Birth Story

By 1657, the plague was largely spent and the Catholic Church was becoming a little choosier about its battles, especially given the spread of the Protestant Reformation.

In Italy, the Renaissance was winding down. Science had become so intrinsic to intellectual life that Leopoldo De' Medici, who was both a prince and, later, a Catholic cardinal, opened his private chambers in the Pitti Palace in Florence to a new scientific academy, the  Accademia del Cimento. ("Cimento" means "trial.")

Leopoldo and his brother, Grand Duke Ferdinando II of Tuscany, founded, and funded, the academy, which would meet for just 10 years. Its influence would last much longer.

Ferdinando had supported Galileo's experiments and had tried unsuccessfully to nudge the Church toward accepting them in the spirit of exploration. In the 1640s, he opened the Boboli Garden, the grounds of the Pitti Palace, his official residence, to experiments with thermometers, poultry incubators and other instruments.

Galileo's spirit hovered over the academy. Its motto was "provando e riprovando" — "testing and re-testing." Founding members included Galileo's students, like Vincenzo Viviani, who with fellow academy member Giovanni Alfonso Borelli, worked on experiments to pin down the speed of sound waves.

Another member was the physician Francesco Redi, who performed what is considered the first scientific experiment.

Distractions to the patrons, and quarrels among the members, doomed the academy. Its last act was the publication of a compilation of members' work, Examples of Natural Experiments, which in its Latin translation influenced the European scientific community profoundly, becoming essentially the science textbook for at least 100 years.

Image courtesy of Wikimedia Commons

In 1665, the Englishman Robert Hooke published an amazing book called Micrographia that contained some of the first peeks at a world that was too small to see with the naked eye.

Micrographia, published when Hooke was 30, was the first publication of the Royal Society of London, and the first scientific best-seller. The diarist Samuel Pepys called it "the most ingenious book that I ever read in my life."

Hooke made the illustrations himself, based on what he had seen through a microscope he had built. Looking at a slice of cork, he saw divisions that reminded him of monks' cells in a monastery, and that is what he called them, "cells."

Robert Hooke's drawing of cork cells

Hooke was born on the Isle of Wight, home-schooled and then apprenticed as an artist. He went on to Oxford at a time of unprecedented scientific activity, and he impressed his teachers with his ability to design and execute experiments: He built the vacuum pumps for Robert Boyle, who would demonstrate that gases all act in more or less the same way.

Hooke himself described how springs work in a treatise that gave rise to "Hooke's law" of elasticity. He was also an architect, and worked to help rebuild London after the Great Fire of 1666.

Hooke would probably be more famous than he is had he not quarreled with Isaac Newton over some of their overlapping discoveries. When the scientific community took sides in the dispute, Hooke was shunted aside.

His writings on fossils showed amazing rigor and originality. In the face of a scientific community that considered fossils a "sport of nature," Hook argued correctly that they were the remains of extinct organisms.

Image from Wikimedia Commons

The germ theory of disease, which holds that certain diseases are caused by living organisms, occurred to people thousands of years ago, but  it was proved only in the 19th century.

In the western tradition, the Roman scholar Marcus Terentius Varro first laid out the germ theory in his book, On Agriculture, a practical guide published in about 36 B.C. In it, Varro advises the farmer against building near swamps because “certain minute animals, invisible to the eye, breed there and, borne by the air, reach inside the body by way of the mouth and nose and cause diseases that are difficult to get rid of.”

Varro was a prodigious scholar and well known public figure, and his works were highly influential. However, at least some of his contemporaries, apparently including the writer/philosopher/statesman Marcus Tullius Cicero, considered his germ theory a crackpot idea.

It is worth noting that the Atharva Veda, the first Indian book that addresses medical topics, includes a fairly detailed germ theory. The book identifies a number of living organisms that were deemed responsible for causing various diseases, and prescribes cures to kill the organisms. The Atharva Veda was written down about 200 B.C., but its ideas may date as far back as 1,000 B.C.

In his excellent review of Annie Murphy Paul's new book, Origins: How the Nine Months Before Birth Shape the Rest of Our Lives in the New York Times Book Review on Sunday, physician/author Dr. Jerome Groopman wrote:

Of necessity, research on fetal development involves observing pregnant women in their daily lives; no one would purposefully have one group eat in a possibly risky way or be exposed to a potentially dangerous substance, and compare outcomes with an unperturbed control group. We have, at best, only correlations between a mother’s lifestyle and her child’s future health, not clear causation.

