Medicalizing birth was the best thing that ever happened to women

Intensive care unit with monitors

Childbirth is a reproductive rights issue.

Every woman deserves access to high quality obstetric care, and every woman deserves access to state of the art pain relief. That’s because medicalizing birth was the best thing that ever happened to women and all women should be able to share in its benefits.

Childbirth, in every time, place and culture, is a leading cause of death of young women and the leading cause of death of babies. As historian Judith Walzer Leavitt has noted in Under the Shadow of Maternity: American Women’s Responses to Death and Debility Fears in Nineteenth-Century Childbirth, until the last 100 years:

A possible death sentence came with every pregnancy.

Visit any cemetery, from any century, in any country, and you will find the gravestones of the countless young women who died in childbirth, many after days of horrific agony.

Maternity, the creation of new life, carried with it the ever-present possibility of death. The shadow that followed women through life was the fear of the ultimate physical risk of bearing children. Young women perceived that their bodies, even when healthy and vigorous, could yield up a dead infant or could carry the seeds of their own destruction… Nine months’ gestation could mean nine months to prepare for death.

The very real possibility of death during childbirth shaped women’s lives and relationships:

Perhaps more valuable to our understanding of the reality of maternal death is the observation that most women seemed to know or know of other women who had died in childbirth. One woman, for example, wrote that her friend “died as she has expected to” as a result of childbirth as had six other of their childhood friends. Early in the twentieth century approximately 1 mother died for each 154 live births. If women delivered, let us estimate, an average of five live babies, these statistics can mean that over their reproductive years, one of every thirty women might be expected to die in childbirth. In another early-twentieth century calculation, one of every seventeen men claimed they had a mother or sister who had died as the immediate results of childbirth.

Medicalizing childbirth changed that. Now no woman with access to medicalized birth expects to die during pregnancy.

But living through the birth was only the first hurdle for many women. Some sustained injuries that affected them for the rest of their lives:

In the past, the shadow of maternity extended beyond the possibility and fear of death. Women knew that if procreation did not kill them or their babies, it could maim them for life. Postpartum gynecological problems – some great enough to force women to bed for the rest of their lives, others causing milder disabilities – hounded the women who did not succumb to their labor and delivery. For some women, the fears of future debility were more disturbing than fears of death. Vesicovaginal and rectovaginal fistulas .., which brought incontinence and constant irritation to sufferers; unsutured perineal tears of lesser degree, which may have caused significant daily discomforts; major infections; and general weakness and failure to return to prepregnant physical vigor threatened young women in the prime of life.

Medicalizing childbirth changed that. Now no woman with access to medicalized birth expects to become permanently incontinent of urine and feces as a result of childbirth.

Women viewed childbirth not as the empowering fantasy so beloved of midwives and natural childbirth advocates, but as a specter of unremitting agony:

Apart from their concern about resulting death and physical debility, women feared pain and suffering during the confinement itself. They worried about how they would bear up under the pain and stress, how long the confinement might last, and whether trusted people would accompany them through the ordeal. The short hours between being a pregnant woman and becoming a mother seemed, in anticipation, to be interminably long, and they occupied the thoughts and defined the worries of multitudes of women. Women’s descriptions of their confinement experiences foretold the horrors of the ordeal.

The voices of these women have the power to move us profoundly more than one hundred years later:

Josephine Preston Peabody wrote in her diary of the “most terrible day of [her] life,” when she delivered her firstborn, the “almost inconceivable agony” she lived through during her “day-long battle with a thousand tortures and thunders and ruins.” Her second confinement brought “great bodily suffering,” and her third, “the nethermost hell of bodily pain and mental blankness. . . . The will to live had been massacred out of me, and I couldn’t see why I had to. Another woman remembered “stark terror was what I felt most.”

“Between oceans of pain,” wrote one woman of her third birth in 1885, “there stretched continents of fear; fear of death and dread of suffering beyond bearing.” Surviving a childbirth did not allow women to forget its horrors. Lillie M. Jackson, recalling her 1905 confinement, wrote: “While carrying my baby, I was so miserable… I went down to death’s door to bring my son into the world, and I’ve never forgotten. Some folks say one forgets, and can have them right over again, but today I’ve not forgotten, and that baby is 36 years old.” Too many women shared with Hallie Nelson her feelings upon her first birth: “I began to look forward to the event with dread-if not actual horror.” Even after Nelson’s successful birth, she “did not forget those awful hours spent in labor…”

Medicalizing childbirth changed that. Now no woman with access to medicalized birth expects to suffer severe, unremitting pain from the beginning of labor to the end. She can request and receive an epidural and simply rest and sleep through hours of contractions.

Indeed, so confident of excellent pain relief are women who have access to medicalized childbirth that some women actually think they’ve “achieved” something by refusing it.

