Book Review: Get Me Out

I’m finished with this book! I loved it. I loved learning so much about the history of childbirth, where and how certain procedures and assumptions came from and more. If you have any aspirations to work in women’s health then I highly recommend this book. Below are some more of my favorite quotes from the rest of the book. Please note that some of these quotes are not listed because I think they’re fact. Remember, these were assumptions for a very long time and some of them are laughable.

Jacobson said Sylvia had suffered from psychogenic infertility. In medical jargon, that translates to infertility caused by one’s psyche. In plain speak, it means your thoughts made you sterile. the thinking was that repressed fears and hostility derailed brain chemistry.

The corpus luteum is part of the ovary that makes progesterone during the second part of the menstrual cycle and prepares the uterine lining to implant the egg.

An NIH study in the mid-1960s compared 249 couples with unexplained infertility who adopted children with 113 infertile couples who did not adopt. Some 35 percent of couples who were infertile and did not adopt got pregnant without drugs compared with 26 percent of couples after adoption.

One article included an anecdote about a married female lawyer who finally became pregnant when she switched to part-time work. The doctor had this to say about her: “After her attitudes towards herself changed, her pelvic physiology under went change and pregnancy then became a delightful anticipation rather than a hateful obligation”.

The researches did not say which came first, the depression/neuroses or the infertility, but it was assumed it was a brain-to-vagina route. A British study of 1000 women suggested that stress can clog fallopian tubes.

While each birthing guru preached a unique variant of natural childbirth, the underlying premise was the same: anxiety tenses muscles, and thigh muscles increase pain. Some researches taught women to relax muscles through exercise, some through meditation, some through religion.

Bing loathed the term “natural childbirth,” preferring the less-headline-grabbing but more meaningful sobriquet “prepared childbirth.” “Natural” sounded like a whole new approach, whereas “prepared” sounded as if they were simply informing you. Her mantra was “awake and alert.”

Unlike the English, who began to train nurses for midwifery, American doctors tried to get them off the playing field altogether.

A devout Christian, Dick-Read preached that the moment of birth should be a divine experience.

Dick-Read believe that perceptions influenced reaction. In other words, if you think childbirth is scary, you will tense your body and realize your fears.

Psychoneurotic women, he said, suffered during labor. Normal women gave birth easily. If one of his patients experienced a difficult birth, it was her fault for being a “selfish introverted woman.”

Yale would become one of the first US centers to launch a natural childbirth ward, thanks in part to a fortuitous confluence of eager nurses, obstetricians, and pediatricians swayed by Dick-Read’s dogma. It blossomed because of the young mothers themselves who demanded kinder, gentler births.

Wessle and the ladies pushed for rooming-in, the notion of having the baby stay in a bassinet with the mother rather than down the hall in a nursery.

One study found that 19.3 percent of 156 women who were coached for natural childbirth did not use any drugs at all.

Babies need to start as close as possible to mom for the mental well-being of both mother and child.

Maternal mortality dropped 70 percent from 1935 to 1948, and newborn deaths dropped by 40 percent.

Excessive bloating is a sign of preeclampsia, not a cause. These were the sorts of treatments that natural childbirthers would start to question. But the rest of the world was not ready for their scrutiny of medical authority.

One of the ongoing childbirth myths from antiquity right up to the 1950s was that dangerous things did not pass through the placenta or breast milk. That was nature’s gift to the perpetuation of the human race, or so it was thought.

Regarding the drug diethylstilbestrol (DES): The thalidomide saga shocked the world because it proved, for the first time, that drugs crossed the placenta.

A large meta-analysis of nine randomized controlled trials, including about 53000 women, found that continuous fetal monitoring was no better than using a stethoscope to hear the heart rate every so often. Several studies have shown that if a woman has a soothing caregiver by her side, labors tend to be shorter.

Cesarean section rates have increased by 46 percent in the past ten years without a comparable drop in maternal morality.

The fundamental philosophy of freebirthers is that female humans would give birth more easily if, like their nonhuman primate friends, they chilled out and if, again like their nonhuman primate friends, they were not surrounded by all the fuss of medical monitoring and doctors and midwives.

The upshot: women with doulas had shorter labors, 8.8 hours versus 19.3 hours, and were less likely to have cesarean sections, 19 percent versus 27 percent.

Ultrasound is energy, High doses are sued to heat and heal muscle injuries. It is used in other countries, but not the US, as an alternative treatment for cancer. If it’s therapeutic-or if it’s changing muscle physiology somehow-there is a chance that it could affect the baby, particularly  at excessive doses for a long time. Doctors say that the low dose used for a few exams during pregnancy are safe, that the benefits outweigh any potential risk. They worry about excessive doses for long periods.

