As some of you may know, we just bought our first house! It's been pretty exciting around here, what with getting things out of storage that have been there for four years while we traveled abroad! Hello KITCHEN AID MIXER! How I've missed you, darling ;) This morning I was chipping away at the basement playroom when I stumbled across an old flash drive. I vaguely remembered that I might have used it for my college papers and was curious to see what forgotten secrets it contained. While my Honors College thesis wasn't on it like I'd assumed, it did contain a paper I wrote on childbirth my sophomore year! Long before I had children I was in love with birth.
While it seems I only kept an earlier draft on the drive, I thought I would put it here, complete with notes to my professor about what still needed work. Just for funsies <3 :D History and childbirth buffs, enjoy! And please be forgiving of any errors...I was only 19 when I wrote it ;)
Childbirth traditions have remained remarkably similar for most of human history. Before the advent of modern medicine, women throughout the world did not have many options when it came to the kind of care they would receive during the birth of their child. Childbirth was primarily a part of woman’s domain, and when the time came for a woman to give birth, it was her fellow women who banded together to help her in her time of travail. This tradition experienced a definite change by the mid-nineteenth century. By that point childbirth was well on its way in the transition from a home centered, female attended event, to a male dominated, hospitalized occasion. This transition not only bent traditional gender roles and tipped the balance of control towards men, but also fundamentally changed the very way we view the process of birth.
During the eighteenth century male physicians first began to be invited to take an active role in delivering the babies of upper and middle class American women. It was life saving instruments such as forceps, that only doctors were in possession of, which secured doctors a place at the bedside of laboring women. In much the same way, it was the use of pain relieving drugs that gave the doctor an indispensable position with many privileged women during their confinement. These scientific advances in childbirth allowed physicians and eventually hospitals to secure an enduring role in the process of birth as women became convinced of the necessity of having a professional in the proper setting to deliver their children.[1]
In order to understand why this change was accepted so quickly, relative to the entire history of childbirth, it is necessary to look at the way society and women in particular viewed childbirth before its medicalization and hospitalization. Understanding why women were so ready for such a momentous change is integral in understanding the reasons for the significant changes that took place in birthing traditions during the last two hundred years.
CHILDBIRTH, SUPERSTITION, AND FEAR
Before modern medicine, childbirth could be, and frequently was, a debilitating or fatal event in a woman’s life. Women knew from a young age that extreme pain and possible death were a part of the childbearing process. In a time before birth control, pregnancy and childbirth were inseparable from married life for most women, so it was something that the majority of women would have to deal with at some point or another.
Unlike today, women in the past did not view pregnancy with much joy. There was no guarantee that they would survive the birth or that it would result in a living child. Women throughout time have dealt with this disturbing knowledge in different ways. Once a woman found out she was pregnant, she was brutally aware of her mortality. (Will add more to this later; I have several good examples, and some lovely, albeit rather disturbing and depressing sources for this one. I just can’t decide which to use, because I have more for this one than any other subject!)
Superstitions were one of the ways people tried to understand and come to terms with the uncertainty of pregnancy and childbirth. As in all aspects of medicine and healthcare before the advent of modern medicine, people came up with explanations and cures for the ailments and injuries that plagued childbearing women. Even before the superstitions pertaining to childbirth accompanied the first European settlers to the New World, American’s had superstitions about childbirth. Among some American Indian tribes, pregnant women were forbidden to turn around to fast while sleeping. If she were to do so, her child’s body fluids might divide in two, causing her to give birth to twins.[2] In many cultures, twins were considered bad luck, which could stem from the fact that giving birth to more than one baby at once is even more dangerous than a typical single birth. Even today, multiple births are considered high-risk pregnancies.
