History of Birth in America

I thought that I would share with all of you my paper that I wrote for my monitrice/midwife's assistant certification course. My assignment was to read Witches, Midwives & Nurses: A History of Women Healers by Barbara Ehrenreich & Deirdre English and write a paper on a particular point of interest. I have always been fascinated with the events that led to the establishment of the American maternity medical system, so I took this opportunity to research the history of birth more thoroughly and organize my thoughts into this paper. If this topic also interests you, I would love to hear your feedback!

Reading Witches, Midwives & Nurses peaked my curiosity about how our modern American maternity system was established, comparative to more humanistic models in other parts of the world. What happened to our culture that enabled the development of the majority of births being “produced” in a hospital setting under the primary care of obstetricians? To explore this question further, I read three other books: Lying-In: A History of Childbirth in America by Richard W. & Dorothy C. Wertz, Brought to Bed: Child-bearing in America, 1750-1950by Judith Walzer Leavitt, and Birth as an American Rite of Passage by Robbie Davis-Floyd. I came to realize that there were multiple cultural, political and scientific threads that converged from the middle of the nineteenth century through the twentieth century, facilitating the development of America’s modern maternity system.

What were the cultural events and beliefs that fueled this system and enabled it to become institutionalized into our culture?

• The American culture was based on the Protestant idea of man’s power over nature. This also led to an acceptance of man-made science dealing with the powerful natural experiences and replacing the ancient wisdom and magic of pregnancy and birth. This entire transformation of pregnancy and birth needed to be culturally controlled and standard obstetrical procedures filled this need for society.
• The strong definition of sex roles at the turn of the century reinforced a male dominated culture when mostly men were becoming doctors.
• The feminist movement focused on women becoming doctors instead of the right of humanistic care for women.
• Americans became more mobile, which led to women leaving their support networks and this left doctors to fill the gap. The mobility of society also broke up the networks that supported midwifery. This lack of support enabled the doctors to easily make women feel fearful that they were weak and susceptible to disease and eager for their aid.
• Strong American class distinctions allowed for the upper & middle class to feel as if they were getting better care through the new specialized doctor that used technology. There was a belief that doctors made birth “less dreadful.” This left the lower classes to still receive midwifery care and as a whole midwifery care started to be looked down upon. Multiple women’s magazines, groups and advocates of women’s health supported and advertised this new and improved specialty.
• During the nineteenth century, ailments became fashionable in the upper class. Women at this time were expected to be weaker than men. Both of these fueled the new idea that a pregnant woman was sick and needed to be managed by a male doctor.
• This new “American” way to have a baby fueled the desire for second generation immigrant families to Americanize themselves by going to an obstetrician and having their baby in the hospital.
• During and after the industrial revolution, the idea of going to the hospital to be “processed” in a factory was the new way to produce things. Also, the machine is now replacing the organism as the way the world is organized, and this created an idea of our bodies working as a machine that can essentially be controlled. Culturally there was a distancing taking place from birth being a human experience and women becoming passively dependent on medicine. This was also the time where the power of the institution over the individual was being developed.
• Women began to want a break from their “confinement” of pregnancy and the hospital took them away from their dreaded housework and obligations.
• During this time women’s identification as a woman and mother was taken away which erased the woman’s power over the process and obliterated their own birthing traditions.
• These choices from generations past declared the choices for each subsequent generation. Women’s choice to have more doctors made less midwives; their choice to have more hospitals meant less home births. Now multiple generations later, the choices of childbirth are limited.

What were the political events surrounding the development of our modern maternity system?

• Once created, the medical profession grew rapidly, making doctors more accessible.
• The development of the nursing profession created more nurses than midwives. This fit with the cultural establishment of the hierarchy within a medical establishment and fueled the patriarchy of American society.
• The feminist movement focused on integrating women into a male dominated profession rather than attacking the male dominated medical profession.
• The establishment of medical schools and certifying doctors forced midwives to legitimize their knowledge while possibly losing the essence of being a wise woman.
• Corporate patronage and support of the new, larger medical schools eliminated the smaller midwifery schools for women and minorities.
• Doctors were not being trained alongside midwives which created a loss of shared knowledge and competition between the two.
• Centralizing care and institutionalizing medicine brought doctors power and prestige.
• The rise in lawsuits and malpractice insurance became deterrents against physicians to humanize and personalize American medicine. This led to the establishment of standardization in the maternity system.

What were the scientific developments that stimulated the American maternity system we have today?

• The lure of technology, which began with the development of forceps, was strong in a society where technology was a sign of progress.
• The discovery of bacteria and the Germ Theory created a mystique of medical science. Since the knowledge was coveted by the medical profession, they gained the superior knowledge that women no longer owned.
• Modern science allowed society to grow rapidly alongside the medical profession.
• The development and use of pain relieving medicines created the lure of a pain free birth that you could only get in the hospital with a physician in attendance.
• The fear of puerperal fever, syphilis, gonorrhea, and other transmittable diseases created the “cleansing” of women in the hospital and the inherent idea that women are diseased and need doctors to cleanse and manage them.
• The development of automobiles enabled rural women to receive urban hospital care.
• As doctors learned about scientific causes of ailments, they started to lose interest in the behavioral and environmental causes of diseases and birth traumas. This was the start of practitioners treating the disease instead of counseling the woman.
• The discovery of the Germ Theory also created a frenzy of cleanliness around the home and birth was viewed as dirty, so going to the sterile hospital was appealing.
• Stemming from Greek Aristotelian traditions, the male body became the prototype of a perfect machine, while the female was defective and needed to be manipulated by man. This also fit well into the Protestant belief of woman being less than man.

The convergence of these culture, political and scientific beliefs and events have brought us to the system that is in place today. It is unfortunate that we are now bound by a dehumanizing maternity system. I am hopeful that midwives will continue to pass down the sacred wise woman knowledge of birth and that we will all educate women and let them demand to be cared for in a humane and safe way, making access to midwifery care a human right among all classes.