WHAT A BLESSING SHE HAD CHLOROFORM: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present. By Donald Caton. Yale Univ. Press. 288 pp. $30

I had my kids without anesthesia and treasure the memory, an attitude that a colleague of mine likens to making a fetish out of having dental work without painkillers. Pain relief during childbirth raises a host of questions: What is best for the mother? What is best for the baby? What is "natural," and does that matter? The world is full of people who think they know the ideal birth experience, and, therefore, full of women who think they got it wrong.

Caton demonstrates that women, obstetricians, social theorists, and preachers (among others) have been reading significance into labor pains for at least two centuries. The author himself is an obstetrical anesthesiologist, trained to alleviate the pain of childbirth, and spurred to undertake this book by his surprise that "many women did not want my help." His historical account is naturally shaded by his professional assumptions (as he freely acknowledges), but it is also informed and enlivened by his technical and scientific understanding of anesthesia.

Ether was first used in childbirth in 1847. In 1853, Dr. John Snow (of epidemiologic fame for tracing a London cholera epidemic to a contaminated well) administered it to Queen Victoria during labor. Later, her daughter was given chloroform during her labor, prompting the queen to utter the sentence that gives the book its title. Caton discusses the reception of ether and chloroform among physicians and patients, tracing the changing social interpretation of pain and the strands of medical doubt (in the mother, ether caused nausea, chloroform caused liver damage—and no one knew their effects on the infant). He moves on to scopolamine, the notorious "twilight sleep" of the early 20th century, and argues that educated, affluent American women demanded it as their due and their emancipation. In his account, the profession has responded to the wishes of pregnant women, adjusting medical practice as the patients’ attitudes shifted. Natural childbirth and Lamaze simply continue this trend.

The book’s foremost strength is its intelligent combination of the science of pain relief—which remains one of the great gifts of modern medicine—with a rich matrix of social history. Caton touches on the medical interpretation of pain, the position of women in society, and the emergence of science as a driving force in medical change. If his perspective remains that of an anesthesiologist, convinced that most fully informed women will choose medication, his intriguing story nonetheless helps us understand childbirth, pain, and pain control.

—Perri Klass