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