As a former Women’s Studies adjunct professor I find the history of birth in the United States to be extraordinarily interesting and important. History can give us insight into the assumptions and cultural movements that inform our current moment. For instance, did you know that in the United States the use of pain management for labor was promoted by the suffragists as a feminist issue?
The history of birth in the U.S. is not a pretty one. Early drugs used for pain relief caused birthing people to experience the pain of childbirth but have no memory of the experience. Birthing people were separated from their babies, partners were not allowed in delivery rooms.
What we can learn from this history of birth in the US is that what is “normal” or standard is constantly changing.
What might be en-vogue today may be obsolete in a decade. For instance, new research suggests that women should be permitted to eat and drink during labor, and that consuming food during labor actually shortens its duration. The practice today in many hospitals is to restrict food and drink in case the birthing person needs to undergo an unplanned or emergency Cesarean Section. This standard practice that may look very different in the future based on new research as well as demands from patients themselves.
I would love to hear your thoughts and reactions on this timeline.
History of Birth in the US
1600’s: People in childbirth were assisted by midwives and other female persons in the community. Special treats were eaten after the birth to help with postpartum healing and milk production, such as groaning cake and groaning beer.
1692: Salem Witch Trials — people who were thought to be witches were persecuted and hung for witchcraft. This is the most famous, but not the only, witch trial across the colonies. Many midwives were lost during this anti-witchcraft campaign, setting the stage for rise of the doctor in childbirth.
1700′s: Physicians first presented the idea that birth is a condition that requires medical intervention.
1750: Bloodletting to control hemorrhage is developed by physicians.
1846: Dentist William Morton developed Ether for surgery in 1846.
1847: Obstetrician Sir James Young Simpson introduced chloroform as an anesthetic for childbirth.
1847: The American Medical Association (AMA) was formed. The AMA formalized medical education, oversaw the obstetric profession, and worked to medicalize birth.
1850: Dr. Ignas Semmelweis discovered that less people died from childbed fever when doctors washed their hands. Doctors were spreading infections from corpses during autopsies to birthing people during childbirth. His recommendations would not become routine until later in the 20th century.
1847 – early 1900’s: The AMA created a campaign against midwives, which included newspaper ads stating that women should come to “clean hospitals”
to have their babies instead of having babies delivered at home by “dirty, immigrant midwives.” The campaign is successful among middle and upper class families and birth begins to move to the hospital.
1853: Queen Victoria used Chloroform during her 8th birth.
1860’s: Suffragists were interested in improving maternal health: Death during childbirth was responsible for 30% of deaths among females of childbearing age. Use of pain medication also became a modern way to approach birth without pain and the way women wanted to give birth – the use of pain management in labor was a feminist issue.
1865: Chemist Justus von Liebig developed the first formula, made from cow’s milk, wheat, malt flour, and potassium bicarbonate. The first formula was developed in liquid form and then in a powdered form for longer shelf life. This formula was considered the perfect infant food.
1900: In the United States, most babies were born at home (90-95%) and most of were attended by midwives.
1900: The National Twilight Sleep Association was formed in order to support the use of a new maternal anesthesia brought to the US by Dr. Carl Gauss. The anesthesia, a combination of Morphine and Scopolamine was used in Europe for a short time, but did not become as popular as it did in the US.
1914 – 1945: Twilight sleep used routinely in response to the movement against pain during childbirth. The drugs used, morphine and scopolamine, caused women to lose their inhibitions. They would have no memory of their labor and birth, nor were they conscious of what was happening. When taking these medications, women became uninhibited and psychotic. They would thrash about on the bed, causing injuries to their heads. They would scream throughout labor. They would attempt to claw at the walls or their medical providers. In order to prevent injury, their heads were wrapped with blankets or towels. They were put in straight jackets or their wrists were strapped to the beds with lambs wool. Then, so they would not fall out of bed, they were put in ‘labor cribs’ and were left to labor, tied down, until it was time to birth. The women had no memory of this. The drugs also affected the baby, and caused some mothers to die in childbirth. However, birthing people reported satisfaction with their twilight sleep birth experiences, and the procedure continued to gain popularity throughout the mid 1940’s.
1901: Dr. Josephine Baker was appointed as city health inspector for Hell’s Kitchen, NY. In this role, she found that 1,500 newborn babies died in the district every week. In order to improve maternal and child health, she improved prenatal care and child health practices, opened clinics, launched a school lunch program, trained babysitters, and opened milk stations. These changes resulted in a significant decrease in infant and child mortality.
1905 : The first maternity clothes were introduced: The use of confining clothes are no longer used during pregnancy.
1908: The American Red Cross begins offering formal childbirth education.
1910′s: Low horizontal cesarean sections significantly decreased infection and ruptures.
1920′s: Birth moved from home into hospitals for those who could afford hospital care.
1930′s: Births become split 50/50 between hospitals and home, and the number of births attended by midwives drops to 15%.
1932: Grant Dick-Read wrote Natural Childbirth, followed by Birth Without Fear in 1944. These books called for a reduction in women’s fear around birth, a call to physiological birth, and began the modern childbirth education movement.
1951: The first commercial infant formulas are available in stores and rapidly became a popular alternative to feeding from the chest.
1955: Dr. Friedman develops Friedman’s curve: A generalized chart for labor progression that is still used today.
1955: 95% of births occur in US hospitals. Birthing people are seperated from family who remain in the waiting room. The birth experience begins with a prep room where the birthing person is shaved and given an enema. The birthing person is then moved to a labor room, where sedation is used. When the birthing person is ready to birth, they are then then transferred to a sterile delivery room, which resembles an operating room, where the birthing person gives birth and is then transferred to a recovery room. The birthing parent is is separated from the baby to prevent infection for 10 days post birth. After birth, they are transferred to a maternity room where they stay for ten days post birth, until the birthing person can return home and be reunited with the newborn.
1956: La Leche League has its first meeting. Breastfeeding rates are at an all time low.
1960: Elisabeth Bing founds Lamaze International
- Episiotomies become routine.
- Laboring people no longer allowed to consume any food during labor.
1965: Dr. Bradley writes Husband Coached Childbirth and The Bradley Method is formed.
- Fathers were allowed in the delivery room.
- Continuous fetal monitoring was introduced and becomes widely used.
1979: 99% of all births take place in hospitals.
- First large scale randomized studies of electronic fetal monitoring were released showing no benefit to electronic fetal monitoring.
- Childbirth Summit is held and Coalition to Improve Maternity Services (CIMS) is created.
- Vaginal Birth After Cesarean (VBAC) increased from 12.6% to a peak of 28.3%.
1992: DONA (Doulas of North America) was formed and began certifying doulas for labor support.
- WHO Guidelines support keeping baby with mother after birth to support skin to skin contact and immediate breastfeeding.
- Some hospitals have an epidural rate of 90% – with epidural use in the United States hoving at about 70 percent.
- Vaginal Birth After Cesarean safety is questioned and the rates plummet.
- More birthing people start seeking out alternative or midwife-assisted birth options (birth center, homebirth) in response to the rapidly increasing intervention use and C-Section rates.