And, in "The Case Against Breast-Feeding," Hanna Rosin's 2009 article in The Atlantic, she wrote, "An ideal study would randomly divide a group of mothers, tell one half to breast-feed and the other not to, and then measure the outcomes. But researchers cannot ethically tell mothers what to feed their babies."

Really? Why not? Both Groopman and Rosin are writing about how vulnerable observational studies are to being tainted by hidden variables. Controlled trials are a better system for testing what works and what doesn't.

But if I am reading their statements correctly, Groopman and Rosin are saying that we cannot even think about practicing actual, rigorous science if babies and fetuses are involved.

Building up a body of "evidence-based medicine" around a segment of the population that is exempted from clinical trials — depending entirely on observational research, that is — seems unwise to me. We don't need to wonder what a worst-case scenario involving babies would look like;  we have the 50-year-old thalidomide catastrophe as a demonstration. Thousands of children around the world were born with deformed limbs after their mothers took the drug.

Subjecting drugs and behaviors that can affect unborn children to standard scientific trials that include pregnant women might save the population from potentially massive damage from those behaviors, and from the drugs once they are put on the market. This is especially true now that we suspect the experience in the womb has a huge influence on the course of an individual's life — the subject of Paul's book, Origins.

Now I understand why the medical ethicist Ruth Macklin, writing in The Lancet last winter, called for the inclusion of pregnant women in drug trials, and retaining women who get pregnant in such trials. Conventional wisdom seems to have rendered the concept so unthinkable that a call for change is necessary.

What do you think about including pregnant women in clinical trials? I would love to read your comments.

Annie Murphy Paul's new book, Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, is getting the star treatment. It is the subject of a Time magazine cover story (written by Paul), and an article by the New York Times' Motherlode blogger, Lisa Belkin.

And why not? Paul has written what looks to be a fascinating exploration of the explosion of research on the effects of the environment human beings encounter while developing in their mothers' wombs.

In a guest post for Motherlode (the link is above), Paul writes, "Startling as it may seem, qualities ranging from our intelligence to our temperament to our health, and our susceptibility to diseases as varied as cancer, asthma, obesity, diabetes and mental illness, are affected by our experiences as fetuses decades ago."

We have already considered one aspect of this research here at Birth Story, how a mother's weight gain during pregnancy can influence her infant's lifetime chances of being able to maintain a healthy weight. But Paul covers the waterfront in this "new chapter in the long-running nature-nurture debate," as she calls it.

In her Motherlode guest post, Paul raises and then downplays the likelihood that mothers will be blamed for anything that goes awry with their children, given the new understandings of the importance of what goes on in the womb.

Love Paul's optimism! And, I'm impressed she researched this book while she was pregnant. I'm looking forward to reading it.

Often, the annual meeting of a medical group produces a flurry of scientific papers, but the meeting of the American College of Obstetricians and Gynecologists seems more like, say, a bunch of writers  getting together. (I attended the 2009 meeting in Chicago.) As a cohort, OB-GYNs seem to want to find out about the newest approaches, tools and techniques they might put to use in their practices, and perhaps exchange some stories from the trenches as well.

But here's something new for consumers from ACOG, which held its annual meeting in San Francisco this week. The fifth edition of Your Pregnancy and Childbirth: Month to Month was unveiled, along with a new companion website,  www.yourpregnancyandchildbirth.com.

While there are many pregnancy books, this one is "unique in the extent of the medical detail that it covers about all aspects of pregnancy, yet it is designed as an easy-to-read, helpful reference for all of those questions that inevitably pop up," said Hal Lawrence, MD, The College's vice president of practice activities in a press release on the ACOG website.

The latest edition of the book has a new chapter that addresses obesity and eating disorders, another devoted to diabetes during pregnancy, and a third covering other chronic diseases like hypertension, heart disease, celiac disease, lupus, and physical and mental disabilities.

"The majority of women do not experience severe complications, but we felt it was important to give a thorough overview so women will know if something's wrong and when to call a doctor," Dr. Lawrence said.

Another new chapter covers feeding the baby, and includes advice on both breastfeeding and the use of formula.

Remember, dear reader, I said there would be tangents. Now we are embarking on a trip to Baltimore, Md., and childbirth will barely be mentioned for a while.

In his groundbreaking 1982 book, The Social Transformation of American Medicine, Paul Starr plumbs the source of mainstream medicine's authority. Simply put, it comes from the public's dependence on the doctor's superior competence, real or perceived.

