Friday, February 19, 2010

Labor movement

Randi Hutter Epstein traces the twisted genealogies of modern obstetrics in Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank

The f
ollowing review was posted last week on the Books page at the History News Network website.

Birth is a fact of life. But as Randi Hutter Epstein shows in this breezy but enlightening little book, it's a fact
that's been subject to endless interpretation. In a survey that spans from antiquity to the reproductive technologies of the 21st century, Epstein traces the power struggles among men and women to cast birth in their own image of the way life should be.

As often as not, this struggle has been among purists of various kinds and those advocating new forms of technological improvement, with pregnant women in the middle. Epstein succinctly captures the dynamics of such debates in her discussion of foreceps, a device that went from secr
et innovation to childbirth staple to source of dread over the course of the last few centuries: "Doctors were confident, sometimes overly so. Midwives were worried, sometimes overly so. Women were confused, rightly so."

One source of this confusion was the sometimes counter-intuitive logic that shaped ideology. At the turn of the century, for example, elite feminists were strong advocates for the use of drugs, often of dubious utility and safety, rather than subjecting women to length
y, painful, and dangerous labor. Yet this typically meant ceding control of their bodies to experts, almost always men, who often feared bourgeois women were too overcivilized to endure the birth process, and who spoke of women with what we today would regard as a comic degree of cluelessness. (An obstetrician who believed doctors should make decisions about childbirth because a woman "has a head too small for intellect and just big enough for love" typifies the juicy quotes that pepper the book.)

Conversely, a founding father of the natural childbirth movement, the evocatively-named Gr
antly Dick-Read, whose heirs Epstein describes as "more Birkenstock than Prada," was a political reactionary who finally settled in the politically cozy confines of apartheid-era South Africa. One of the great medical breakthroughs of modern medicine, a technique to repair vaginal tears during childbirth, was achieved by performing medical experiments on slaves.

Such conundrums continue to our own time. Prenatal care has greatly extended the reach of professional medicine earlier and earlier into pregnancy. But such fetal monitoring has also prom
pted over-intervention in ways that range from the commercialization of sonograms as mall souvenirs to ethically questionable forms of genetic engineeering. Perhaps to avoid a political bog, Epstein steers clear of the implications of the implications of such technologies for the abortion debate. She also (surprisingly) largely stints the advent of in vitro fertilization; there's no mention of Louise Brown, the first test tube baby, for example. But she does make an entertaining visit to a sperm bank, and discuss cutting-edge techniques for freezing human eggs.

Get Me Out is a fast read because Epstein is a terrific writer. Trained as a journalist, she conveys a sense of joy in her research to accompany an often wicked wit, as chapter titles like "Men with Tools" and "Womb with a View" suggests. Epstein is also an MD, one whose lightly worn authority allows her to gracefully digest and contextualize medical research for a lay reader. The experience of tracing the shifting tides of obstetric opinion has apparently engendered epistemological modesty; attentive to irony and contradiction, she rarely takes sides in the debates she describes (though her skepticism about the number of caesarian sections performed in the United States is all the more credible as a result). Perhaps Epstein's shrewdest observation is her final one: that all the control over child birth has done nothing to making child rearing any easier. A mother of four, she speaks from experience.

Get Me Out is a quintessential work of pop history: light, funny, provocative. Yet it's got enough depth and resonance to function as a highly effective teaching tool in any number of classes that range from medical schools to gender studies programs. Think of it as an brainchild with DNA from Barbara Ehrenreich and Gail Collins. And then appreciate it on its own terms.