Separating Fact From Fiction When It Comes to Non-Hospital Births

3 years ago
This article was written by a member of the SheKnows Community. It has not been edited, vetted or reviewed by our editorial staff, and any opinions expressed herein are the writer’s own.

In 1833, the respected midwife Veronika Paul was summoned to the bedside of a laboring woman after the local midwife required help. Paul examined the mother whose baby was trying to come out sideways, a rare and difficult transverse lie.

The skilled midwife assured the worried family she had supervised many similar births. She finagled one of the infant's hands through the vagina. Next, she pulled. And pulled. And pulled. She tore the infant's arm off, leaving its body inside the mother. The mother, and presumably her baby, died (80).

Thankfully, this horrifying story wasn't typical, but for most of human history, death or mutilation from childbirth was the experience of a "sizable minority." A mother's chance of avoiding this depended on the skill of her birthing attendant and on the medical procedures at her disposal.

Image: Gabi Menashe via Flickr

Contrary to myth, traditional pre-medicalized childbirth was not the beneficiary of millennia of received wisdom. It was often the stomping ground of incantations, brutal interventions, un-repaired tears, uncontrollable hemorrhaging, and possible death.[2]

This post is not a diatribe against midwives. Heck, my first two children were delivered by certified nurse midwives and my mother-in-law is a certified nurse midwife (not to be confused with midwives without medical training).

Ignorant or foolish doctors of the past also maimed their patients. In fact, as doctors took over childbirth in the first decades of the twentieth century, maternal mortality increased![3]

Therefore, this post is not about midwives versus doctors. It is about dispelling mythology, about critically examining the folklore of birth as natural and uneventful, about questioning the impetus to cast the medicalization of childbirth as a greedy, patriarchal villain who slapped us on our backs, gave us pain relief, but cut us open as the compromise.

Traditionally, birth could be scary, disfiguring, and complicated. True, a majority of the time, women didn't die in childbirth. Their babies didn't die. But, other uncountable unlucky women did encounter ghoulish dilemmas and their after-effects.

I focus on this sizable minority because they represent real women whose lives were cut short, whose babies were killed, or who spent the rest of their years battling infections, prolapse, even fistula.

As you have probably surmised, this topic is one of my "buttons." I try not to get worked up about too much involving postpartum bodies or the mommy wars: Not about boobs and what comes out of them, not about what kind of diaper you use, not about whether you carry your 15 year old in a sling. Nope. Not going there.

But historical myth making? That gets to me. Therefore, indulge me my soapbox for a moment.

Why is this topic important to me?

1) I would have been one of those sizable minorities. You can read my story here. Honestly, I'm still part of the sizable minority today. I have repercussions from childbirth that most women don't face, but at least I live now.

I am incredibly lucky to live in this "over-medicalized" time, and I reject protestations that we should always trust the female body and its instincts. Nope. Sometimes Mother Nature can be a b-t-h.

2) I am a former student and forever fan of history. I didn't pursue history for my graduate studies, sometimes I wonder why (oh right, jobs), but I did major in History at Gettysburg College and have incredibly fond memories of searching through primary sources, working in special collections, listening to the microfilm scroll, deciphering 18th century newspapers, and breathing in the musty historical societies (And later, if you ever visited Boston's Otis House, yours truly could have been the oh so exciting docent).

History is amazing. It is also contentious and misused. I can't pretend to be a historian. Undergraduate studies do not a historian make. I don't mention my long ago past to throw around credentials I don't have. Instead, I merely describe the tunnel through which I view myth-making.

History is not dumped in our laps. It is molded; it is analyzed; it is created. Interpretation and disagreement are par for the course. But, it shouldn't be a propaganda crutch for present day agendas.

3) I'm kinda annoyed about my 3 months of Bradley Classes. Over time my memory of those classes has morphed from enthusiasm, to ambivalence, to bafflement. Much of the information was fine, but much was misleading.

The details don't matter. Rather, I mention it because it represents a particular popular viewpoint, a vision of birth that criticizes present day hospitals as somehow denuding childbirth of its inherent safety and beauty.

In this version of history, hospitals stand in for patriarchy and traditional childbirth represents a lost feminism.

