If you are scared of the idea of birthing you aren’t alone! Nearly 80% of mothers express fears about their pregnancy of upcoming birth. I know I did when I entered the third trimester with my first born. The thing is, we know that birth is a natural and normal process that our bodies are made to do. So, why are so many people afraid?
There are a lot of reasons for this fear and most of these reasons were created by society and aren’t the result of a problem with our bodies. The fear and the problems with birthing come primarily from a history where our bodies and minds were undermined and the process of birth thwarted by those in power who thought their way was better. As our world explored and created medical advances, it often came at the expense of the mother and child.
Hopefully, by understanding the history, perspective, and approach to birthing that is currently dominating birth, we can now choose if that’s what we agree with and want or if we want a different approach. I believe how we birth and see ourselves as birthers has to do with how society and culture view us and our role in the world. Below I’ll do my best to highlight historical attitudes and practices of birthing to give you a sense of context and understanding for how we’ve gotten to where we are at present. Perhaps then you can gain a new perspective about how we are viewed (and view ourselves) and why so much fear exists so that you will be better able to choose how you truly want to see yourself and what you are capable of. This can help inform the actions you take to prepare for birth so that we can take the best of medicine with the power and strength of honoring ourselves and our needs.
“Fish don’t know they‘re in water. If you tried to explain it, they‘d say, “Water? What’s water?” They‘re so surrounded by it that it’s impossible to see. They can’t see it until they jump outside of it.” Derek Sivers
Biblical Era
We have to begin somewhere and since this needs to be fairly brief, let’s begin with the Bible, a text that has undoubtedly shaped much of our collective thought here in the West whether you follow the doctrine or not.
There is a well-known passage in the Bible, after Eve ate the apple and is being punished, in which God says:
“I will greatly increase your pains in childbearing; with pain you will give birth to children…”(Genesis 3.16)
The childbirth experience was, in effect, a punishment for the sins of women and women were to be punished with physical pain. A more recent examination and translation of the same passage shows that it is the mental anguish not the physical punishment that birthers must endure that was decreed by God.
““I will greatly increase the anguish you will experience in the birth process, from the anxiety surrounding conception to the strenuous work of giving birth.” This cannot be viewed as an imposition of labor pains.” – John H. Walton
If you have children then you know these worries, fears, and anguish well. The punishment also speak to the strenuous work. Our body can certainly do strenuous work, our mind is what limits what we are capable of. Do we give up or keep going? Yet this mental challenge has been interpreted as physical pain and well, there’s an epidural for that, but that isn’t the challenge at all is it? We need to prepare for the mental challenge, which has been left out of the story by a translation and simplified to make us more like animals than the conscious thoughtful beings we are. (https://zondervanacademic.com/blog/pain-in-childbe).
In another passage (Levitivus 12:1-8), Moses is instructed by God to declare women “unclean” following birth and establishes prohibitions on new mothers during a period of “purification” in which she must not touch anything holy or enter the sanctuary. So, first we are supposed to have to suffer physically then be shut away as dirty? Birthers were certainly not revered for the amazing feat of birthing, but reduced to second class citizens. This is not a very dignified view of women and birth, which we can see continued into the birth of obstetrics, as we’ll get to shortly.
Pre-medicine
Throughout western history, women didn’t have a lot of power over their bodies and reproductive rights. They were considered the property of men and were blamed and shunned if they began pregnant outside of wedlock, even if it was against their will. When it came to birthing, most villages had a midwife that was most often held in high regard. Midwives were experienced in birthing and were an important part of everyday village life. When it came time for birthing, the birther knew the person helping her and was at home, in a familiar place. We know that feeling safe and cared for helps birth move along more easily because of the beneficial hormones that can flow in states of relaxation. However, the downside during this time was that while many of these midwives probably had herbal knowledge, while helpful, they didn’t have the more robust emergency care for special circumstances in birth that we have now. So, if a mom experienced postpartum hemorrhage, there wasn’t a quick fix. Special circumstances in birth didn’t have great outcomes.
