Sunday, 7 June 2009

A rather wordy history of childbirth.

This post is dedicated to Patricia Crawford (1941-2009), feminist, historian of women, and author of 'Attitudes to Menstruation in Seventeenth-Century England', Past and Present.
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Recently at the F-Word, there has been a discussion of childbirth practice, which at times has become rather heated as questions of hospital v. homebirth, vaginal birth v. caesarean, pain relief v. none, have been debated. The issue of pregnancy and childbirth is clearly important to woman, but this alone does not explain why so many women are so defensive of their personal choices. And I think that at times, a lot of us are not sure WHY we are protective of our personal choices in childbirth- we understand that this is a controversial and political issue without understanding what created that context. So, it seems to me that some historical context is necessary.

First of all, childbirth choices are part of wider discussion on the control of woman’s bodies. A woman’s right to own and make decisions over her own body is a long and on-going fight for feminists, perhaps mostly clearly seen in the debate over abortion, but certainly not limited to this. Every day women’s bodies are splashed over the media as magazines argue over whether celebrities are too fat or too thin, whether their breasts are the right size, whether they have cellulite, and whether their dress conforms to whatever arbitrary standard is ‘in’ that week. This discussion is not new. Fashion columns, discussions of women’s clothes and who is wearing them well have been part of newspapers since the 18th Century, while the link between clothing and modesty- a central part of woman’s identity for centuries- dates to earlier than the medieval period.

Until very recently, it was not just society that acted to constrain and control women’s bodies. Women were understood as property. When a woman was ‘seduced’, it was her father or husband who demanded compensation from her lover- both seduction and criminal conversation (where a husband sued his wife’s lover) cases operated on the basis that a woman’s body belonged to a man who must be compensated for its use by another. Seduction legislation was still in force in 20th Century England (and I am not sure it has ever been abolished); while criminal conversation was still available to husbands in Canada in the 1980s. The control of women’s bodies has long been a contested issue. The politics of childbirth therefore was created in a context that was about women’s bodily autonomy and the rights to their own body, and therefore was never understood as just about individual choice.

Childbirth, of course, has always been a part of human history, but in Western Europe from the 17th century, a process, often referred to as the ‘medicalisation of childbirth’ occurred. From the 17th century, and closely linked to other medical developments, pregnancy and the gestation of the child became of medical interest. Scientists began charting the steps of pregnancy, performing autopsies on dead women at various stages of pregnancy to see how foetuses developed, and exploring how pregnancy ‘worked’. Yet, these studies were still very detached from the experience of childbirth, where birthing remained a woman’s problem and where the birthing room was a place for women. Midwives and knowledgeable women both held the skills and the knowledge of how to help women birth, how to relieve pain, and what to do when things went wrong. A skilled midwife could cost a considerable sum of money and women understood the importance of having them at the birth. Indeed, some cruelty suits, where women sued their husbands for separation for cruelty, list a husband’s unwillingness to fetch a midwife as a form of cruelty and even as evidence of his desire to kill her.

Over the 17th and 18th centuries, as male doctors become an increasingly important part of medical care more generally, they also start to play a role in childbirth. Initially, childbirth was still a woman’s job, but doctors would be called in to deal with post-natal illness and infection, or to aid sick babies. Then as the eighteenth century progressed, and as medical care became regulated, with male doctors having to be trained and qualified through universities (rather than the traditional apprenticeship system), the unregulated and ‘untrained’ [aka not university educated] midwives became a medical problem. Doctors demanded that midwives be removed entirely from the birthing room, and childbirth became the forum of male doctors. Yet, initially male doctors, with their general medical educations, were not particularly knowledgeable about childbirth, so their success rates were often worse and certainly no better than the women they replaced. Over time, male doctors specialised in gynaecological care and so made headways in understanding what’s going on in pregnancy and how to aid childbirth, and so the success rates increased. But, it should be noted, it was not until nutrition improved and anti-biotics are invented to deal with post-birth infection (what is thought to be the biggest killer of women after childbirth) that we see meaningful improvement in childbirth mortality for mother and child.

This first step in the ‘medicalisation’ of childbirth did not come without a fight from midwives, who in some places demanded to be recognised and given qualifications to allow them to do their jobs (and are more or less successful depending on the region). And, this whole debate went on with almost no input from mothers. Male doctors demanded that female midwives be pushed out of medical care and male politicians and leaders said yes. There were no women voters or mothers with a political voice to speak for what was best for women. And, in many ways, the problem was that there still was no ‘best’ for the mother, whether you had a male doctor or a female midwife, your survival chances were usually down to a woman’s general standard of health and whether any complications arose during or shortly after delivery.

As should be a surprise to no one, male doctors won in the fight for women’s bodies in the 18th century and their control over women’s bodies was to increase with Enlightenment science. Enlightenment ideology, created in a highly religious world, strongly equated science with truth and incorporated a strong belief that there was ONE answer to every problem. Medical doctors as the holders of this TRUTH, became like gods whose opinion and advice could not be questioned (although there is some great work being done just now which highlights that many people did question standard medical advice in this period and often in idiosyncratic ways). People did what their doctor told them as he held the ANSWER. And women were particularly vulnerable under this system as their opinions, experiences and voices were worthless in a male-dominated world.

