Birth: The Surprising History of How We Are Born.

Birth: The Surprising History of How We Are Born. By Tina Cassidy

The other day I found myself at the edge of a bed, applying counter pressure to my client's lower back as she moaned through the waves of another contraction. She and her partner are both history buffs and after her contraction subsided, her partner began wondering out loud, "What was this process like 100 years ago?" My client, still talking in between the surges, answered, "Yeah, I would love to find out. It must have been so different."

Different it was, as Tina Cassidy points out in her book, Birth: The Surprising History of How We are Born. Cassidy, a Boston-based journalist, gave birth to her first son, George, "at a major hospital in the medical mecca of Boston." After being told that her baby was stuck in her birth canal and an emergency cesarean section was performed, she asked her doctor, "What did they do in that situation before there were cesareans?" The doctor's reply: "The baby would have died in the birth canal ... They would have had to wait for it to disintegrate, or they would try to get it out some other way, drilling a hole in the fetal head, emptying the contents and collapsing the skull, before it started to poison the mother."

Shocking? Cassidy thought so, and it was this response, among other things, that led her to do the research and find out exactly WHAT might have happened to her 100 or so years before the day that George was born through an incision in her lower abdomen. The result of this research is Birth: The Surprising History of How We Are Born, the often shocking and sensational history of childbirth practices. Cassidy begins by explaining why childbirth is so different for humans. She says that as we evolved into bipedal animals, the shape of our pelvis in relationship to the size of the fetal head changed, making childbirth a trickier and more complicated process. Cassidy states, "Human newborns--and their heads--are proportionately much larger than what other mammals deliver. Female gorillas produce offspring that average only about 2 percent of their mother's weight, compared with 6 percent for humans. Polar bears, who weigh more than five hundred pounds, give birth to cubs with heads smaller than those of human newborns." Birth for us bipeds, Cassidy stresses, is no piece of cake.

[ILLUSTRATION OMITTED]

So what did humans do about it? We developed systems of support as well as elaborate machines and tools to help women birth their babies. Cassidy details how traditional midwifery supported women with "encouragement, a massage, or a salve, as well as suggestions for position changes to facilitate birth" but goes on to describe how men began to take over in rooms of birthing women. She writes that throughout the nineteenth century, "The men ... launched public education campaigns promoting ideas that birth was painful and should be treated like a disease, and that male attendants were best qualified to handle deliveries ... By 1900, midwifery had lost half its base to doctors ... midwives continued to dwindle." Instead of offering the gentle interventions such as those described above, obstetricians began developing crude tools to facilitate birth, such as the basiotribe, used to crush the fetal skull and knives used to perform techniques such as the symphyseotomy, a procedure that cuts through the pubic symphosis in order to widen the birth canal. Cassidy also describes the history and use of tools and techniques still used in modern obstetrics, such as forceps and the cesarean section.

Birth does a good job at inspiring awe at some of the more gruesome aspects in the history of childbirth. At times, the history just seems unbelievable! Yet, Birth also made me realize how much has NOT changed in the history of humankind. Childbirth is still viewed by-and-large as an intense, mysterious process, and we humans are still trying to "fix" it, work with it, encourage it, and understand it. And, most certainly, some of the practices used today are just as gruesome and awe-inspiring as those used 100 years ago or more.

Cassidy gives us a clear picture that the history of childbirth is full of successes and failures, pain and pleasure. The sensationalism often present in this history creates a fun, interesting page-turner, making Birth incredibly accessible to a wide variety of people who may not usually be interested in reading "The Surprising History of How We Are Born." And, for this, Cassidy deserves credit--it is no wonder this book has exploded in popularity.

On the same note, the sensationalism sometimes compromises something that I can't always put my finger on. In my own life, I deeply trust birth and am incredibly comfortable with so-called "alternative" options for childbirth. But because Cassidy often wrote from the point of view that birth is, in its nature, a wild, scary, unpredictable event inspiring weird inventions to "cope" with the complications of labor, she lacks the perspective that birth is also a natural event and wellness experience that does not need to be fixed or manipulated on a regular basis. She says, "Writing this book certainly gave me the perspective I needed to judge my own experience. But if I could rewind the tape, I doubt there's much I would have changed. Like most women around the world, I am a product of my age, my upbringing, and my culture. I'm not brave enough to have a baby at home--although I respect those who do. I'm too aware of how intensely painful birth can be to cut myself off from the possibility of an epidural..." The good news is that she is honest and interesting, but I couldn't help hoping there would be something more: a fuller trust in birth, a positive perspective after all her research on the history of childbirth.

I definitely recommend Birth for a variety of reasons. It is interesting, captivating, and an accessible first step at moving toward questioning the status quo of modern birth practices in America. So, pass along Birth to your friends who are thinking about getting pregnant and wondering what OB to work with. Give it to co-workers, parents, sisters, and people who usually refer to What to Expect when you are Expecting as their ultimate resource in all things birth. And then follow up by giving them Ina May's Guide to Childbirth. Now, that should do the trick.

Reviewed by Gina Forbes, CLA (ALACE), ALACE Workshop Coordinator