Monday, February 07, 2022

Birth by Tina Cassidy

Birth: The Surprising History of How We Are Born by Tina Cassidy is a surprisingly entertaining read about the ever evolving norms around humans giving birth to babies. I am a bit squeamish about medical things and there were moments when I was reading this when I was absolutely repulsed, but in general, I found this to be entertaining and fascinating, if a bit contradictory in many places.


Essentially the book covers trends in childbirth, across cultures and time. It's clear, and the author even writes it, "birth always reflects the culture in which it happens" (page 250). So Cassidy helps us through a lot of those changing trends.  I've sort of divided the book up into four main areas: who is with the laboring woman, the role of medical professionals, tools used in childbirth, and mortality rates.  As childbirth has moved from something that happens at home with the help of other experienced birthers to a more medicalized environment, women have become less and less involved in childbirth. For a time, doctors made things worse that midwives, what with an increase in infections in dirty hospitals and an increase in unnecessary/unwanted procedures.  And there's still so much that we don't really know about birth.  

There's also a couple of chapters about the tools of birth (I feel so much like I need to know more details about my own birth and have several questions for my mom when I see her next - I feel like these would be inappropriate questions to text her - including whether or not forceps were used to deliver me and what type of pain medication she had) that are absolutely frightening, especially when Cassidy starts talking about various extraction tools (forceps! vacuums!) and the rise in caesarean sections.

I will never be giving birth and I am divided about who this book is for. On one hand, maybe all would-be mothers should have to read this book and complete a test about it to determine their fitness. On the other hand, maybe expecting mothers should not read this book because it's terrifying at times. Should this book be read by men? Women who have already given birth? I feel like mothers might get some PTSD reading this book, to be honest, and start questioning whether or not they made the right choices when many were never given choices at all.  I don't know. Maybe everyone should read it and then write their mother a nice note if she's still around or send her a thought of thanksgiving. 

I have some criticisms of this book, but most of those criticisms come from the juxtaposition of the first and last chapters. In the first chapter, Cassidy spends a lot of time talking about how, because of better nutrition, babies are getting bigger and bigger and women's pelvises are not changing at the same rate to accommodate those huge heads, so that makes human birth more and more dangerous. Then, in the last chapter, Cassidy starts talking about how we should all go back to natural births without all those pesky medical interventions, like caesarean sections, despite the fact that she spent pages and pages telling us that women's bodies just aren't ready for giant-headed babies of today.

Another relatively large issue I have with this book is the difficulty of using her citations. She doesn't number her endnotes, so it's kind of challenging to actually find original sources. There's a bit that I have questions about (see below) and I tried to figure out where it came from, but I just couldn't. It's not user-friendly and I would have liked a more robust citation system.

Lines of note:

The contrast between human births and those of four-legged mammals is stunning. Women have a much more difficult time than, say, polar bears, or the free-ranging howler monkey - which can deliver in about two minutes - as each has plenty of space in her birth canal. In fact, we are the only mammal species that needs assistance to give birth. (page 10)

I guess I just didn't realize that humans were so unique in their birthing process.

Although women's pelvises are universally narrow compared with those of other primates, they vary enough in shape that there are four categorizations for them. If she is lucky, a woman has a "gynecoid" pelvis, the most common and successful shape for birth because it is the most spacious and round. The other shapes - android, resembling a funnel or narrow heart similar to a male's pelvis; anthropoid, a thin oval; and platypelloid with a mildly deformed kidney-shaped brim - can also accommodate a baby, but only if they are simpatico with a the child's size. (page 16)

Source.

I am sure that pregnant women know the shapes of their pelvises (maybe?), but I had never heard of this varied shape thing. Fascinating!

In 1910, midwives were delivering only half of all American babies; the women they helped were mostly blacks and immigrants - those who had little choice or did not want a doctor. By 1930, midwife-attended births had dwindled to 15 percent and were primarily in the South, where doctors were few and far between. By 1973, midwives were handling less than 1 percent of deliveries. (page 31)

Midwives have a much higher percentage of vaginal births than c-sections, but there are a variety of reasons for that, particularly that many midwives won't take on patients who are at high risk, including older mothers, mothers with previous c-sections, and mothers with difficult health conditions. Cassidy spends a lot of time on the pros and cons of midwives versus doctors, but she doesn't actually address that hospitals and doctors see patients with more challenges than midwives do.

Quote from Dr. Alexander Hadden (1860) "She stated that she thought her child was born. I immediately examined and found the child beneath the hips of the mother, in a lifeless condition, and mutilated, apparently by rats. In the position in which the child was, life could have existed but a few moments." (page 55-56)

I read this aloud to my husband and I want to make sure you don't miss it, either. Gruesome.

