Though birth has remained the same from the beginning of creation, the practice of childbirth has evolved. In the Bible it is noted in John 16:21 “Whenever a woman is in labor she has pain, because her hour has come; but when she gives birth to the child, she no longer remembers the anguish because of the joy that a child has been born into the world.” As most mothers understand, pain can be inevitable, but your new baby brings joy to her, and the pain can be forgotten. Through history childbirth has changed as care providers have shifted their involvement and focus, pain management has been invented and utilized and a woman’s personal philosophy regarding how they chose to birth.
The Roman writer Sornaus in the 2nd century AD made a list of all the things needed for women to labor, “For normal labour one must prepare beforehand: olive oil, warm water, warm fomentations, soft sea sponges, pieces of wool, strips of cloth, a pillow, things to smell, a midwife’s stool or chair, two beds and a proper room.” Before the 1700’s, Midwives were utilized to assist birthing women. These women were trained by passing skills down from generation to generation. Midwives were expected to help provide comfort, pain relief and encouragement. They would perform rituals and prayers that would protect the mother and her baby, to deliver the baby and assist if any complications would happen in birth and supervise and help the mother with postpartum care.
In the 1500’s, pregnant women prepared their wills when they learned that they were pregnant. Women viewed birth with fear of death and eternal judgement. During colonial times, there were few doctors and it was considered indecent for a man to be present during labor and childbirth. Many midwives during this period were respected in their communities. Anne Hutchinson was a midwife and a pioneer in civil liberty and religious toleration. Deformities or disabilities reported in newborns were not completely medically understood. One of Hutchinson’s students delivered a baby with deformities and was suspected to worship the devil and practice witchcraft. They were both later exiled and massacred by Native Americans.
During the 1700’s a shift began, instead of viewing childbirth as a natural process, advanced medical professionals began to see childbirth as a pathological condition that required medical intervention. The rise of the men in the medical profession brought on numerous accusations of witchcraft among midwives. These accusations pushed midwives out of the profession, while men became more and more skilled and educated as obstetricians. In 1716, New York City required the licensing of midwives, this placed the role of the midwife at the mercy of the state. Though death during childbirth was not accurately reported at that time, one historian estimated that birth was still successful 95 percent of the time.
As the idea that childbirth was an unnecessary painful event, in the mid 1700’s the forceps were introduced to help encourage babies to be born and spare the mother pain. Chloroform was a medication that could be used in the 1800’s to ease the pain of childbirth and by the early 1900’s scopolamine and morphine, named Twilight Sleep, could be used to completely put the mother to sleep during labor. During this time period, the rising feminist movement fought for more use of pain management. Hospital birth became more common, while using forceps routinely, episiotomy and anesthesia. Dr. Joseph DeLee was known as the “father of obstetrics”, advocating for hospitals to provide women with a safe place for childbirth with the use of interventions. Dr. DeLee commented, “ The midwife is a relic of barbarism. In civilized countries the midwife is wrong and has always been wrong.” The American Red Cross in 1908 started to offer formal childbirth education classes. Cesarean sections became more common as a skeletal disorder called Rickets prohibited mothers from having a vaginal delivery.
During the Jim Crow laws, Black American women were refused healthcare by doctors as well as utilizing hospitals. For centuries before, Black women helped other women in their communities to birth their babies. Since colonial times, Black women or “Granny Midwives” were in charge of delivering babies in their communities as well as their slave master’s home. James Marion Sims invented the vaginal speculum, which is a tool used for dilation and examination. He was also known as a racist, who used Black women and children slaves in barbaric experimental reproductive surgeries.
In 1942, Dr. Grantly Dick-Read proclaimed benefits of “natural childbirth without anesthesia or interventions. He wrote the bestseller “Childbirth Without Fear”. Many fellow colleges discouraged him from publishing his book, claiming he was not a reliable source of information. Many critiques couldn’t understand why women would want a natural childbirth and not medication. In 1956, the La Leche League was founded while breastfeeding was at an all time low while women were entering the workforce more readily and formula was heavily marketed.
In the 1960’s, the effects of using medications, especially Twilight sleep became widespread. These side effects included hallucination and temporary impairment of the baby’s ability to breathe.
Epidurals gained popularity in the 1970’s, along with pain management techniques in labor including hypnosis, breathwork and waterbirth. Fathers became increasingly involved in the pregnancy and birth process and were increasingly allowed to stay with their partners during labor and delivery. Continuous fetal monitoring was introduced without any randomized controlled studies to determine their benefit to the mother and baby in labor and birth.
In the 1980’s, women began advocating for alternatives to giving birth in hospitals, seeking home births and birth centers. The first large scale randomized studies of electronic fetal monitoring were performed and released indicating no benefits. “The effect of a supportive companion on perinatal problems, length of labor and mother-infant interaction” was published and includes the term “doula”.
In the 1990’s the Coalition to Improve Maternity Services was created while Vaginal Birth After C-Section (VBAC) increased from 12.6 percent to 28.3 percent.
In early 2000, cesarean sections account for about a third of deliveries and over half of all women giving birth vaginally have received an epidural or spinal block. In 2018, researchers found that of 658 women who died of maternal causes, Black women were 2 and a half times more likely to die than white women, 37.1 versus 14.7 deaths per 100,000 live births.
Though history has evolved through time regarding childbirth, women are still giving birth everyday. Medical advances have been dark and discouraging, but interventions used today are available to help mothers and babies in emergency situations. Care providers differ on views regarding childbirth, but we live in an age when most women can make their own choices. Though we have a long way to provide equal opportunity to mothers to birth the way they want to, advances are promising while the process of birthing a child will never change.