Good morning! Does everyone still remember our book menage, where we discussed Sherwin Nuland's The Doctor's Plague and Joanna Kavenna's The Birth of Love? We raised a few questions for Ms. Kavenna, and after I emailed her with those, she was gracious enough to reply. I'll post the answer to one question today, and to the other tomorrow. And our thanks to Joanna Kavenna!
Our Question: Did you purposely contrast the "doctor's intervention" in Semmelweis's time and modern day intervention in the form of Caesarean sections, both of which result(ed) in higher mortality rates? (I think this reader had in mind that c-sections carry an increased risk of danger for the mother.)
The answer: "I was very interested in good medicine and bad medicine, or rather the idea that there are medical procedures and then flawed individuals trying to decide when to apply them. Medicine is very interesting to me because a wrong theory or wrong action can be completely devastating and even lead to the deaths of patients. My own equivocations, and those of most people, are less significant in their effects. So in the Semmelweis, Brigid Hayes and future narratives I was looking at scientific conviction, and even at times dogmatism. The doctors in the Semmelweis narrative thought they were right, and that Semmelweis was wrong, and yet it turned out the whole thing was inverted, that he was right all along. When I was reading about the professional resistance to his theories, it amazed me that some of his colleagues refused even to contemplate the possibility that he might be right. As with the present day, there's a slender distinction between having convictions, being able to take decisions, and becoming rigid in your certainties, refusing to change.
I wrote The Birth of Love after my own experiences of birth, in hospital. Towards the end of the birth of my first child, the doctors said I might well have to have a caesarean, made me sign forms, wheeled me off to the operating theatre. In the end, I didn't need a caesarean after all, but there was an interval when I was lying on an operating table, completely inert, my lower body paralysed by an epidural, with these doctors coming in and out, talking to each other, or sometimes to me. I was lying under a bright light in a sterile room, everyone wearing surgical gowns, myself - my body - the passive centre of it all. Even though I knew the doctors were doing their best to keep me informed, were really being highly professional and kind, there was still something very uncomfortable about the whole thing, losing control of your body, being surrounded by masked figures. It was very strange, like a bad dream. And later, it made me think about all those women - say, in Semmelweis's hospital in Vienna, who were examined by one doctor after another, and not really told what was happening to them, just that it was 'the best thing', and how, doubtless, those poor women had submitted to it all, because they didn't want to endanger the lives of their babies. And yet, in the end, the doctors were infecting them with childbed fever, unnecessarily, because Semmelweis had already realised how it could be prevented. So much human suffering, so many mothers who died in agony as their babies cried beside them and so many children deprived of their mothers, and all because of a few rigid-minded individuals, who clung to what they regarded as the 'facts', which turned out to be wrong.
I didn't want to say that all medical intervention in birth is intrinsically bad - it can often be life-saving and completely necessary. But I was very interested in that basic dilemma - that doctors need to be able to act, without being paralysed by a sense of uncertainty, and yet certainty can become dangerous, even fatal, when it becomes dogmatic and unyielding."
Tune in tomorrow for another answer from Joanna Kavenna!