In 2002, a forty-year-old Mexican woman went into labor with her ninth child. Labor was not going smoothly, and, having lost one baby in childbirth before, the woman was determined that this one would live. In her remote dirt-floor home, alone, with no electricity or running water, she drank three glasses of liquor. Then, equipped...with a kitchen knife as well as as experience in slaughtering animals, she gave herself a crude cesarean section, eventually opening her abdomen after three attempts. (page 108)

You guys. She gave herself  a c-section!!! Also, see how this contradicts the whole "humans are the only mammals who need assistance to give birth" thing? Apparently this woman didn't need help. The book is like that.

It wasn't until 1983 that the first major study of episiotomies were published...American episiotomy rates, which hovered around 90% in the 1970s, had dropped to 39% by 1997 and 20% by 2000. (page 144)

Dare I put "did you have an episiotomy?" on the list of questions for my mom? So many questions. Sorry, mom.

The Germans also believed that scaring the mother could accelerate a protracted labor and sometimes flogged pregnant women in an attempt to frighten and bring forth the baby. (page 176)

I spent a lot of time with my mouth ajar reading this book,  but the idea of flogging a pregnant woman (can you imagine a more venerated group in modern American society?) was downright shocking. The Germans can't catch a break with stereotypes,  can they?

Igor Charkovsky, a Soviet researcher and swim coach...in 1962...his daughter, Veta, had been born two months prematurely, weighing only 2.5 pounds. Desperate to help her live, he put her in a tub of warm water, shallow enough for her to lie on the bottom with her head above water, to help strengthen her muscles without stressing them. Eventually he added more and more water to larger and larger tanks. He gave her live fish and frogs to lay with. The baby thrived.

"When she felt hungry she would dive down and pick up a bottle that lay on the bottom of the tank," Charkovsky told one interviewer. "She spent the greater part of her first two years in water." (page 185)

I suspect this story is nonsense. I was surprised Cassidy included it without interrogating the facts a little bit more.

On New Guinea, men were not allowed to see their wives from the moment labor began until one month later, when a big public feast introduced the baby to all, including its father. After the feast, mother and child retreated to the birth hut - sans father - for a year of seclusion. (page 201)

WTF is this?  The man gets a feast and fucks off for a year?! I...am glad I am not part of New Guinean culture.

Among the Huichol tribe of Mexico, in order to make the father a partner in the mother's pain, a string would be tied around his testicles; the mother would pull the tether as each contraction peaked. (page 201) 

That's more like it.

Optimal timing for clamping the umbilical cord at birth is unclear. (page 217)

This! This is absolutely dumbfounding to me. More than 100 billion people have been born in the history of time and we still don't know when or how is the best way to cut the umbilical cord?!  How is this possible?! This is definitely science letting me down.

And, to the memory of my dog Sigmund, who spent her final days by my desk. She always kept my feet - and my heart - warm during the coldest of times. She will be missed. (page 257, from the acknowledgements)

This is the very definition of bittersweet. I nearly cried. (And then I wondered what was wrong with me because this book does not shy away from talking about infant and maternal mortality, but the closest I came to crying was thinking about a dead dog. I'm basically inhuman.)

Things I looked up:

altrical infant (page 17) - Born relatively helpless and dependent on others. 

In 2005, why were a few drops of sugar water put on a baby's tongue immediately after birth? (page 75) - Apparently it is commonly thought that sugar water relieves pain a newborn may be feeling. It seems like a terrible idea for the first thing a child would consume is sugar and it's a controversial practice.

Apgar scores (page 156) - Test administered to newborns, typically 1 minute and 5 minutes after birth, to determine how well the child is doing to see if extra medical care is necessary. 

A score of 7-10 is normal, 4-6 is moderately abnormal, and 0-3 is abnormal. Anything below 7 will trigger medical intervention. 

Caudal notch (page 156) - Nub at the end of the spine - frequently used in ultrasounds to help determine sex of a fetus.

In general, this was a super interesting and fascinating read. It's not perfect and I have some quibbles, but if you think this topic might be something you'd be interested in, give it a shot!  4/5 stars

13 comments:

  1. I’m usually ignore book reports because I know thatI am unlikely to read the book. However, I found this interesting. It seems like more of a précis. I had no idea about the shape of birth canals I rust that my wife and daughter had the right shape, for they seemed to have good deliveries — at least once they got to that point. 😎

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    1. Ha ha! I don't think of what I do as "book reports," but just reviews. It's helpful for me to organize my thoughts and I like to go back see what I thought about books.

