Childbirth

Childbirth. Women controlled the childbirth experience in the Colonial Era. At the onset of labor, the expectant mother sent for her midwife and called upon her female friends and relatives to attend her in her home. They offered moral support and assisted the midwife during labor and delivery. While childbirth was acknowledged as potentially dangerous to both mother and child, birthing was viewed as a natural process, and midwives intervened as little as possible. After the birth of the baby, friends and relatives assisted the new mother during her convalescence, which was typically short if the birth was normal and free of complications.

The first major change in childbirth practices for white women began after 1750 when affluent colonists in urban areas began to call upon male doctors to attend them in their homes during delivery. Regularly trained physicians assured these women that knowledge of anatomy and access to ergot (a medicinal substance that promotes uterine contractions) and obstetrical forceps could ensure faster labors and safer deliveries. By 1850, ether and chloroform were available to reduce labor pains. Unfortunately, hiring doctors did not necessarily guarantee safety. Medical intervention was accompanied by concern over the incidence of puerperal (childbed) fever, a bacterial infection of the womb, as well as the misapplication of forceps.

Besides choosing doctors over midwives, those who could afford to do so also began hiring monthly nurses to assist during delivery and to provide postnatal services. Women who aspired to social prominence extended the confinement period before birth and the lying‐in period afterward to testify to their affluence and physical delicacy.

Economic status, geography, ethnicity, and race significantly influenced the way women experienced childbirth. The obstetrical services available to poor women depended on where they lived. Those who resided in small towns, rural areas, or urban ethnic neighborhoods continued to use midwives and to depend on their female support network for services. Urban women utterly without resources could seek obstetrical care in almshouses or charity hospitals. The prevalence of malaria and other diseases complicated the birth process for southern women, and before the Civil War they had little access to anesthesia. Slave owners had an economic interest in managing the fertility of slave women. Pioneer women delivered their own babies or sought help from whomever was available. Throughout the nineteenth century, Native American women tried to maintain their own culturally prescribed birth rituals.

In the early twentieth century, childbirth began to move from the home to the hospital. Doctors encouraged this development because hospital births centralized obstetric care, enabled them to combat infection, and provided a regular supply of patients for the clinical education of medical students. Women accepted this change in the conviction that hospitals could provide safety in the form of specialized services in cases of premature or complicated deliveries. Extended hospital stays also offered respite from household responsibilities.

The increase in hospital births resulted in a further shift in the balance of power between doctors and their obstetrical patients over who would control the childbirth experience. Doctors increasingly looked for pathology in their obstetrics cases and intervened in the childbirth process by routinely performing episiotomies and cesarean sections and using forceps. They also began to experiment with new forms of anesthesia such as scopolamine, a drug with amnesiac properties that suppressed a patient's memory of painful contractions, as well as various forms of spinal anesthetic.

Continuing concern about maternal and infant mortality prompted Congress to pass the Sheppard‐Towner Act in 1921 to provide programs for prenatal, obstetric, and postnatal care for poor women. By the mid‐1950s, the mortality rate for childbearing women had declined, partly as a result of the availability of antibiotic drugs, blood banks, safer forms of anesthesia, and X rays.

In the 1940s, women began opposing the medicalization of childbirth and demanding more control over the procedures associated with the experience. Following the lead of Dr. Grantly Dick‐Read, who argued that pain in childbirth resulted as much from anxiety as from physiology, they opposed the routine use of anesthesia, called for less medical intervention, and advocated a return to what they called “natural childbirth.” By the 1960s, reformers were promoting such innovations as Lamaze breathing techniques, birthing at home, the presence of fathers during birth, and the utilization of nurse‐midwives instead of doctors. Nevertheless, most American women continued to experience childbirth in a medicalized context over which they had only limited control.
See also Medical Education; Medicine; Midwifery; Slavery: Development and Expansion of Slavery; Slavery: Slave Families, Communities, and Culture.

Bibliography

Richard W. Wertz and and Dorothy C. Wertz , Lying‐in: A History of Childbirth in America, 1977.
Jane B. Donegan , Women & Men Midwives: Medicine, Morality, and Misogyny in Early America, 1978.
Judy Barrett Litoff , American Midwives, 1860 to the Present, 1978.
Judith Walzer Leavitt , Brought to Bed: Childbearing in America, 1750–1950, 1986.
Sylvia D. Hoffert , Private Matters: American Attitudes toward Childbearing and Infant Nurture in the Urban North, 1800–1860, 1989.
Sally G. McMillen , Motherhood in the Old South: Pregnancy, Childbirth and Infant Rearing, 1990.

Sylvia D. Hoffert