In Enforcing Its Account Obstetrics Has Usurped Any Sense of Agency on the Part of The

Talk on Politics of Childbirth.

December 2, 2002

Birth and how it is accomplished can be seen as the ground on which the conflict between men and women’s rights rests. While birth around the world and throughout history has been the province of women, when men began to get interested and make money from childbirth, we can see this conflict as symbolic of many of the unresolved power issues between the sexes.

My history with this subject: Writing in the mid-seventies on a convention of nurses. The women’s movement and taking control of the birth experience.

As we are covering birth in this class, I decided to explore this area further to learn if there is historically any support for the idea of birth issues being related to the issues of women and women’s issues.

There are supporting arguments for both sides. What follows is a history and information so that you can decide for yourselves; In the workshop after this talk, I will give you some situations to consider from different perspectives so that you can think about this subject and assess the current effect of politics on birth.

The history of Childbirth

Historically, midwives were the ones who assisted in birth. Illustrations #1, Lying-In.
Pictures of midwives, birthing stools used Illustration #2
It was thought that babies kicked their way out of the womb. Woodcut from first birthing manual in 1545 and revised a number of times until 1626. Illustration #3.

Surgeons (men) were called in for emergencies—often having to take apart the baby to save the mother’s life. This procedure was called craniotomy. Surgeons were often very aggressive with women, cutting women to expand the birth canal and performing cesareans. Since women often died, these techniques were abandoned. They were able to announce that a woman might die, if she had a misshapen pelvis, but could not really help in any other way. Illustration #4

The invention of forceps, by 1695 by Chamberlan was kept a family kept a secret for over a century, but finally the secret leaked out. Some male midwives used these forceps in the earliest stages of delivery, before the baby was in the birth canal, with deadly results.

In Paris, there were established school/hospitals where in wards for poor women, doctors learned and trained. New techniques included measuring the pelvis and getting a sense if the baby would be able to fit through the birth canal. (the “touch” of the attendant.). These ideas were based on the notion that the body was a machine, and the womb would expel the fetus. This began a new “science” of midwifery, and magic, and religious incantations were no longer seen as necessary. While they understood birth better, they did not really have better techniques in aiding birth. Illustration #8

Rise of male-midwives: First birth manual—by a man to instruct female midwives 1545 and revised a number of times, to 1626. Illustration p.16. Women in the colonies often did well in childbirth, they were stronger, healthier, more well-fed than their counterparts in England. After 1750, male doctors returned from training in Europe to practice medicine in America. They often used the obstetrics they had learned to get their practices started and found themselves in conflict with midwives. Childbirth was redefined: medicine vs. “granny and superstitious” midwives

Forceps were often used by male midwives in the earlier stages of labor, before the head was down in the birth canal, often causing damage to both mother and baby. There was little or no training of those who used these instruments—especially in England.. Women did not use the instruments, either because they could not get them, did not want them, or were not strong enough to use them. Because they were not shaped as the mother’s body, the person using them had to be very strong. A few cases of midwives having instruments show that they used them rarely in their careers.

Illustration #5 of a male midwife who dressed as a woman. He was later burned at the stake.

Illustration #6 of the modesty used by male midwives—woman giving birth is fully clothed, and cannot see what he is doing.

#7 Quote from a new medically trained obstetrician. He didn’t have a clue.

Hospitals were established for women giving birth, but were rampant with childbirth fever. Many women still continued to give birth at home and slowly midwifery began to make a comeback. Midwife-assisted births had better outcomes and almost no evidence of the childbed fever rampant in hospitals. Some hospitals even employed midwives at one end of the hospital to care for the poor and less wealthy patients and doctors at the other end to deliver the babies of wealthy clients. Even here, the midwives' outcomes were better and incidence of childbed fever was much lower. Wealthier women who could afford the doctors often pleaded to be delivered by the midwives to avoid the death in the medical wards.

In 1847, Dr. Ignaz Semmelweiss instituted rules in his ward that physicians must wash between patients. He was convinced that the infections were being spread by the doctors and that the reasons midwives had better outcomes was directly related to their practices of cleanliness. This practice dramatically decreased the incidence of childbed fever, but most of his contemporaries ridiculed his research and continued to practice as they always had.

