Wednesday, July 6, 2016

The Complicated Birth of Midwifery

By Abby Norman on September 13, 2015

Around 353,000 babies are born every day. Some of them will be born in hospitals, others at home with the assistance of a midwife or doula, while others will make their grand entrance in the back of a car or ambulance somewhere in between home and hospital.

The history of childbirth, and in particular of midwifery, is a complicated and often cyclical one. Throughout 19th century America, midwives attended the majority of births, especially in the American South. Improved medicine and accompanying technologies meant that by the early 20th century, midwifery was highly discouraged, only to come around again when the natural birth movement was born in the 1960s.

In other words, the natural act of childbirth reflected the technological, social and medical beliefs and practices of the time. You can learn a lot about what life was like in a particular time period by examining societal attitudes toward childbirth.

16th Century
Midwives have been around since the beginning of human history. No doubt our caveman ancestors had other female tribe members help hold them up or stagger into a cave long enough to give birth. Even prior to modern language, some human acts require no verbal communication: coitus and childbirth among them.

If we start by looking at a period in history when midwifery became a specified community role, we’d start around 1522. At this point, elder females in communities worldwide ruled the roost when it came to helping younger women deliver babies. Having been licensed and educated in childbirth, midwives were highly respected community members. So much so that when they arrived to aid a laboring woman, it was the mom-to-be’s task to make the midwife feel at home and appreciated, offering her “groaning beer” or special cakes.

Midwife History Medieval
Thus childbirth became a very social event, where women close to the new mom would join the midwife in the home to cluck around, eat cake, drink and maybe lend a hand as the woman struggled. These women had a cute nickname, too: God sibs. Over time, the name morphed into a term you’re probably more familiar with: gossips.

Towards the middle of the century, and after hearing horror stories of childbirth fatalities, a family known as the Chamberlens created a tool that they believed would change the birthing game forever. They created the obstetric tool commonly known as forceps, and they guarded their invention ferociously.

They would often attend births with the tool hidden under their cloaks, blindfolding the mother so that she wouldn’t see it, and bang pots and pans to disguise the sound of the tool (which they feared, if heard, could give away the key to its design). It would be another two hundred years before forceps became widely used, in part because the original prototype would be discovered in the floorboards of the Chamberlens’ house long after the inventors had died.

Midwife History Experiments
The next major renaissance in midwifery and obstetrics came from the Antebellum South. Young doctors practiced suturing techniques on female slaves and often bought slaves specifically with that purpose in mind. Subsequently many common gynecological procedures were developed during this time, most notably the treatment of fistulas, tears that can occur during childbirth and lead to complicated infections if they aren’t repaired.

Victorian England
Across the pond, London’s destitute women were dying in droves of something called “childbed fever”, or puerperal fever. “Lying-in” hospitals, which were also cropping up in many U.S. cities during this time, were almost entirely dedicated to delivering the poorest women’s babies. It’s an interesting corollary to modern times, when giving birth to a baby in the hospital can cost up to $32,000.

As women came into the hospital to give birth—only to die within a week—young doctors were scurrying back and forth between the birthing room and the morgue to suss out why these women had died. Unfortunately, they weren’t washing their hands after conducting the autopsies, and continued to spread the very bacteria that had killed the women on whom they were performing autopsies to the otherwise healthy women in the ward.

Midwife History Crib
Luckily for the women of London, “germ theory” (what we would call bacteriology today) began to take hold in city hospitals, and new medical students were being taught proper hand washing and sterilization techniques. Not surprisingly, as soon as these simple innovations were added to lying-in protocols, the occurrence of childbed fever dropped dramatically.

PR damage had already been done, however, and most upper class Victorian women wouldn’t be caught dead in a hospital to give birth. Queen Victoria herself gave birth at Buckingham Palace—though, not without help. It was she who blew the next winds of change into midwifery in the form of ether.

Twilight Sleep

Midwife History Victoria
Word got out that the Queen herself had made use of ether to ease the pain of childbirth, and many religious figureheads were strongly opposed to it. Pain was the point of birth, because it was the punishment women endured on Eve’s behalf (eating the apple and all that). Queen Victoria thought that was hogwash, and many women followed suit. They began to regularly request not just the use of ether, but cocaine, marijuana and opium.

