanguinate within a matter of minutes. The reader gets no sense of the agony experienced by a woman who underwent an internal version and extraction—and manually turning the fetus by inserting a hand inside the contracting uterus to extract the fetus by the feet in cases of difficult delivery—in the days before anesthesia. The helplessness and horror experienced by the onlookers (be they physicians, family, or friends) of a woman undergoing repetitive eclamptic seizures is likewise absent from this book.

At times Schwartz’s narrative descends into incomprehensible chaos, as in her chapter on “Cancer and Other Tumors,” in which she lumps together giant ovarian cysts, malignant tumors of the uterus and breast, vulvar hematomas, pelvic abscesses, ovarian cancers, and uterine polyps, along with a case of abdominal pregnancy (which was actually probably a very large benign cystic teratoma). Because a “tumor” at the level of its most basic meaning simply refers to a “swelling,” unless the reader has some way of sorting out the underlying pathophysiology (with its vastly different implications for the patient), the chapter becomes a formless jumble.

When she writes of “Gynecological Surgery,” Schwartz encounters similar problems. She refers to vesicovaginal fistulas throughout her work as “tears” between the bladder and the vagina from childbirth, when in fact obstetric fistulas are almost always the result of a prolonged crush injury to the pelvis that leads to sloughing of tissues from ischemic injury. This physiological fact is central to an understanding of how fistulas developed and the problems inherent in their repair. That this misconception is so pervasive leads one to question how deep her understanding of these problems really is. She repeats the common accusation against J. Marion Sims that “When experimenting on black women, Sims regarded anesthesia as unnecessary. Yet when he began performing the surgery on white women, he found it indispensable” (239). In fact, Sims rarely used anesthesia when operating on fistulas no matter what the race of the patient until at least the time of the American Civil War.

The author’s underlying assumptions strongly color her narrative. For Schwartz, physicians were nothing more than agents of slave-holding power, another means for slave-owners to assert hegemony over their human property. She views physicians as poorly trained, marginally...