By the end of the 1800's many doctors were finally beginning to accept the research of Dr. Semmelweiss and others. Washing standards and protocols were instituted across Europe and American, but many women continued to favor delivering at home to a hospital delivery.

The death of women proved to be the result of attendants not washing their hands after dissecting cadavers or between helping at different births.

By mid-1800’s there was serious competition between male midwives and doctors and classic midwives who competed to deliver at births. Gradually, women midwives disappeared from and doctors won the contest. According to Wertz and Wertz, one of the reasons that midwives disappeared is that they never organized, developed leadership or training requirements. It came to be seen, especially by upper and middle class women, as more up to date to have a doctor rather than a midwife. A doctor’s reputation was based on the social standing of his patients, and they wanted the rich ones. However, the doctors were trained in established medical schools, and midwife schools, and both left much to be desired. Women midwives often fought against interference with the birth process.

Women were not allowed to have medical training.

A woman who bucked the social trends and did apply to medical school was at first rejected and then, when allowed in the next year, forced out by her fellow male students. They wrote: “We object to having the company of any female forced upon us who is disposed to unsex herself and to sacrifice her modesty by appearing with men in the medical lecture room where no woman of any true delicacy should be found.” P. 59 The difficulty women had getting into medical schools inspired the opening of medical schools for women—New England Medical College founded in 1848 by Samuel Gregory and the Quakers began one in 1850.

Early gynecologists were seen by the medical historian Barker-Benfield, as “ruthless and ambitious.” While traditional histories extol the glories of medical surgeries, he describes them as developed with “ulterior motives.” Surgeries, which allowed the removal of all parts of women, were attempts to retaliate against and control women, who, under the impetus of the Industrial Revolution, were increasingly entering the work force and stimulating the growth of the women’s rights movement. Rather than humanitarian concerns, Barker-Benfield argues, “hostility toward women and competition among men were the conditions for the rise of gynecology.” (Scully p.39)

For men to convince women that they were needed in childbirth, they had to begin to convince women that childbirth was “a pathological state requiring the intervention of obstetricians and their instruments and surgical techniques.” (p.28 Scully) Normal childbirth was now unusual, and complicated birth was seen as the norm.

Even though the need to wash was known, many doctors did not follow such rules. Women continued to die in hospitals. In the 1900’s many poor women, and then others who could afford them, were taken to hospitals to give birth. The women often died as a result of childbed fever. I have heard stories about wealthy women begging to give birth at home and not go to the hospital where so many died.

The issue of pain in childbirth was an interesting question. It appeared that women who were “uncivilized” had less pain than other women. There were stories of Native Americans who gave birth easily, and some women who gave birth in their sleep. Fashionable women of the mid 1800’s wore corsets tightly cinching their waists. Pale, sickly, weak women were seen to be gentile, and strong healthy women were seen as coarse and vulgar. Also in another source was a biblical reference to Hebrew slave women have no pain in childbirth compared to the Egyptian women who had to do nothing for themselves, and suffered terribly in childbirth.

Chloroform was introduced for women in labor around 1860. Despite the fact that these chloroformed women were unable to care for their babies for several days while they recovered from the effects of the gas, a growing number of women saw the use of anesthetic to be a boon. Mothers were unable to care for their infants, resulting in the beginnings of nurseries for newborns

Also in the mid-1800’s was the development of the speculum by Dr. Marion Sims, who is seen as the father of gynecology, but operated on slave women who had developed a condition known as vesicovaginal fisutula, which meant that after childbirth, women were not able to control their urine. It made the slaves useless, and he performed many operations on these women, without the use of anesthesia. While he caused these women enormous pain, he did figure out how to fix the problem.

In 1940, Twilight Sleep was introduced. This heavy dose of narcotics and amnesiacs completely incapacitated laboring women and caused women to loose control. Many were literally strapped to their beds to keep them from injuring themselves. Recovery was a long process because of the drugs and breastfeeding was more impossible than before. Fathers, unable to help, were not needed at all. Twilight sleep was also difficult on the babies were born sleepy and unable to respond or suck. Breathing was difficult and babies had to be watched carefully to insure that they didn't stop breathing. Many were force-fed in those first days after birth because they would not or could not suck effectively due to the drugs in their systems. My brother almost died after my mother gave birth in twilight sleep. Interestingly, I always heard this story about the fabulous doctor who saved my brother, not about the doctor who almost killed him with so many drugs given to my mother.

