Randi Hutter Epstein, M.D., On Birthing Trends & Procedures
by Shana Thornton
When a woman is pregnant, the advice may be welcoming at first, giving some women comfort in knowing all of the possibilities. At other times, pregnant women may be assaulted with advice, from strangers in a restaurant or an elevator.
“Epidural, definitely,” I heard a cashier telling another at a clothing boutique counter over the holidays. The cashier at the head of my line looked like the sheepish, newly pregnant woman, with a tiny swell above her hips, while the other cashier who was offering advice had the look of know-how. She darted a look at her co-worker that said, “Listen up, because I have felt that pain.”
In front of me in line, a woman who had already experienced menopause, and obviously childbirth, offered a sentence to our cashier, “You can withstand more than you think, and once the baby is here, you forget all about that pain and you honestly don’t remember.”
Our cashier shuddered with a giddy grin, “That’s what my Mom told me.”
I was holding a gift for a friend, a pair of 0-3 month crocheted booties. My friend recently visited her midwife and her OB-GYN. She’s heard both welcome and unwelcome advice and isn’t even half way home. Are human ears tuned to pluck out the word “pregnant” from any conversation, or noses honed to discern pregnancy from the very air wafting around a pregnant woman? Even while walking around the block or through the grocery store, anyone might offer or blast her with words of wisdom—do a prenatal class, buy the best baby carrier, don’t forget to kegel, use olive oil to avoid stretch marks, and beat the pain by demanding x, y, and z. Many pregnant women jump straight into books on birthing methods, not to mention all of the advice for how to care for yourself as well as a baby in the womb.
You won’t find that same style in Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank (W.W. Norton & Co., 2010) by Randi Hutter Epstein, M.D. In her book, Epstein explores the historical and modern trends in the process of giving birth.
“I think we are flooded with advice,” Dr. Epstein wrote to me in an email, “so women do not need any more do-this-don’t-do-that books. What we didn’t have is a book that explains our history and how we’ve gotten where we are and why we’ve made the choices we have made when it comes to childbirth.”
In Get Me Out, Epstein emphasizes the careful and often clever, sometimes sacrificial, often controversial, people who have helped shape the changes in birthing; she not only includes the mothers as patients, but also the midwives, obstetricians, and attendants throughout history who dedicated their work to the process of birth. One of the controversial figures that she discusses early in the book is J. Marion Sims, an obstetrician who performed repeated surgical experiments on slaves known only by their first names, Anarcha, Betsey and several others. For his discoveries in obstetrics, Sims has been memorialized with a statue and, in the book, Epstein questions how the slaves should be remembered. I asked her what could be done to honor the female slaves that Sims used in his experiments?
Epstein answered, “We should have their statues right next to his.”
For pregnant women or anyone who wants to learn about childbirth, reading Epstein’s book is a welcome distraction from the standard advice books. While Epstein begins with a discussion of midwifery and Biblical influences, she moves through 18th century Europe and into the United Kingdom, however, much of her focus is on trends and advancements made in the United States during the 19th through the 21st centuries.
The cesarean section is a procedure that Epstein dissects. She shows trends that began even before a 20th-century obstetrician’s prediction about their popularity. I sent a series of questions to Epstein about this portion of the book. On page 31, she writes, “In his most prescient joke, Newell said that he envisioned elected cesarean sections, when women could opt out of labor altogether.” Newell was an obstetrician at the beginning of the 20th century, and I asked Epstein what his prediction says about birthing trends?
She responded, “I think Newell would be utterly shocked to know that c-section rates are approaching 40 percent in some U.S. hospitals today. The national rate is about 27 percent. I mean, he was just kidding. He did, though, understand how our notions about childbirth would impact the way we would want to give birth. So if there is an option for operative births and women are convinced that they are not able to give birth vaginally, they’ll go for the cut. His prediction, while facetious, shows that we may not be making wise judgments about how and when we need to use medical technology.”