Obstetricians and occasionally midwives attended births at the homes of middle and upper class women, bringing along their drugs and tools. Given these women’s perceived delicate nature, many worried that if they were not relieved of childbirth pain, their babies would suffer because they would be too exhausted to parent. Thus, it was not the poor, inner city women of the lying-in hospitals who got the ether, but the countesses, duchesses and baronesses.

Midwife History Nurse
The decades wore on and women’s rights—particularly their reproductive rights—became a social focus in a way that they hadn’t been before. In the decades that would follow, women would essentially surrender themselves entirely to the childbirth process. They would kiss their husband goodbye, go into the hospital, be knocked out with a drug cocktail (called scopolamine) and wake up several hours later cleaned up with a pink, sleepy baby in their arms. This was Twilight Sleep.

What the women weren’t aware of, however, was that while they were in this “sleep” they were often strapped to the bed to keep from injuring themselves—or nurses—as they writhed about in agony. It wasn’t uncommon for them to be put in padded pens so that they couldn’t escape during the birth, which was often a problem considering the drug cocktail was known to cause vivid hallucinations. But since women woke up from Twilight Sleep with no memory of the birth, they had no complaints and hailed it as a revolution.

Natural Birth Movement and Lamaze

Natural Birth Figures
Childbirth became largely medicalized during the early to mid 20th century. Women went into the hospital, had their Twilight Sleep, and woke up fresh-faced with a baby in their arms. The baby went home and a woman had the wise words of Dr. Benjamin Spock to guide them in child-rearing. The supportive, female-empowering and maternal community of midwives had been somewhat forgotten—along with the entire childbirth experience, thanks to scopolamine.

As the Gestalt theory of psychology, being more in touch with one’s inner experience, became more prevalent, the idea that a woman should be an active and aware participant in the birth of her child soon followed. This was the basis for Dr. Lamaze’s work, which followed in the footsteps of Russian psychologist, Ivan Pavlov. Remembered largely for his studies with salivating dogs, Pavlovian psychology had one key offering to laboring mothers: the art of mental preparation.

Dr. Lamaze was convinced by the idea of “psychoprophalaxis”: if a woman could convince herself that she was ready to give birth, then she would be. By psychologically conditioning herself for the reality of giving birth, she could manage her pain without drugs. This idea was further ingrained into the minds of women everywhere when Dr. Grantly Dick-Read published his formidable tome, Natural Childbirth, in the 1970s. Dr. Dick-Read promoted the idea that childbirth itself wasn’t painful, women just made it painful by worrying about it.

Yoga Moms
This was the foundation for the Lamaze classes of the ‘80s, which have by contemporary standards almost become a trope: a room full of heavily pregnant women, their birth partners, and a lot of “hee hee hoo hoo” going on. The co-founder of Lamaze, Elizabeth Bing, also taught many of the courses and lauded the technique.

That is, of course, until she had her own children.

In an interview many decades later, Bing admits that she not just requested—but demanded—an epidural and drug relief when she gave birth to her son. Despite decades of debunking the necessity of either to thousands of women, she wasn’t even a little bit sorry.

Modern Times

In today’s world, women have more options than ever before when it comes to having babies on their own terms—at least when it comes to delivery (abortion restrictions in the U.S. continue to abound) and, assuming a woman has health insurance to pay for the costly services. They can choose home births, hospital births, hospital births with a midwife, doulas, water births, planned cesarean sections or, if they’ve had a c-section before, they can opt for a “VBAC” —a vaginal birth after cesarean.

Regardless of what the mother has in her birth plan, one thing has been true about childbirth since the dawn of time: the baby is the one that decides when it’s time to be born.

Abby Norman is an author based in New England. Her memoir FLARE has been acquired by Nation Books (Hachette). Her work has been featured on The Rumpus, Medium, Hippocampus Magazine, The Atlantic, The Mary Sue and The Huffington Post.



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