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LESSONS FROM LITERATURE: PREGNANCY AND CHILDBIRTH PATRICIA GIBBS* The twentieth century has seen extraordinary advances in medical science, and the field of obstetrics has been no exception. One hundred years ago, in-hospital mortality caused by postpartum infection was still at an intolerably high level, and antiseptic measures were only first being instituted on a widespread basis. Cesarean section was a feared procedure with a three-in-four risk of mortality. Anesthetics had been discovered but were risky and available to relatively few women. In general, unrelieved pain, prolonged labor, and poor outcome in the case of complications constituted the rule. Individuals born and raised in the postantibiotic era of obstetrics may find it difficult to fully appreciate the difference between modern childbirth and that of previous ages. Though today some discomfort in labor cannot be avoided, analgesia is safe, available, and effective. There is always an ultimate escape route from a prolonged or complicated labor: cesarean section. The days of horrendous agony, fetal mutilating procedures for breech and dystocia, and medical impotence in the face of maternal hemorrhage or infection are gone. The overall effect of all these advances is reflected best in the 100-fold drop in maternal mortality rates over the past 100 years [1-3]. The effect, then, of medical science and obstetrical advancement on society has been profound. The purpose of this article is to explore the effect of obstetrical advancement on one aspect of our culture, literature . It is my hope that the descriptions, stories, and metaphors of this medium of artistic expression will act as both inspiration and teacher to the physician practicing obstetrics. These stories about childbirth may be ?Class of 1987, Yale Medical School. Address: 2642 East Ward Street, Seatde, Washington 98112.© 1987 by The University of Chicago. AU rights reserved. 0031-5982/88/3101-0545$01.00 94 I Patricia Gibbs ¦ Lessonsfrom Literature of more general interest as well, since every person attends at least one labor in his or her life. This study will explore the works of four authors, two who wrote during the final years of the nineteenth century and two whose writings belong to the twentieth century. I will analyze their works concerning pregnancy and childbirth. Authors to be considered include: Arthur Schnitzler, William Somerset Maugham, William Carlos Williams, and Richard Selzer. AU of these writers were (are) also physicians, and thus their literary work has the benefit of grounding in personal experience.1 In addition, it sheds light on the particular problems and dilemmas unique to the physician. In comparing and contrasting the works of these four authors, I will determine whether and how the ideas expressed in their writings have changed over the years of tremendous obstetrical advancement. Apart from the medical progress of the last 100 years, this era was marked by another development that strongly influenced attitudes toward pregnancy and childbirth, that is, the so-called sexual revolution. Instrumental in its inception were the theories of Schnitzler's Viennese compatriot, Sigmund Freud. Over the present century, Western culture has moved from the extremes of Victorian sexual conservatism to the "free love" of the 1960s and 1970s. The well-known historian of the Victorian era, Peter Gay, emphasizes that the Victorian age, defined as the period between the early nineteenth century and the First World War, was an age of sexual constraint and secrecy. "Many of Sigmund Freud's patients seemed to him irrefutable proof that the bourgeois culture of his time had excessively constrained the sexual impulse" [4, p. 6]. Gay also writes that this era was characterized by a "cult of privacy" and "timidity in naming physical acts, let alone sexual relations, in public" [4, pp. 280-281], Contrast this with the situation today, in which virtually every monthly women's magazine contains an article on sexuality and sex itself has become a respected and vital subject of study. The writings of the four physician/authors may reflect some of the turmoil surrounding this revolutionary change in society's attitudes toward sexuality . Childbirth as Punishment The idea that childbirth is a punishment for sin is as old as the first book of the Bible. As penalty for tasting the fruit of...


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