Reading birth and death: a history of obstetric thinking

Feminists and those who work in conventional obstetrics have often been at loggerheads. Progress towards mutual understanding has been marginal. Birth and death is different from most books on the subject because it is largely about Ireland and its references and statistics come in the main from famous Irish hospitals, such as the Rotunda in Dublin, and from wellknown Irish doctors such as Sir William Wilde (father of Oscar), Fleetwood Churchill and Kieran O'Driscoll. These are welcome contributions to general knowledge, especially since many generations of British obstetricians in training have learned their trade in Ireland. The book begins with an intriguing account of childbearing among the Quechua people of Bolivia and their efforts to fend off the evil spirits that lurk over childbirth. These include burying the placenta at the entrance of the house. The idea behind this seems to be to illustrate a contrast with "western" practice in childbirth. As one would expect from a sociologist who teaches at the Centre for Women's Studies at Trinity College, Dublin, the text is more sympathetic to feminists than to "scientific" obstetricians. It contains many obstetric horror stories of a kind that a pregnant woman might tolerate only with reassurance that they are in the past. There are also a few, rather touching, stories, and discussion of many things not usually defined in obstetric discourse, such as the establishment of what is "normal" and "abnormal", dangerous and safe, rational and irrational. The author compares two concepts of "normality" long thought to be important in the struggle between women and doctors about birth. "Normal" for doctors is "about medicalising a body which cannot be relied upon to work, and where a successful pregnancy is measured only in terms of whether a well mother and a live baby emerge at the end of it". In contrast, for women, the concept of "normal" involves "a process rooted in their bodies ... not in a medical textbook". Commendably, these discussions refer back to Thomas Kuhn, seeking to establish that proofs reflect the world as it is, and to Ludwik Fleck, who pointed out that whereas within science a fact should be capable of being distinguished from "transient theses" because it is concrete, permanent, independently measured for its validity, and free from "subjective interpretation", in reality scientific "evidence conforms to conceptions just as often as conceptions conform to evidence". This is the kind of reasoning hated by most scientists and conventional practitioners of biomedicine. There follows a critique of modern "scientific" obstetrics with its emphasis on the incompetence of women and its promotion of intervention. Various interventionary techniques are described and discussed. The book is meticulously researched and referenced. I found the jacket rather messy and both the title and the chapter headings difficult to follow, for example "Women, power and obstetric rationality" and "Obstetric pairings and knowledge formation". I set out to read the book from cover to cover but found this difficult because of its long sentences filled with jargon and complicated constructions and words. Anyone who cares about the English language is likely to be put off by such words and phrases as "impacted" (meaning influenced), "throughput", "palpable responses", "experiential resources" and "disempowerment". There are many such. Nevertheless, this is a worthy addition to the history of obstetrics.