What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present (review)

What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present, by Donald Caton; pp. ix + 288. New Haven, CT and London: Yale University Press, 1999, $35.00, £30.00.

Perplexed by the predilection of certain birthing women to reject obstetrical anesthesia, Donald Caton, an obstetrical anesthesiologist, has written this study of the antecedents of his own profession in order to gain a historical perspective. Why might some women resist the well-intentioned beneficence of anesthesiologists? To Caton, intrapartum pain relief represents an unqualified good. Taking as its subjects the men who advanced the science and the birthing women who were its intended recipients, Caton's study places them within the social milieu of ascendant philosophies that variably influenced the 150-year course of obstetric anesthesia.

Caton adopts a medicalized notion of labor as the lens through which to survey this particular historical landscape. Because of this medicocentric perspective, labor's attendant pain is perceived as a "problem" (xi). Midwives, who were the primary caregivers for women in both Britain and the United States over much of the period covered, are excluded from the inquiry.

Ether was first introduced to the lying-in chamber in 1847 by Scots obstetrician James Young Simpson. Since that introduction, stormy debates over the wisdom, the danger, the moral justification, the physiological ramifications, and the philosophical rationale of obstetric analgesia and anesthesia have percolated through the medical and lay childbirth literature. Caton tells us that Simpson was something of a medical maverick when he first administered ether to a laboring woman. His precipitate attempt to rescue parturient women did not go unchallenged within the medical community, and Caton's balanced account of the controversy over labor anesthesia in both the United States and the United Kingdom, is one of the book's strengths.

The issue of pain relief in labor has always been contentious. Over time, a cycle was established whereby new pain-relieving pharmaceuticals were introduced and their use was then attacked by skeptics; new pharmacological pain medications such as chloroform and scopolamine, and later the incorporation of psychoprophylactic pain management strategies, provoked the same thrust and parry of champions and critics. Caton attempts to draw generalizable conclusions from this history, but the course of medical and social acceptance of intrapartum pain relief in the two countries has not been uniform. What a Blessing She Had Chloroform fails to adequately problematize important regional and contextual aspects of parturient care. This reviewer shares with Caton a comparative research perspective centered on childbirth management in these same two nations and therefore well appreciates both the appeal of cross-cultural analysis and its associated limitations. But scholarship that seeks to compare US and UK populations easily suffers a loss of credibility when attempting concurrent generalizations about either individual behaviors or population behaviors. The two countries have not always addressed intrapartum pain in the same fashion and women from the US and the UK are likely as different as their countries.

The topic of intrapartum pain relief furthermore is a gendered topic, inextricably linked to the health and well-being of women and their babies. The topic is equally tied to the political economy of professional and institutional coffers. Caton probes the social meaning of pain but his medicalized view at times proves inadequate, as when he questions women's behaviors, motivations, and attitudes. For example, Caton mentions the Victorian misperception of "native" women delivering their babies effortlessly and without pain. He recognizes that this romantic generalization essentialized "native" women. Yet his treatment commonly homogenizes "Victorian women" as if class distinctions were irrelevant in that society.

Similarly, Caton disregards social location when examining women's agency in the twentieth century. There was indeed an outspoken contingent of middle- and upper- class...