Childbirth: Past, Present, and Future

Content Warning: This post discusses medical complications, a history of medical interventions in birth, medical racism, non-consensual and experimental surgeries on Black women, and violence against women in a historical context.

Birth is a normal, physiologic process. There is, however, the potential for complications to develop. Until recent history, there were very few options for managing them. In extreme cases, the interventions that did exist did not allow for the survival of both birthing person and baby. Early cesarean sections were done in an attempt to save the baby, while early versions of tools, like forceps (and others), were used in an attempt to save the mother or individual giving birth. Thankfully, many improvements have been made throughout recent years. As much as we lament the overuse of obstetrical interventions in today's world, they can be life-saving.

Cesarean Birth

In 1508, a Swiss pig farmer named Jacob Nufer is said to have performed the first cesarean section where both mother and baby survived. His wife had been in labor for days, and using his expertise in pig anatomy, decided the only option was to attempt this dangerous procedure. Mrs. Nufer supposedly went on to successfully deliver more children. The accuracy of this possibly tall tale is up for debate, as the odds of both mom and baby surviving this type of operation wasn't likely until the late 1800's.

In pre-colonial Africa, cesarean sections were performed in some societies, although the exact methods and frequency varied across different regions. These procedures were often conducted by traditional healers or experienced midwives using rudimentary tools and herbal remedies. While specific historical records are limited, accounts suggest that cesarean sections were sometimes performed as a last resort to when vaginal birth was not possible.

James Barry was a fascinating figure in 19th-century medicine. Born Margaret Ann Bulkley, Barry lived as a man to pursue a career in medicine, as women were barred from studying and practicing medicine at the time. Barry's life and work challenged traditional gender norms and contributed significantly to advancements in medical practice, including performing one of the earliest recorded successful cesarean sections in Africa (by a European). Barry's legacy highlights the complexities of gender identity and the barriers faced by women in the field of medicine during the Victorian era.

If you want to learn more about James Barry, there’s a great podcast episode on this:

🎙️ Dr. James Barry- The Medical Pioneer with a Secret! (Episode 68) | Who Did What Now

Success rates greatly increased in the 1900's for several reasons. More people were living in urban environments and lacked access to nutritious foods, and cases of rickets, a bone disease, increased because of malnutrition (mainly from a lack of vitamin D). This disease causes bone deformities, which can severely limit the size of the openings in the pelvis. Because it was difficult or impossible for those suffering from rickets to safely deliver a baby vaginally, the need for cesarean sections greatly increased. At the same time, more people were delivering in hospitals, the use of anesthetics was increasing, and infections were on the decline.

Forceps

In the late 1500's, Peter Chamberlen designed the first set of forceps that allowed for the safe delivery of a baby stuck in the birth canal. These tools were shrouded in secrecy, protected by many generations of the Chamberlen family. Sharing the details of these life- saving forceps could have saved many more lives, but the Chamberlen family did not want any competition. In 1813, the Chamberlen forceps were eventually discovered beneath a trap door by the new owners of a home previously occupied by one of the members of the Chamberlen family. The design continued to be improved upon, and forceps are still in use today.

Anarcha, Betsy, and Lucy

In the 1840’s, J. Marion Sims performed experimental surgeries on enslaved Black women without consent and without anesthesia. We know three of their names: Anarcha, Betsy, and Lucy. But there were more. In spite of how inhumanely he treated these women, J. Marion Sims went on to be recognized as the Father of Gynecology. Recently, there has been a push to lift up Anarcha, Betsy, and Lucy as the Mothers of Gynecology, as many advances in this field are a direct result of their suffering. A statue of J. Marion Sims that was erected in Central Park has been taken down. Even so, today, Black birthing people are 3-4 times more likely to die of a pregnancy-related issue. Removing a statue is a start, but so much more needs to be done to reduce existing health disparities.

🔗 Remembering Anarcha, Lucy, and Betsy: The Mothers of Modern Gynecology | NPR

Managing Pain

Childbirth is notoriously considered to be painful, and Eve has taken much of the blame for this as a result of eating that apple in the Garden of Eden. This Bible passage (Genesis 3:16) has had a significant influence throughout history on how the pain experienced in labor and birth is viewed:

Unto the woman he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children; and thy desire shall be to thy husband, and he shall rule over thee.

It has been thought by many that those giving birth must suffer for Eve's sin, and there are even stories of people (both birthing people and midwives) being burned at the stake for their desire to lessen the pain of labor and delivery. It wasn't until Queen Victoria of England used chloroform during the birth of her eighth child in 1853 that attitudes began to change.

While chloroform did help with pain, it came with some dangerous side effects. Also, it could only be inhaled just prior to the pushing stage, because it could slow or stall labor if given earlier. There was a desire for something better. Word spread of a new method of pain relief being used in Germany called Dämmerschlaf, or Twilight Sleep. Doctors injected a combination of scopolamine and morphine into a laboring person, who would later wake up with a baby in their arms. There would be no memory of the pain or the birth. People were thrilled to hear of this option of a "painless" birth, so they pushed for it.