Religion was another method of dealing with and explaining the uncertainty of birth. Birth has always been a spiritual matter. In fact, in Christianity birth is of a highly spiritual nature. The Virgin Mary was not impregnated by man, but gave birth to the Son of God. She serves as a strong mother image and a protector of women in childbirth.[3] Traditionally a midwife had a spiritual function during the birthing process. “In many birth cultures she is also responsible for prayers, chants, invocations, and other actions that clear the way for birth and to nurture the right relationships between all those participating.”[4] Women in early America frequently turned to God during their confinements, and placed their fate as well as the fate of their unborn child in his hands. “When mothers suffered or their children died, women blamed themselves or viewed their loss as his plan.”[5] (I may add a little more to this if I run across something in another source)
Parents also utilized psychological methods to distance themselves from the all too frequent tragedy that attended the reproduction process. It has been conjectured that parents before the eighteenth century must have viewed infants “with realistic caution about their prospects” so as to shield themselves from growing too attached to them. As a result of the extremely high infant mortality rates, only the wealthy could afford the time and money to invest in an infant’s life whose future was so unsure.[6] Sally McMillen, in her book on motherhood in the old south, states that this idea does not apply to antebellum southern mothers. Of course, the women that make up the focus of her book were of the upper class, but their infant mortality rates were certainly not any lower than women in the rest of the country. McMillen believes that they were probably worse as a result of the “disease environment.” (Two or three heart wrenching quotes are going to go here)[7]
FROM MIDWIVES TO DOCTORS AS BIRTH ATTENDANTS
The change in the location of where women typically gave birth occurred over time, and for a myriad of reasons. First and foremost was the tradition of fear associated with childbirth. Women had always lived in constant fear that their next pregnancy could be their last nine months of life. So if there was anything that gave them hope of surviving their next confinement, perhaps with the bonus of a living child, most who had the means to, were willing to try it. Doctors’ possession of new medical technologies such as forceps and pain controlling drugs were a source of hope for women. Technology was something that women’s midwives could not compete with. With doctor’s seemingly great amount of knowledge, many women were in awe of them, and believed that their medical education could save them. At the same time, people were starting to express concerns about midwives’ lack of education and use of superstition, or old wives tales. However, it is important to note that these people tended to be doctors, who would be business rivals with midwives. While most doctors probably had women’s best interest at heart, a general practitioner had a stake in providing safer births for women. If he performed well at a birth, then the family would probably call him back out for the next birth, and for any other situations in which the family might need a doctor. If the use of new technology would earn them new patients, doctors were frequently all too willing to provide it, and in the process expand their practice.
Before the 1940’s doctors’ results were no better than a traditional birth attendant’s, and in many cases they were worse. This was true especially once the trend towards hospital birth began to grow. In 1933 hospital births accounted for seventy-two percent of all American births, and “for the first time [the hospital] was not associated with higher rates of puerperal deaths.”[8] (I need to find the journal article I had about Doctors spreading fevers and infection so I can finish this thought)
Education was one of the main reasons for the doctors’ poor track record during the first half of the nineteenth century. Their education at that time was inadequate on most subjects, but in the field of obstetrics it was the worst. Professors and students alike found the subject embarrassing. One student from the University of Pennsylvania said that it was almost painful to witness his professor’s blushes and obvious embarrassment over his lectures.[9] Most students never actually saw a birth during their education, and had to wait for the first time until they were hired to attend a birth to see the real thing. The majority of their knowledge was theoretical rather than practical and they were taught that they must learn to examine their patients, even use their instruments, without being able to see what they were doing.[10]
When women called on a doctor to assist her during childbirth, she expected something more than the policy of non-involvement that midwives typically practiced. With everyone sitting around waiting for the doctor to do something, they often intervened when there was not an indication that it was needed. The problem with this tactic was the fact that most births do not require intervention, and can actually be made more dangerous if the natural process is interfered with. Experts repeatedly warned doctors against the excessive use of forceps and anesthesia, but this “meddlesome midwifery” did not stop.[11]
Despite the fact that doctors were generally not producing better effects than midwives, women who had made the transition to doctor attended births did not want to go back to the old way, even if they were to realize that they were not, in fact better off with their doctors. Instead of going back to all female attendants supervised by a midwife, they put their faith in improvements in medical technology.
However, despite the growing number of upper and middle class women who were attended by doctors, most women still used midwives, especially lower classes, immigrants and those people who lived in rural areas.
