I do a lot of reading while I'm nursing. If I haven't been to the library and gotten new stuff, I tend to choose old favorites like this one by Gail Collins. I first read it when my first was born, and can't even count how many times since then. What's great is that every read I seem to pick up on something I'd missed beforehand---almost like themes emerging from every subsequent journey back into it.
Anyway, if that's the case, this current reading's theme is childbirth. I was actually brought to tears yesterday when I read one woman's story of giving birth on the frontier with no one around but her two toddlers and the dog. She set out food and milk for them and the dog kept watch and delivered a baby boy. Her daughter said she fainted a few times while trying to dress the baby shortly after his birth.
This is not how birth looked for most women for the vast majority of our existence. Of course, for some women birth was a lonely event, depending on where she lived and who was around. It's not as if this pioneer woman had the option of company and declined it. But, since humans have from the beginning been social creatures and lived in groups, birth was done in front of the group, too. The word "gossip" is actually derived from the term "God's sibs," a term given to the women who accompanied a laboring woman in the delivery room (i.e. usually her bedroom).
The group approach to birth served many purposes: it provided the laboring woman with support and encouragement, which is absolutely vital, especially to first-time mothers; it helped to actually facilitate the birth, with various women working to prop legs, wipe brows, catch the baby, etc; and it provided women with a system of built-in knowledge and advice on everything from breastfeeding to diapering to postpartum care (in fact, in some cultures a newly postpartum mother wouldn't immediately nurse her baby--if a woman in her attendance was lactating, the baby was passed on to her). Birth is an inherently feminine activity, and for all but the past 150 years or so, it has been dominated by women who called the shots and doled out the advice.
To me, this is an immensely comforting image. Childbirth and the first days of motherhood are tough. To be surrounded by a group of women one knows and trusts, who impart wisdom and knowledge and care, feels like it'd just be right somehow.
So what happened in the United States that changed this? People started moving around, first of all. Instead of being born, living and eventually dying all within the same small geographic area (or moving to where your husband was born), families started striking out on their own. Sometimes women were fortunate enough to end up where there were other women, and friends replaced sisters and mothers and cousins as birth attendants. For many, though, like the aforementioned pioneer woman, there were no friends to be had, and husbands had to do their best (I should add that the woman mentioned above went into labor while her husband was traveling about 20 miles away to get wood) at being midwife and support person.
The next phenomenon was the entrance of the doctor into the delivery room. Starting around the turn of the eighteenth century doctors started attending births, mainly of wealthier women in larger cities. They quickly started gobbling up the midwives' business, in part because they used forceps, a life-saving tool when needed, and enough of an incentive for women to trust them. Unfortunately for the women, the doctors also had astronomically high rates of maternal mortality. Skilled midwives typically had much lower rates than the male doctors, as is evidenced by Laurel Thatcher Ulrich's eighteenth century midwife:
"Her results attest to her skill. Her comment on August 20, 1787, that the death of Susanna Clayton and her infant was the "first such instance I ever saw & the first woman that died in Child bed which I delivered" allows us to add the 177 prediary deliveries to the total: in almost 1,000 births Martha did not lose a single mother at delivery, and only five of her patients (including Mrs. Clayton) died in the lying-in period. Infant deaths were also rare. The diary records fourteen stillbirths in 814 deliveries and an additional five infant deaths within an hour or two of delivery.
By our standards, mortality was high. Martha saw one maternal death for every 198 living births. Today that rate is one per 10,000. But as late as 1930, there was one maternal death for every 150 births in the United States; the major gains in obstetrical safety have come in the past fifty years. In fact, many historians believe that the routine employment of physicians in the nineteenth century probably increased rather than decreased mortality. Records of an early-nineteenth-century New Hampshire physician, whose case load was almost identical to Martha Ballard's, shows higher stillbirth ratios and four maternal deaths at delivery, though only one during the lying-in period (see Table IV). What is even more striking is the large number of complications recorded in his records: 20 percent of his deliveries (as opposed to 5.6 percent for her). The difference was partly in perception- as a physician he was attuned to biological anomalies in a way that she was not- yet there is good evidence that birth had become a more complex process in the nineteenth century, as physicians began to employ ergot, opiates, and forceps in what Martha Ballard would have considered routine deliveries. Those dangers did not decrease as hospital delivery became more common. A study of a Portsmouth, New Hampshire, hospital found stillbirth rates in the second decade of the twentieth century five times as high as Martha's."
The third factor is the movement from homebirth to hospital birth. Birthing at home a woman can have as many people around as she can tolerate or her bedroom or house can hold. Hospitals, understandably, have limits on the number of people who can attend a woman in labor. In the interest of public health, many have restrictions on visitors during the postpartum period as well. A woman attended by her partner, her doctor and a nurse may not feel the need for a circle of women to support her during childbirth.
The fourth goes along with the third. Men started being present in delivery rooms around the sixties. Pioneered by OBs like Robert Bradley (who for all his misogyny, had an important and vital point about women feeling supported by their partners during labor), men were encouraged to take over the role of support person while their partners labored and gave birth. If a hospital restricts the number of people who were allowed to accompany a woman in labor, she invariably, and understandably, chooses her partner to be the support person. For what it's worth, my husband was an excellent support and showerhead-holder during my two labors and deliveries. And I loved him being in there with me. No offense to him, though, but I also loved giving birth with a midwife and a doula present in addition to him. I felt like I was a part of some kind of historical continuum that included all the women in history who had given birth surrounded by a group of supportive women.
Ok, so that's the brief and very generalized story of how we got where we are now. The question then, for those who want to, is how to get back to that intimate cocoon of support women can offer each other.
The first answer is obvious: have a home birth. Unless you have an OB who's willing to attend you at home, chances are your midwife will be a woman and she'll likely let you have whomever you want present, from your mother to a picture of your dead dog. Home birth for low-risk women with a trained midwife and access to a hospital has been shown to be extremely safe. And not to scoop myself, but I want to address the pathology of birth in a separate post that goes along with this.
The second option, if home birth isn't for you (or, if like mine, midwife-attended home birth is illegal in your state), would be to have a hospital birth with a doula and preferably a midwife or "midwife in disguise". This is not just for women who want to have natural births! Sometimes labors are long and in-laws are a pain and the laboring woman and her husband may still be cognizant enough to not want to hurt someone's feelings by kicking them out of the room. A doula is an excellent enforcer.
Most doulas who call themselves such are the products of various training workshops put on by professional organizations, but the idea of a doula is not exclusive to a professional association. Having a friend or family member who is experienced in birth and can offer appropriate support is practically the same thing (and usually free!).
Contrary to what is sometimes said (I love you, Sam Mendes and John Krasinski, but that whole line in Away We Go about doulas only being for women whose partners are uninterested or uninvolved in childbirth is total bullshit), a doula is not there to replace the mother's partner, but rather to be a support to both. A doula can do everything from massage to taking pictures to ushering out nosy relatives. The pictures I got from my labor and delivery--ones I will never, ever share, I promise--were worth every penny I paid to have her there.
I hope everyone has enjoyed today's history lesson. Stay tuned for my hopefully forthcoming "the pathology of birth" post!
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