Birth – Then and Now

We are in a unique period in our lives as most of our friends and family have only experienced medically managed birth.  There are very few grandmothers who even remember birthing at home and of those that are left, they were a part of the big transition from medical access once being unavailable to being readily available and used as preventative care vs. a healthy lifestyle as preventative care.  Until the 1930’s, home birth was the norm.  Because of this, and many other aspects such as the feminist movements, Hollywood drama, and midwifery being a lost art, we no longer view birth as the normal biological process that it is.

From the beginning of time, birth has been a significant part of our lives.  Because of various translations in the Bible, women believed that they were to be in agonizing pain rather than just doing hard work (the word that was translated to Eve’s pain in childbirth was the same word that was translated to emotional sorrow or hard work in various other places in the Bible), and this misconception increased as birth became a medically managed event.

Prior to the medicalization of birth, women were surrounded by friends and family that understood birth, and often attended by a midwife.  A woman may experience pain, but she was listening to her instincts and managing discomfort.  She may describe her experience as painful, but the joys of the birth and empowerment that she felt far exceeded any uncomfortable sensations she may experience.  Due to limited access to medical care, however, mothers and babies died more than they preferred and the fear of birth increased.  Physicians, who were typically male, only assisted with birth if there was an emergency, and often only to save the baby’s life by cesarean if the mother passed away during birth.

As male physicians began to learn more about the physiology of the body, they were seen as experts and began to manage more of the functions of the body, such as birth.  They were seen as elite attendees due to their education and women were viewed as prestigious if they could afford a physician-attended hospital birth occurring around the 1940’s (after the great depression and during the baby boom era when technology began to rule the world).  Midwives were used mainly for the poor families and various campaigns were used by the medical establishments to drive people away from “uneducated” midwives and into physician-attended hospital births.  Although these were touted as safer, mortality rates actually increased when birth moved to the hospital because of the spread of infection.  The rates were decreased when attendees started washing their hands, though still high due to medicated births.

As more medical technology became available, women and physicians believed that these options would improve birth and decrease pain, though they tended only to dilute the memory of birth without actually reducing pain.  Women were given drugs, such as “twilight sleep” that would knock them unconscious, eliminating their memory of the birth experience – and requiring women to be strapped down in labor.  Simply being in the hospital increased birth pain and changed the course of labor and part of this was due to women requesting pain relief and part of this was due to staff not wanting mothers to disturb the other laboring patients with their loud labor noises.  Because women were knocked out and the baby needed to be born after birth was intervened with, they had to lay flat on their back with their feet strapped in stirrups to receive the standard episiotomy and forceps extraction.  Babies were taken to the nursery while their mothers woke up, and breastfeeding was not initiated when biologically intended, which also coincided with formula companies and physicians advertising the benefits of formula over breastmilk.  The first wave feminism movements of the 1900’s fed the idea that men’s bodies and positions were prestigious and women were essentially disgusted with “womanly duties” such as staying at home, birthing, raising babies, and breastfeeding.  All of this contributed to women taking more control, though they didn’t quite understand what they were taking control of with medicalized birth.

Pain relief options progressed but many of the routines surrounding birth remained even through natural childbirth movements of the 1960’s and 1970’s and much of this was due to the physician’s perspective and medical education which is different than the midwife’s perspective of biological birth and knowledge of non-medical ways of assisting a laboring woman.  Even though women were becoming more educated about their bodies, they were still not birthing biologically.  The majority were still in a hospital under the care of a medical team with very little belief in the biological process.  Women were beginning to take control of their experience, but with this also brought requests for inductions, requests for “better” pain relief, and requests for more scheduled cesareans.  The fact that anyone – man or woman – believed they could control this experience is a great downfall in the biology of birth.

We are now in a time where the majority of births are medicalized.  They are often induced (synthetically started) and we have gone so far beyond where the medical system helps the natural system that we don’t believe the natural system even exists.  It wasn’t until Ricki Lakes’ The Business of Being Born that released in 2008 that families started to realize that a natural and very different method of birth did exist, and this was often not in a hospital setting.  Even though the home birth rates did increase since this new natural birth movement, they still only account for less than 1% of births in the US.

What we’re now seeing is an increase in midwifery access, though midwives are only attending about 10% of births, but we’re even seeing many medically managed births in a home setting.  Obstetricians are no longer being taught breech birth skills and other techniques that support the biology of birth because cesareans are easily scheduled.  When pitocin (the drug most often used to induce labor) was developed, the rate of births between Monday-Friday from 8-5 increased, and we often see an increase before major holidays.  Childbirth courses within the medical system often omit choice details and parents aren’t even informed about the options they have simply because of the beliefs and regulations of the system.  Providers are not practicing evidence-based techniques, and are not informing the parents of their options despite that it is legally required within the Patient Bill of Rights.  The autonomy of parents is quickly diminishing as the government and medical industry controls more of the country.  Mothers are being forced into procedures, midwives are being arrested, and parental rights are being taken away.  We are not as free as we seem to make decisions for ourselves and our families.  We can see that the history of birth continues to go into the realm of others making decisions for us, and options being removed, just as we see in every other aspect of our lives.  Parents are encouraged to research their surroundings and determine who really has their best interests in mind because our choices are changing our future.

What we need to remember is that business is successful on a supply and demand mechanism.  If there is no demand for something, then there will be no need to create a supply.  Women have demanded medical birth because they have been made to believe it is superior.  We went from having minimal access to medicine, to medicine ruling our lives and we are not using the middle ground.  We went from believing in the birth process to learning about medical technology and very few are using the knowledge of both worlds.  Even in midwifery, we are seeing more medically-educated midwives rather than midwives that truly trust the biological process.  Though many women and babies may have died in childbirth long ago, in retrospect the statistics are remarkably good.  To have little to no knowledge about how to help a women in an emergency and create a planet full of people, there has to be something rather normal about biological birth.  Now, imagine if we could use that same approach, but bring in medicine only when necessary.  We would have amazing births, healthy mothers and babies, and reduced perinatal mortality rates.  What choices are you making for your future?