How far have we come? Princess Charlotte's death in childbirth

Princess Charlotte Augusta of Wales
by George Dawe, oil on canvas, 1817

I'm not going to devote the time this topic deserves. That's more of a promise to myself than anything else, but I have been inspired to speak on the subject, and I will do so, even if I do not go as deep as the topic warrants.

I spoke not long ago of Princess Charlotte of Wales when I was sharing my adventures in London at the National Portrait Gallery (read the post here). She died after an excruciating breach labor to a still-born son which use of forceps could have prevented, but such intervention was against the philosophy ascribed to by her attending physician. This national tragedy sparked a new interest in birthing practices amongst members of the medical establishment: an entirely male body. Prior to this time, many doctors were content to leave the mysteries of childbirth in the capable (if often dirty) hands of the midwives. The effect of childbirth becoming such an intense focus of study had many positive effects but also many drawbacks, and we remain to this day subject to the inadequacies of a field of study conducted almost entirely by those who have no first hand knowledge of the experience.

Two articles in the news lately grabbed my attention. The first's headline is one that I'm sure ensnared many. 100 Women in 2016: Researching the female discusses the lack of knowledge we have in mapping the nerve endings in female genitalia as opposed to the swath of information available on the male. This dearth of knowledge leads many in gynecology and obstetrics to attribute responsibility for sexual dysfunction on the patient, as they do not understand the medical cause. The second article, Cesarean births "affecting human evolution", regards a study conducted in Austria demonstrating an increase in the number of women suffering from fetopelvic disproportion, or FPD, and attributing it to medical intervention's effect on the evolution of humanity. Basically, because cesarean births have enabled women who (like Princess Charlotte) may not otherwise have survived and delivered healthy offspring to do so, a genetic predisposition for a narrow pelvis is being passed down from one generation to the next, increasing the number of women who aren't able to deliver vaginally because the baby's head is too large to pass through the mother's birth canal. The result is the cervix doesn't dilate all the way, and labor fails to progress naturally.

This next paragraph is somewhat gruesome. Be warned.

Princess Charlotte went into labor at 42 weeks and 3 days on the evening of November 3, 1817. Having followed her prescribed diet, called a "lowering" treatment, she was weak due to inadequate nourishment and bloodletting. Mild contractions came at 8 to 10 minute intervals. Her cervix was considered to be a "half penny dilated," whatever that means (I could find out, but I'm not taking the time to do so). Around 3 am the princess had a violent vomiting spell, and important state personages were called into attendance. At 8 o'clock in the morning on the 4th she was only 3 centimeters dilated, and the labor continued to progress slowly. The following day at noon, after the presence of meconium was detected, doctors began to fear for the cild's life. A 9 pound, still-born boy was not delivered vaginally until 9 pm on the 5th of November. Charlotte had been in labor for 44 hours. Thirty minutes later she began hemorrhaging. The doctors were able to extract the placenta, and for a time all seemed relatively well, yet by the 6th she was dead, having experienced a series of severe spasms (follow the link for a detailed account of Charlotte's labor and death: http://www.innominatesociety.com/Articles/The%20Death%20of%20Princess%20Charlotte%20of%20Wales.html).

This is in many ways so similar to what happened to me when I gave birth to my daughter, yet with all the benefits of modern medicine that a 19th century princess could ever imagine. My daughter wasn't breach, but she was facing backwards, so all my labor pains were in my back and very intense. I could have blessed the anesthesiologist when I received the epidural. From then on my pains were not acute, but the labor didn't really advance. I had discussed with my doctor upon first being pregnant my doubts about being able to deliver vaginally, and she must have recalled my warnings, because after only one round of pushing at 8 centimeters with no progress she looked at me and said, "How wed are you to the idea of vaginal birth, because this is going to take a very long time. A mere hour later I had my daughter, but I could not hold her for several because of hemorrhaging. Sound a bit like Charlotte?

The reason I doubted my ability to give birth naturally was many fold. First, I was so fortunate as to have a gynecologist once who thankfully bothered to mention that I had unusually narrow cervix. Second, my husband and I were both the products of mothers who only had cesareans. Both are small women who delivered large babies. Third, my husband has one of the biggest heads I've ever seen. I mean, he can hardly buy a hat. I considered the matter and concluded it was quite likely I would not have a natural childbirth. Every medical expert I spoke with fervently disagreed.

