“A mother does not become pregnant in order to provide employment to medical people. Giving birth is an ecstatic jubilant adventure not available to males. It is a woman’s crowning creative experience of a lifetime.”
– John Stevenson
A Century of Changes in the Maternal Institution of Pregnancy and Childbirth
The first known book written about midwifery, written by Jane Sharp, was published in 1671. In her opinion, the profession was unsuitable for men who could never have the first-hand knowledge and experience of the female body equal to that of a woman. She expressed this opinion because even then, the male midwifery that would over time be transformed into the profession of obstetrics, was becoming more common. One of the reasons for that was their suspicion that female midwives participated in the practices of abortion and infanticide. Although many midwives were highly respected within their communities, some were even suspected of witchcraft. Author Tania McIntosh’s book, “A Social History of Maternity and Childbirth: Key Themes in Maternity Care“
The English Midwifery Act was passed in 1902, largely due to the efforts of nurse, midwife and suffragette Rosalind Paget. Before that, most midwives were unlicensed, although some were licensed by the church. One of the first inventions to was forceps, which are used in difficult breech deliveries. Obstetrics became a specialty when men took over midwifery. The field of obstetrics was devoted to the study of the gestational process and involved developing guidelines for what constituted normal versus pathological. The control over childbirth gradually went from midwives to general practitioners to obstetricians.
Medical Technology That Improved the Maternal Institution of Pregnancy and Childbirth
Before the invention of the fetal monitor in the1960’s a baby could only be monitored with the use of a stethoscope. Today, there are a number of monitoring devices and methods, including the Doppler ultrasound, used to detect the baby’s heartbeat. There is also a device that can be placed on the baby’s head during an internal exam to measure the electrical current generated by the heart.
In addition to devices, the medical profession has also developed a series of screening tests that can often diagnose potential medical conditions even before the baby is born. For example, the prenatal Quad Screen can identify an increased risk of a woman giving birth to an infant with Down’s Syndrome, and the process of amniocentesis can accurately diagnose that condition.
In addition to forceps, the vacuum extractor was developed as another tool to assist in difficult deliveries.
Another medical advance, which many claim is overused, is the cesarean section. Statistics show that Cesarean births have reached nearly 30% in the United States. Part of the reason for this is that more women are choosing it as an elective surgery to prevent potential future complications such as incontinence. Surprisingly, the use of labor-inducing drugs has also risen to an estimated 40% of women in the U.S. even though only 10% is for medical reasons.
The use of an IV is also now part of standard maternity care, while episiotomies are no longer done automatically, as they once were.
State Regulation of the Maternal Institution
Medical advances made during WWII, such as blood transfusion and anti-biotics served to improve infant mortality rates. That was important for the country since as a result of the war, many women began working outside the home, which caused a decline in the birth rate. These advances also led to what some call the “industrialization” of the maternal institution. Increasingly, the health care system began to operate on a strict time schedule. With the use of scans, monitors and surgery, births were scheduled rather than occurring naturally. This scheduling continued after birth, with obstetricians advising feeding and sleeping times.
The professionalization of medical care in the form of education, licensing, and state regulation in many ways transformed women into consumers forced to purchase medical services from a maternal institution increasingly influenced by the state. Some of the benefits to the state provided by the industrialization of the maternal institution includes readily available census data. Hospitals are required to register every birth, as well as information regarding race and gender.
The Effect of Birth Control on the Maternal Institution
Perhaps the medical advance that most impacted women’s experience of pregnancy and childbirth was birth control because it helped give rise to equal rights through feminism. Some early feminists argued that childbearing was partly responsible for the subjugation of women. Women began taking more control of their bodies, and midwifery enjoyed a resurgence that continues into the present.
Among the women responsible for reclaiming the maternal institution of childbirth for women was Janet Balaskas, childbirth educator and founder of the Active Birth Movement. As the name implies, the movement encourages women to take a more active role in creating their own childbirth experience rather than allowing the medical community to dictate it. The movement educates women about effective birthing positions designed for mother and child rather than the comfort and convenience of hospital doctors. It also makes information about alternative birthing options, such as water births, available.
The many changes in the maternal institution over the last century would indicate that progress hasn’t always been positive. Today’s mothers face the daunting task of determining the best of both old and new to make their childbirth experience healthy, safe, and joyous. Luckily, there are now more options available that can help make that possible.