"Birth in Transition": Medicalization, Gender Politics, and Changing Perceptions of Childbirth in the United States and Late Imperial China

In 2009 Catherine Skol, a Chicago police officer, sued the obstetrician who attended the birth of her fifth child because of the pain and abuse she suffered during childbirth. Doctor Scott Pierce was angry with Skol for not alerting the hospital early enough (in his opinion) about her labor, and in addition to performing a painful vaginal examination he deliberately withheld an epidural from her as "punishment." He allegedly told Skol that "sometimes pain is the best teacher."¹ (Pierce was ultimately fined $500 and put on one year's probation.) This event indicates that, nowadays, educated, middle-class American women feel they have a right to effective pain management during labor and that an extremely painful birth is culturally unacceptable. It highlights how far American women's expectations regarding pain during childbirth have changed over the past 200 years, from dreading its inevitability to believing that with the proper technology pain can and should be, for the most part, avoided. More broadly, it is an example of the malleability of perceptions of the pregnant body and maternity, a theme shared by the four books discussed. These monographs provide very different new insights into the longstanding (and ongoing) debate in the United States and beyond about how best to care for birthing women, but one thing they have in common is a social constructionist approach to changing ideas about the pregnant body. Culture and politics, they demonstrate, not biology or technology, ultimately determine a society's ideal of a "normal" birth.

In her book Deliver Me from Pain: Anesthesia and Birth in America, Jacqueline Wolf traces the history of medicalization of childbirth in the United States, where medical intervention in parturition is now the norm: she cites a doctor who told Newsweek in the 1980s that when he first studied obstetrics in the 1940s "every caesarean section required careful review at monthly staff meetings. Now . . . the opposite was true—the vaginal birth had to be justified." Wolf's book closely examines one important aspect of the medicalization of birth, namely the relationship between American women's perceptions of labor pain and obstetric anesthesia from the 1840s to the present day.

The book opens with the story of Fanny Appleton Longfellow of Cambridge, Massachusetts who, in 1847, was pregnant with her third child. She and her husband were determined to find a doctor who would administer anesthesia during her labor but this proved impossible because local doctors refused, declaring anethesia unnecessary. Finally Nathan Cooley Keep, a Boston doctor specializing in dentistry, agreed to Fanny's request and thus she became the first American woman to inhale ether while giving birth. (She was "elated" with the experience and declared it "far superior" to her previous births (13)). Knowledge of the possibility of pain-free childbirth rapidly spread because of increased popular access to information via a flourishing print culture, especially such women's magazines as McCall's. New knowledge fostered demand and, before anesthesia became widely accessible, American women with means travelled as far as to Germany to get it. The growing demand for the technology spurred obstetricians in the competitive medical market place to develop an ever-widening array of chemical options because women voted with their feet: Wolf cites a doctor who, in 1904, reported with irritation that his refusal to use anesthesia during birth (because in his opinion it...