Deliver Me from Pain: Anesthesia and Birth in America (review)

Deliver Me from Pain is a history of American childbirth and obstetric practice from the middle of the nineteenth century to the present day. The author, a historian of medicine at Ohio University, takes as her starting point the view that “while the physiology of birth is fundamentally the same for all women, the experience of birth is not” (3). She then proceeds to document how social practice and cultural attitudes have shaped and defined the physiological event that is childbirth over the last 150 years. Deliver Me from Pain focuses on the history of obstetric anesthesia, charting the swings in the pendulum of anesthetic use and practice from the early controversies between Charles Meigs of Philadelphia (who was adamantly opposed to obstetric anesthesia) and James Young Simpson of Edinburgh (who was adamantly in favor its routine use), through the fervor for “twilight sleep” in the early decades of the twentieth century, to the “natural childbirth” movement that arose in reaction to twilight sleep, up to the “epidural industry” of the present day. It is a fascinating story, written in spritely fashion, paying close attention to primary sources and appropriate scholarly documentation. Throughout this story, the reader can watch the struggle between two fairly consistent attitudes toward childbirth: the naturalists who are predisposed to let nature take its course with minimal outside interference, and the interventionists who have a much lower threshold for interfering in the course of any given labor. At times each camp has held the upper hand in social practice, only to be displaced by a new innovation or a subtle cultural shift in attitudes toward women, toward birth, and toward the place of innovation in clinical practice.

If I have one criticism of the book, it would be that it tends to emphasize the controversies surrounding the nature and use of anesthesia in routine childbirth and as a consequence the author tends to neglect the important role that anesthesia has played in the management of obstetrical emergencies and difficult childbirth. The author minimizes the contribution that anesthesia played in the precipitous drop in maternal mortality that occurred during the last 150 years, particularly during the first half of the twentieth century. For example, she writes “Most obstetricians chose to ignore the potential for normalcy in the vast majority of births and instead exaggerate the potential for pathology” (84). A doctor who takes on the care of a pregnant patient can reasonably expect a relatively uncomplicated delivery in most instances: however, there is solid clinical evidence that 15 percent of pregnancies will develop potentially life-threatening complications which arise unpredictably and unexpectedly. One spends 85 percent of one’s obstetrical training preparing to take care of 15 percent of one’s patients. The responsibility involved in managing such cases is not light and it is easy for a writer who does not have to carry such burdens herself to overlook their implications for practice. Anesthesia is hugely important in an obstetrical crisis.

The book’s somewhat rosy view of childbirth can be seen in the following passage: “Historical demographers believe the maternal death rate observed by Maine midwife Martha Ballard between 1785 and 1812 had long been typical. In almost one thousand births, Ballard lost five mothers in the postnatal period and none during delivery. This maternal death rate of 0.5 percent of births, though extremely high by today’s standards, was miniscule in comparison to eighteenth and nineteenth-century perceptions” (16). Midwife Ballard’s statistics work out to a maternal mortality ratio of 500 maternal deaths per 100,000 births, roughly the level of maternal mortality currently found in the west African nation of Ghana. The problem is that while a woman’s chances of dying in any given pregnancy are relatively low, when the risk of death over a woman’s entire reproductive life is calculated, the statistics are more sobering. A Ghanaian woman has a lifetime risk of maternal...