What a Blessing She Had Chloroform.

Abstract

What a Blessing She Had Chloroform.D. Caton. New Haven: Yale University Press, 1999. ISBN 0-300-07597-9, 288 pp, $30.00. This book, according to its author, is divided into three sections, a “history of the medical management of the pain of childbirth, the changing social reaction to childbirth with both its associated pain and suffering as well as its other meanings,” and finally, “the interaction between medical practice and social values.” Historically, very little beyond the 1950’s is discussed. The contributions, as well as the shortcomings, of the great advocates and pioneers of obstetric anesthesia such as Sir James Young Simpson of Scotland, John Snow of England, and Walter Channing of the United States are given in detail. The lives, theories, and arguments of major opponents to obstetric anesthesia, such as Charles Meigs of the United States, who for years debated with Simpson, and in more modern times Grantly Dick Read with his completely unsubstantiated theory of “childbirth without fear” are reviewed. Contributions of Paul Zweifel, who showed that drugs given to the mother cross the placenta to the fetus, Virginia Apgar, and Robert Hingson are outlined. Unfortunately, very little space is dedicated to modern techniques of central neuralaxis (epidural and subarachnoid block) analgesia. This book is much more than a history of obstetric anesthesia, it considers in detail the role of pain not only to the mother, but to the family and society. It details the efforts of pioneering women to assure analgesia is available to all women, regardless of social and financial status and discusses the relation of this to the early feminist movement. The foundation of two women’s groups, the defunct National Twilight Sleep in the United States and the active and productive National Birthday Trust Fund Campaign of the United Kingdom resulted from these efforts. The goals, accomplishments, and shortcomings of these two organizations are recalled and made fascinating reading for this reviewer. Finally, the change in attitude, not only of the laboring mother, but of society and especially that of the medical community, is discussed. In the sixties, distrust of labor floor nurses and obstetricians to the anesthesiologist on the labor floor to the present demand for our services is delineated. Most importantly, Dr. Caton describes the reasons for and the importance of hearing and understanding the attitudes and desires of women in labor and, indeed, their “support people” toward obstetric analgesia during labor. This is a unique work, unlike any other work of obstetric anesthesia with which I am familiar. Its content is certainly not that which will likely appear on the American Board of Anesthesiology or the Continued Demonstration of Qualification exam. Nonetheless, the thoughtful reading of this short book of fewer than 300 pages can have great meaning and the potential of improving the skills of the anesthesiologist who attends the woman in labor. Indeed, it contains much relevant material pertinent to all medical professionals, both physicians and nurses, including midwives, involved in the care of the parturient. Although scholarly in its approach with an extensive bibliography, it is interesting, easily read, and reflective of the real humanity and understanding of its writer.