"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 count-
ered with another question. cc
ered with another question. cc
"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."
"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."
-- Century Illustrated Magazine, February 1926
1900’s
· Less than 5 % of all women gave birth in hospitals.
1914: a technique called Twilight Sleep was developed. This involved first injecting a woman in labor with a drug called morphine and then secondly giving her drug scopolamine ( aka “scope”). These injections were given so that a laboring woman not only felt less pain, but would have no memory of the pain of labor or of giving birth. This took the mother completely out of the birth experience and also affected the baby’s central nervous system causing the newborn to be born in a very drowsy state and with a poor breathing capacity. It was later found that morphine greatly contributed to maternal deaths. At this time the United States had this highest maternal mortality rate with an average of six deaths per every one thousand births.
1915: Dr. Joseph DeLee, the head of obstetrics at Northwestern University, the chairman of obstetrics and gynecology at the University of Chicago, and the author of the most widely used obstetrics textbook said that “if birth were properly viewed as a destructive pathology rather than as a normal function, “the midwife would be impossible even of mention.”” In the very first issue of the American Journal of Obstetrics and Gynecology he proposed that physicians begin to routinely use interventions like ether, sedatives, episiotomies, and forceps in order to suppress the “evils natural to labor.” In order to justify the common use of forceps Dr. DeLee described labor as being the same as a baby's head being crushed in a door. He also said that to a woman, giving birth was like “falling on a pitchfork, driving the handle through her perineum.” His remedy for this was an episiotomy. Consequently, an episiotomy was necessary in order to use forceps. Dr. DeLee believed that during the course of labor and delivery, problems should not be dealt with as they arose, but instead prevented during each and every labor. His very strong influence began to change labor and delivery in a drastic way. Now instead of using interventions as needed, they were used routinely with every woman. Today American obstetrics still follow Dr. DeLee’s model.
1920’s
· Middle-class women in the United Stated begin to choose to give birth in a hospital setting with a physician in attendance. During this time infant deaths caused by injuries occurring during birth rises nearly fifty percent.
1921: 30 – 50% of women gave birth in hospitals
1930’s
· Giving birth at home is still considered to be a cultural norm until the late 1930’s. Women are mostly attended by other women. At this time The American Hospital Association developed a special insurance program that made an expensive hospital birth very affordable to pregnant women. This special insurance program later evolved into what we commonly know as the Blue Cross Association.
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| Twilight Sleep |
1933: The White House Conference on Child Health and Protection issued a report regarding maternal mortality. It said that maternal mortality had not declined substantially between 1915 and 1930. Despite a dramatic increase in hospital deliveries as well as the introduction of prenatal care the number of deaths remained quite high when it had been predicted to decrease dramatically. Between 1915 and 1930 the number of infant deaths from birth injuries increased by 40 percent to 50 percent instead of dropping as planned by doctors. The reason for this was that women received inadequate or no prenatal care. Also at the time of birth dangerous medical interventions that took place were improperly done, killing the mother or her child, or both of them.
1935: 37% of all births occurred in hospitals.
1939: 50% of all women (and 75% of all urban women) delivered in hospitals.
1940’s
· Women were practically running to have their babies in a hospital. Physicians gave promises of a pain free birth. Anesthesia became common practice and women got through hard labor and delivery with little or no pain and no memory of birth. This became known as “The modern way” to have a baby and it was greatly accepted among American society. Drugs like ether, chloroform and opium were common anesthetics. These medications not only blocked pain, but also stopped a laboring woman’s contractions too. The physician’s answer to this issue was invasive devices like forceps. They also used enemas, pubic shaving, and arm and leg restraints to make birth easier for themselves. Male doctors were able to control women’s bodies with these interventions and made childbirth more scientific and predictable. While births were attended by male doctors, fathers were not allowed in the birthing room, and would commonly wait comfortably in a hospital waiting room to wait for the arrival of their child.
· 88% of births occurred in hospitals.
1952: The Midwifery Section of the National Organization for Public Health Nursing developed a philosophy that emphasized that pregnancy and childbearing were normal processes. They advocated that birth should be a family-centered event as well as a phase in growth and development.
Around this decade Dr. Robert Bradley and Dr. Ferdinand Lamaze were introduced. Both of these doctors advocated for natural childbirth methods that involved breathing and relaxation techniques in order to alleviate the pains of labor and put women back in control of their bodies.
