'Get Me Out': Making Babies Through The Ages

TERRY GROSS, host:

The new book, "Get Me Out," is a history of childbirth. It's about the advice women have been given about pregnancy and birth, why so many women died during or after birth before modern medicine, how modern medicine changed the experience of childbirth, and the changing views of feminists regarding the pros and cons of painkillers.

My guest is the author of "Get Me Out," Randi Epstein. She's a medical journalist.

Randi Hutter Epstein, welcome to FRESH AIR. I think we forget how dangerous childbirth used to be. Not that it still doesnt have its dangers, but the mortality rate for mothers and children was so much higher in the past. What were some of the most common problems for women giving birth?

Ms. RANDI EPSTEIN (Medical Journalist; Author, "Get Me Out"): The big problems were hemorrhaging - bleeding to death - and childbed fever, of course, was the huge problem. Now, if you go back and look at the statistics which other historians have done, statistically, it was not this huge epidemic of childbed fever.

GROSS: Explain what childbed fever is.

Ms. EPSTEIN: Okay, childbed fever. We didnt know. We named childbed fever for women years ago who would give birth, spark a fever in the next couple days, some would recover but others would die and no one knew what was happening. So that's why they just named it childbed fever. We didnt know what it was. Today, we now look back, or weve figured it out along the way when we discovered germs, that a lot of these women were infected with germs. There was - and a lot of the cause was from doctors who might've done an autopsy or delivered someone else's baby, they were rushed, then they came and delivered yours. They weren't washing their hands so they were just sort of passing things from one woman to another. And remember, this was before we knew about germs and the germ theory, so the few doctors that started saying, shouldnt we wash up in between patients? They were kind of seen as a little kooky.

GROSS: In writing about the history of childbirth, you write about how forceps changed childbirth both for the person delivering the baby and for the woman having the baby. Forceps were invented by a family that kept these instruments secret from the rest of the medical world. Tell us what you know of the story of how the forceps were invited.

Ms. EPSTEIN: Sure. I mean what - there were all these whacky forceps that date back years and years ago, generations, hundreds of years ago. Most of those forceps really ripped the baby, didnt work so well. What we think are sort of the first of modern forceps that were safe for both the mother and the baby were invented by this family called the Chamberlains who go back to the late 1500s. And they passed on their secret forceps from son to son to son who all became male midwives. Their popularity really grew in the 1800s. Although they had been doing this for years, there weren't a lot of men in the business for the first generations of the Chamberlain family. And one of the things I think that a lot people feel about the Chamberlains is what a bunch of jerks.

I mean they had what supposedly was saving lives of babies and women and they didnt share their secret with anyone, with their colleagues. But actually, that was standard practice in those days. Doctors were highly competitive. So if you had something that worked you kept it to market your own business and that's exactly what the Chamberlains did. And they were not well-liked by their colleagues. But they became, by the 1800s, the doctors who rich, wealthy women would seek out if they decided to choose the route of male midwife.

GROSS: And where were the Chamberlains? Were they in England, in the United States?

Ms. EPSTEIN: They were in England. They were originally from France but they came over to England and that's where they set up shop, in England.

GROSS: So when forceps really started to catch on to people beyond the Chamberlain family, you say that the doctors who were delivering with forceps, because of the kind of cultural taboos of the era, couldnt really see what they were doing. Would you describe the kind of sheet that would separate the woman and the doctor and what that was like?

Ms. EPSTEIN: Sure. Now this has to do with male doctors whether or not they used forceps. There were other forceps starting to be invented but when women started to think, gosh, I'll get a man in the room because he seems so professional, or for one reason or another, her husband thought it was more professional to have a medically-trained person in the room, we still could not fathom that this male doctor would see you naked. So what they would do is cover the woman with a sheet and basically it was set up so it looked like she had a tent over her. So the doctor really couldnt see what he was doing. And I think the scariest was those with a forcep in their hands and they would put their hands under the sheet and deliver the baby without seeing anything.

And the oddest part of all of this is that part of medical training in some of the medical schools in America and in England and in France required young apprentices to watch a baby being born. So basically, what these medical students did is they would walk into a birthing room and they would watch their mentor sticking his hands under sheets and pulling a baby out. But I'm not sure how much they learned from that experience.

GROSS: Now you write in your book that after forceps started catching on that other doctors and inventors came up with, you know, odd tools and gadgets.

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Ms. EPSTEIN: I know where this is going.

GROSS: You know where this is going...

(Soundbite of laughter)

GROSS: ...to help women deliver and the most bizarre one that you mentioned, and you have an illustration of it, is do-it-yourself forceps?

Ms. EPSTEIN: Oh it's great. It didnt catch on. I do think it didnt catch on.

GROSS: Thank goodness. Yeah.

Ms. EPSTEIN: But it is there. I mean one of the things I do have to say before I get to this do-it-yourself forcep, is all these books that I looked at, I can't judge except for this, that said it didnt last. It's hard to judge what advice women listened to and what, you know, what was in the books that we really - that women took to heart because there's books now that we just sort of ignore.

But these do-it-yourself forceps, I think that it was partly done because, again, we talked about that immorality of doctors just getting in there and sticking their hands in a woman, and I think that people thought well, gosh, with forceps maybe we could make this more culturally acceptable to keep these male doctors farther away from this naked woman. So they did come up with these contraptions that all had your basic forceps, which sort of looked like these two big ladles attached together, and then some of them had all these strings and pulleys attached so that the doctors could be far away - sort of like when you see workmen with scaffolding and all those poles outside a building and somehow get the baby out.