One of the great deceptions of contemporary midwifery involves midwives fooling themselves and others that the philosophy of natural childbirth reverts back to unmedicalized birth. Nothing could be further from the truth. Natural childbirth is a philosophy of privilege, specifically the privilege of having easy access to medicalized childbirth. An “unmedicalized” birth can only be safe when embedded firmly within a society to provides unlimited access to the ability of obstetricians to rescue women from their own folly. A midwife without an obstetrician is better than nothing at preventing death in certain limited circumstances, but virtually useless when it comes to saving lives in most emergencies. Without the ability to perform a C-section, midwives, like their ancient counterparts, are helpless in the face of everything from life threatening crises to simple failures of the baby to fit through the maternal pelvis. Without the ability to end a protracted labor by means of forceps or C-section, midwives are helpless to prevent obstetric fistula. Without the ability to offer epidurals, midwives are reduced to pretending that ineffective measures are effective, or, bizarrely, that labor pain is beneficial.

Childbirth is a reproductive rights issue.

Every woman deserves access to high quality obstetric care, and every woman deserves access to state of the art pain relief. Those are only available in a system that medicalizes birth.

123 Responses to “Medicalizing birth was the best thing that ever happened to women”

  1. Caleb Hart
    January 5, 2015 at 4:49 pm #

    I have been thinking about visiting an obstetrician as well. I think it would be good to learn more about what is going on in my wife’s body while she is pregnant. I just want to be supportive. I think it would be good to help her with this whole thing.

  2. Allie
    December 31, 2014 at 11:51 am #

    I’d be dead if it weren’t for medicalized birth. My labour and delivery weren’t too bad, but I sustained a torn clitoral artery and would have bled to death, I assume in mere minutes, had I not been in hospital. There were only 3 people in the room throughout most of my labour (obstetric nurse, midwife and doula), despite the woo-mongers who claim dozens of strangers will be wandering in and out of your room if you give birth in hospital. However, moments after she was out, there were suddenly 4 doctors in the room attending to the two of us (two had shown up just before she came out because my water had been dirty and two for me to attend to the stitching). I love hospitals : )

  3. Liz Leyden
    December 30, 2014 at 2:37 pm #

    Exhibit A- England’s Queen Anne, who ruled from 1702 to 1714. As queen, she had access to the best health care available. Her 17 pregnancies resulted in 7 miscarriages, 5 stillbirths, and 5 live births. Her only child to survive infancy died at age 11.,_Queen_of_Great_Britain#Pregnancies

  4. SporkParade
    December 30, 2014 at 3:29 am #

    My childhood babysitter was born in the 1910s. I remember she once told me about the (non)birth of her little brother. The baby wouldn’t come out (the details why aren’t clear to me), and the doctor eventually decided that, in order to save the mother’s life, the best course of action was to slice up the baby and pull it out piece by piece. And that is why I love C-sections.

    • demodocus' spouse
      December 30, 2014 at 10:37 am #

      God, I hope he was dead already. What a horror for everybody involved

    • fiftyfifty1
      December 30, 2014 at 3:14 pm #

      This still happens today in resource-poor settings. I have had African -immigrant patients this happened to. Jeevan, a physician in India, from the blog The Learner (link located on the right) does them occasionally on dead obstructing babies.

      • SporkParade
        December 31, 2014 at 2:23 am #

        That is both interesting and tragic.

  5. Sue
    December 29, 2014 at 10:47 pm #

    The great advances in infant and maternal mortality – from vaccination, antibiotics and modern midwifery/obstetrics – have transformed the societies that have access to them.

    • Kate
      December 29, 2014 at 10:44 pm #

      There is soooo much wrong with that birth story that I don’t even know where to begin…

      • Young CC Prof
        December 29, 2014 at 11:30 pm #

        The 2 previous c-sections, one classical? The OB who actually BEGGED her not to do it a few days beforehand, and she got upset that he was making her feel uncomfortable? The 57 hours ruptured membranes, including walking around Wal-Mart (to pick up vodka to make her placental tincture? Her conviction that she couldn’t rupture unless her labor was augmented? (Augmenting it by nursing didn’t count, obviously.)

        That can’t possibly be real. She made up the story and found some birth pictures somewhere.

        • Kate
          December 29, 2014 at 11:38 pm #

          Oh, and don’t forget the PPH and the unhealed tearing!

          Sadly, it is real…the midwives’ FB link has the mother tagged in it.

          • Young CC Prof
            December 29, 2014 at 11:46 pm #

            Oh, right, the tear that the midwife didn’t find and then apparently said was too hard to reach for stitches. Speaking of the medical care available 300 years ago…

        • Susan
          December 30, 2014 at 12:42 am #

          Gee, you can play Russian Roulette with one gun at yourself and another at the baby and win…how empowering. Isn’t it amazing the more risk these moms take the more bragging power they get.