97% of births occurred in hospitals.
1960: The birth control pill became available. Continuous electronic fetal monitoring was introduced so doctors could keep track of an infant’s heart rate during labor and delivery.
· Some women expressed doubt in modern birth practices. They had a desire to be an active part in the birthing of their children and wished for control over their own bodies during labor and delivery. This movement was the beginning of changes that we recognize today: birth classes and the admittance of fathers in the birthing room.
1970’s
· National Certification in nurse-midwifery educational programs became available.
1973: The ACNM stated, "The preferred site for childbirth because of the distinct advantage to the physical welfare of mother and infant is the hospital."1974: A movement to deinstitutionalize dependent people and demedicalize life events like childbirth and dying surfaced. People seemed to want to escape the insensitiveness of hospitals and break free from dependencies on doctors. They felt that the attendance of an obstetrician wasn’t necessary for a normal life process. From this some women decide that home is the best place for them to bring their children into this world. This is when “home birth” started to be an option could be considered.
This movement caused an incredible between the medical profession and the women's movement. The ACOG discouraged it homebirth but did not forbid it. However- in cases where a medical emergency occurred and a doctor attended a home birth they were threatened with losing their medical license and in some cases did.
1979: The FDA reported that they found that many children with motor deficiencies were birthed by mothers who had received anesthesia in large doses, particularly the common drug Demerol.
1980’s & 1990's
· There was much doubt in the country's ability to provide adequate maternity and reproductive for women. The scare of AIDS, as well as ethnic and socioeconomic awareness made people realize that there were many women in the U.S. with poor or no health care who did not have access to a high standard of care.
· At this time the United States provided the world's most expensive maternity care in the world. It also had the worst pregnancy outcomes statically than almost every other industrialized country on Earth.
· Midwives were attending more births—5.5% in 1994, compared with 1.1% in 1980.
· The cesarean section rate was falling, from 25% in 1988 to 21% in 1995.
· The use of forceps was declining, from 5.5% in 1989 to 3.8% in 1994.
· Labor was induced in 14.7% of women in 1994, up from 9% in 1989.
1997: Most insurance carriers begin covering midwifery care for hospital or birth-center births (but not for homebirth). By now all state in the country license certified nurse midwives and about 25 percent license direct-entry midwives.
Today
2003: 27.5% of all births were c-section. 23.5% of those were low risk pregnancies.
2006: 22.5 percent of births were inductions
2009: Number of vaginal deliveries: 2,933,056
Number of Cesarean deliveries: 1,367,340
Percent of all deliveries by Cesarean: 32% (information from CDC)
Right now a growing number of women have
turned their back on the medical model of a typical, sterile, scientific, hospital birth. Some women are returning to their roots and having their children where their great, great grandmothers did- in their own home. There are also other choices for birth, like birthing centers. Places like this provide a safe environment for women to give birth, but out of a hospital setting. However the vast majority of women still continue to give birth in a hospital. According to the National Institute of Health more than 50 percent of pregnant women in the U.S. receive epidural analgesia to relieve the pain of labor. Giving birth in a hospital can now cost anywhere from $3,000 to more than $40,000.My Own Thoughts
After researching the history of giving birth in the United States it made me wonder about my own mother’s birth experience with my sister and I. I also wondered about my Grandmother’s experience and my even my Great-grandmother's. I decided to ask my mom about it and see what she knew. I wondered- was my own mother born while my grandmother was under “twilight sleep?” Her answer was no. She and my grandma were “coddled.” I was dumbfounded. Coddled? I didn’t find anything about any sort of "coddling" in my research. What she told me is that both she and my grandmother had given birth with the same attending obstetrician. His name was Dr. Peter Merzbach. According to my mother he was from Germany and came to the Northampton, MA area very shortly after World War II. He had said that because of the horrors he had seen during the Holocaust he could not bear to see a woman in pain. Apparently he used a anesthesia technique he called “coddling” where he administered pain medication in a very similar matter to the epidurals we see today. The different being, according to my mother is that you felt no pain, but could freely move your legs just as if you hadn’t had any anesthesia. How interesting! My mother said to me “Did you really think Grandma went through six unmedicated births? She couldn’t feel a thing! She always said that’s why she had six kids!” The things we learn. I guess I can research, and research all I want. In the end the real information comes not from a book of statistics or any source on the web, but from the mouths of women. Just as I have been learning all along, if you want the real story, or a real account of history, just ask a person who has experienced it.