The advent of obstetrics and the influence of the church
Medicine has sought to improve outcomes through scientific inquiry, but the way they were inquiring might have been skewed and not very helpful to women. As the study of medicine became formalized, only men were educated. As the study of medicine began to include obstetrics (meaning “being present” and midwife) the vast knowledge from women and midwifery wasn’t included in their studies. Since the church was largely responsible for educating doctors and establishing early hospitals to care for the sick, midwifery came to be seen no longer as a practice held in high regard, but as something superstitious and less reliable/scientific. It was thought that these women midwives should not be able to “play god”. That role belonged only to the church (men) and their practices were regulated by the church. Sadly, early obstetrics didn’t take the woman birthing into account at all either. As with any other medical intervention, the doctor was in charge, knew what was best, and the birthing parent just needed to do what they were told. This effectively stripped the power, knowledge, and intuition from the actual birthing parent.
Here you can see how the church’s teachings and early obstetrics are intertwined:
“In 1804 the pains of labour were considered an inevitable accompaniment of childbirth, an attitude perpetuated by the Church on the basis of the statement “In sorrow thou shalt bring forth children” (Genesis 3:16). Thus in his lecture notes to Maltese medical students, Dr. Francisco Butigiec commented: “Owing to the sin of our first parents, God condemned woman to bring forth her children in pain; and the art does not have sufficient means to prevent it . . . while God has ordained that woman should face the dangers of pregnancy and labour . . . as a punishment for having eaten the forbidden apple, He has, through the study of the anatomical structure and physiological mechanisms involved in child-bearing, provided us with the means of assisting her in her trying situation.”
From: “The Influence of the Roman Catholic Church on Midwifery Practice in Malta” by C SAVONA-VENTURA in Medical History, 1995,39:18-34
And the means of assisting the birthing women were often more harmful than good.
Industrial Revolution
If we move forward to a big change in village life, the Industrial Revolution (1760-1840), many people moved to rapidly growing cities for work. This was also the beginning of the rapid spread and development of hospitals as we know them today. As cities grew, living conditions were more cramped and crowded and there was a lot of disease spread in the often-unsanitary conditions in which people found themselves. Most women still birthed at home, but for those who became pregnant outside of wedlock and were shunned, early hospitals (lying in facilities) were a place they could birth. However, early lying in facilities used women as guinea pigs during the development of obstetrics practices. Infection was also rampant in hospitals of the time as germs were not understood. Deaths from puerperal (childbed) fever were dramatically higher than among home births. (https://pubmed.ncbi.nlm.nih.gov/3511335/)
Early 20th Century
Here’s an expert from the General Practioners and Obstetrics: a Brief History:
“Scarcity of records makes it difficult to judge quality of care in the first half of the 20th century, but we do know that the standard of maternity care in general practice was often low, even by the standards of the time, and that many preventable deaths were not prevented. This was shown by the response of GPs to a lecture on the practice of obstetrics which was published in the British Medical Journal.10 There was nothing controversial about the lecture, which stressed the need for patience, minimal interference and strict antisepsis; but it provoked an extraordinarily hostile response. One GP boasted that he never used antisepsis because the idea of bacteria causing sepsis was nonsense. Another believed the crux of the matter was the fee:
‘This waiting midwifery, this scientific midwifery, cannot be done at the price, and the public must be taught this … the remuneration a general practitioner receives is probably a fraction of what the cabman would obtain for waiting at the gate … I use chloroform and forceps in every possible case and have done so for many years. The whole procedure occupies from 15 to 40 minutes, according to the difficulty of the case.’9
Similar comments were so common that it is difficult to know which is the most surprising: the fact that GPs held such views or that they published them so proudly.’
General Practioners and Obstetrics: a Brief History, Irvine Loudon, Journal of the Royal Society of Medicine, 2008 Nov 1; 101(11): 531–535.
It wasn’t until 1929 that the College of Obstetrics and Gynecology was formed and even then, it still wasn’t considered to be a proper medical specialty. Most practitioners birthed babies because they had to, or they would lose their patients. The thought was that if you birth their babies, the family will be clients for life. (from the same source, General Practioners and Obstetrics: a Brief History, Irvine Loudon, Journal of the Royal Society of Medicine, 2008 Nov 1; 101(11): 531–535.)
