Possibly one of the most profound changes in obstetric practice in the past 25 years has been the seemingly inexorable rise in birth by caesarean section. The caesarean delivery rate in developed countries has risen from 5% of births in the 1970s to about 30% in the first years of the 21st century, and there is no sign that this trend is slowing. It is concerning that in times of debate whether caesarean section should now be considered a “normal” birth option in these countries, millions of women in developing countries continue to experience severe complications due to meagre or restricted access to caesarean delivery.

Caroline de Costa is an experienced obstetrician, providing information for women and their families about caesarean birth and the history behind this operation. The book is written for the Australian and New Zealand community, with references to the professional bodies that govern medical practices in these countries — a refreshing change for those of us continually bombarded by international publications. While there are many short publications written about the indications and conduct of caesarean birth for women, this book provides an in-depth and thoughtful review of birth and the processes surrounding it.

This is not a book for medical practitioners, but interested non-medical readers will find it illuminating as to the evolution of not just caesarean birth. but obstetric practice in general. Indeed, I found the title somewhat of a misnomer — this really is a book about the evolution of the medicalisation of obstetrics and the significant improvements in health care delivery to pregnant women. The section about pain relief during labour is particularly salient in these times of high epidural rates: imagery of women agonising for days only to deliver a stillborn fetus are a stark contrast to modern obstetric practice with the availability of excellent analgesia and shortened, well monitored labours. The safety of modern obstetrics is well illustrated in this book — a factor often poorly appreciated by women and their families. Nature can be a cruel midwife and this book clearly demonstrates this feature with some vivid stories of difficult labours throughout history.

The language is colloquial, which facilitates ease of reading and appeal to the general public, who continue to have a great interest in one of the great events of humanity — birth.