I discovered an article, “Trends in Obstetrics” from 1950 in the Journal of the American Medical Association (or JAMA). It was authored by two doctors from the Boston Lying-In Hospital, Duncan E. Reid and Mandel E. Cohen. Some of the trends they discussed may surprise modern readers/listeners because they are still hot button issues today: for example: natural childbirth.
They discuss the arguments about pain in childbirth and the idea that women in less industrialized cultures and more “natural” environments have easier, safer births, and faster postpartum recoveries– and less trouble bonding with their babies. The authors also consider the psychological consequences of nursery vs rooming-in, bottle vs breast, and prenatal influences on health and happiness of the child. And they give their conclusions about whether modern maternity hospitals should adopt or promote particular practices concerning these topics.
Discussion
When I first started looking into what I call baby history (culture and history), it was focused on childbirth. I had been recommended the book “Birth as an American Rite of Passage” by Robbie Davis Floyd by a woman I babysat for. From that I found “The American Way of Birth” by Jessica Mitford.
Through authors like these and internet chat boards, I learned about alternative childbirth communities, including the so-called “unassisted birth” community, in which women with access to healthcare nevertheless rejected prenatal care and medical assistance for childbirth. Some were more committed to the unassisted bit than others, with some going to a conventional obgyn for prenatal care with all the conventional tests and exams but intending to accidentally have the baby alone at home, with or without their partner, friend(s), family, etc. before going to hospital for postpartum care. Others were fully unassisted, even eschewing prenatal vitamins as an unnatural interference. But the one thing all of them had in common was the veneration of the book, Birth Without Fear.
It was surprising to me to find references to it in this article, within a decade of its publication, that it had been acknowledged and rejected by conventional obstetricians as having no basis in reality, no evidence, and no data to support any of the claims made about pain in childbirth or how less civilized people had easier births. Yet by the time I was coming of age, fifty years later, online natural birth communities were celebrating the book with an almost religious furor (and still are).
I still come across a lot of misinformation about childbirth being easier in indigenous (that’s the word used in place of “primitive” these days) cultures because they are more natural (read: poor), despite loads more observations and data proving that it most certainly isn’t. I wonder if this misinformation portraying the births of poor women as an ideal of natural childbirth has resulted in the neglect of maternity care for indigious communities and developing nations.
Reid and Cohen’s reference to the higher mortality rates for black women in the United States was so important not just with regards to ideas about natural childbirth but also the problem (and it was seen as such at the time) of racially segregated hospitals in areas where there weren’t materntiy hospitals for black women. Either one can face the fact (supported by data) that lack of access to “modern” obstetric care during pregnancy and childbirth increases the risk of death to mother and baby, or one can ignore it and pretend that the experience of those without access to obstetric care have easier, pain free births from which they recover quickly.
A soupçon of hypocrisy
The thing that stuck out the most to me was the last section, “methods of the conduct of labor”, where they defended the use of routine episiotomy. Throughout the rest of the article they made an effort to be rational critical thinkers, to make a point of not confirming their bias but looking for evidence and determining where more data is required. They had even admonished those who used threats of risk for not choosing a particular method, when it came to pain relief in labor, rooming in and feeding, as it could frighten new mothers. But then there’s the episiotomy– they posit that an intentional cut at the right time with the use of low foreceps would prevent the “demolition” of the pelvic floor and prevent permanent brain damage of the fetus from a non-operative second state of labor. No evidence was provided comparing the pelvic floor health and rates of brain damage to children between these methods of labor.
For decades following this article, the majority of women who gave birth in the US experienced routine episiotomies (meaning they were done because a woman was in labor not because the individual case had medical indications). Research has now show that episiotomies, increased risk for 4th degree tears and did not preserve pelvic floor health, and did not improve outcomes, nor reduce labor time by a significant margin. An retired obstetrician explained it to me: a straight line, however severe it became, was easier to stitch up than a bunch of less severe “ragged” tears– it was about their post partum efficiency.
Prenatal Influence
Today we know from studies that maternal emotional stress does influence the fetus, affecting brain development both during gestation and in early childhood. This is obviously a shame in terms of human suffering and limiting of potential but when the news got ahold of these studies they used the word “harm”– that maternal stress harms her baby.
One could argue that those headlines were harming the unborn by stressing out their mothers. But with anthropology we can shift the perspective, if a mother is pregnant during a time of stress, in a dangerous environment, it only serves to protect the infant to be born adapted to stress, if the world they are being born into is actually hostile– rather than mom being on Real Housewives of Dramatown.
Just as an aside: I see a lot of fear mongering about people being shaped by the events of their lives, as though the ideal is to have no experiences, no individuality. We are products of our biology, our culture, and of our times. And we are resilient and able to learn, grow and heal from traumatic experiences– and sometimes positive events are traumatic, giving birth is a great example. Our experiences and our reaction to them make us unique and provides humanity with diversity of thought.
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Reid, Duncan L. and Mandel E Cohen. 1950. “Trends in Obstetrics.” JAMA 142(9)
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