Deliver me from pain: Anesthesia & birth in America

Jacqueline H. Wolf. The Johns Hopkins University Press. Baltimore, Maryland. 2009. 296 pp. $50.00. ISBN: 978-0-8018-9110-6 (hardcover).

Although the experience of labor and delivery in America is quite different from that in Switzerland, Afghanistan, or sub-Saharan Africa, having a baby remains for most women the most emotionally and physically challenging, and at times dangerous, experience in their lives. Childbirth, overwhelmingly a happy and desirable event, still carries a maternal death toll of 11 per 100,000 live births a year in the US and claimed 2,100 deaths per 100,000 live births in Sierra Leone last year (1). In consequence, striking a balance between a quiet, private, intimate experience surrounded by the husband, family, and doula and a “medical” experience with midwives, nurses, obstetricians, and obstetric anesthesiologists is not simple to achieve and is undeniably sculpted by convention and culture, but also knowledge and resources allocated for women’s health.

As a woman, mother, and obstetric anesthesiologist, I was pleased to have the opportunity to read Deliver Me from Pain from Jacqueline H. Wolf, professor of the History of Medicine at the Ohio University College of Osteopathic Medicine. It was anticipated to be, as promised by its title, NIH funding, and systematic chaptering, a comprehensive review of at least the last century and a half on anesthesia and birth in America. I was hoping to read a text based on the vast medical evidence that has accumulated, especially this last decade, that showcases our ever-growing abilities to protect the mother- and child-to-be and our aptitude to enhance childbirth as a safe, pain-less, and memorable event even in perilous conditions.

Unfortunately, as I read through the chapters, I found Deliver Me from Pain to be an anecdotal manuscript based on collective memories from the author’s presence at three births (two at home and one in a hospital) of two of her best friends as well as her own childbirth experience and several dozen nonstructured interviews with mothers and physicians. The “analysis” provided by Wolf is based on her fortunate positive delivery experience (even though she admits of being on the “brink of losing control”), and she declares being stunned to discover that other young women do not share her own enthusiastic passion for and fearlessness of “natural” childbirth. The author does not appear to understand what the fuss is all about and why medicine should accompany childbirth. In fact, most American women do choose to take advantage of modern state-of-the-art obstetrical anesthesia and labor analgesia techniques (2); therefore, it was surprising that there was no discussion of the experience of these women who do benefit from medical management during childbirth.

This “banalization” of childbirth is so revealing that I could not find in the Glossary of Medical Terminology the terms maternal morbidity and mortality or perinatal morbidity and mortality, and although I did find definitions for anesthesia and analgesia, these were surprisingly inaccurate and readers may be left with no clear understanding of the difference.

In an attempt to implicate obstetric anesthesia in some sort of conspiracy to deny American women their right to an exhilarating “natural” childbirth, Wolf misses an opportunity to examine the benefits of low-risk, evidenced-based, safe maternity care and to explore the risks and benefits of all choices available to a laboring woman. While great detail is provided regarding the birthing process over the last 150 years, little attention is given to the major developments in obstetric anesthesiology over the last decade. Therefore, ironically, almost all the information contained in the book is of little use to the expecting mother, looking forward to childbirth in America today. This book also offers little to academicians or clinicians interested in the most up-to-date and accurate status of the specialty of modern obstetric anesthesiology.

From its title, regrettably misleading, to its content, I found this book to be a disappointment. Rather than a scholarly work, the text is anecdotal, opinionated, and amateurish. Unfortunately, it reflects what appears to be little or no understanding of the medical discipline of obstetric anesthesiology. Therefore, after exposing her own preconceived biases and uninformed beliefs on the “agony and ecstasy of childbirth,” in my opinion Wolf’s book is at best misleading and at worst incorrect.

References

1. http://www.who.int/whosis/whostat/2009/en/index.html.
2. http://www.childbirthconnection.org/pdf.asp?PDFDownload=LTMII_report.