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  2. This book does sound really interesting, but I would agree with your question of who it's written for. I'm not sure many expectant mothers would enjoy it. I guess it's really for people like you who have a curious mind!

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    1. The audience for this book is a mystery to me, but I'm happy to hear you think I have a curious mind.

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  3. I've heard of this book before; I can't decide whether I want to read it or not (and thanks to all the "fun?" facts you list, I almost feel like I don't need to at this point.
    Birth is crazy and the high mortality rates of mothers and infants from previous generations still blows my mind. I read a statistic the other day that in Shakespearean London, 1/3 of children died before the age of 10. The grief is just too much to comprehend. And yet it was "normal?"

    I ended up with two C-sections; the first very much unplanned (I was in the first woman in my family to ever have one) and the second one regrettably planned (turned out to be a very good thing as the doctor told me I had a very thin uterine lining and due to all the scar tissue from the unplanned C-section, I could have been in serious danger if I tried for a VBAC which I had so desperately wanted).

    It's also incredible how each delivery can be so different. One of my friends had three "normal" deliveries and then a very harrowing 4th delivery where she almost died, had an emergency C-section, almost died again, and had to go back to the OR. It blows my mind that someone I love so much came so close to death because I just think of delivery as being so routine. But it really is a miracle every single time.

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    1. Birth is STILL very dangerous for women and babies. Whenever I hear about people trying to get pregnant, I'm in a state of wonder. Ha! It just seems so scary!

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  4. I kind of want to read this but then I kind of don't! I had 2 c-sections. I have live videos of them so can see the assisting doctor pushing on my abdomen to help get the baby out so I can not imagine how that woman gave herself a c-section!

    I don't know the shape of my pelvis and I don't think that is something any/many women know? Both of my sons had enormous heads - like 90%+. Paul just would not descend in the birth canal and then his heart rate dropped so I had an emergency c-section after laboring for nearly 24 hours. I had a planned c-section for Will which was a much much much better experience and a faster recovery. I never would have been able to see a midwife for my pregnancy, though. I had far too many complications, including being of advanced maternal age, having a massive blood clot at 34 weeks and having major issues w/ managing my RA. So I also saw a perinatalogist, all because of the blood clot.

    My sense is that this author has a bias towards midwives/less medicalized births. That works for some women, but would never work for me. I watched a ton of "Call the Midwife" before I had my first baby and my husband asked why I was torturing myself by watching that show. I said it made me appreciate the doctors/facilities I have access to. I probably would have died if I was living in the 1960s in a poor area of London because of that blood clot... So I am very much pro "do what works for you and the health of your baby."

    My mom has talked a lot about her childbirths with us, I think because she was a nurse? We had 5 kids and only had an epidural with 1 - her 2nd baby. She said it was so awful so she said never again. I was baby #4 and her biggest at 10 pounds, but my little sister was probably 9.5? I think some women, like my mom, are just built to have babies. But you can never tell by looking at a person. I have friends who are teeny tiny, like barely over 100 pounds, and yet they had big babies that they pushed out in like 20 minutes. They must have that idea pelvis or something!

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    1. Yes! You raise an excellent point - the author is definitely biased towards less-medicalized births, but so many women and babies would really suffer if modern interventions weren't around. I think it's a terribly complicated issue and I think we definitely have to leave it to every woman to decide what's right for them.

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  5. That sounds like a far more interesting book than I would have been inclined to think.

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  6. I have this book on my list, I think it was Stephany who recommended it to me. It sounds totally up my alley, I find this kind of stuff absolutely fascinating. Mind you, my childbearing days are long behind me and I don't think I would have read this twenty years ago. Eeeee. The DIY c-section. GAHHHHHH.

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  7. I liked this book, too! It was really fascinating. I don't think I'd ever give this book to a woman who wants to give birth or someone who has had a traumatic birthing experience. So maybe just curious people, ha? I'm not even sure how it got on my radar, but as someone who is not planning on having children, it was easier for me to read about! The story of the woman who did her own c-section was insaaaaane.

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  8. OK, so what did you want more info on / a citation for? I was looking for it, wondering if I could help, but didn't see you call it out?

    My mother - a retired L&D nurse, whose hero is Semmelweiss (sp?) - the "wash your hands!" doc - will read this book, as will I (peds nurse but I love this kind of stuff). Mom was trying to figure out whether she can convince her book club(s) to read it. Reading your synopsis, I'm thinking no. ;)

    Thanks for the review!

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    1. Oh, I wanted more info on the Igor Charkovsky quotations. It all sounds like BS to me and I was hoping the primary source material might have been less credulous. I didn't do any more digging, though, so it obviously wasn't THAT important to me!

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