In the 1940’s, In 1944, Dr. Grantley Dick-Reed wrote Childbirth Without Fear. He studied midwives with laboring women and learned how these women assisted laboring women to give birth without medication using relaxation techniques. He also studied the fear-pain cycle and discovered that women who were not afraid of childbirth had less pain and fewer problems.

In 1953, Dr. Fernand Lamaze published his findings about labor and delivery in Russia. His philosophy substituted scientism for faith and introduced self-hypnotism as a method of coping. His "prepared childbirth classes" were accepted by many hospitals because the instructors taught couples to accommodate hospital practices instead of listening to their own bodies. His work did, however, open the door to childbirth education classes –fathers had a role in birth helping their wives.

Not many years later, Dr. Robert Bradley introduced his philosophy of husband-coached childbirth in a book by the same name..

1970’s feminism and childbirth. During the 70’s and later there was a rise in women who wanted to have natural childbirth. Women began having babies with midwife assistance in their homes. The response of hospitals was to make birthing units that were as much like home as possible. Some hospitals allow midwives in take care of women for the first stages of labor. However, there continues to be much use of ultrasound, fetal monitors, epidurals and these all contribute to a high rate of cesarean sections. While the rate has reduced somewhat, it is over 20%. Interestingly, the statistics show that 90% of births are normal.

Some other issues where politics and birth intersect.

1. Contraceptives. Still condemned by some religions and in some countries. What are the politics involved?

2. Money to other countries dependent on abortions. Bush is holding back money to assist in health care if any of that money is used for abortions. We have not yet seen the toll this will take on women’s health care world wide.

3. High rate of death for Black women in the US. The death rate for Black women in poverty in this country is high. Poverty, lack of prenatal care, adequate nutrition, access to hospitals and doctors. How can policies affect this situation? What policies can you suggest?

What is done today:

Induction: Babies who doctors think are late may be induced to prevent harm to the baby. Simplest way to induce is to puncture the membranes. Early puncturing—in the first stages of labor, result in contractions pressing directly on the walls of the birth canal against the fetal skull. “Tracings from fetal heart monitors have shown that as each contraction increases this pressure, a marked decrease in blood to the baby (and oxygen to its brain) occurs in cases of early ruptures, but is rarely seen in cases where the mother’s membranes are still intact.

Workshop on Politics of Birth

December 2, 2002

Dividing into groups of four or five, discuss the following questions after reading the appropriate sections. We will reconvene to hear some suggestions and findings that your groups come up with.

1. From Reading Birth and Death by Jo Murphy-Lawless, 1998.

“In enforcing its account obstetrics has usurped any sense of agency on the part of the birthing woman. In effect the science tells women, “You can escape death if you follow us. But you must hand over to us your role as the central player in childbirth.” Examining the history of obstetric thinking has led me to conclude that we need to interrogate the obstetric demand that it should remain the single arbiter about childbirth management because—it contends—its practices have brought to an end danger in childbirth for the vast majority of women and their babies in the West. This demand with its accompanying rationale is, I believe, at the heart of our dilemma with obstetric science. We should be demand in of obstetrics that it acknowledge the limits of its actions, that it has been but one element, and one with contradictory effects, in a complex picture of the changing lives of women in the modern period.”

“Obstetrics argues that its power to determine what ought to be done in childbirth is founded on its authority as a form of scientific rationality and it is not amenable to accepting as expert any voice from outside that community (and dismisses the dissident voice within.)

“Women see the issue of obstetric power differently and question what we experience as an overt exercise of power, one that is often expressed in distinction irrational practices and language. This irrational response emerges pretty rapidly whenever we query obstetrics and it always turns on the same issue, the risk of death in childbirth whether for woman or baby.

“I think we need to recognize and maintain our awareness of our proximity to death in the sense that there are never guaranteed outcomes. If we reclaim the awareness that there are no guaranteed outcomes, we can deal critically with obstetrics strategies of risk, its categories of normalcy.”