colonial America - childbirth part of female domestic sphere, daily life.

20-25 year cycle of pregnancy, birth, nursing, interrupted by abortions, miscarriages, stillbirths, & infant deaths.

Herbs - mint, sage tea, bayberry tea, sassafras tonic.

 

France 1500s more women giving birth in hospitals;

England, barber-surgeons  - private clinics;

new "scientific midwifery" & special tools - forceps.

mannequins & rag-doll babies.

Men-midwives replacing traditional midwives for middle & upper-class urban women in US early 1800s,

Women still had control over decision - set limits, negotiating. 

loss of feminine community & modesty. 

paved way for medical interventions - bloodletting - drawing "upwards of two quarts" from one woman in labor until she fainted, then "everything appeared better. I introduced the forceps and delivered a living & healthy child."

midwives noninterventionist - physicians use instruments & drugs to speed up, slow down & otherwise manipulate process.

 

doctor when called in "must do something. He cannot remain a spectator merely, where there are many witnesses, and where interest in what is going on is too deep to allow of his inaction."

Forceps, "hands of iron"

Safety record worse. 

Opium;

ergot, fungus growing on rye, to increase contractions.

Ether & chloroform late 1840s - slow down labor. 

Philly doctor Charles Meigs had "not yielded to several solicitations as to its exhibition addressed to me by my patients in labor,"

AMA arguments on both sides, believed many women had benefited, "substituting sweet repose for restless suffering" but others had died from misuse.

Changed physical nature of birth - back or sides - limited use of birthing stool or chair or standing or squatting or walking. birth injuries - tears in perineal tissue, acute or chronic infection.  Lacerations in bladder or rectum, in vaginal wall or cervix.

"the widespread mutilation is so common that we scarcely find a normal perineum after childbirth."

prolapsed uterus or "fallen womb" - pessary,

Ignaz Semmelweis in Austria urged cleaning hands.

End 1800s more than 25,000 US women dying from childbirth-related problems each year - "walking under the shadow of maternity".

Death from maternity-related causes at early 20thC 65 times greater than in 1980s.

Risk in each pregnancy about one in 150;

Sweden lost just one mother for every 430 live births.

New England woman, "My friend, Mrs. John Howard has died as she has expected to, under the most aggravated circumstances that a woman can leave the world. She never gave birth to her child; but died in the effort. In this dreadful manner have six of my youthful contemporaries departed this life."

getting "through your trial."

Men wrote wife "had a fearful time";

1870s NY doctor James Bailey wrote, "To see a female, apparently in vigorous health until the period of accouchement, suddenly expire from some unforeseen accident, which is beyond the control of the attending physician, is well calculated to fill the mind with alarm and gloomy foreboding."

 

 

 

South, black women use traditional midwives;

Mormons;

Immigrant women;

Poor women "clinical material";

 

1902 Philly physician Barton Hirst said over last decade, no branch of medicine "displayed such a remarkable development" as obstetrics and "no other specialty promises such development in the next ten years."

1910 about one-half of all births still attended by midwives,

most doctors who handled births general practitioners rather than obstetric specialists. 

1910s increasing efforts to eliminate midwives;

By 1920s, independent midwives rare everywhere except in rural South.

1919 Johns Hopkins Med School first full-time dept of obstetrics;

1918 "I have placed myself in the hands of a specialist in obstetrics. I have every confidence in him, and it is a great relief." 

Good Housekeeping,  "choose a doctor you have faith in. you can trust him to guide you through. Slowly but surely, childbirth is being lifted out of the realm of darkness into the spotlight of new science."

Most graduates Woman's Medical College of Philly 1800s general practitioners with heavy emphasis on obstetrics & gynecology.

Anna Broomall established separate maternity hospital connected with Woman's Medical College.

 

1900 90-95% babies still delivered at home.

1920s on, hospitalization appealing;

One mother, "the hospital is equipped with every modern device for the safe delivery of babies, nursing and medical attention is available at any hour of the day or night. How much simpler and more restful to be in a hospital where babies are an accepted business.  I can't tell you the relief I feel as I walk out my door headed for the hospital to have a baby. I have nothing to worry about and have only to concentrate on giving birth."

Physician clearly in charge, medical authority over all decisions - moral, ethical, religious, social, economic, even political.

Birth more removed from women's own knowledge. 

still high maternal and infant mortality. 

Hospital made intervention more common.

Urban rates of puerperal infection increased 1920s;

Reformers suggested separate maternal building, staff, laundry.

  

scopolamine and morphine "twilight sleep"

"I experienced absolutely no pain. An hour after my child was born I ate a hearty breakfast. The Twilight Sleep is wonderful."

baby more ready to nurse, fewer cervical tears, fewer forceps deliveries, less strain on the heart and a "better race for future generations";

developed in Germany,

US women calling on others to "take up the battle for painless childbirth, fight not only for yourselves but fight for your sex." 

National Twilight Sleep Association, upper and middle-class clubwomen - "create a more perfect motherhood"; rallies in department stores & street corners,

doctors "absolute control over your patient at all stage of the game. You are boss. I am never harassed by relatives who want me to tell them things."

Controversy 1914 & 1915. 

Feminists promoted it, "just as the village barber no longer performs operations, the untrained midwife of the neighborhood will pass out of existence under the effective competition of free painless wards."

 

issue of control - for women, lack of physical control less important than decision about what type of delivery.

Feminists agreed that birth domain of obstetrician, but wanted women to decide own method.

Doctors wanted control, freedom to develop professional judgement, refused to be forced into "indiscriminate adoption" of "quackish hocus-pocus" or be "stampeded by misguided ladies." 

To doctors, method of childbirth was "a question for the attending man and not the patient to decide."

1915 Mrs. Francis Carmody, died childbirth Long Island College Hospital.

1940s & 1950s women dismay at being strapped down & drugged during labor;

natural-childbirth movement of 1960s - who controls birth.