THE TRANSITION FROM HOME-BIRTH TO HOSPITAL-BIRTH
The transition from home-birth to hospital-birth began for many reasons as well. The growth of hospitals contributed to the trend, and as more people went to the hospitals for treatment, the more hospitals that were built. Some people had no choice whether or not to go to the hospital, because it was getting harder and harder to find midwives or doctors willing to make house calls. In fact a lot of the transition had to do with the doctors or specialists in obstetrics. Most wanted their clients to come to the hospital where they could see more people during a day and have all the technology and help of nurses that they needed. The advent of scopolamine played a large part, because doctors claimed it was best monitored in the hospital. The doctor also preferred to have laboring women in the hospital, away from the meddlesome family and friends at home, who undermined his authority and occasionally refused a proposed method of treatment. Lone women in labor are not in much of a position to argue with what the doctor says is best. The male doctor who attended births in the hospital no longer had to be threatened by birth belonging in the woman’s domain.
The preference of women also played a large part in the spread of hospital birth. Women were told that they and their babies had a better chance of survival if they would only submit to giving birth in the hospital, where an expert could take the very best possible care of her. Having the means to give birth in the hospital was seen as a matter of status as well as safety.[12] Long gone were the days when the only women who gave birth in hospitals were charity cases, or women bearing illegitimate children. The king of women who were taken care of in return for their role as a guinea pig for medical students practice.
In fact, some women saw hospital birth as a kind of vacation. (Fun quotes on this to come pertaining to the new “streamlined childbirth” and women claiming they wouldn’t mind having a baby every week if that’s all there was to it…)
CURRENT TRENDS, AND THE PENDULUM’S SWING BACK TO
MORE TRADITIONAL PRACTICES
Gender roles in the birthing room
Legal matters
Hospital or Home?
(I just decided to add this section, so I am looking through the books for pertinent information)
CONCLUSION
Throughout history, most civilizations have seen women as inferior and have tried to dominate all aspects of their lives. Childbirth was one aspect of a woman’s life that was generally controlled by women. At first the introduction of male doctors to birthing rooms didn’t have much effect on the traditional way of things. However, as modern medicine grew, and doctors began insisting on hospital births, women started to find themselves isolated from their traditional female birth supporters and their opinions being ignored. They lost their right to make decisions about their own birth experiences, and found their wishes being ignored.
However, all responsibility for this does not rest in the hands of the physician. Birthing women themselves had a great deal to do with this shift of power. At the time, they probably did not think they had anything to lose, and if they did, it is doubtful that they understood its significance.
After this transition was complete, traditional spiritual aspects of birth were all but extinct. Faith in God had been replaced with faith in science. Today’s women are more vulnerable to fear and pain as a result of this “desanctification” of childbirth.[13]
Social/female aspects of birth were lost as well as a woman’s personal control over her birth experience
Of course much has been gained in the transition as well; a source of hope for a successful birth, and after the 1940’s a plunge in infant and maternal mortality.
(Yes, the conclusion needs work, but I need to finish the last section before I can write a complete conclusion)
[1] Philip K. Wilson, Childbirth: Changing Ideas and Practices in Britain and America, 1600 to the Present (New York: Garland Publications, 1996) 234.
[2] Claude Levi-Strauss, Myth and Meaning: Cracking the Code of Culture (New York: Schocken Books Inc, 1995) 30.
[3] Sheila Kitzinger, Rediscovering Birth (New York: Pocket Books, 2000) 88.
[4] Kitzinger, Rediscovering Birth, 85.
[5] Sally G. McMillen, Motherhood in the Old South: Pregnancy, Childbirth, and Infant Rearing (Baton Rouge: Louisiana State University Press, 1990) 186.
[6] Philip J. Adler, and Randall L. Pouwels, World Civilizations: Volume II, Since 1500 (Belmont: Thomson Wadsworth, 2006) 457.
[7] . McMillen, Motherhood in the Old South) 186-173.
[8] Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750-1950 (New York: Oxford University Press, 1986) 188 and 194.
[9] Walzer, Brought to Bed,40.
[10] Ibid., 40-41.
[11] Jane B. Donegan, Women and Men Midwives: Medicine, Morality, and Misogyny in Early America (Connecticut: Greenwood Press, 1978) 144.
[12] Wilson, Childbirth, 234.
[13] Kitzinger, Rediscovering Birth, 91.
