Book Review

What a Blessing She Had Chloroform: The medical and social response to the pain of childbirth from 1800 to the present

N Engl J Med 2000; 343:1276-1277October 26, 2000

Article

What a Blessing She Had Chloroform: The medical and social response to the pain of childbirth from 1800 to the present
By Donald Caton. 304 pp. New Haven, Conn., Yale University Press, 1999. $30. ISBN: 0-300-07597-9

From biblical verses to Homer's “sharp sorrow of pain” to Sylvia Plath's “long, blind, doorless and windowless corridor of pain,” chroniclers, poets, and novelists have recounted the suffering of women in childbirth. Physicians, midwives, and others who have helped women through labor and delivery have also witnessed their pain, and throughout history many of them tried to relieve the suffering. In the 19th century, the demonstration of the efficacy of ether in relieving the pain of surgery led physicians to start using ether, chloroform, and then other agents to relieve the agonies of childbirth.

Donald Caton is an academic physician who has devoted much of his medical practice to obstetrical anesthesia. As he points out in the introduction to What a Blessing She Had Chloroform, there are numerous histories of surgical anesthesia and of childbirth, but Caton's book is the first to explore the relation between these two topics. Moreover, he examines not only the science of obstetrical anesthesia but also the social context in which ideas about pain and its relief arose.

Early in the book, Caton notes that the introduction of ether and then other analgesic and anesthetic agents raised questions about the physiologic response to pain during surgery and childbirth, as well as about the moral aspects of pain. Both topics were taken up by medical scientists of the times, as Martin S. Pernick relates in A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth-Century America (New York: Columbia University Press, 1985), a classic study that Caton curiously does not cite until later chapters. A close reading of Pernick's book might have helped Caton avoid a substantial problem with his own book — the judging of 19th-century science by 20th-century standards. Other medical historians have shown that 19th-century physicians did understand science and that they practiced scientific medicine, though they often did not use quantitative methods or resort to the laboratory. Instead, good medical science of this period — especially in physiology and therapeutics — was predicated on an understanding of each patient's unique constitution. Indeed, as Caton points out, anesthetic agents fit this model, because what produced mild pain relief in one woman might produce almost total anesthesia in another.

Caton is more successful with the thinking of the physicians who developed and then used obstetrical anesthesia. James Simpson in Great Britain and Walter Channing in the United States are his heroes. Facing substantial criticism from colleagues, these two physicians developed and used a number of agents, including ether, to relieve pain during childbirth. Both men also urged others to use these agents, and Channing's book, A Treatise on Etherization in Childbirth (Boston: William D. Ticknor, 1848), played a large part in popularizing the use of ether to relieve pain during childbirth. Not surprisingly, Caton disagrees with feminist critics who have argued that physicians developed and used these agents to “control” women during labor. He argues that these physicians had grave concerns about the use of forceps during delivery in women with deformed pelvises or those who became exhausted during a long and difficult labor. Indeed, as Caton points out, many women themselves called for obstetrical anesthesia because they were frightened of the extreme pain they might suffer. However, Caton paints too extreme a picture of feminist scholarship on this matter. For example, he cites Judith Walzer Leavitt as one of the feminist critics, but she is actually sympathetic to the physicians who used anesthesia. It was Leavitt, in fact, who pointed out that women were the first to campaign for twilight sleep.

Caton's last chapter nicely brings together the physician's view of pain as a biologic process and the philosophical or theological view of suffering as a psychological or even moral process. Caton is clearly most comfortable with the biologic explanation of pain. But he has also listened to his patients' descriptions of pain in a moral context, and he speculates that women's willingness to use analgesia or anesthesia may in part be due to lack of the social structures — families or religious communities — that previously sustained women in pain.

Charlotte G. Borst, Ph.D.
Saint Louis University, St. Louis, MO 63156