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of midwives who lacked formal training. The Boston Women’s
Health Collective asserts that nineteenth-century physicians ‘‘waged
a virulent campaign against midwives, stereotyping them as ignorant,
dirty, and irresponsible. Physicians deliberately lied about midwifery
outcomes to convince legislators that states should outlaw it.’’ These
strategies, coupled with the significant risks of childbirth (infant and
maternal mortality rates remained high throughout the nineteenth
century), helped to create a climate of fear surrounding pregnancy and
birth. Rather than seeing childbirth as a natural practice, people began
to see it as a medical emergency, one that should be relinquished to a
physician’s control.
Once childbirth had been pathologized, the door was opened to
begin moving women in labor out of their homes and into hospitals
where, according to the medical community, the ‘‘disease of child-
birth’’ could best be battled. Until the beginning of the twentieth
century, it was actually a stigma to have to give birth in a maternity
ward, which had generally been reserved for the poor, immigrants,
and unmarried girls. As better strategies were developed to prevent
disease (especially deadly outbreaks of puerperal fever that had
flourished in hospitals throughout the nineteenth century), the hospi-
tal birth, with its concomitant costs, was recast as a status symbol.
Eventually, however, having babies in hospitals became a matter of
course. According to Jessica Mitford, while only 5 percent of babies
were born in hospitals in 1900, 75 percent were born in hospitals in
1935, and by the late 1960s, 95 percent of babies were born in
hospitals. Eakins’ American Way of Birth notes, ‘‘the relocation of
obstetric care to the hospital provided the degree of control over both
reproduction and women that would-be obstetricians needed in their
ascent to professionalized power.’’ This power was consolidated
through non-medical channels, with advice columns, media attention,
popular books, and community pressure working to reinforce the
primacy of the professional medical community in managing wom-
en’s childbirth experiences.
In the twentieth century, giving birth in a hospital environment
has meant a loss of control for the mother as she becomes subject to
numerous, standardized medical protocols; throughout her pregnan-
cy, in fact, she will have been measured against statistics and fit into
frameworks (low-risk vs. high-risk pregnancy; normal vs. abnormal
pregnancy, and so on). As a result, the modern childbirth experience
seems to depersonalize the mother, fitting her instead into a set of
patient ‘‘guidelines.’’ Women in labor enter alongside the ill, the
injured, and the dying. Throughout most of the twentieth century,
women were anesthetized as well, essentially being absent from their
own birthing experience; fathers were forced to be absent as well,
waiting for the announcement of his child’s arrival in a hospital
waiting room. If a woman’s labor is judged to be progressing ‘‘too
slowly’’ (a decision the doctor, rather than the mother, usually
makes), she will find herself under the influence of artificial practices
designed to speed up the process. More often than not, her pubic area
will be shaved (a procedure that is essentially pointless) and some-
times cut (in an episiotomy) by medical personnel anxious to control
the labor process. Further advances in medical technology, including
usage of various technological devices and the rise in caesarian
sections (Mitford cites rates as high as 30 percent in some hospitals),
have also contributed to a climate of medicalization and fear for many
women giving birth. This is not to say, of course, that many of these
medical changes, including improved anesthetics (such as epidurals)
and improved strategies for difficult birthing situations (breech births,
fetal distress, etc.) have not been significant advances for women and
their babies. But others argue that many of these changes have been
for the doctors’ convenience: delivering a baby while lying on one’s
back with one’s feet in stirrups is surely designed for the obstetri-
cian’s convenience, and the rise in caesarian sections has often been
linked to doctors’ preferences rather than the mothers’.
In the 1960s and 1970s, as a result of their dissatisfaction with
the medical establishment and with the rising cost of medical care,
various groups began encouraging a return to older attitudes toward
childbirth, a renewal of approaches that treat birthing as a natural
process requiring minimal (if any) medical intervention. One of the
first steps toward shifting the birthing experience away from the
control of the medical establishment involved the introduction of
childbirth classes for expectant parents. These courses often stress
strategies for dealing with the medical community, for taking control
of the birthing process, and for maintaining a ‘‘natural childbirth’’
experience through education; the most famous methods of natural
childbirth are based on work by Grantly Dick-Read (Childbirth
Without Fear), Fernand Lamaze, and Robert Bradley.
Also significant were various feminist critiques of the standard
birth practices. The publication of the Boston Women’s Health
Collective’s Our Bodies, Ourselves in 1984 offered a resource to
women who wanted to investigate what had been essentially ‘‘under-
ground’’ alternatives to the medicalized childbirth experience. Through
this work (and others), women learned how to question their doctors
more assertively about the doctors’ practices, to file ‘‘birth plans’’
(which set out the mother’s wishes for the birth), and to find networks
of like-minded parents, midwives, and doctors who can assist in
homebirths, underwater births, and other childbirth techniques. In
some states, midwives not attached to hospitals are still outlaws, and
groups continue to campaign to change that fact.
Finally, many hospitals are recognizing women’s desire to move
away from the dehumanizing and pathological approaches to child-
birth associated with the professional medical community. In defer-
ence to these desires (or, more cynically, in deference to their
financial bottom lines), some hospitals have built ‘‘Birthing Cen-
ters,’’ semi-detached facilities dedicated specifically to treating child-
birth as a natural process. Women enter the Birthing Center, rather
than the hospital. There they are encouraged to remain mobile, to have
family and friends in attendance, and to maintain some measure of
control over their bodies. Often patient rooms are designed to look
‘‘homey,’’ and women (without complications) give birth in their
own room, rather than in an operating theater. Many of these facilities
employ Nurse Midwives, women and men who have been trained as
nurses in the traditional medical establishment but who are dedicated
to demedicalizing the childbirth practice while still offering the
security of a hospital environment.
As women and men continue to demand that childbirth be
recognized as a natural, rather than unnatural, process, the dominant
birthing practices will continue to shift. Additionally, rising pressures
from the insurance industry to decrease costs are also likely to
contribute to a decrease in the medical surveillance of childbirth—
already new mothers’ hospital stays have been drastically reduced in
length as a cost-cutting measure. Clearly the move in recent years has
meant a gradual return to earlier models of childbirth with a return of
control to the mother and child at the center of the process.
—Deborah M. Mix
F
URTHER READING:
Boston Women’s Health Collective. The New Our Bodies, Ourselves,
Updated for the 90s. New York, Simon and Schuster, 1992.