One of the effects of the domination of medical science by men was the adoption of the male body as normal and of the female body as aberrant and less perfect. The female body was always contrasted with the perfect male body and the things that women’s bodies did differently were understood as being not ‘normal’ or not ‘right’. As a result, everything that women did differently was understood as illness. The female body became pathologically unwell (and there is some really interesting work on the way that Victorian women use illness as a means opting out of social normativity- like the being too constitutionally ill to ever marry and so justifying their life of singleness). Pregnancy in particular was understood as an illness and if you read Victorian newspapers, court cases or even literature you frequently come across references to women’s illness, like she was in bed unwell, or she was by the fire ill, and what they mean is she was pregnant, or occasionally in the period shortly after childbirth. As an illness, pregnancy became the domain of doctors (much like woman’s bodies more generally) and woman’s experiences or desires became less relevant as they were not the experts on illness. In this sense, women became completely detached from their pregnancy, which was no longer seen as a natural part of life for many women, but an aberration.

In the Victorian period, unless you were very poor, you gave birth at home. This was because hospitals were where people went to die and where infection was rife, making it a place where only the poor and desperate went. However, with greater knowledge of infection and germs, and the importance of cleanliness, as well as general improvements in medical treatments, hospitals became much safer places. As a result and in line with a very medical mindset that doctors should be in control of every aspect of health and recovery, in the 1930s, childbirth moved from home to hospital. Again, a lot of the motivation for this move was still motivated by the belief that childbirth was an illness and the appropriate place for ill people was a hospital. However, it also brought benefits such a broader range of pain relief and for many women (who also understood pregnancy as illness) it made them feel safer and more in control. However, despite the fact by the 1930s nurses were a central part of nursing and midwives were once more a central part of childbirth practice, birthing mothers had very little control or say over what happened to them while they were in hospital.

The mantra of ‘doctor knows best’ informed women’s experience of childbirth and increasingly childbirth became more and more of a medical procedure, with women receiving increasingly identical and regimented ‘treatment’ for pregnancy, and having little control over what happened. By the 1950s, women going into hospital to give birth could find themselves having their personal belongings removed and put into hospital gowns, having their pubic hair shaved off in preparation for birth, keeping fathers and family members out of the maternity room, and having their children removed immediately after birth. Pain medications were heavily used and many women couldn’t remember the birth, and they were encouraged to bottle feed for ‘hygiene’ reasons. Women’s bodies during childbirth were considered to be an open access area. They were not offered options on procedures and consent was not asked when doctors decided things were not going to their liking and chose to intervene. The mother’s opinion was of little relevance, because after all this was a medical procedure, and what did she know about medicine. And there is some work that suggests that women’s inability to connect with the experience of childbirth had repercussions in the form of postnatal depression and an inability to bond with children [although neither of these phenomenon were new or unique to women at this historical moment].

From the late 50s onwards, the role of doctors in society came under increased scrutiny (not least when in the 1960s it was discovered that British doctors were performing experiments on patients without their consent that were more than a little similar to Nazi experiments in WW2, under a rubric of ‘doctor knows best’). The National Childcare Trust as well as many (other) feminist organisations began to challenge the necessity of the increased intervention of doctors in childbirth. They began to promote ‘natural’ childbirth- that is an understanding of childbirth that saw it as a natural part of the female experience and one that did not need to be co-opted by men or treated as an illness. These campaigns were founded on a need to give women control over their own bodies. Over time, hospitals responded to these demands and now (at least in theory) woman should be treated as individuals with individual pregnancies. They should be given information on what options they have (ie home birth or not, pain meds or not) and what is best for their peculiar needs and desires. Yet, as you can imagination, the fight for these rights was not easy or painless. Men had no desire to give up their control over women’s bodies and it was a long, hard-fought campaign.

Today, when we discuss our childbirth options, we discuss it in the context of what was a long-fight for the control over women’s bodies. That is why it is such a heated issue. The choice to have an elective caesarean brings back memories of a time when such medical intervention wasn’t a woman’s choice; while for other women, the right to have a vaginal birth at home is founded on a battle to give women that right. More recently, there is a debate over whether choosing not to have pain medication is a form of 'martyrdom' that is patriarchal in its own way- which at least in part comes from uncertainty over what the relationship between women's bodies and the medical profession should be. It becomes very easy to see one action as ‘feminist’ and another as ‘betrayal’ and yet, this is not what our foremothers fought for. They fought for our right to choose and our right to be in control of our own bodies. It was never meant to be that one way of birthing was more ‘right’ than another, but rather that these are our bodies, ourselves.

20 comments:

polly said...

Childbirth, of course, has always been a part of human history,

No pulling the wool over your eyes, FA, I can tell you're a proper historian.

Feminist Avatar said...

Thanks Polly.

Anastasia said...

"Over time, hospitals responded to these demands and now (at least in theory) woman should be treated as individuals with individual pregnancies."

In theory, yes. In my experience, not really. In fact, not at all. There is a textbook pregnancy and if you are not having it, all bets are off. And because doctors are no longer the unquestioned authorities they once were, they frequently resort to manipulation and deception.

Feminist Avatar said...

I wast just reading your post on just this issue and thought that same thing!

Jehenna said...

Thanks for the well constructed and thought out post.

(Popped over from the F-Word)

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Anastasia said...

i also meant to say this is a great post. very timely for me. :)

Jo@fairplaytoher said...

Came to your blog via the f-word.I wasn't aware of the history of this issue. This post (much like your latest on rape laws) was really informative and interesting. Thank you!

Anonymous said...

It should be said that the sway of doctors was not merely a matter of men over women, but doctors over everyone else. I recall a time when I had to fight to get any detailed information out of my doctor. Additionally today many doctors are female, so if they are taking control during pregnancy it is because medicine is often, many times rightly so, about doing specific things in response to particular events.

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