There were voices speaking out in favor the innate biological women’s ability to birth without undue intervention. Peter Horrocks, MD, Senior Obstetrics Physician to Guy’s Hospital, published several papers and addresses the Lambeth Division of the British Medical Association in 1906, imploring the doctors to not unnecessarily interfere with labor. In this address he states:
“All these facts prove, if proof were needed, that parturition [childbirth] is an act of Nature, and, like all other physiological acts, such as swallowing, breathing, defeacation, or micturition [urinating], you will find that it is very similar to them in that it is a reflex act…”
In this address, Dr. Horrocks also instructs his fellow doctors on properly disinfecting their hands, gloves, and any equipment they use so as to prevent deaths from puerperal (childbed) fever, the source of which he makes sure they know, was absolutely not the woman’s body or the child’s, but from the doctor. Childbed fever was a leading cause of death for mothers and babies postpartum.
As far back as the 1840s, Ignaz Semmelweis and Wendell Holmes independently first developed the theory of doctors washing their hands and later their equipment in a disinfectant solution prior to delivering babies and brought down childbed fever to 1% (or less), down from 15% or higher in some places, but both were challenged and even discredited. It was believed that it was the air that was the problem and that hand washing would be too difficult for doctors and that they’d have to redesign hospitals to have running water within reach. Wendell Holmes was told that “Doctors are gentlemen and gentlemen’s hands are clean.” (https://www.ogmagazine.org.au/11/1-11/childbed-fever-major-cause-maternal-mortality/)
It wasn’t until decades later, after the germ theory was established, that hand washing became a practice in obstetrics. How many lives could have been saved?
Dr. Horrocks also instructs doctors to let the placenta be birthed without interference, and says not to pull on the umbilical cord to help release the placenta. When my son was born in 2012, the obstetrician was pulling on the cord to release the placenta. Dr. Horrocks also states that you should not cut the umbilical cord for at least 5 min after birth so that the infant can receive the needed amount of blood. In 2012, when my eldest was born this was not the practice. Thankfully, it is now.
In the 1920s, the most popular obstetrics book of the time The Principles and Practice of Obstetrics by Joseph B. DeLee, (free at https://www.google.com/books/edition/The_Principles_and_Practice_of_Obstetric/wsZNAQAAMAAJ?hl=en&gbpv=1&printsec=frontcover), gives instructions for forcibly dilating the cervix, giving ether during the 2nd stage of labor to knock mothers out, cutting an episiotomy, using forceps to extract the baby, then removing the placenta, and stitching up the episiotomy.
In 1942 Grantly Dick-Reed published Childbirth Without Fear showing the trouble that the fear women have about birthing and also advocating for leaving birthing alone for healthy mothers, healthy babies, and healthy pregnancies. While he was in support of birthing without unnecessary fear he unfortunately wasn’t a big supporter of women. He felt women should just stop being hysterical and be more efficient baby factories. His work on childbirth was ridiculed by the medical community and it wasn’t until the 1960s when it was embraced as women fought for their rights. While birthing has become more baby friendly, has it become more mother friendly?
Why was Dr. Horrocks and then Grantly Dick-Reed ignored and what other care is still being denied to women? What common place practices are harming more than helping?
Present Practice and thoughts
Let’s get back to trusting the natural process of labor and getting medical help if a true medical need arises.
You might ask, how was hospital care for babies? Unfortunately, babies were routinely removed from their mother’s care and put on a strict feeding schedule. In the 1940s babies were routinely removed from their mothers to prevent infection.
We now know how baby needs feeding and rooming in with mom, but, during the ongoing COVID pandemic, fathers were banished and babies were taken from mothers suspected or confirmed with having COVID, without any skin to skin contact, and then mothers were isolated with a breast pump while the babies stayed in the nursery, only to be given back to their moms days later with the mothers told to wear and mask and wash hands…and the mothers wondering why they couldn’t have done that in the first place. These new mothers were treated like criminals, with the nurses afraid to care for them and not wanting to come near. Many of these women were left to suffer in silence.