At first, according to Tina Cassidy in her book, Birth: The Surprising History of How We Were Born:

...American obstetricians were still alarmed. They knew that Twilight Sleep newborns did not always breathe immediately, that some mothers still felt the pain, and that there was a great risk of stalled labors and postpartum hemorrhaging. On top of that, they were aware of the seedy underside of Twilight Sleep, the side that injected women did not remember: the thrashing, the helmets, straightjackets, and wrist cuffs mothers were forced to wear for protection... One doctor said his screaming patient could be heard four floors down.

Twilight Sleep eventually became the standard, despite the initial concerns, and remained so in some U.S. hospitals until the 1970's. First-wave feminism was on the rise. Women were fighting for the right to vote and for the right to a painless birth.

The birth process had dramatically transformed in a very short time. Less than 5% of people gave birth in hospitals in 1900. The small percentage that did were very poor and/ or lacked a support system, and the outcomes were not good. It was much safer to give birth at home with a midwife. A doctor-lead smear campaign against midwives (unfairly calling them uneducated and unsanitary), improved sanitation (meaning less infections), and a desire for pain relief led to almost 90% of people giving birth in hospitals by 1950.

This wasn't the only major change, however. For most of history, those in labor were attended to by female midwives and a support system of other women in the family or community. Men had very slowly started to enter the birth scene with the introduction of the various interventions described above, but the shift from home to hospital quickly led to the rise of the male obstetrician and the decline of the female midwife, midwives of color, and Indigenous midwives. Less than 10% of births today are attended by midwives and the vast majority are white. And so much knowledge has been lost.

Natural Birth Movement

When the pendulum swings too far in one direction, there are usually calls for change. Not everyone wanted a birth they couldn't remember, but those that wanted something other than standard were met with resistance. Dr. Grantly Dick-Read, an English obstetrician and author of Childbirth Without Fear, is considered to be the founder of the natural birth movement. He believed that reducing the fear of childbirth would reduce tension and, therefore, pain (science now backs up this claim).

Dick-Read wasn't the only big name in the world of natural birth. We can thank Dr. Fernand Lamaze of France for influencing the rise and importance of childbirth preparation and education. The patterned breathing techniques he developed are still synonymous with childbirth even today.

Dr. Robert Bradley developed the still popular and successful Bradley Method of Childbirth Education, and is a major reason why husbands/ partners gained entrance into the labor and delivery room. Prior to his push for husbands as childbirth coaches, they were forced to just pace nervously in the waiting room.

Dr. Virginia Apgar, an anesthesiologist, developed a test in the 1950's (which is still in use today) to assess the condition of newborns, because she was noticing the negative effects of Twilight Sleep on babies. She found that babies born unmedicated had the highest scores on average.

Dr. Michel Odent of France has been a leading advocate for waterbirth.

In the 1970's, Ina May Gaskin created The Farm Midwifery Center (one of America's first birth centers) on the commune she founded with her husband in Tennessee. Also the author of important books, like Spiritual Midwifery and Ina May's Guide to Childbirth, she has been a major influence on the renewed interest in home birthing and midwifery. Because of the very low rate of interventions used and the great outcomes for mothers and babies at The Farm, she proved that this “alternative” way of giving birth was safe. Birth had become so clinical and medicalized with the rise of hospitals and obstetricians. She has helped many birthing people to realize that birth can be a very spiritual, empowering, and transformative process.

Jennie Joseph and her JJ Way® Model has been:

…effective in reducing disparities and improving outcomes because it operates from the premise that every woman wants a healthy baby and that every woman deserves one.

Despite the natural birth movement, most people today still give birth in a hospital with an obstetrician. Epidural is the most popular form of pain management in the United States. Though there are risks and side effects, it is an excellent choice when compared to the options that existed for women in the past. We now have research and studies to show which birth practices are effective and safe and which are not. Sometimes the evidence has a major effect (episiotomies, perineal shaving, and enemas used to be routine but no longer are), and sometimes it doesn't. VBAC (vaginal birth after cesarean) is still not allowed in many hospitals, despite being proven to be a safe option. Inductions are still being done for convenience, the cesarean section rate is too high, and continuous electronic fetal monitoring is still routinely done, despite evidence showing it fails to improve outcomes. 

Childbirth of today should center the birthing person as decision-maker and respect it as a transformative (versus viewing it as predominately a medical) event. Unfortunately, many of us still experience obstacles. Birth is not always quick; it doesn't always happen at a convenient time. Care providers are busy and hospitals desire efficiency. Insurance companies can limit the choice of care provider and location, and fears of malpractice have an effect on the overuse of interventions. And birthing people of color (especially Black birthing people) are experiencing worse outcomes that can be directly attributed to racism. Childbirth education, proactive preparation, choosing the right care provider, and supportive, trained labor support people (called doulas) are the best defense against unwanted and unnecessary interventions. It is, and has always been, difficult for those that desire a type of birth that isn't the standard. 

In the future, I hope expectant families will truly have a full range of options, including access to trauma-informed care, and will no longer have to battle against routine practices that aren't supported by evidence. More BIPOC birth workers are needed in order to reduce racial disparities. Maybe someday there will be more options for families interested in out-of-hospital birth, and hopefully hospitals will be set up as well for those who don't want or need to labor in bed as for they are for those who do.

Fortunately, there are birth workers taking action right now to lead this shift. You can read more about some of them here:

🧭 Shifting the Zeitgeist: Challenging the Status Quo in Maternity Care

References

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