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A natural process? Women, men and the medicalisation of childbirth

Smellie-type obstetrical forceps, England, 1701-1800

Smellie-type obstetrical forceps, England, 1701-1800

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Childbirth was once ‘women’s business’: women assisted births as well as bearing children. Midwife, from the Old English, literally means ‘with woman’. Before the 1700s childbirth was customarily a domestic event, attended by female friends, relatives and local women experienced in delivering children. It still is for much of the world.

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The beginnings of new birthing practices

A more technological approach to childbirth gained momentum in Europe and North America throughout the 1700s. Professional medical men were the focus. Over time female midwives lost status and came to be portrayed as unenlightened, unhygienic and entwined with superstition and folklore. Contemporary accounts such as the diaries of midwife Martha Ballard are more positive, but she noted fundamental shifts in childbirth practice. Modern obstetrics is a hi-tech hospital-based speciality of men and women. Its origins are the appearance of so-called man-midwives.

Women dealt with straightforward births. However, male physicians were often called when complications needed physical intervention. They often carried destructive instruments to remove dead, obstructed foetuses. There were also instruments to assist live births. The origins of the obstetric forceps lie with the man-midwives of the secretive Chamberlen family, as do the origins of lesser tools such as the vectis, fillet and ventouse.

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The most influential early man-midwife in Britain was William Smellie. He was a leading teacher of obstetrics, midwifery and forceps use. Despite growing professionalisation, man-midwives only found real respectability in the early 1800s, when they gained approval among the upper classes. Families who could afford their fees increasingly ‘called for the doctor’, invariably male. Female midwives became unfashionable, outmoded and associated with the poor.

Female midwives voice their opposition

This gradual shift was criticised. Martha Ballard recorded her displeasure, and English midwife Sarah Stone complained about ‘young pretenders’. These were men who took credit for success but blamed women when things went wrong. Many maternal deaths from puerperal fever were the result of overzealous interventions by forceps-wielding man-midwives.

The ideal of a ‘normal’ birth

Obstetrics had not developed significantly by the early 20th century, despite these changes. The majority of births were still at home, attended by midwives. However, obstetricians began defining ‘normal’ standards for childbirth as the century progressed. This was in keeping with drives for standardisation in the wider medical world. The epitome was Friedman’s curve, developed by Emanuel Friedman, a graphic representation of a ‘normal’ labour. Deviations from normality were seen as reasons for medical intervention, and childbirth became an ideal sequence of events to be monitored and managed.

Childbirth moves to the hospital

The ideal environment to monitor, manage and potentially intervene in childbirth was the hospital. In the 20th century childbirth in the developed world moved from the home to the hospital. Home birth rates fell to around 1% in the United Sates by the late 1970s.

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Associated with this new birthing space were childbirth technologies. Hospitals provided a hi-tech, highly medicalised birthing experience. The measuring of foetal heart rate became key to clinical decision-making. The hospital also gave greater options for pain relief, such as the epidural anaesthesiaCaesarean sections embody this change; once a last resort, they are now commonplace.

The desire for a more natural process

This clinical vision of childbirth has met with a recent backlash, resulting in more hybridity in practice. For example, medicalised foetal heart monitoring might occur alongside ‘natural’ pain relief provided by a water birth. In the UK women are again central to childbirth, and midwives are active both in the hospital and other contexts. Home birth rates and the use of female-midwife-managed birthing centres have modestly increased.

Bibliography

E van Teijlingen et al. (eds), Midwifery and the Medicalization of Childbirth: Comparative Perspectives (New York: Nova Science, 1999)

P L Brodsky, The Control of Childbirth: Women Versus Medicine Through the Ages (London: McFarland & Co., 2008)

J Donnison, Midwives and Medical Men: A History of the Struggle for the Control of Childbirth (London: Historical Publications, 1988)

P Rhodes, A Short History of Clinical Midwifery: Development of Ideas in the Professional Management of Childbirth (Hale, Cheshire: Books for Midwives Press, 1995)

M Tew, Safer Childbirth? A Critical History of Maternity Care (London/New York: Free Association Books, 1998)

C Hanson, A Cultural History of Pregnancy: Pregnancy, Medicine, and Culture (Basingstoke: Palgrave Macmillan, 2004)

 

Glossary:

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