THE SILENT CRADLE by Margaret Cuthbert, MD, Pocket Books, New York, 1998, 353 pages, $23. Simon & Schuster Audio, 2 cassettes, 3 hours, read by Tonya Pinkins, $18. ISBN: 0-671-01513-3

The Silent Cradle, by Margaret Cuthbert, MD, is immediately distinguished by two details--the featured "detective" is a black woman, and she's an OB/GYN. These two realities color this suspense thriller and result in a new treatment of a traditionally male genre. Cuthbert tempers the medium and makes it uniquely her own. Female detectives in suspense novels tend to possess plenty of machismo and dry "male" reasoning--not so Dr. Rae Duprey, Cuthbert's heroine. This is no coolly calculating protaganist--Cuthbert shows again and again that Rae has risen to the top because she listens to and follows her emotion, those vague impressions that can trace out truth if they are carefully and judiciously monitored. Because Dr. Duprey does just that, she stands ready to become Chair of Obstetrics and Gynecology at Berkeley Hills Hospital. But just as she readies for this career pinnacle, fate throws a monkey wrench in the works of her brilliant career, and she finds herself fighting merely to remain on staff at the hospital.

Women in labor who are transferred to her hospital mysteriously encounter near-fatal complications with their deliveries. Rumors spread, and Dr. Duprey's name is slandered. Of course, she has no choice but to redeem her good name, and try to save the OB/GYN Department at the same time. After she controls her pique, she's on the trail like a bloodhound.

But who can she trust? When she follows her instincts, she unerringly finds the right way. How else can she make a path through the rampant egotism flooding the hospital? Many of the male characters come off as insufferable egotists (the surgeon clicks), awash in their own self-importance and status. Cigars and Jaguars are their props. But then, her own ego can get in the way; she drives a black Porsche herself and does want to be chair of her department. She fights to control a hot temper and read the many suspects surrounding her, including her ex-boy friend, a charming man who runs a competing birthing center from which these endangered women originate. She sorts through her old feelings for him, attempting to define the new ones.

In one scene, Dr. Cuthbert describes Rae's office as "definitely a woman's office," with a French desk and wingback chairs for the patients, a waiting room that looks like an elegant living room from a fine French home, fresh flowers everywhere, and abstract paintings of women and their babies." The Silent Cradle is clearly a woman's suspense thriller. The issues raised aren't the traditional bullets and revolvers, loot and narrowly avoided violence. Rather, we hear about childbirth, Rae's thoughts about having children, and about her own mother and how the medical environment can be made safer for women in delivery. The new spin gives the book a freshness in this often predictable genre.

Dr. Duprey suspects someone is trying to kill the babies with an oxytocin drip, normally used very gingerly to induce labor, but dangerous in large amounts. When she gets onto this lead, her own life becomes endangered. Along the way, she makes informed observations about the conditions under which women give birth and comments on being "the only black" in the administration meeting rooms. It was such a common situation for her that, being the one and only was second nature to her, like breathing. An advantage--she now understood. Being different has taught her to be tough, resourceful, and self-reliant." And to sort through a mystery no one else seems able to take on.

The Silent Cradle is one medical mystery where every detail is reality--it can and it does happen every day. Doctors are eliminated because they conflict with large medical groups controlling their departments and clinics. Cuthbert has done the profession and the public a service to point out these abuses. Such criticisms of the reigning health care system can only be done in a work of fiction. Careers are jeopardized by nonfiction pieces. Dr. Cuthbert, an obstetrician and gynecologist, who is now a full-time writer, served as the vice chair of obstetrics and gynecology at Alta Bates Medical Center in Berkeley--her experience shows, and her insight is welcome.

Del Meyer, MD