I am now thinking of having another child. My hope is that this new research will allow me to point out a body of evidence to my new Swiss docs that helps them take my concerns about a VBAC seriously. My fear is that it will increase an already strong cultural reluctance towards assisted births of all sorts. I'm not particularly concerned about receiving proper medical attention if I need it, but I would rather avoid the rigamarole of waiting for the doctor to see the evidence before his or her eyes that I have been trying to explain for months and just get the whole ordeal over and done. First world problems, I suppose, but they take up a great deal of my attention.

So these are my thoughts on this sunny Tuesday morning. Doctors need to be less satisfied with their breadth of knowledge and start filling in the massive holes left by centuries of male-dominated medicine. In the meantime, please listen to your patients. Particularly when it comes to the female body, we are each so unique that it is impossible to boil us down into neat categories and distinct experiences, no matter how hard pregnancy manuals might try. It's disgraceful I should be able to compare the birthing practices of two hundred years ago to those of today and find doctors still subject to the same prejudices.

Amazing Grace - 2006

I ought to be in Texas, visiting family and friends, but the day before we were set to depart I fell and injured my neck, leaving me with some unexpected time on my hands. And what better to do when convalescing than to watch a movie? I rewatched Amazing Grace, a film about the efforts of William Wilberforce to abolish the slave trade in the British Empire, and felt the need to share how my thoughts here. We all know that Austen only mentioned the slave trade twice in her novels. The first time she is subtle about it; Fanny Price says to Edmund Bertram, "Did not you hear me ask [my uncle] about the slave-trade last night?", upon Sir Thomas' return from the Indies. But during this famous exchange between Jane Fairfax and Mrs. Elton, she is rather more explicit:

"Excuse me, ma'am, but this is by no means my intention; I make no inquiry myself, and should be sorry to have any made by my friends. When I am quite determined as to the time, I am not at all afraid of being long unemployed. There are places in town, offices, where inquiry would soon produce something--Offices for the sale--not quite of human flesh--but of human intellect."

"Oh! my dear, human flesh! You quite shock me; if you mean a fling at the slave-trade, I assure you Mr. Suckling was always rather a friend to the abolition."

"I did not mean, I was not thinking of the slave-trade," replied Jane; "governess-trade, I assure you, was all that I had in view; widely different certainly as to the guilt of those who carry it on; but as to the greater misery of the victims, I do not know where it lies. But I only mean to say that there are advertising offices, and that by applying to them I should have no doubt of very soon meeting with something that would do."

Amazing Grace takes place between 1782 to 1807, the bulk of Austin's life. Abolition was much talked about during this time, and we must assume Jane had some opinion on it (which we would like to deem "correct" by our modern standards), but attempting to pinpoint what her thoughts actually were through the fog of not only time, but also the radical changes in notions of equality developed over the past two hundred or so years, is pretty futile in my opinion. Though it is interesting to speculate and debate upon the matter, it is not my purpose behind this post. The film is fascinating - the story it tells, intensely moving (if a bit prettied up for the screen) - but what I find of particular interest, at least in the context of this blog, is the gorgeous chronology of the changes in fashion between the eighteen and nineteenth centuries, and a cast that is jam packed with Austen veterans.

Romola Garai, so very familiar as the heroine everyone loves to hate in last year's production of Emma, plays Barbara Spooner, the wife of Wilberforce. I wish I could find endless images of her costumes, which were one of my favorite parts of the film (particularly the bib front dress she wears as a bride), but few are to be had. Her Emma costar, Michael Gambon (Mr. Woodhouse), portrays a surprisingly endearing Lord Charles Fox (historically The Honorable Charles James Fox). Nicholas Farrell is Henry Thornton, Wilberforth's cousin, familiar as Mr. Musgrove in the 2007 production of Persuasion, while his wife, Marianne, is played by Sylvestra Le Touzel, memorable in her recent performance as Mrs. Allen in the 2007 adaptation of Northanger Abby. As soon as I saw her, however, I thought not of the silly shopaholic who provides such ineffective guardianship to her young companion, but of my very favorite portrayal of Fanny Price from the 1983 version of Mansfield Park. Ciaran Hinds represents the opposition as Lord Tarleton (historically General Sir Banastre Tarleton, titles being one of the bigger inaccuracies in the film), a far cry from his depiction of Captain Wentworth in the 1995 version of Persuasion, though both are military men. The remainder of the cast, though not known to us from Austen, have a multitude of costume drama credentials. All demonstrate their remarkable abilities in this film; there is not a weak performance amongst them.

The issues debated in this film - slavery, revolution, religion, morality - are the same as those that formed the intellectual discourse of Austen's era. Though she scrupulously avoided including politics in her novels, knowledge of the ideas that permeated her society undoubtedly help us develop a better understanding of who she was. Amazing Grace is a beautiful vehicle towards that end. I highly recommend it to all.