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Bulletin of the History of Medicine 74.3 (2000) 623-624



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Book Review

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


Donald Caton. What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present. New Haven: Yale University Press, 1999. xvi + 288 pp. Ill. $30.00.

Historically and currently, there are few aspects of health so contentious, so surrounded by emotion, as the management of childbirth in general, and of obstetric anesthesia in particular. Donald Caton, an obstetric anesthesiologist, has been well aware of this when writing his excellent account of the subject from 1800 to the present. The story of obstetric anesthesia includes many well-known names and methods, such as James Young Simpson and chloroform, John Snow and Queen Victoria, the fiasco of twilight sleep, the heavy use of opium derivatives in the first half of this century, the role of such bodies as the National Birthday Trust Fund, the rejection of drugs that characterized the work of Grantley Dick Read and Fernand Lamaze, and finally, the modern methods. All have been the subject of historical publications, so at first sight Caton might seem to be simply traveling over familiar territory. But there are several features that make this a notable and valuable work.

First, Caton--who writes very well--brings all these stories together in one work, produces new insights into almost all of them, and is particularly good at understanding the reasons for the emotional content of his subject. As a result of wide reading he has explored changes over time in attitudes toward pain and pain relief, and the distinction between pain and suffering. For instance, he identifies the nineteenth century as the period in which, with a decline in the influence of the church, there was a radical change from the widely held religious view that pain is an inevitable element of life to be accepted meekly, to the secular view that pain is an evil to be fought, resisted or prevented, by all available medical means. This was a change parallel to, but independent of, the introduction of anesthesia, which obviously influenced the ways that patients and physicians thought and behaved. [End Page 623]

Most historical accounts of obstetric anesthesia confine themselves to the effects of anesthetic agents on the mother and moral questions as to whether pain relief is justified. Few deal with the associated problem of the transfer of analgesic and anesthetic drugs across the placenta with potential ill effects on the baby. I had no idea of the extent to which this was recognized as a matter of concern, and also the subject of scientific exploration, throughout most of the nineteenth century. The history of the gradual understanding of the physiology of infant respiration, and the growing realization that anesthesia could adversely affect the baby, is one of the many important and original aspects of this work.

When it comes to modern debates on the management of childbirth, Caton blends common sense with great sensitivity to the needs of individual women. He recognizes the wide variation in attitudes that has always existed, and the need to adapt the method of pain relief according to the wishes of the woman in labor; to some, labor pain is an essential element of the experience of childbirth and the process of bonding with the baby, while others are grateful for as painless a labor as possible. I feel pretty certain that Caton is a marvelously sympathetic doctor to his patients.

If I wanted to quarrel with the author (which I do not) I would find it hard to do so, except for a few trivia: C. J. Collingsworth (p. 285 n. 30), an important figure in British obstetrics, was in fact C. J. Cullingsworth; and it is not always clear which of several citations in a single footnote applies to a quotation enclosed in...

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