Childbirth and Childbearing
CHILDBIRTH AND CHILDBEARING
When the English settled in North America, they brought with them English birthing traditions. The most prominent of these customs was the midwife, who relied on the camaraderie of laboring women's female neighbors and relatives for assistance. Historians refer to this longtime practice of women gathering for hours and days under the auspices of a midwife as "social birth." Birth was not a private medical event during the colonial and early national periods, but a quasi-public social event albeit for women only. Birth networks were not universal, however. In isolated rural areas, women often found themselves alone during birth or with only their husbands for support.
Prior to the middle of the eighteenth century, women customarily excluded husbands as well as physicians from the birthing chamber. Midwives summoned doctors only during difficult deliveries. Eventually prompted by the interest and expertise of men like William Shippen, who trained in Europe and taught the first midwifery classes for physicians in the North American colonies, women in urban areas began to invite physicians to attend births in the 1760s. Physicians' presence at normal births increased gradually throughout the nineteenth century, although other childbirth traditions remained static. Women often gave birth in birthing chairs (a chair with a hole in the seat), or leaning against another woman in either the sitting or standing position. Until birth moved from women's homes to the hospital in the twentieth century, it remained an event controlled by women even in the presence of a male physician.
As long as birth remained in the home, midwives and physicians treated birth in virtually identical ways: they spent the bulk of their time comforting laboring women and waiting for babies to be born. Medical interventions were minimal, although doctors, unlike midwives, did have at their disposal a greater array of obstetric instruments, most notably forceps. The first British record of forceps use appeared in the second quarter of the eighteenth century. Despite the availability of these instruments, however, most doctors (and all midwives by law) limited their medical activity to periodically examining the cervix, lubricating the perineum to aid stretching and avoid tearing, "catching the baby" ("catching babies" was the trademark phrase used by midwives to describe their vocation), and tying the umbilical cord.
Birth was a communal female affair in the South as well as the North. It was common in the South for black and white women to attend each other's births. In letters and diaries, white women occasionally expressed appreciation for a slave's assistance during birth, and white women apparently reciprocated when slaves were in similar need. Unmarried sisters appear to have been the most valued birth attendants in the South, although birth networks were large and bonded married women to each other.
Following the example of women in the urban Northeast, some wealthy southern women began to rely on male physicians before the Civil War, although this change in primary birth attendant occurred more slowly in the South than in the North. Physicians and midwives also probably cooperated to a greater extent in the South; even when physicians were present at a birth, their casebooks indicate that a midwife was usually there too.
Pregnancy, childbearing, and breast-feeding dominated most women's lives during the colonial and early national periods. In 1800 white women of childbearing age gave birth to an average of 7.04 children, and women often wrote of the strain of unrelenting childbearing. As Abigail Adams observed in 1800 of a young relative, "It is sad slavery to have children as fast as she has." Partly as an effort to space pregnancies, mothers customarily breast-fed their children for several years. Lactation tends to suppress ovulation; in an era without readily available contraception, prolonged lactation often served as the only method of birth control. Women who did not breast-feed, or who breast-fed minimally, gave birth annually. Women who practiced extended breast-feeding gave birth every two to five years.
Extant midwives' records indicate that the maternal death rate in the eighteenth and first half of the nineteenth centuries was one maternal death for every 200 births, or one-half of 1 percent of births. Although this is 62 times higher than the maternal death rate in the early twenty-first century, it is vastly lower than early Americans' notions of the maternal death rate. Women believed the possibility of death during birth was so great that they spent considerable time worrying about and planning for that possibility. Some historians speculate that women feared birth as "potential death," despite the small number of actual deaths, because Puritan ministers stressed the chance of death in childbirth. When women did die in childbirth, either hemorrhage or postpartum infection usually caused the deaths.
Native American families were considerably smaller than white families, and the fewer pregnancies experienced by Native American women likely translated to significantly lower maternal mortality. Indian women gave birth to roughly half the number of children that white women had, probably owing to heavy physical labor, diets low in fat, and lengthy periods of breastfeeding, all of which contributed to fewer menstrual cycles. There is also evidence that Native Americans had knowledge of herbal abortifacients (substances that induce abortion)—juniper berries, slippery elm bark, pennyroyal, tansy, peppermint, spearmint, rosemary, and catnip—and probably shared that knowledge with white women whose birth rate declined throughout the nineteenth century. Native Americans also practiced infanticide to limit their numbers, and some tribes forbade sexual intercourse with lactating women, effectively limiting population in these ways. African American slaves also seemed consciously to limit births. Physicians occasionally reported that slaves miscarried more often than white women, either because of excessive work or, as plantation owners complained, because slaves deliberately aborted fetuses as a form of resistance.
English observers often remarked on the apparent ease with which Native American women gave birth. According to white observers, Native American women preferred giving birth alone (and largely in silence), although there is evidence that relatives closely monitored the progress of women's labors. A host of herbal remedies also seems to have been available to Indian women to reduce pain during labor. Given their knowledge of pain remedies, cultural prohibition on expressions of pain, and relaxed attitudes toward childbirth, Indians deemphasized the pain of childbirth. In sharp contrast, European Americans considered pain the salient characteristic of birth.
The varied experience of women living in North America during this era is evidence that birth is an event influenced as much by culture and cultural expectations as by biology and medicine.
Hibbard, Bryan. The Obstetrician's Armamentarium: Historical Obstetric Instruments and Their Inventors. San Anselmo, Calif.: Norman Publishing, 2000.
Kass, Amalie M. Midwifery and Medicine in Boston: Walter Channing, M.D. 1786–1876. Boston: Northeastern University Press, 2002.
McMillen, Sally G. Motherhood in the Old South: Pregnancy, Childbirth, and Infant Rearing. Baton Rouge: Louisiana State University Press, 1990.
Plane, Ann Marie. "Childbirth Practices among Native American Women of New England and Canada, 1600–1800." In Women and Health in America: Historical Readings, 2nd edition. Edited by Judith Walzer Leavitt. Madison: University of Wisconsin Press, 1999.
Scholten, Catherine M. "'On the Importance of the Obstetrick Art': Changing Customs of Childbirth in America, 1760–1825." William and Mary Quarterly 34 (1977): 426–445.
Ulrich, Laurel Thatcher. A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812. New York: Vintage Books, 1990.
Jacqueline H. Wolf