In Chapter 10, Epstein looks intensively at cesarean sections, writing on page 154, “Today the cesarean section is the most common operation in America among women of reproductive age. (…) In 2005, nearly one in three babies were born surgically, a record high.” She goes on to write that doctors called earlier (but much lower) cesarean rates, an “epidemic.” On page 165, she writes that “Maureen Cory, executive director of Childbirth Connection” finds it “’mind-boggling’ that women today have to hunt for the rare provider to agree not to do fetal monitoring” and that “her concern is that the monitor kicks in a cascade of interventions that are likely to lead to a C-section.” And further down the page, Epstein adds a study that shows that fetal monitoring isn’t any more effective than listening to the baby’s heartbeat with a stethoscope, so are women allowing their choices to be taken away by physicians? I asked Epstein why it seems as if doctors are now eager to perform surgery rather than allow for a natural birth?
“I truly believe that no matter how informed you are,” Epstein answered, “when you are pregnant and want to do anything possible to ensure a healthy baby, it’s hard not to be swayed by your doctor’s advice. I’ve spoken to many women who have told me that while they really wanted a vaginal delivery or wanted to forgo the fetal monitoring, they worried when their doctors told them about potential imminent dangers. Let’s face it, all we want are healthy babies. It’s one thing to be a demanding patient when you are feeling good and maybe not even pregnant yet, it’s quite another when you are in labor and desperate for a good delivery.”
In her focus on 20th and 21st century developments in childbirth, Epstein shows ways that feminists have influenced ideas about childbirth. In one decade or century, women demanded drugs, and in another they wanted to be drug-free. Similarly, feminists wanted to be able to choose a C-section if they wanted it, but in some hospitals are now stuck with fetal monitors and high C-section rates. So, I asked Epstein, “what does the history of childbirth tell us about the history of feminism or vice versa?”
She responded, “Feminists have championed women’s health. Feminists in the 1970s spread the word about the dangers of DES. Feminists launched the patients’ bill of rights campaign. But I also believe that doctor-patient relationship influence what feminists demand. What I mean by that is when women are angry with their physicians, we will tend to fight against medical judgment. We are not naïve or simply rebellious for the point of being rebellious, but when we are not trusting the experts, we lose faith, and when we lose faith, we won’t listen to advice. The bottom line boils down to communication. Healthy doctor-patient communication promotes healthy medical decisions.”
In Epstein’s book, I noticed that other Western countries or industrialized nations didn’t seem to have high cesarean rates. So, I asked why there was such a difference in America.
“The answer is complex,” Epstein answered, “and has to do partially with American culture (we love technology) and partially with money (we are a fee-for-service system). That means, doctors are encouraged, at times, to provide the costly alternative and we are eager to use the latest tools. Doctors here also worry a lot more about being sued. As one doctor told me, you’ll rarely be sued for doing a c-section, but you are likely to be sued for not doing one. You can’t blame doctors for their fear of litigation, either. It has ruined careers and destroyed their own confidence in their abilities.”
During a section of the book, Epstein writes about women who give birth at home, known as freebirthers, some of them without any medical assistance or without the presence of a medical specialist of any kind. For the women like Laura Shanley, the home birth appeared simple and natural, without the complications of machinery and too many advisers, though some believe freebirthing is an extreme. However, I wondered why the American medical community shies away from home births. “Is it ultimately the fear of litigation?” I asked Dr. Epstein.
She answered, “I do believe that there are many decisions about childbirth that are influenced by a fear of litigation, but not the choice of hospital over home births. Doctors know that even when pregnancy is going smoothly, emergencies can arise and it’s best to be close to a good medical center. For this reason, many doctors prefer that women are located close to (minutes away) from state-of-the-art care. It really boils down to the way we perceive risk. The risk of something going awry is very low, and this low risk for many women and some doctors means that a home birth is fine, as long as a woman has access to get to a hospital quickly. For other women, and for many doctors, the low risk means a real risk and they would prefer a woman nanoseconds away from lifesaving medical technology. That’s how I felt. A homebirth really sounds lovely and I understand why many women go that route, but I didn’t want to take the one in a billion chance that I may need medical intervention immediately. Turns out I didn’t. I could have given birth at home without any assistance at all. And if I were guaranteed a safe and easy delivery, I would have chosen that option. But there are no guarantees.”
On page 115, Epstein writes about midwifery in the United States in the mid-20th century: “Midwives were angry because they were losing turf to the obstetricians. Unlike the English, who began to train nurses for midwifery, American doctors tried to get them off the playing field altogether.” I didn’t notice a significant change today, in the 21st century, and asked her why America is so slow to change its medical practices, even when professionals are aware of the need for change?
