What a Blessing She Had Chloroform (review)

Donald Caton. What a Blessing She Had Chloroform. New Haven, Connecticut, Yale University Press, 1999. xvi, 288 pp., illus. $30.00

Queen Victoria was one of the first women, after the discovery of “modern” anesthesia in 1846, to have the pain of labor dulled and perhaps ablated by an anesthetic. She had delivered several children without anesthesia, yet for her last two deliveries she inhaled the vapors of chloroform during the final stages of labor. When hearing that her daughter had given birth under the same type of anesthetic, the queen declared “What a blessing she had chloroform.” The attitude of the queen and all women toward obstetric anesthesia over the past century and a half fascinates Donald Caton. A life-long obstetric anesthesiologist, Caton traces the origin and ideals of obstetric anesthesia from the 1840s to today.

Within the confines of the book, Caton examines the medical trends in obstetric anesthesia and layers this against the prevailing attitudes of the women of the times. Noting that patients demanded “twilight sleep” at the beginning of the twentieth century, often against the judgment of their physicians, Caton seeks to understand why patients have alternatively demanded and adamantly refused obstetric anesthesia. Caton traces both the medical and the social paradigms that revolutionized the care of obstetric patients.

One of the best sections in the book deals with the transition of physicians from rhetorical argument to evidence-based medicine. This transition was critical to obstetrical anesthesia because rigid scientific criteria and observation were necessary to prove the efficacy of an anesthetic regimen to both the mother and the child. Gone were the rhetorical arguments of the nineteenth century. However, evidenced-based outcome studies distanced physicians from feminist groups clamoring for and later against obstetric anesthesia. Caton’s discussion of these issues, first around the German “twilight sleep” of the early twentieth century, and later covering Grantly Dick Read and his “natural” childbirth is both insightful and clear. Spending the past thirty years caring for women in labor has sensitized Caton to the nuances of this debate.

One of the surprising strengths of Caton’s book is his clear acknowledgment that each patient is an individual. Many women are able to deliver children with minimal anesthesia. Others have a greater need for anesthesia, and that need should be addressed in a manner that is safe for the child and the mother. As an obstetric anesthesiologist, Caton feels no need to push his services upon the former, but feels the need of the latter for his services. There is no “control” issue—simply a physician realizing that individual patients have different needs. This is the obstetrical anesthesiologist side of the late twentieth-century version of the debate about labor analgesia. Both touching and thoughtful, Caton’s comments on our times balance the medical and social needs of patients.

What a Blessing She Had Chloroform is a complex, fascinating book. It explains how the current attitudes toward obstetrical anesthesia haveevolved. Charmingly crafted, the book balances the discussion betweenthe social forces on physicians and patients with the concerns of medical practice. Caton clearly explains how physicians looking for one set of answers came in conflict with their patients who had different needs and worked from a completely different paradigm. The book offers a unique perspective on the historical development of obstetrical anesthesia and ought to be mandatory reading for those seeking to understand the needs of both obstetrical patients and the anesthesiologists who care for them.

Reviewed by Douglas R. Bacon, M.D., M.A.,
Department of Anesthesiology, Mayo Clinic,
Rochester, Minnesota 55905.

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