How far have we come? When concerns of COVID arose, what was the first course of action against women?
So, let’s back up a bit and look at when and why hospitals became the main place to deliver if the care wasn’t supportive of women and often harmful?
Women started to ask for doctors to deliver babies around 1760 instead of midwives (also the beginning of the Industrial Revolution). Medical colleges were being formed at this time and since doctors were thought to be more educated, women hoped that birth could be safer with the new medical knowledge. However, outcomes weren’t great for women as we’ve covered above, but the male doctors were still thought to know better and they often spoke out against midwifery instilling the idea that midwives didn’t have the right knowledge.
In 1900 about 50% of babies were born by midwives. By 1935 only 15% were born by midwives. By the 1950s, 95% gave birth in hospitals and birth was treated as “high risk” for all.
After WWII, medical insurance became commonplace as a way to compensate employees during times of limited wages. Insurance companies would only pay for hospital births. This is still how it is today. US medical insurance will not pay for home births.
It wasn’t until the 1970s, during the Women’s Rights Movement, that midwives gained ground and women started demanding better care and options. The first birth center opened in New York City in 1975.
Today we still have high rates of unnecessary intervention and the prevailing belief that birth is a medical event. Recall that back in the 1920s, DeLee’s seminal text on obstetrics was a big supporter of intervention for all. Is this what we really believe?
The current reality is that there have been huge gains in reducing both maternal and neonatal adverse outcomes. There are also movements to have more mom and baby friendly care. However, the gains are much smaller if you are a birther of color. Racism is greatly impacting maternal and infant outcomes still. Is this fair?
Overall, childbed deaths have plummeted as a result of timely and effective medical intervention in high-risk cases. Universally recommended prenatal care has had a positive impact. Caesarean sections have saved lives where they were necessary (10-15% of births according to WHO 1985). And yet in the US, in 2018 31% of all deliveries were by C-section. Where is the medical necessity in at least half of those instances? If it is not medically necessary then why are they happening? We know that c-section can adversely affect mothers and babies. Humans are designed to give birth vaginally. So, when it’s possible to have a vaginal birth, that should be the priority for the health of the mother and baby. Why isn’t it?
‘This waiting midwifery, this scientific midwifery, cannot be done at the price, and the public must be taught this … the remuneration a general practitioner receives is probably a fraction of what the cabman would obtain for waiting at the gate … I use chloroform and forceps in every possible case and have done so for many years. The whole procedure occupies from 15 to 40 minutes, according to the difficulty of the case.’9
Perhaps we haven’t come as far in our thinking as we have in our medical procedures. Perhaps, the time a vaginal birth takes, which we can’t predict, the emotions and support needed for the birther, all of which don’t have a billing code, just aren’t considered worth it. Let’s not forget having that expensive hospital room all tied up. It just isn’t worth it to the hospital system. Women and their babies aren’t worth it if they make more money in less time by having birthers just lie there and do what they are told. After all, why wait for so long when we can get so much more money in a lot less time and with less mess with a nicely controlled c-section? What parent will question a doctor when their baby’s life is at stake? If a mother or baby’s life is truly at stake we want the intervention, but how do we know what’s really an emergency? We shouldn’t be put in this situation where we don’t know.
What do we want the next decade of birth to look like? What changes do we want to see? It’s up to each of us to choose what we want for our births by knowing the standard practices of care and making informed choices for ourselves and our babies. We also need to honor our complicated history and perpetuation of fear in birthing that lives within us and create new mental models of birth for ourselves. We are the directors of our minds and we can absolutely use our births to heal and create a new positive story of birthing, with planning and preparation. We can create change with what we choose to do.
Eve took a chance and bit into the apple from the tree of knowledge. We’ve all been paying for how she was treated and we’ve allowed that treatment to persist. Maybe it’s time for a change? While my hope is that the world begins to see birthers differently and with dignity we must first see ourselves this way.
We now find ourselves at another tree. There’s no going back. What are you going to do?
Eat the apple.
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