A Brief History of Birth

I’ll admit I’m a big time history nerd.  As in I’m not entirely opposed to going to Gettysburg for a Civil War reenactment for a family vacation.  Yep, that nerdy. So I totally salivated at the opportunity to write about the history of birth. What I’ve found is that childbirth has evolved throughout history and has experienced many ups and downs.  A woman’s birth experience has been largely determined by her social status--in good and bad ways. Also, there have been some kooky-ass practices that took place in the birthing world (like drinking pulverized rabbit genitalia mixed with wine to increase the chances of birthing a boy…  Needless to say, this was a practice during the Dark Ages).

Midwives have been a constant in birth for most of history.  The term “midwife” comes from the old English “with woman”. Midwives or women with similar roles have been mentioned in the Bible, in Greek and Roman writings, and have been shown in Egyptian archaeological findings.  Historically birthing mothers have had the emotional and physical support of other experienced females. Birth was never meant to be an isolating event for the mother. Her community has gathered around her to help bring baby into this world.  Midwives were central to the birthing world prior to the middle ages, when midwives were labeled as witches and became the scapegoats for maternal mortality. The medical base of knowledge was lacking at the time and midwives were easy to blame for anything that went wrong during labor and delivery.  While midwives continued to attend the majority of births in countries like Britain, Sweden and Japan, their presence took a dive in the United States. While the midwifery model of care insists that birth is a normal, natural process which requires little intervention, obstetric care during the 20th century popularized the idea that everything could and would go wrong during childbirth.   

Male care providers weren’t introduced to the birthplace until the 1700s.  Until this time, it was considered indecent for a man to be present during birth.  In fact, in 1522 a male German physician was executed for posing as a woman to attend a birth.  Once medicine became viewed as an elite science (which men, of course, dominated), hospitalized births became more popular and were seen as a privilege for those in higher classes who could afford care, while home births were still the only option for those of lower status.  While male care providers gained entrance into labor and delivery, male partners were still not in the birth room until the mid to late 20th century--hospital waiting rooms were the place for dad and he was oblivious to what was happening to mother and baby until notified by a care provider.  

One of the most prominent examples of male presence in birth is the supine birthing position: birthing while laying on your back.  For most of history, women stood, squatted, knelt, used birthing stools, etc. It’s been said that Louis XIV was the one who popularized this on-your-back position as it gave him a better view of childbirth, with which he was deeply fascinated.  (Yes, that’s as creepy as it sounds. Although to be fair to Louis, royal birth was always a public affair. Marie Antoinette had more than 200 people watching her birth in 1778). Additionally, the supine position was popularized when male doctors came into the birthplace because it is a more convenient position for the care provider.

The risk of dying during pregnancy or childbirth was quite high for most of history as germ theory didn’t make its debut until the mid-19th century.  In 1847, Ignaz Semmelweiss introduced the revolutionary idea that medical professionals should be washing their hands between handling cadavers and obstetrical patients to reduce the risk of puerperal sepsis, otherwise known as childbed fever.  Despite a dramatic decrease in maternal mortality with the use of his handwashing practice, Semmelweiss still faced a lot of backlash and criticism as many in the obstetrical field refused to acknowledge that they could be the ones spreading infection from dead bodies to birthing mothers.  Sadly, Semmelweiss’ discovery did not gain much credibility during his lifetime and he died after a life of depression. Thank you Ignaz for encouraging doctors to wash their hands!

As hospitalized births became popular, so did different avenues of intervention.  For much of early history when a baby was stuck in the birth canal, either the mother’s pelvic bones were cracked or the baby’s skull was cracked to deliver baby.  Obviously, this resulted in death of either mother or baby. From about 1600 onward, forceps became popularized and enabled care providers to deliver babies that were otherwise thought to be undeliverable.  However, improper and excessive use of forceps increased lacerations in mothers and still damaged babies’ skulls. Episiotomies, forced dilation, forced extraction of the placenta and other interventions were overused throughout the mid-20th century.  At the time, birth was widely viewed as a pathological event and it was assumed that something would go wrong. Dr. Joseph DeLee was at the forefront of obstetrical care during the early part of the century. His outspoken view that pregnancy and childbirth were dangerous rang throughout the medical establishment.  His 1920 article in the American Journal of Obstetrics and Gynecology stated: “So frequent are these bad effects that I have often wondered whether Nature did not deliberately intend women should be used up in the process of reproduction, in a manner analogous to that of salmon, which dies after spawning”.  During the 1970s and 1980s, the United States saw increased rates of cesarean birth, rising to about 30% of births according to 2015 estimates, while the World Health Organization advises a 10-15% rate. While cesarean birth can certainly be lifesaving, this intervention again became overused along with earlier obstetrical interventions.

During the Middle Ages, pain relief during childbirth was rarely an option.  Rather, women were expected to endure the pain which was God’s punishment to women for Eve’s first sin.  However in 1853 Queen Victoria used chloroform, which she described as “delightful beyond measure”. Thereafter, more forms of relief became available and acceptable.  At about the same time, ether was first used for pain relief. Around the turn of the 20th century, twilight sleep became the chosen method. This use of scopolamine and morphine put mothers to sleep all together, and was often the cause of infant mortality as it impaired the baby’s ability to breathe.  While this was certainly a dark time in childbirth, the feminist movement of the early 20th century did lead to progress in the availability of pain relief for women. Nitrous oxide became a common option in European countries as it carries little risk, but it has not made its way into American obstetrics until fairly recently.  Rather, epidurals gained popularity throughout the 1960s and 1970s. This practice, however, may slow down uterine contractions and interrupt labor progression. In 1942, Dr. Grantly Dick-Read published Childbirth Without Fear which examined female anxiety about birth and highlighted the benefits of natural childbirth.  Throughout the remainder of the 20th century, non-medicated forms of pain relief popularized with practices like Lamaze breathing, water birth, hypnobirthing and other relaxation methods.

In the United States, we’ve been lucky to see women taking back their births in recent years.  With increased childbirth education, mothers and their partners are gaining a better understanding of the risks and benefits of interventions.  Safer options to alleviate pain are becoming available. Fathers are encouraged to be in the birth room with mom as an additional form of support.  Formal midwifery training has made leaps and bounds, midwives have regained credibility and we’re starting to see an increase in their presence in hospitals.  Midwives and obstetricians are working side-by-side and finding a beautiful balance between the two schools of thought. The recent resurgence of feminism has reminded women that they carry the authority over their bodies and their births, and we’re seeing harmonious relationships between patients and care providers.  While there are always improvements to be made in any industry, I am very optimistic that now is a pivotal time in the birthing world and the lessons learned throughout history are coming to fruition.