I don't care how other women give birth. I really don't — other than wanting birthing practices to keep mothers and babies alive and to not cause pathological postpartum bodies. My main concern is with mythology. Mythology that seeps into our new mom brains and makes us feel bad about our birth story or makes us romanticize a past that never existed.

As far as I'm concerned, medicalizing childbirth has been the greatest feminist success of our time.

To be clear, even most modern home birth in the developed world is a form of medicalized birth because a distressed mother is moved to the hospital. The hospital is always waiting in the wings, assuming the home birth midwife knows what she is doing.

If you plan for a home birth, you actually have more than a 1 in 10 chance of going to the hospital. Look at impoverished undeveloped countries to see what un-medicalized, traditional childbirth really looks like.

Your birth plan is a privilege

Being able to make a birth plan is the result of modern medicine. Let me repeat that. Being able to give a rat's ass about how you give birth is the result of approaching birth from a place of excitement rather than a place of dread.

In other words, a birth plan is evidence that in this microsecond of human history we are at a place of profound progress for the birthing mother and her baby.

This doesn't mean all present day hospital births are good. This doesn't mean all c-sections are necessary. This doesn't mean certain hospital rules and regulations shouldn't change. I'm not wading into that debate right now.

All it means is we must be skeptical of a folkloric past invoked to counter the modern medical establishment. That past was dirty. It was a breeding ground for infection. It was the time of old wives' tales that could kill the mother.

It was the time of putting a hook into a baby's head to pull it out (called embryotomy, done by doctors and midwives) (86). It was the time of uteruses dangling from un-sutured perineal tears, etc...

Despite the popular naturalist refrain, hospitals didn't steal women's autonomy. It is reductive to say hospitals were patriarchal institutions trying to medicalize the natural and rip childbirth out of women's hands.

Childbirth was never in their hands. They weren't making choices. They were trying to not die. Choosing a hospital was perhaps the first choice many women had about childbirth. It is a sad irony that this choice at the wrong time in history could have been deadly.

Nonetheless, before this choice, women weren't trusting the ingrained knowledge of their bodies in some sort of pre-industrial birthing bliss. Before the hospital became a safety net, traditional birth was not inherently empowering.

Even if most women didn't die during traditional childbirth, most women knew of someone who did. Death was in the air. Every time a woman gave birth, which was more than most of us, she faced those possibilities.

For example, before 1800, a women who had 6 children had an 8% lifetime risk that she would die in childbirth (98). That might not seem like much, but it is. Childbirth was the second leading cause of death for women in their childbearing years. (Second to tuberculosis. That reminds me, did you get your TB test?)

As childbirth became medicalized, yet still unregulated in the early 20th century, it actually became more deadly. That's tragic. However, beginning in roughly the mid 1920s, as the medical establishment began to clean up its act, the maternal mortality rate plummeted.

Therefore, the reduction in the maternal death rate in the early and mid twentieth century cannot be extricated from medical advances.[4]

In the developed world, we are history's lottery winners. I say this as someone who has reservations about my birth experiences, who still faces the repercussions of large children, who might need surgery in the future. Nonetheless, I am lucky, and I refuse to romanticize the past.

Instinct isn't innate

Eventually, the midwives and doctors with the best training and knowledge of the female body helped make birth safer. Instinct did not. The instinct of many untrained midwives, who did the majority of rural births, was to pull as hard as they could on anything that presented itself (79).

Let's abandon the image of the "granny midwife" patiently letting the uterus do the work, calmly helping the mother birth down, or eschewing interventions.

No. Some were literally pulling off heads and limbs. Many were tugging on placentas so forcefully that the uterus came with it. They were intervening when they shouldn't and throwing up their hands when they should have been intervening. They were trusting their "instincts."

Ultimately, instinct is a misnomer. Instinct isn't innate. It is culture. When we say instinct, we really mean received wisdom, and sometimes received wisdom is awesome, but sometimes it is dumb. Science helps separate out the two.

Your shampoo isn't "toxic"

Again, I won't pretend early hospitals were glorious improvements for all aspects of childbirth. For example, close quarters could be swift breeding grounds for infection. Remarkably, only in the last 75 years or so have our infection expectations changed. It was everywhere.

Even home births were petri dishes and about 4% resulted in a serious infection for the mother. (Before asepsis took off in all levels of society, mild infections were actually considered normal) (107).

