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

In Deliver Me from Pain, Jacqueline H. Wolf examines physicians’ use of obstetric anesthesia from the 1840s through the present. Wolf’s unique focus on pain management brings a fresh perspective to the literature about childbirth and new understandings of this life-changing event in women’s lives and histories. Wolf’s analysis is grounded in the notion that women’s pain and expressions of pain are shaped by cultural norms, as are physicians’ interpretations of pain. She convincingly argues that cultural ideas and social norms caused changes in obstetrical anesthesia protocol more than technological innovations did. Wolf is one of the first scholars to extend her study of childbirth beyond the 1970s and the first historian to study contemporary childbirth trends.

Wolf finds that social birth began to decline earlier than previously thought, in the 1840s and 1850s, as soon as physicians began to introduce ether and chloroform to their practices, rather than in the early twentieth century, when twilight sleep first appeared. As a result of this change, expectant mothers lost the support of a network of women and the knowledge about birth and expectations of labor pain that these women possessed. Physicians’ interpretations of labor pain replaced those of other women, a shift that Wolf finds deeply problematic because physicians routinely misinterpreted women’s pain, which caused them to administer anesthesia after the worst pain of transition had subsided and during second stage labor, thus rendering women unconscious or “oblivious” at the moment of birth (p. 42).

Most physicians chose not to offer emotional support to laboring women, believing instead that anesthesia provided sufficient comfort. This trend continued through the baby boom, when childbirth in American hospitals resembled an assembly line; women labored under the influence of multiple drugs and were delivered, while still unconscious, by physicians who relied on forceps, episiotomies, and other interventions to ensure that birth proceeded according to a fixed schedule. Only when hospitals adopted some natural childbirth techniques in the 1970s did support people reappear to comfort laboring women. Notably, hospitals adopted the Lamaze technique, the natural childbirth method most open to medical intervention, and physicians continued to use drugs to control the pace of birth. This portion of Wolf’s study complements another book on childbirth published in 2009: Judith Waltzer Leavitt’s Make Room for Daddy: The Journey from Waiting Room to Birthing Room.

The natural childbirth movement of the 1970s developed concurrent with rising rates of cesarean sections. Wolf argues that hospitals adopted some reforms suggested by natural childbirth advocates, for example, they constructed birthing suites that offered home-like comfort during confinement, but that physicians used these same advances to define a “normal” birth as one that involved pain management technologies. By the 1990s, the concepts of “choice” and “rights” in childbirth first introduced by feminists in the 1970s had been appropriated by physicians and women seeking elective cesareans, who argued that scheduled births provided comfort and convenience to busy women and who characterized this type of birth as empowering.

Wolf’s story is one of decline. She argues that innovations in obstetric anesthesia reduced the agency of laboring women and caused physicians to replace women as the central players in childbirth. Wolf maintains that physicians’ routine administration of obstetrical anesthesia undermined women’s ability to participate in their own labor and delivery and supported a view of birth as a pathological event that required medical management and intervention. Even as Wolf demonstrates how women themselves demanded changes in obstetrical practice, for example at the turn of the twentieth century, when they used their power as consumers to request twilight sleep from reluctant doctors, she argues that the consequences of these shifts hurt women because when they were under the influence of the anesthesia they sought, they literally lost control over their bodies at a critical moment in their lives. “Ultimately,” Wolf writes, “the...