In Chapter 9, Gawande begins his meditation on the book’s final section, “Ingenuity,” by examining the advancements that have been made to improve childbirth. Historically, childbirth has been hazardous for both babies and mothers: “For thousands of years, childbirth was the most common cause of death for young women and infants” (174). Although modern medicine has greatly improved the chances for survival for mothers and babies, there are still many complications that can arise during childbirth.

For many years, obstetricians labored to mitigate complications during childbirth, and they discovered “dozens” of maneuvers and advancements that greatly improved the outcome of problem births as a result (177). The invention of forceps and cesarean sections are two such advancements (177). However, despite these innovations, many babies still died after childbirth because there was no uniform system in place to gauge how healthy they were. One in 30 babies who were deemed too weak to live died right after birth. This statistic changed with the advent of Virginia Apgar’s method of rating a baby’s health.

Though Apgar was a brilliant doctor, her path to innovation was complicated by the fact that she was a woman in a mostly male profession. Still, she persisted and created the “Apgar score, as it became universally known” (186).