By Jill Arnold
The index of the fifteenth edition of William Obstetrics features a mysterious, sarcastic entry.
The sixteenth edition was not neglected by the subversive indexer(s), who took the length of the new text into account and changed the entry to indicate that the chauvinism found within had increased from “variable” to “voluminous.”
Robbie Pfeufer Kahn, currently an associate professor at the University of Vermont in the Department of Sociology, chronicled the dedications in various editions of Williams Obstetrics and offered speculation as to the possible origin of the index subterfuge in her 1998 book, Bearing Meaning: The Language of Birth.
On page 200, Pfeufer Kahn begins by examining the dedication of the fourteenth edition of Williams Obstetrics.
Beginning with the assumption that all texts, to one degree or another, tell stories and that beginnings of stories matter, I turned first to the dedication in the 14th edition of Williams Obstetrics and was not surprised to find that it offered: “To the men of high purpose who have sometimes jeopardized their careers in defense of the right of all children to be well born, this text is respectfully dedicated.” In 1971, most obstetricians were men (whether or not they were of high purpose). Although critical attention hadn’t yet fixed on physicians to the degree it would in the next fifteen years, the phrase “who have jeopardized their career” acknowledges a larger social order and, with it, a critical view of obstetric practices. At issue is “the right of all children to be well born.” Here being “well born” seems to imply the use of controversial methods that, before Roe v. Wade (1973), undoubtedly meant abortion and, perhaps, involuntary sterilization. But the dedication also may refer to the practice of “defensive medicine” in childbirth, even if this tendency was far less marked than it would become in the 1970’s and 1980’s, as “Frontline” documents.
Aggressive management of labor and delivery has been part and parcel of doctors’ involvement in childbirth, but technologies for childbirth expanded greatly in the 1960’s and proliferated in he early 1970’s. An issue of Clinics in Perinatology from 1974 notes that since 1965 there had been enormous advances in the technological management of labor and delivery. The journal goes on to say that declines in infant mortality are not necessarily correlative with these technological advances but might be due to better intrapartum spacing and the availability of birth control and abortion. Even the discipline of obstetrics questioned the effectiveness of technologies for childbirth.
The dedication of the fourteenth edition reveals the status of the woman in the text, both as practitioner, since only male doctors are mentioned, and as patient. The dedication makes visible the rationalized control over women in childbirth—“wellbornness.”
Pfeufer Kahn continues by providing sociological context, contrasting the dominant attitudes of the era in which the fourteenth edition was published and those prevalent when the sixteenth edition was published.
By the publication of the sixteenth edition, ten years had passed. During the 1970s the woman patient—uniting above and below—propped herself up naked on the examining table and taught pelvic exams to medical students on her own body; the childbirth movement increasingly challenged hospital practices; birth centers and people’s homes became serious alternative places of birth (the American College of Obstetricians and Gynecologist [ACOG] even feel compelled to publish a rather shrill position paper in criticism of homebirth); midwives began to be again considered best suited to care for women in childbirth; women began working in state and federal agencies to reform childbirth practices (a newsletter informing women about upcoming legislation or administrative rulings that they might want to comment upon even appeared); women published numerous books on childbirth (in 1973 Our Bodies, Ourselves became a best-seller); and, finally, owing to the women’s movement, women became 27.9 percent of students studying obstetrics in medical school. Thus, with great eagerness I turned to the dedication of the sixteenth edition of Williams Obstetrics and found a most ingenious response to the times. It was not dedicated to midwives (the foremothers of obstetricians); nor to the men and women of high purpose (bring female obstetricians into the fold); nor the parturient woman herself; nor to the childbirth movement for helping obstetricians practice better medicine (I didn’t really expect the last two dedications, of course). It was not dedicated to women patients, activists, obstetricians of both genders, or midwives: It was dedicated to wives. “This edition of Williams Obstetrics is dedicated to Signe and Sue, whose love, loyalty and devotion allowed us to pursue the career that pleased us most—and whose patience, assistance, and criticism renewed out dedication to do so.”
Turning and twisting to find a way to acknowledge women and at the same time not give in to the changing times, practicing a different kind of defensive medicine, the doctors make their statement against the invasion of women. For women had become irrepressibly visible as they pressed for their right to a decent birth and insisted on the right to attend women in childbirth. To all these women the dedication is offered as an acknowledgement and a rebuke. For Signe and Sue stand by their men with love, loyalty and devotion. Where other women turn their backs, these women not only stand by their men but allow them to pursue the careers that pleas them most. This is nothing less than a salute to the traditional woman.
With anthropologist Robert Hahn, Pfeufer Kahn speculates as to one possible origin of the chauvinism entries in the fifteenth and sixteenth editions of Williams Obstetrics.
But how loyal are these wives? Beth Shearer, cofounder of the grass roots organization Cesareans/Support, Education and Consern (C/SEC) told me that someone in the childbirth movement found an entry in the index to the fifteenth edition of Williams that read: “chauvinism, male, variable amounts, 1-923.” We speculated that a feminist secretary or indexer inserted this telling line, which gives the true story of the text. Anthropologist Robert Hahn offers an even more delightful speculation. In the preface to the fifteenth edition he found that “authors Pritchard and MacDonald thank Ms. Signe Pritchard ‘for her myriad contributions beginning with manuscript and ending [?] with index.’” In the sixteenth edition the entry about male chauvinism reads: “voluminous amounts, 1-1102.’” By the seventeenth edition it was removed (Signe was not involved in the seventeenth edition). If one of Signe Pritchard’s contributions was to name Williams Obstetrics as a patriarchal narrative, she truly deserves praise.
The word pleased in this dedication is crucial because it acknowledges the subjectivity, indeed the pleasurable subjectivity, of the physician. The dedication of the sixteenth edition of Williams Obstetrics inverts a woman’s pleasure during childbirth, and it is a powerful symbol of the patriarchy. The doctor, with his wife’s backing, takes his pleasure in birth; legitimated by women, he rules illegitimately over the new beginnings of life.