But the Italian one where I, you know, its just - it's hard to explain without the picture, but its a forcep and all these strings that tie it around a bedpost so apparently a woman can just keep pulling and then the baby will shoot out. And I'm not sure who catches it on the other end.

GROSS: My guest is Randi Hutter Epstein, author of the new book "Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank." We'll talk more after a break. This is FRESH AIR.

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GROSS: If youre just joining us, my guest is Randi Hutter Epstein. We're talking about her new book "Get Me Out: A History of Childbirth."

One of the threads in your book is how women have dealt with the pain of childbirth and how cultures have dealt with it. Of course, you say this all goes back to Eve in the Old Testament. What was Eve's contribution to pain and childbirth?

Ms. EPSTEIN: Well, I blame her for starting it all. I mean, you know, she ate the apple, she was punished, and then they said now birth will be painful so she started it. Whether we believe the story or not, I mean that's sort of in our culture. And since then, weve grappled with, is pain a good thing or a bad thing? So for years it was thought of as sort of a hazing process, that it was part of your heavenly duty to give birth through pain, to survive it and then you could become a mother. So a lot of the things that were done to maybe try to alleviate the pain were considered heresy in a way.

And it wasnt until - we say that it wasnt until Queen Victoria gave birth using ether that some other women said, hey, well, the queen did it. It's got to be good enough for us. So she is thought of as giving the green light to drugs for delivery. And in terms of culture you asked me about, I still think that how we use pain medication is a cultural response. At the turn of the century, around the 1910s, a group of women here - in New York, actually -heard about a new technique in Germany that was called twilight sleep, and basically you were knocked out during delivery.

Interestingly, this became this feminist crusade: We deserve to be knocked out. We deserve not to have to remember anything about childbirth. And what I think is fascinating is, jump a few decades ahead to the 1970s, and feminists were saying: We deserve to be awake. We deserve to remember everything about our pregnancy. So to me, again, this has nothing to do with scientific evidence or improvements in medical technology. It's what women themselves wanted in the birth of their children.

GROSS: Now, let's contrast the feminist movement that of the early 1900s that asked for painkillers during childbirth. Let's contrast that with the later 1900s and in the '60s and '70s when women started demanding to be awake during childbirth and to be more active participants in childbirth and endure the pain that came with that with the help of prepared techniques, like breathing. So tell us how the Lamaze technique of breathing during childbirth, to help control pain and relax muscles, how did that get imported to the United States?

Ms. EPSTEIN: Well, that came over - well, it was really two things. That came over from someone called Grantly Dick-Read, who was a doctor. He never was board certified as an Ob/Gyn and he became this birthing guru. And there are women today who are very involved in natural childbirth who really look back on him as this wonderful doctor that was preaching natural childbirth while all the other doctors were saying, no, you know, let's use drugs. We're in charge. He really started talking about natural childbirth in the late 1940s. If you read what he was writing, he was saying things basically opposite what the doctors were saying, that modern women are too frail to give birth.

He was sort of saying, you know, youre so neurotic. You are just too - and he used that word. He said these women are too neurotic. They should be able to give birth and its the Christian way to give birth, is through pain. So his message wasnt as 1970s as we'd like to think it was. That said, women did pick up on this anti-doctor sentiment that he had. And what I do think, both looking back at the turn of the century and looking back at the 1970s, the real issue isn't so much pain or no pain, drugs or no drugs, the real issue is doctor-patient relationships. And in both cases you'll see that women were angry with their doctors so they were demanding the opposite of what their doctors wanted to do. And I think that's what motivated some women - not all, but motivated.

Yes, of course, in the 1970s there were women that said, you know, we're worried about the drugs and we're worried about the side effects, but I also think there was an anger against authority then, too, the way there was the anger in the 1910s and '15s by some women against some doctors. So I think that propelled both movements.

GROSS: What development do you think is most changed in childbirth now?

Ms. EPSTEIN: I think for better or for worse, all the assisted reproductive technology - and I'm not talking in-vitro fertilization. I'm talking really a lot of the genetic diagnosis and looking at embryos and analyzing them before we put them - transfer them into a woman. Of course, for better, it would be phenomenal to be able to say, look, I have this devastating genetic disease in my family. Please make sure the embryo does not have that disease. I think that's terrific. It would be great to break a cycle of a disease. But on the other hand, I think that so many people feel that theyll be able to choose the perfect baby.

And one of the threads I think going through my book is that this search for perfection has been going on forever. You know, thousands of years ago, we thought if we have sex in a certain way or if we think happy thoughts then we will have the perfect child. And now I think it's, if we choose the right sperm from our Ivy League donor who was a musician and an athlete and we choose the egg of this gorgeous Ivy League, brilliant woman then our child has to be perfect. And I think that that can lead to parents being let down by the end result.

GROSS: Well, Randi Hutter Epstein, thank you very much for talking with us.

Ms. EPSTEIN: Oh, this has been a pleasure. Thank you so much.

GROSS: Randi Hutter Epstein is the author of "Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank."

You can download podcasts of our show on our Web site freshair.npr.org. And you can follow us on Twitter and friend us on Facebook at nprfreshair.

GROSS: I'm Terry Gross. Transcript provided by NPR, Copyright National Public Radio.