After researching the history of giving birth in the United States it made me wonder about my own mother’s birth experience with my sister and I. I also wondered about my Grandmother’s experience and my even my Great-grandmother's. I decided to ask my mom about it and see what she knew. I wondered- was my own mother born while my grandmother was under “twilight sleep?” Her answer was no. She and my grandma were “coddled.” I was dumbfounded. Coddled? I didn’t find anything about any sort of "coddling" in my research. What she told me is that both she and my grandmother had given birth with the same attending obstetrician. His name was Dr. Peter Merzbach. According to my mother he was from Germany and came to the Northampton, MA area very shortly after World War II. He had said that because of the horrors he had seen during the Holocaust he could not bear to see a woman in pain. Apparently he used a anesthesia technique he called “coddling” where he administered pain medication in a very similar matter to the epidurals we see today. The different being, according to my mother is that you felt no pain, but could freely move your legs just as if you hadn’t had any anesthesia. How interesting! My mother said to me “Did you really think Grandma went through six unmedicated births? She couldn’t feel a thing! She always said that’s why she had six kids!” The things we learn. I guess I can research, and research all I want. In the end the real information comes not from a book of statistics or any source on the web, but from the mouths of women. Just as I have been learning all along, if you want the real story, or a real account of history, just ask a person who has experienced it.
My Own Experiences
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| Kara and Anthony on November 8, 1999 |
On November 8, 1999 at the age of 21 I gave birth to my son. As a young, new mother I was uneducated about any kind of birth plan and I saw a team of obstetricians not knowing which one would actually attend the birth. I was seen by a doctor in the morning of my labor and told to go home because my baby wouldn't be born until the next day. I was after all- three weeks early. Within an hour of leaving the doctor's office I was alone at my parent's house. I was in hard labor and my water broke. A call to my mother and my husband (then boyfriend) got me quickly into their care and to the hospital. I progressed quickly. I immediately received an iv with antibiotics because I am group strep B positive. I then received an epidural. Shortly after that, and three good pushes and an episotomy later, I was a new mom. My birth went by in six quick hours and my input was rarely asked about the care that I was given. Still- I received the "best" care possible and was very happy with my birth experience.
On November 16, 2003 I had my little girl. I was four days late and anxious. Contractions started at 6:15 pm while I was visiting co-workers at the grocery store I worked at at the time. By the time that I got home I was almost certain I was in labor. My husband and I left the house with our four year old son and left for dinner at my parent's house. By the time we arrived there (which was a five minute drive) I was certain I was in labor. Thankfully the hospital was less than a mile away. Throughout my pregnancy I had read numerous books on labor and deliver and breastfeeding. I had been seeing a team of midwives at my Ob/Gyn. I had a birth plan. I wanted the epidural, and no episiotomy. My midwife was great. I had taught myself breathing techniques and progressed to seven centimeters. I must say, maybe it was having already had a birth experience, but I was much more calm and relaxed at the hospital this time despite my fast labor. I received a botched up epidural which went into my spinal fluid and caused my to hear loud echoes (this was one of the strangest experiences of my life.) It was corrected, and then I felt no pain. When I reached ten centimeters all it took was a couple of pushes before I saw my girl. I did tear a little, but at least it was my choice. My water hadn't broken until right before I started to push and there was meconium in it. I was thankful to have been in the hospital where she was given excellent care. She was also fine despite my not been given the hours of required antibiotics for my group B strep.
I've often reflected on how I would choose to give birth. Would I attempt to give birth at home? Probably not. If I had to do it all over again, I think I would choose to do things exactly the same. As much as it bothers me how birth is so medicalized, I appreciate all of the medical interventions we have. I consider myself lucky to live in a place where I now have a choice of where and how I want to have a baby, and who I want to deliver it. I expect that in the future, we will see more home births and birthing centers and hope that our government and insurance companies respect that.
--Kara
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| Kara and Danielle on November 16, 2003 |
Sources:
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This article was written by Dr. Ian Carr of the Department of Obstetrics, Gynecology, and
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This article was written by Alison Haasch. Alison is a licensed midwife who specializes in natural home birth, childbirth education, breastfeeding, in the Phoenix, Arizona.
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