hommage à ceux qui, il y a cent ans cette année, vécurent une

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hommage à ceux qui, il y a cent ans cette année, vécurent une expérience si
traumatisante, si violente et si extra-ordinaire, qu’elle ne put que les conduire
à la folie.
ALEXANDRE KLEIN
Université d’Ottawa
NOTES
1 La France a ainsi mis en place une mission dédiée (http://centenaire.org/fr), ainsi que
le Royaume-Uni (http://www.1914.org/).
2 A l’exception notable de travaux de Geneviève Allard, Névrose et folie dans le corps
expéditionnaire canadien (1914-1918) : le cas québécois (Montréal : Athéna Editions,
2012) ; Julien Bogousslavsky et Laurent Tatu, La folie au front. La grande bataille des
névroses de guerre (1914-1918) (Paris : Imago, 2012) ; ou de Sophie Delaporte, « La
psychiatrie pendant la Grande Guerre », mémoire de DEA, 1993.
3 Hervé Guillemain, Chronique de la psychiatrie ordinaire. Patients, soignants et institutions
en Sarthe du XIXe siècle au XXIe siècle (Le Mans : Éditions de la Reinette, 2010 ; Laurence Guignard, Hervé Guillemain, et Stéphane Tison (dir.), Expériences de la folie. Criminels, soldats, patients en psychiatrie (XIXe-XXe siècles) (Rennes : Presses universitaires
de Rennes, 2013).
4 On pense notamment au travail pionnier de Marie-Claude Thifault et André Cellard,
Une toupie sur la tête. Visages de la folie à Saint-Jean-de-Dieu au tournant du siècle dernier
(Montréal : Boréal, 2007) ou celui, plus récent, de Benoit Majerus Parmi les fous. Une
histoire sociale de la psychiatrie (Rennes : Presses universitaires de Rennes, 2013).
Deliver Me from Pain: Anesthesia & Birth in America
Jacqueline H. Wolf
Baltimore: Johns Hopkins University Press, 2009, 277 p., US$27.00 paper
With Deliver Me from Pain, Jacqueline Wolf makes an important and innovative
contribution to the literature on the history of childbirth. In this book, Wolf, Professor in Social Medicine at Ohio University, argues that debates surrounding
the value and uses of obstetric anaesthesia have been characterized by hyperbole since its development in the mid-19th century: “voices of moderation” were
consistently “drowned out by proponents of two extreme and contradictory
views of labor” (p. 1). Wolf contends that, rather than being shaped by medical
innovations and discoveries, lay and medical attitudes toward obstetric anaesthesia and physicians’ uses of it were inextricably connected to the wider milieu
of any given period. She centres her discussion around a series of “questions”
(of necessity, professional respect, safety, authority, convenience, and choice)
that have complicated both historical and contemporary debates surrounding
the role of anaesthesia in obstetrics. She ultimately concludes that, as women
have become increasingly distanced from their bodies and birth experiences as
part of an ongoing process of medicalization, “birth has become principally a
problem of pain management” (p. 7).
Taking a chronological approach, Wolf first demonstrates how ideas about
the nature of the female body in the second half of the 19th century supported
the obstetrical use of recently discovered anaesthetics such as chloroform and
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comptes rendus ether. Delicate women were idealized in the mid-to-late Victorian period. But
they were also thought, due to their fragility, to experience particularly agonizing and perhaps unbearable labours. Such women presented a susceptible
audience for physicians’ arguments about the benefits of and need for obstetric
anaesthesia. For many of these women, more and more distanced from traditional female-dominated cultures of social childbirth, birth was an event increasingly “shrouded in mystery” and anticipated with “incapacitating trepidation”
(p. 20). In these changing times, the promise of pain relief offered much needed
comfort to anxiety-ridden women, while simultaneously allowing physicians to
stake claim to the emerging specialty of obstetrics. During this period, increasingly pathological views of childbirth, championed by physicians including
Chicago’s Dr. Joseph B. DeLee, supported the growing acceptance and use of
anaesthetics.