Therefore, when thinking about historical birth, we should imagine the microbes creeping into the mother's body, causing death or permanent discomfort and pain.

If you spend sleepless nights worrying your shampoo is full of "toxins," you are fretting over a #firstworldproblem. (I'm also a product of the first world because I once spent hours making homemade "nontoxic" deodorant. It smelled lovely, but did little for my own stink.)

Real toxins arose from decreased oxygen to the tissues in the cervix and vagina, or from the poking and prodding hands of the doctor or midwife, or from contact with another infected person.

Anaerobic and aerobic toxins were carried throughout the poor mother's body. Keep in mind, the prevalence of infection was "a state of affairs that had always existed" (122). Infection was normal. If it didn't kill the mother a couple weeks after birth, it could cause smelly vaginal discharge, pelvic inflammatory disease, and pain throughout the entire body.

From resignation to choice

Women were fatalist about the risks of childbirth. Edward Shorter argues, "Traditional mothers accepted obstetric risks with the same fatalistic resignation that villagers displayed toward all risks they felt themselves unable to control, such as hail, plague, and war" (160).

Once doctors and midwives began advertising their new techniques (including forceps, episiotomies, pain relief, and c-sections), this resignation turned to choice. And once the c-section became a relatively safe and viable option in the 1920s, women increasingly turned towards the hospital based doctors and away from traditional midwives.

Today, many birth advocates see this move from traditional midwives to male hospital based doctors as patriarchy writ large, as evidence of decreasing autonomy for mothers, as a historical mistake. I agree and disagree. It's my blog post. I'm allowed to do that.

For many women, it was a mistake. Hospitals were pretty deadly at the turn of the twentieth century. However, hospitals with their male doctors weren't caricatures of capital P patriarchy. Sure. Patriarchy isn't absent from the story. The doctors were men. That's because they were afforded the education and opportunities.

From this standpoint, all of medicine and science and innovation is capital P patriarchy. Unfortunately, this outdated and decades old feminist interpretation overlooks the burgeoning autonomy of the women who chose the hospitals. Women weren't always bamboozled into hospitals. They went willingly.

Hospitals were often way too interventionist. Some early pain medicine was itself deadly. And episiotomies were certainly overdone in routine childbirth, but jeez louise, at least they were sewn back together. Before modern medical care, a woman could tear through to her rectum and the midwife would leave it. Or maybe not. Luck of the midwife draw.

Hospitals didn't represent perfection. Of course not. But they did represent the first step towards progress, progress that has been remarkably swift in the context of women's historical birthing experience.

Eventually, doctor training improved, dangerous techniques were abandoned, and regulatory boards stepped in. Traditional childbirth — free from doctors, from hospitals, from pitocin, from c-sections, from epidurals, from monitors, from unfeeling and authoritarian medical staff — that childbirth was not folklore's empowering feat.

It was a crapshoot. Let us never forget that.

"When, therefore, we repeat the truism that 'most births are normal,' let us remind ourselves that the substantial minority that are not could entail death or mutilation for the mother." ~Edward Shorter[1]

  1. Edward Shorter, A History of Women's Bodies, New York: Basic Books Inc., 1982, 88. All in-text citations are from this book. The information for this post has been gleaned from Shorter's thoroughly researched work. It is an old book, almost as old as me, and some might argue outdated. Although portions referring to the present day birth experience clearly are outdated, the book is mostly about primary materials from the 18th and 19th centuries. I don't agree with all Shorter's conclusions or theses, but the source material is intriguing, devastating, and well researched.
  2. Midwives were childbirth attendants for much of history. I'd like to note that pre-medicalized or "traditional" midwifery is not the same as standardized and highly trained midwifery. Many urban midwives were well-trained and associated with hospitals or medical establishments. In this respect, they were usually more similar to the doctors of the time period than to the traditional rural midwives. Indeed, often they were better equipped for emergency situations than male doctors. However, even the best trained urban midwife was unable to perform a safe c-section or vaginal operation before the rise of hospital births.
  3. Laura Helmuth, "The Disturbing, Shameful History of Childbirth Deaths," Slate, Sep. 10 2013.
  4. Helmuth

Read more from Meredith at Motherfigure. You can also follow her on Twitter or like her Facebook page.

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