Artificial insemination is not new, but turning what had been a secretive medical treatment into a moneymaking business is.

Specific enzymes at the head of the sperm digest an outer portion of the egg, permitting entrance. It is called the acrosomal reaction.

Sperm swim about 30 micrometers per second, which means it would take a sperm 10 minutes to swim across the period at the end of this sentence.

It was not just the experiment but Sim’s newfangled notions about making babies that enraged the medical community. Women who got pregnant while knocked out with ether debunked the long-held notion that a couple needed simultaneous orgasms to make babies. He wrote that if great sex were necessary to make babies, humans would be fossils by now.

Book Review: Get Me Out (Part 1-2)

(A note: I KNOW this is long. Please, if you have any interest in this subject, read through. I add several direct quotes from the book which I feel are important. Thank you for checking it out! If you’ve read this, please leave your thoughts in the comments and if you haven’t, well, you should!)

I have been so excited to share this book with you guys! It wasn’t even on my reading list (see tab above) and as I was checking books out over the weekend I found this little gem.

Get Me Out was written by Randi Hutter Epstein, MD and is a comical, factual, and historical account of the history of childbirth “from the Garden of Eden to the Sperm Bank” as the front cover reads. As most of you readers out there are childbirth guroos like myself, you may also know of Abby Epstein, co-author of Your Best Birth with Ricki Lake. I have yet to find any credible resource that these two are related somehow, however I would not be surprised if they were.

This post is only to summarize and discuss the first two parts of the book (I just couldn’t wait!) as I am still reading it. The book starts off with a lot of history in regards to how the concept of childbirth came about. Many believed that labor pains were “the curse of Eve” since she ate that damn apple. Regardless of your spiritual beliefs, the book does an excellent job of bringing forth history which most have never even heard of and most of which is rather comical. For example, many believed that “good sex made for good babies” but no one really defined what “good sex” was, just that if you had a “good baby” then you must have had “good sex” at conception.

Epstein goes on to discuss how childbirth tools came about, specifically forceps and the speculum. and how the inventors of those tools were mearly trying to prevent internal damage to the woman, specifically vesicovaginal fistulas (holes/tears) from childbirth. It’s disturbing to read that these doctors tested out their new inventions on slaves because if a woman was so damaged during childbirth, then she was useless to her owner and breeding more slaves was an important aspect to maintaining the plantation.

Homebirth was the only way women gave birth hundreds of years ago and historically, no man was allowed in the birthing room. Only midwives and her supporters (sisters, mother, etc). A male doctor once dressed as a woman and entered the birthing room. Once he was discovered he was killed. Seriously?! It’s this kind of history that has me hanging on every word in the book, to think that men were truly not allowed and today, thousands of male OBs practice and treat women. Wow.

Maternal and infant mortality is discussed quite a bit, mostly in regards to how the birth was handled as men seeped their way into the birthing room. Doctors never washed their hands before seeing patients, causing a huge rise in deaths to mothers from childbed fever. It was very common for a doctor to see a patient to her death and go into the next room to deliver another baby and passing on infection to both. Even in the early 1900s hand-washing was still not believed to prevent the spread of infections.

At the turn of the 20th century, the ideas of a Lying-In hospital began to open up across the country, the new birth place for women. Women were told that there was nothing safer than giving birth at the Laying -In hospital, despite the maternal mortality rate staying the same for several years due to lack of hand-washing, among other things (uneducated doctors, student-doctors, misuse of tools, hemorrhaging, etc).

Lastly, twilight sleep. I had never heard of this form of childbirth until now. Women were fighting for their rights in the early 1900s and one of those rights was to give birth without pain (which is ironic today, since natural, med-free childbirth is harder to push for). Two docs put an odd concoction of drugs together (morphine and scopolamine) and within a few hours the mother was not pain-free, but “awoke” hours later to find that she’d had her baby and had no recollection of the pain when in fact she was writhing in pain, being restrained to her bed and treated like a wild animal. Yeah, nuts I tell ya.

As I like to do with all my reviews, here are my favorite notations so far (chronological from the beginning of the book through part two):

(Middle Ages) One guide-book told women that getting pregnant was the same as catching a serious disease-an opportunity to die.

When do you call for extra measures and when do you let nature take its course? It’s a debate that began in the late sixteenth century but resonates loudly and clearly into the twenty-first.

Sims was not the first person to do vaginal-tear experiments on slaves. But he was the first one to do it successfully and the first one to turn his procedure into global fame and fortune. Fifteen years before Sims did his trails, Dr. John Peter Mettauer tried the same kind of thing on several slaves, but he used lead sutures instead of silver.

