Friday, November 21, 2008

The History of Childbirth in America

I love history. Especially American history. It was the only textbook I read from cover to cover in college. The history of childbirth in America tells so much about why we are at the place we are at. It is so fascinating and infuriating. I hope you enjoy it as much as I enjoy telling it.

Before 1900, less than 5% of births took place in the hospital. Birth took place at home. Birth was a social event with other women present to help the laboring mother. Nearly all births were attended by midwives. They focused on the whole person, not just the birth canal. Birth usually took place in a vertical position. This always surprises people.

Birth was perceived, especially by men, as superstitious and magical. As more men began training to become doctors, their courses in childbirth were minimal. They were scared off by the rituals surrounding birth and many felt it was beneath them to attend births. Midwives only called in a doctor when a cesarean was needed to save the life of the baby after the mother had died, or was going to die.

As these doctors began looking for work, they found that they could play upon the fear that women had of childbirth by convincing them that they could improve upon the natural process. They convinced women that they could possibly prevent childbirth from going wrong, and shorten the birthing process. And they had a tool that the midwives didn't have: forceps. Forceps were originally used to remove stillborn babies from their mother's bodies, but it eventually became standard practice for nearly all doctors as a tool to shorten the birthing process. With a forceps delivery, a woman had to lay on her back with her legs in stirrups. An episiotomy, a surgical enlargement of the vagina, was necessary to make room for the forceps. The majority of American women still give birth in this position, even if there is no episiotomy performed or use of forceps for the delivery.

Midwifery became a lost art form. Doctors demanded the midwives be licensed, which became synonymous with competence. She had to prove her skills to a state licensing board, which was controlled by the medical profession. Midwives today, even thanks to the release of The Business of Being Born, are gaining popularity again. Even as this happens, the American College of Obstetricians and Gynecologists (ACOG) has gotten the American Medical Association (AMA) on their side in opposing homebirth. History repeating itself in the defamation of midwifery.

And so it became "fashionable" to be delivered by a doctor in a hospital. If a midwife attended your birth, it was only because you were too poor to afford to go to the hospital. (Both my parents were born at home -- 1940 & 1942 -- for this exact reason!) I read an excerpt from a 1926 magazine convincing women that the hospital is better:
"But is the hospital necessary at all?" demanded a young woman of her obstetrician friend. "Why not bring the baby at home?" "What would you do if your automobile broke down on a country road?" the doctor countered with another question. "Try and fix it," said the modern chauffeuse. "And if you couldn't?" "Have it hauled to the nearest garage." "Exactly. Where the trained mechanics and their necessary tools are," agreed the doctor. "It's the same with the hospital. I can do my best work -- and the best we must have in medicine all the time -- not in some cramped little apartment or private home, but where I have the proper facilities and trained helpers. If anything goes wrong I have all known aids to meet your emergency."
Who could argue with that? This was very much the thinking of the day.

By 1936, 75% of all American births took place in the hospital. By the 1950's, only 1% of babies were born at home. That is still the percentage of births that take place out of the hospital today, be it at a birthing center or at home.

We cannot forget the introduction of drugs in childbirth. In all fairness to the doctors, a lot of them tried explaining to the women that the drugs were too dangerous. The women didn't care. They didn't want to feel labor or birth. Sound familiar? So strong was this fear, women overcame their modesty in order to have a doctor "deliver" them and use the drugs he could offer her in childbirth.

In the 1920's, Twilight Sleep became popular. It was a combination of 3 different drugs -- morphine to dull the labor pain, amnesiac scopolamine which caused her to forget the experience, and a whiff of chloroform or ether to put her out as the baby came through the birth canal. Women behaved like "deranged animals" and were tied to their beds. They were flat on their back, in terrible pain, and could do nothing to help themselves. When they awoke, they didn't remember any of it.

By the 1950's, women had lost all confidence in their bodies to give birth without intervention and a doctor. They began to look for "expert" advice on how to parent their baby. Breastfeeding numbers plummeted.

In the 1960's, a handful of women started to question the process. Childbirth classes started popping up. It was an era of change. Midwives, like Ina Mae Gaskin, appeared on the scene again, after being pushed out by male doctors for so many years.

The 1970's, thanks to Dr. Robert Bradley, saw husbands "allowed" into the delivery room for the first time. They weren't sure what to do with them, so they gave them the job of cutting the cord. It was something to make him feel important and he couldn't screw it up!

In the late 1970's and early 1980's, we saw the introduction of the Electronic Fetal Monitor (EFM). Shortly afterwards, we saw the c-section rate jump from 6% to 23%.

Introduction of "legal birth" which is very much present today. Women would be shocked to know how many of their "medical" decisions made for them have nothing to do with good medicine, but have everything to do with the doctor's or hospital's fear of being sued.

"Birthing suites" became popular, trying to recreate home -- as they figured out, this is where moms labor best. The drugs changed. The method of giving the drugs changed. We can speed labor. Slow labor. And end labor. We can intervene a million different ways. A woman almost never dies in childbirth anymore. We feel like the drugs are safe. A hospital is safe. Right?

It's amazing to look at the last 100 years in childbirth and how in the world we got to where we are now. I said it earlier, and I'll say it again: I love this quote by Brigham Young: "Would you want doctors? Yes, to set bones. We should want a good surgeon for that, or to cut off a limb. (!!) But do you want doctors? For not much of anything else, let me tell you, only the traditions of the people lead them to think so; and here is a growing evil in our midst. It will be so in a little time that not a woman in all Israel will dare to have a baby unless she can have a doctor by her. I will tell you what to do, you ladies, when you find you are going to have an increase, go off into some country where you cannot call for a doctor, and see if you can keep it. I guess you will have it, and I guess it will be all right, too." I do not know what year he made that statement, but Brigham Young died in 1879 when no one would have had a baby in a hospital or with a doctor.

The last time I put my quote by Brigham Young on the blog, I didn't get a single comment. Doesn't anyone else find it so fascinating that he would make a statement like that nearly 150 years ago?!

1 comment:

Monica said...

Wow, it's quite scary the way childbirth has been turned into something to fear. It's very sad. I have never seen that quote from Brigham Young, but he certainly got it right! Amazing!