Wolf argues, however, that by the 1910s, changing perceptions of the ideal
woman went hand in hand with a new approach to anaesthetization. With the
“sturdy, bicycle-riding Gibson girl” now in vogue rather than her fragile counterpart of the previous generation, both expectant mothers and the lay popular
press emphasized the benefits of “Twilight Sleep,” a scopolamine-morphine
anaesthetic that promised to allow mothers to resume normal activities shortly
after giving birth (p. 54). Although initially reluctant to embrace the technique
and bend to patient pressure, many physicians ultimately adopted Twilight
Sleep’s intricate and complicated protocol as a means of promoting hospital
births and elevating the status of both obstetrics and the obstetrician. Its use was
short lived, but Wolf demonstrates how debates over Twilight Sleep highlighted
women’s power as medical consumers.
With the decline of Twilight Sleep, growing concerns about the health of
mothers and babies brought the question of safety to the forefront of American
obstetric debates. Despite concern about side effects, many mothers continued
to choose anaesthesia as part of the growing trend of medicalized birth. New
advances in anaesthesia during the interwar period, arising out of what Wolf
argues was now the “predominant goal of mainstream obstetrics”—the alleviation of labour pain—fuelled women’s growing interest in anaesthetized births
as well as the move from the home to the hospital. This shift, in turn, further
promoted the use of anaesthesia as the “unsettling sounds” of the labour ward
exacerbated expectant mothers’ anxiety (p. 81). Wolf argues that obstetricians
came to define all hospital births as “potentially high-risk” and physicians, both
urban and rural, were quick to offer and use anaesthesia, often according to
regional preferences and the class of the patient (p. 83).
As a result, Wolf suggests that new mothers during the baby-boom era were
particularly deferent to medical authority. Recent medical advances, coupled
with a growing body of articles in women’s magazines that hailed the benefits
of anaesthetized births, enhanced the status of the physician. Consequently,
although “doctors now enjoyed authority in all aspects of health and medicine … nowhere was physicians’ authority more evident than in obstetrics” (p.
110). By emphasizing now-routine prenatal care, unprecedented numbers of
visits to the doctor, and the precarious mental health of the expectant mother,
obstetricians extended their influence and control over the bodies and minds
of pregnant women. For both women and their physicians, “convenience” was
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paramount, and as part of wider cultural emphases on efficiency during the
baby-boom years, heavily-medicalized and increasingly prescheduled births
became the norm for many women.
This atmosphere gave rise to the most notable challenges to medical and
physician authority—the natural childbirth and birth reform movements. By
the late 1940s, Wolf suggests, many American women were aware of at least the
basic principles of “natural childbirth,” due in large part to the popular writings
of England’s Dr. Grantly Dick-Read. The more organized, and, at times, militant,
birth reform movement evolved out of the civil rights, women’s, and consumer
movements and reached its heights in the 1970s, as American birth reform activists redefined a “good” birth as one that was controlled by the expectant mother.
Despite its limited (and largely white) membership, natural childbirth became,
Wolf argues, “a vehicle to demonstrate women’s effectiveness and power” (p.
146). Though some physicians, influenced, in part, by their own negative experiences with anaesthesia, spoke out in favour of birth reform, the backlash against
natural childbirth after the 1970s indicates that it remained contentious.
Wolf valuably concludes her book with a discussion of current American
attitudes toward obstetric anaesthesia, and argues that in the face of unprecedented medicalization—typified by new and commonplace technologies
including electronic fetal monitoring and caesarean sections—the generation of
women coming of age since the 1970s has effectively “spurned” natural childbirth. In embracing the epidural, this generation of women has “unwittingly
mimicked their grandmothers, who glorified anesthesia” (p. 176). Ironically,
the rhetoric of “choice,” key to the natural childbirth movements of the 1970s,
remained pivotal, though “choice in relation to childbirth had come to mean
acceptance or rejection of three routine treatments—labor induction, epidural
anesthesia, and caesarean section—and even in the case of these few treatments,
a patient’s refusal was not always a realistic possibility” (p. 192). Ultimately, she
argues, the use of the term now paradoxically marks the limited choices most
women have when it comes to American hospital birth.
In this conclusion, as throughout the book, Wolf makes clear her position and
willingness to criticize medical authority. As such, the feminist contributions of
her work are significant. But, at its core, Deliver Me from Pain takes an exciting
new approach, bringing insights from the still embryonic history of pain into
the wider and more established literature on childbirth.
WHITNEY WOOD Wilfrid Laurier University