THE CASE AGAINST NATURAL CHILD BIRTH.

By Waldo L. Fielding, M.D. '43and Lois Benjamin. New York: AvonBook Division, The Hearst Corp., 1962.128 pp. 60C (paperback).

Natural childbirth was advocated by Dr. Read in the 1930's. He believed that much of the pain of childbirth was due to fear and the reflex tightening of muscles which we all experience when we are afraid or when we anticipate pain. He advocated "childbirth without fear" (not without pain as suggested by Dr. Fielding). Dr. Read, however, was selling an idea against some pretty stiff opposition. If his method was properly carried out there was little or no pain, he suggested, and this he believed was the only natural way or normal way to have a baby. All was black or white to him and he could see little good in any other method.

It soon became apparent that frequently this method was not successful in many patients so that a combination of the two methods as described by Dr. Fielding in his book came into use. The patient under this "sensible method" receives the prenatal education and exercise instruction that is believed to be so essential to natural childbirth, the physician makes a greater effort to become better acquainted with the patient and with her thoughts and her mental and physical needs - but he reserves the prerogative of giving medication when and if he feels it is necessary. An anesthesia agent of some type is almost always utilized for delivery. This is very well presented by Dr. Fielding in the last chapter of his book and the section on choosing an obstetrician is superb. The heavily-medicated patient has become as rare as the pure "natural childbirth" enthusiast, but with each decade we tend to use less medication and less general anesthesia.

Recently I became aware that even in good teaching centers, there are purists at either extreme, still in active practice. I suppose it is with these in mind that this book is written. Although it is directed mainly at the natural childbirth over-enthusiast, the book could well have contained more about the injudicious use of drugs and anesthetics because of the two extremists, the "heavy medicator" is potentially the more dangerous even though his following is less vocal and less fashionable at present.

This is a difficult book to review because its presentation is not uniform. There is much that is good - very good; yet there are many half truths and debatable theories presented as proven facts. The "red journalism" Style is used - i.e., opinions are stated as facts and facts are distorted to make a point more dramatic and to increase reader interest. This is not fair to the lay readers at whom the book is directed. The author compares the book to a political speech, which is very apt, for he is a skillful politician - one moment you are irritated by statements that cannot be scientifically substantiated, and on the next page you cannot agree with him more.

As a politician, he runs down his opponent, and everything is described in terms of black and white. He compares the worst and most rigid aspects of the natural childbirth method as advocated in 1930, with his modern (the so-called "commonsense") modification of medication and anesthesia as advocated in 1960. During the intervening years, the natural childbirth method has been modified also. He gives little credit and then only briefly to the parts of "natural childbirth" which he has adapted to his method. It may shock the author to know that his reviewer, who has on occasion advocated natural childbirth (with the judicious use of analgesia and anesthesia) and the author, as described in chapters 6, 7 and 8 of his book, practice what I consider identically the same (and of course the best) type of obstetrics!

Assistant Clinical Professorof Surgery (Obstetricsand Gynecology)