“I’m not sure doctors are any different from any other profession,” Epstein answered, “We are creatures of habit and need a lot of encouragement (pushing) to get us to change longstanding traditions. There are schools of midwifery today and I think things are ever-so-slowly starting to look a bit brighter for midwives.”
While progress is moving slowly in midwifery, Epstein shows that sperm and egg banks are a fast-paced business in the U.S. She thoroughly evaluates the current trends in sperm and egg shopping. While reading, I noticed that the women who comment in her book appear to be waiting for perfection. More and more young women are holding out for perfection in every aspect of their lives (career, travel, finances, and a partner with the same plan and outlook). This doesn’t seem like a realistic recipe for parenting, so I asked Epstein to discuss the trend to have a picture-perfect life and baby.
“This trend to mold our embryos into perfect athlete-musician-scholars drives me insane,” Epstein answered. “While parents talk about needing vacations or days at the spa, we are sending our children off to tutors and intensive training camps. For some reason, we appreciate that we need down time, but forget that to foster imagination and happiness are kids need to play and need unstructured, non-adult-driven free time, too. I am grateful for all the kinds of things we can do with artificial reproductive technology and I know there are hundreds of parents today who are thankful every day for medical technology that has allowed them to experience childbirth and parenthood. And yet, I think we need to take a deep breath and remember what the point of this is. Are we in the business of product development or child rearing?”
In Get Me Out, Epstein gives the readers a wide view of the history of our birthing processes. She writes about the invention of forceps and the family that hid the invention; she also covers the first maternity wards in the U.S., DES and so many more fascinating, tragic and valuable moments in the history of childbirth.
“I say that my book is not an advice book,” Epstein wrote in our correspondence, “but if someone were to glean advice from this, I would say that my message is: All our medical decisions are swayed by culture and tradition, so think about that when you are having discussions with your physicians. What is true today may not be true tomorrow as our scientific knowledge is always evolving. And yet, we have to make decisions based on the available information.”
Epstein’s book shows the gynecological advancements by women, for women and babies, and the reader is left with a profound message about the power of what women want concerning our health care and childbirth.
Book Giveaway!
Leave a comment at the bottom of this Interview anytime from January 1st-20th in order to qualify for a chance to win a copy of Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank. Entrants must be 18 years or older with an address in the United States or Canada. No purchase is necessary. The winner will be chosen randomly and notified by January 21, 2011. Her Circle Ezine respects your privacy and does not share email addresses with third parties.
Book Giveaway Winner!
Congratulations to Jodi who is the winner of a copy of Randi Hutter Epstein’s book, Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank!
Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank, published by W.W. Norton & Company, is available now.
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Randi Hutter Epstein, M.D., is a medical journalist who has written for the New York Times, the Washington Post, the Daily Telegraph, the Associated Press, MORE magazine, Ladies Home Journal, Condé Nast Traveler, Geographical, and Parents. She received her M.S. from the Graduate School of Journalism, Columbia University, and her M.D. from Yale University. She lives in New York City with her husband and four children. Visit her website, http://www.randihutterepstein.com/.
Shana Thornton serves as Managing Editor for Her Circle Ezine’s Books and Literature section. In addition, she writes interviews, features and fiction. She also teaches composition and literature courses, chases her husband and daughter, and runs trails with her dog Mojo.
Author: Shana Thornton
Shana Thornton serves as Editor-in-Chief of Her Circle Ezine and Assistant Director of the Institute of Arts and Social Engagement. Her first novel, Multiple Exposure, reveals an intimate, ghostly portrait of the impact of war, and generations of military service, on a family. Multiple Exposure will be available for purchase on Sept. 2. Read more at http://shanathornton.wordpress.com/
Thank you, Randi, for talking about your book and research. It’s important to see the discussions happening, and we thank all of you for commenting. Good luck in each of your practices and studies about the topic. It’s wonderful to see the perspective of so many women in the comments (a midwife, a nurse, a first pregnancy, a mother post-menopausal, and a woman in the stages of research on a similar topic… and all those birthing stories & experiences among you). As you read the book, don’t forget to let us know what you think.
