Before reading this book I had not heard of Eileithyia, divine midwife of the Greeks, never mind her mischief. This may be an indictment of the comprehensive school system but it is not just in relation to the Greek Gods that it provides an important education.
Professor Brockington takes as his subject a group of conditions that, although now rare in the West, represent a major source of morbidity in many parts of the world – the organic psychoses of pregnancy and childbirth. His dedication is to those mothers in Africa, Asia, South and Central America and the Middle East who still suffer from these forgotten diseases.
It is a limited edition of just 100 copies, beautifully hand-bound, self-published and, to borrow a phrase from the lager advert, ‘reassuringly expensive’. It is unlikely, therefore, to be a book you will read or even stumble across in your medical bookshop or library. This, I believe, is a shame, as despite the specialised subject area and weight of scholarship it is a surprisingly good read. In addition to chapters considering expected conditions such as infective and eclamptic psychoses, within its covers are fascinating accounts of women with the unusual and sometimes bizarre – unconscious labour, parturient rage and even delivery after death (Sarggeburt – coffin birth).
What is most impressive about this book is the depth of research. The author visited 20 countries across 4 continents to consult literature from the past 300 years. On a number of occasions he was the first to cut the pages of important historical publications – one example from 250 years ago. This approach to scholarship has become unusual in the age of internet searches and online publication. It serves as a reminder that ‘the literature’ is more than what has been published in English in the past dozen years, and of what can still be learnt from carefully documented clinical observations, whenever published.
A vital message is the large number of causes of unusual symptoms or behaviour occurring in relation to childbirth, and the importance of not automatically labelling them as psychological or psychiatric. This lesson is particularly true for those with a psychiatric history and is reinforced by the confidential enquiries into maternal deaths that described a number of deaths where serious medical problems following labour were misdiagnosed as psychiatric problems. It reminds us that, as doctors, a primary task is to make accurate diagnoses.
The author subscribes to the view of M. Paul Bar (1904) whom he quotes in the introduction: ‘puerperal mental disorders must be rigorously classified if they are to be studied effectively’. Nosological confusion has lead to serious problems in perinatal psychiatry research and must be a priority for the field to address with ICD–11 and DSM–V currently under consideration. Detailed scholarship, such as that evidenced here, can only help us along that road and I look forward to the author's forthcoming book on the puerperal psychoses.
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