There was no such thing as informed consent-or any kind of consent, informed or otherwise.

Sims used his newest invention, the speculum, made from two large spoons he picked up at the local hardware store.

He created the so-called Sims position: placing a woman in a fetal position to make it easier to look inside.

Sometimes doctors went from autopsy to delivery, back and forth-death to birth, birth to death, chaffering germs with them. Long before doctors eyed bacteria or knew anything about them, a few scientists suspected contagion. They did not know what was spreading but had a hunch something awful was passing from one sick new mother to the next.

The hand that is relied upon for succor in the painful and perilous hour of childbirth becomes the innocent cause of her destruction.

Then Semmelweis reasoned that doctors who perform autopsies before delivering babies carried something deadly from the morgue to the delivery room. He was proposing a sort of germ theory without knowing anything about germs. His colleagues saw otherwise. They saw a young arrogant doctor claiming that doctors were murderers.

The germ theory provided one reason for illness, but it was at odds with several other well-rooted theories.

Joseph Lister discovered that carbolic acid destroyed germs lurking in wounds; he named his cleaning technique antisepsis. And Rober Kock devised a four-step program to prove, without a shadow of a doubt, that germs triggered illness.

Kochk’s four steps: 1) The bacteria must be present in every case of the disease, 2) the bacteria must be isolated from the host with the disease and grown in pure culture, 3) the specific disease must be reproduced when a pure culture of the bacteria is inoculated into a healthy susceptible host and 4) the bacteria must be recoverable from the experimentally infected host.

Events during the turn of the twentieth century proved that germs caused the disease; that doctors passed the infection to patients; and that antiseptic technique (scrubbing between patients) prevented infections.

About 8 mothers died for every 1,000 births.

By the turn of the twentieth century, doctors accepted the idea that germs caused childbed fever. But for the next few decades, many of them could not accept the idea that they carried the germs.

They promoted an autoinfection theory, insisting that new mothers got sick by ‘infecting or by the spread of an inherently bacteriologically fertile reproductive organs’, aka endotoxin theory (a toxin growing from within).

Eventually, other studies would make it crystal clear that pregnant women may be more susceptible to colds and flu, but the pregnant womb does not grow its own garden of bacteria. The endotoxin theory died. The only way a women got childbed fever was by having a contaminated band or instrument inserted during delivery.

They (doctors) believed they were saving lives by luring women away from midwives and into the hospital, where doctors could control the business of babies. Ironically, what they thought was the best medical care was sometimes the deadliest.

They (doctors) hoped the buzz about the reopening of the Laying-In hospital would dissuade women from going to midwives.

In 1900, 5 percent of women gave birth in hospitals. By the 1930s, about half of all women and 75 percent of women in cities delivered in hospitals. And by the 1960s, nearly every pregnant woman chose a hospital birth over a home birth.

The feeling among most women was that if you wanted to survive childbirth, you were better off at home and far away from maternity wards.

It was not only a move from home to hospital, it was a move from one culture to another, from the familiar to the strange. It meant you were on doctor’s turf.

In 1900, a baby was born in New York City every 10 minutes.

Doctors believed that women needed to be in the hospital to get the best care in the cleanest surroundings. They also knew that a hospital birth spared them from running from house to house.

Dammerschlaf, or twilight sleep, as it would become known in America, provided women with drugs during labor that lulled them into a woozy forgetfulness during the birth of the baby.

The added amnesia meant that women felt pain but forgot about it-which makes you wonder if anything is painful if there is no memory.

Sheppard-Tower Maternity and Infancy Protection Act, a federal program that gave grants to states for prenatal and child health clinics. The act also provided funding for nutrition and hygiene education, midwifery training, ad home visits by nurses to check on pregnant women.

The Twilight Sleep Association illustrates, perhaps more than any other turn-of-the-centurey organization, the zeal of the early feminists; the simmering anger toward male doctors; and the power of the media to shape public opinion.

Yet there were plenty of doctors who thought that women who could not bear the discomfort of childbirth could not withstand the selflessness of motherhood.

Drug advocates convinced women that taking medicine was not a sign of weakness but was healthier for themselves and their newborn.

Childbirth drugs diminished uterine contractions and caused hallucinations. It also impared newborn breathing. Doctors  called it newborn oligopnea, halted breathing. The doctors reassuringly added that while some twilight babies stop breathing for a bit, they never turn blue.

A Long Island doctor wrote a letter to the editor of the New York Times calling its twilight-sleep stories an ‘unprofessional and dangerous way of misinforming the public’.

Forgetting the moment of birth should not make any difference whatsoever on the kind of mothers these women would become. Epidurals, which remove pain but allow women to be alert, were a long way away.