NOTES emerged in the second decade of the twentieth 1. Bruno Ramirez, "French Canadian Immigrants in the New century. England Cotton Industry," Labour I.E TRAVA1LLEVR 11 (Spring 1983), p. 130). Twilight Sleep was "a state of semiconcious- 2. Mason, Vinovsksis and Hareven, "Women's Work," in Tran• ness induced by morphine and scopolamine." sitions, p. 209. 3. Bettina Bradbury, "Women and Wage Labour in a Period of (3) What it essentially did was to separate the Transition,'' Social History H1STOIRE SOC1ALE, 17. Mav mind/body link which had so dominated nine• 1984. teenth century medicine and which had ac• 1. Frances Early, "The French Canadian Family Economy," Journal of Family History, Sunimet 1982. p. 183. counted for female mental disorders. Twilight 5. Judith Mt Caw "A Good Place to Work," Journal of Interdis• Sleep continued to accept the nineteenth century ciplinary History, 10, 1979, p. 210. 6. Thomas Dublin, Review, Technology and Culture. 24 (Octo- belief in the efficacy of pain in the actual labour ber, 1983). stage of childbirth but after the birth, removed the memory of that pain. It was a procedure Pain, Pleasure, and American Childbirth. From demanded by patients and rejected by most the Twilight Sleep to the Read Method, 1914- American physicians. These patients, however, 1960. Margaret Sandelowski. Westport: Geen- were not trying to win back control over child• wood Press, 1984. Pp. xix, 152. birth or agitating for popular and safe medicine. As Sandelowski carefully points out, Twilight Pain, Pleasure, and American Childbirth is a Sleep accepted science as a solution for pain. small book, only 105 pages of actual text and at And if Twilight Sleep provided women libera• $27.95 (American), rather expensive. But it is tion from their biological functions, as some well worth the price, for it is a gem. It is well believed, it did so at the expense of their partici• researched, argued and written. It focuses on pating in the actual birthing experience. attitudes toward pain as a reflection of changing societal values beginning at the turn of the cen• While the American medical profession never tury when pain was regarded as part of living, to engaged in the practice of Twilight Sleep to any the 1960s when people attempted, sometimes to significant degree, Sandelowski argues that the absurd degrees, to eliminate pain from their debate over it was nevertheless important: it lives. reawakened interest in physicians in the preven• tion of pain; it raised the possibility that pain As it applies to women and childbirth, pain could be eliminated safely; it focused attention was considered "inevitable," "necessary," and to on drug therapy; it justified both the presence of be "endured." For mid-nineteenth century phy• a doctor at childbirth, and a hospital birth; and, sicians, pain was a moral necessity, part of it stressed the complexity of childbirth. "Most childbirth, and therefore natural. It was also importantly, since Twilight Sleep advocates be• class related, for they believed it was experienced lieved that the method made modern childbirth more by middle-class women than working- natural again, unassisted childbirth was, by class women. Doctors were hesitant to remove default, unnatural." (19) this pain, not only because it was viewed as natural but because intervention required skill. After the Twilight Sleep campaign, medicine But as the century progressed, they became increasingly focused on the alleviation of pain in increasingly sensitive to the pain of their middle- childbirth. After all, that is what patients had class patients and willing to intervene. In fact, been demanding. In fact, until the late forties there was a very strong belief that civilization obstetrics was characterized by the search for the was making it difficult for women to bear their safe drug to end pain. Doctors believed, unlike in children without medical intervention. It was in the nineteenth century, that pain must be this context that the debate over Twilight Sleep stopped, but they realized that using drugs on pregnant women was hazardous: their effects With the stress of the psychological, attention were passed on to the fetus; certain features of a was paid to the fear of pain in childbirth. pregnant women's physiology made the drug Grantly Dick-Read, a British obstetrician, was therapy more hazardous than for non-pregnant the main proponent of eliminating this fear patients; and since labour lasted longer than through natural childbirth. Advocates argued surgery, more drugs were needed which itself that it was safer than drug controlled birth and it was a complication. The perception of these allowed women to participate. Critics accused it difficulties was heightened because pregnancy of rejecting physicians and science. Needless to was seen as a non-healthy state, to be handled by say, in the U.S., natural childbirth became medical personnel. Americanized. Drugs continued to be used, but not to the same degree. American medicine Drugs in childbirth made patient participa• simply could not accept non-intervention, for tion difficult and this led to more intervention so too many physicians, pregnancy itself was an that physicians could monitor the progress of abnormal condition. Natural childbirth in turn the delivery. Because drugs were viewed as was refined by the Lamaze method which not hazardous, pregnancy was increasingly seen as only placed women at the centre of the child• dangerous which may not have helped women birth experience, as did natural childbirth, but any, but certainly increased the status of obstetri• also put her in control of her pain. Or at least cians. By providing doctors with more activity some pain for Lamaze ignored, as did all the rest, they also relieved the boredom of childbirth from the pains accompanying afterbirth, episiotomy, the physician's perspective. Along with drugs and breast engorgement. It did, however, shift arose an entire retinue of procedures: forcep the focus to the pleasure of childbirth and recog• delivery, episiotomy, the early removal of the nized that pain was both physical and mental. placenta, and Caesarean sections. Nevertheless, it still left doctors overseeing child• birth.

Although women may have demanded the use of drugs to reduce pain, they had not demanded Pain, Pleasure, and American Childbirth is an total immobility. Many were discovering that if excellent study. It reveals the way in which the motherhood was the fulfillment of their lives as medical profession has maintained control of women, the childbirth experience as presented to the childbirth experience. It analyzes the conse• them in hospitals was a less than auspicious quences of our search to alleviate pain in society. beginning to it. The result was the demand not Pain is to be ostracized from childbirth. Those only to eliminate pain but to provide pleasure in feeling it have failed in the twentieth century the childbirth experience. By the 1950s, the search for pleasure. mind/body link had been reestablished. "The physician who treated women for their repro• Wendy Mitchinson ductive problems was also treating their minds University of Windsor since so much of the symptomatology encoun• tered in these patients was of 'purely mental origin.' (59) Such an attitude was based on the Small Expectations. Society's Betrayal of Older work of Helene Deutsch who maintained that Women. Leah Cohen. Toronto: McClelland and "the center of a woman's mental and emotional Stewart, 1984. Pp. 228. life lay in her reproductive organs." (58) The wisdom of the nineteenth century had been rein• This book examines how older women are vented. Because childbirth involved body and treated in our society and seeks to expose the mind, physicians now had to monitor both. great injustices they suffer. Cohen wishes to en-