As the title of Starr's book suggests, doctors were not always able to lay claim to that authority. Indeed, before the germ theory was proved and methods of administering anesthesia devised, making possible the development of effective surgery, physicians had very little to offer. (That didn't keep them from practicing, though.)

But in Baltimore, late in the 19th century, with new technologies and understandings developing rapidly on all sides, events were unfolding that would help solidify the medical profession's authority.

Image by permission  http://creativecommons.org

My favorite book about a mother is To the Lighthouse, by Virginia Woolf. I read it for the first time only recently. I couldn’t believe how powerful it was.

I have had friends who loved To the Lighthouse. They usually admired the character of Lily Briscoe, an artist and independent woman who seems to stand in for Woolf herself in some ways. In the book, Briscoe visits a British family, the Ramsays, at their vacation home on a Scottish island before World War I.

Incredibly, to me now, anyway, my friends never talked about Mrs. Ramsay. I guess I can understand why they didn’t. Lily Briscoe was what we wanted to be at the time, serious women devoted to our art. Or at least that’s what we thought.

Mrs. Ramsay. Woolf doesn’t even give her a first name. Mrs. Ramsay is married to a celebrated intellectual who has come to Scotland with his favorite students. While he marches up and down the beach spouting great thoughts and obsessing about whether his work will live on after him, she is thinking about all the people in her home, her children and guests, and how she might make them happy.

Using the stuff of ordinary life, Mrs. Ramsay pulls off one magical evening in particular, even in spite of a number of glitches, that will stay with all of them for the rest of their lives, tying them with emotion and memories to that time and place.

I don’t want to trivialize a literary masterpiece, but that is what mothers do. Woolf is making that point, of course, that this woman who is almost part of the furniture to the people around her creates the moments that make their lives worth living.

I’m starting to think about Mother’s Day, and I hope you are, too, especially if your mother is still alive. Make that dinner reservation. Plan to give your mother something that will make her happy — flowers, a card, a phone call, a big kiss, or maybe a copy of To the Lighthouse.

Whatever your relationship with your mother, she is the only one you have.

Only one American midwife of the Revolutionary War era left a diary that has been recovered, Martha Ballard of Hallowell, Maine. It is a fairly basic document. Some entries are just a few words. Still, between 1785 and 1812, a time of incredible change in New England, Martha tended her diary regularly.

A Midwife's Tale

In 1990, the historian Laurel Thatcher Ulrich used her own considerable knowledge of the period to connect the dots in Ballard's diary. The result was A Midwife's Tale, which won the Pulitzer Prize and other awards. It is a terrific book, and it was made into a film for PBS's "American Experience."

One of the best things about A Midwife's Tale is the fact that Ulrich has given us a fully fleshed-out picture of Martha Ballard, and has at the same time retained her distinctive voice. Ballard was a religious, hard-working wife and mother who trained her daughters and other young women to assist her, understood the medicinal uses of the plants she grew in her kitchen garden, and in her prime delivered two-thirds of the children in Hallowell.

The town had more than one doctor, but in 816 births over the course of 27 years, Martha called a doctor in to help her with a birth just twice. In all those years, Martha saw 19 babies and five mothers die just before, during or just after birth.

While childbirth rested on a community of women when Ballard began her career, one of the tensions of the book comes out of the inroads male doctors were already making into midwifery by the time Martha died in 1812.

Mary Wollstonecraft, the earliest feminist writer in English, died in childbirth in London in 1797. At a time when women were bound to the home and dependent on the men in their lives, Wollstonecraft was a professional writer who had already had one child out of wedlock, and had only recently married her lover, the writer William Godwin.

Mary Wollstonecraft

The birth began with a midwife of Mary’s choosing, but when the placenta would not come out, a male physician was called in and removed it surgically.  Wollstonecraft died 11 days later, at the age of 38, of puerperal fever, a wound infection.

At the beginning of the 19th century, women found their public voice.  Wollstonecraft didn’t have an easy life, but the speed with which others followed in her footsteps reflects seismic changes.  Jane Austen’s first novel, Sense and Sensibilty, was published in 1811; born in 1775, Austen was a well educated woman.

Mary Wollstonecraft not only supported herself with her writing, but she started women on the path to speaking for themselves. On the day she died, Godwin wrote, “There does not exist her equal in the world.”

The daughter Wollstonecraft bore that day grew up to marry the poet Percy Bysshe Shelley, and to write a seminal Gothic novel, Frankenstein, as Mary Shelley.