Thank you shana for such a close read of my book. I love when I can generate conversation about this important topic–and fascinating piece of women’s history. I was so happy to see the comments and looking forward reading more. I would love to hear from those of you who have read the book, or plan on doing so. please email me.
Eager to read this book. This will help me relate to my postnatal mothers in my research even better. Shana nails the angst expectant mums feel with an ambush of unsolicited advice. I really appreciate the author’s wisdom as evidence by the quote “Are we concerned with product development or rearing children.” This idea is further fleshed out in the fabulous book Last Child in the Woods. a superior read as well
I can’t wait to read this book! I am studying to be a childbirth educator and I know this will be a great addition to my reading list!
This book changed my practice, and heart. The evidence presented is balanced, where I find Jennifer Block’s book, Pushed, fails, perhaps unintentionally, to address the trends, influence, and class implications of the alternative birth movement in America.
If I could tell a birth professional, or young woman, to read one book, it would be this one. I will have my daughter read this book right after she reads, “Of Woman Born”, by Adrienne Rich (1985). A truly journalistic exploration of modern maternity care, with a heart-wrenchingly honest presentation of the history of obstetrics in America. The chapter on slavery haunts me. And to know the origin of so many interventions, and instruments, lie in the horrifying history of slave women. I believe Get Me Out will become a classic.
Then, reading “Half The Sky” by Kristof and Wudunn (2010), tells me that globally, we haven’t come that far from those times. The atrocities are just happening far enough away from us to not look at them.
I am midwife from Europe – Czech republic. Percentage of sectio ceasera is raising on the whole world. I think it´s only scare of doctors, midwifes and pregnant woman, but sectio ceasera is really more dangerous than natural delivery. Sectio ceasera has many complication postoperative, it is difficult abdominal operative. Labour is natural way. Every labour bears hazards. The most important is trust. Trust pregnant woman to her own body to her child, trust midwife and doctor to their ability it is important. Doctor have to presumption, when he is cooperate with pregnant woman. Our head physician-he is shake hands with every his patient, look in her eyes and he using instinct, he know she will be ok or not. When he feeling something is wrong he is very careful and rigorous. On our clinic is 13% of sectio ceasera. We using epidural analgesia very extraordinarily. Our clinic is prosperous, we have minimum pathological cases. Midwife take care about all fyziologic labours alone. She is here all the time with woman and partner. Her part is necessary. She recognise character of woman, because every woman need different care. Some woman need touch and calm and some woman need silence and order. The most important is correct pursuivant of labour. Good midwife learn to you treat with pain, with natural methodic. Necessary is comfortable and domestic atmosphere. I am prefer labour since Frederik Leboyer. We are using this method. All obstetrics is about patience. Patience and trust of woman, partner, doctor and midwife.
This book Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank is for sure contribution for general public, but for specialists too.
As a woman who just entered her 15th week of her first pregnancy, I have been reading every book about pregnancy & birth I could get my hands on! This one sounds particularly interesting in that it is not about giving advice but rather about the history of giving birth – how we arrived at our current state of accepted medical practices. I really like the idea of putting statues of the women who were experimented on by Sims next to his statue…
Thanks for the great article!
Adding this to my wish list on Amazon so I can remember to read it!
Great review! Being post-menopausal, it’s been a while since I was interested in this subject in only the way pregnant, recently pregnant, or hoping to be pregnant women are, but it was still an interesting read. My children were born in the 1980s and 1990s, and I remember the big debate about increasing C-section rates even in the early 80s. I’m sad to see that those rates continue to increase. (I had four successful VBACs myself.)
Anyway, excellent work reviewing what looks to be an excellent book!
I am so impressed on the history information in this book. I’m very excited to read more of it.
Finally, someone has written a historical, factual account of childbirth and healthcare of women. She brings us up to date by today’s standards in childbirth, while it is up to each individual where to give birth, at home or hospital.
The author claims she does not give advice, yet even in this interview tells the reader a “medical facility” and “access to immediate advanced medical care” are preferred. What we need to read is a true “natural history” of childbirth. This would combine the fact that the maternal death rate was high at a time when even basic hygiene was unknown to medical science, for example. These kinds of information cannot be examined separately. Thus, home birth today is the safest possible way to give birth for the majority of women who are otherwise risk-free. This is proven, with medical and scientific evidence, around the world.