    • Samantha06
      December 29, 2014 at 10:51 pm #

      I feel sick after reading those….

    • Guest
      December 30, 2014 at 2:11 pm #

      Someone responded on the AMA with a link to the 450% increase in death post and they responded by quoting Dr. Tuteur’s sarcastic epis post implying that she was being serious and wanted to increase the epis rate. Bizarre.

    • Medwife
      December 30, 2014 at 8:19 pm #

      Well that was horrifying.

  6. The Bofa on the Sofa
    December 29, 2014 at 8:28 pm #

    Look back at life expectancies in the past. Women had shorter life expectancy on average because of those that were dying during childbirth.

    Back in rural China in the 1920s, for example, median life expectancy was something like 25 years for men and 24 for women.

    These were areas that were prime places for the uses of “Traditional Chinese Medicine” btw. Shows you how effective that was.

    • Trixie
      December 29, 2014 at 10:47 pm #

      Didn’t Mao basically say TCM was bunk, but since they couldn’t afford to offer anything else to most people, they went ahead and used it?

      • Sue
        December 29, 2014 at 10:48 pm #

        Yep – there is no ”western” vs ”eastern” medicine – everyone who has access and can afford it wants effective medicine.

    • SporkParade
      December 30, 2014 at 6:24 am #

      In all fairness, a lot of the problem was not merely lack of modern medicine but lack of food. Starvation was a huge problem in Imperial China. It was a problem in Communist China, too, but the party did eventually fix it once millions of people had already died…

      • Young CC Prof
        December 30, 2014 at 9:00 am #

        The first round of Mao’s agricultural “reforms” created a famine so severe it left a dent in the entire planet’s population growth curve.

  7. OldTimeRN
    December 29, 2014 at 8:05 pm #

    When I think how far we’ve come in the world of childbirth it amazes me. When I think of those wanting to send us back a few generations it saddens and angers me.

    The best thing about medical care is how it’s ever evolving. It’s not perfect. We make mistakes. But we learn from those mistakes. I can’t say the same for those trying to set us back in the name of natural childbirth.

  8. Mac Sherbert
    December 29, 2014 at 7:11 pm #

    I’ll never forget when I was pregnant with my first child I was visiting with my parents and some of their friends at their river house. The river place is way out in the middle of now where. We all went out for a drive and came across an old church with a small graveyard. We walked around just enjoying the weather and each others company until we came to series of graves. The women were quiet….5 little graves (one set of twins) the babies had all died either the day of birth or a few days later and then finally…the mother’s grave and yes she died apparently giving birth. —- I believe the dates were the late 1800’s.

    • SporkParade
      December 30, 2014 at 6:26 am #

      The graveyard where most of my relatives are buried (founded in response to the Spanish Influenza and WWI) has its own section just for babies and small children. A lot of them died within the first month, although I always remember the 3 year old who got run over by a fire truck. Wow, this is a really morbid comment section today.

      • Mishimoo
        December 30, 2014 at 7:21 am #

        Every time we go to visit my husband’s grandfather, we take a moment to visit the kid that has toys on his grave, the baby born sleeping on my birthday, the babies and their mothers, the kids that died of preventable diseases, and the family plots dated during the Spanish Flu. Morbid, but they deserve to be thought of and visited even though we never knew them.

  9. Guest
    December 29, 2014 at 4:30 pm #

    OT: I’m unimpressed with the author’s conclusions.

  10. just me
    December 29, 2014 at 4:11 pm #

    There’s a local charity that raises money for I can’t recall which 3rd world country, where young girls give birth and get tears plus anal fissures due to being too small to birth, and they’re left untreated and live like lepers ostracized begging for food etc.

    This is supposed to be a reply to Sanveann but came up above.

    • Young CC Prof
      December 29, 2014 at 4:42 pm #

      Hamelin Fistula?

      • Mishimoo
        December 29, 2014 at 5:18 pm #

        That was one of my Christmas presents and it made me so happy – My sister + her husband donated to charities instead of doing presents, as well as donating the monetary gifts from their wedding. I asked ages ago if she’d consider supporting Hamelin Fistula because it’s really important, and she remembered!

      • just me
        December 29, 2014 at 6:52 pm #


        I meant fistula…sorry.

    • Sue
      December 29, 2014 at 10:54 pm #

      The remarkable Australian obstetrician, Catherine Hamlin, is still active at her practice and teaching in Ethiopia in her 90s. I’m sure her patients are pleased that she ”medicalised” childbirth in their country.

    • Liz Leyden
      December 30, 2014 at 1:55 pm #

      Is it Ethiopia? The fistula hospital is featured in the movie “A Walk to Beautiful”

  11. Sanveann
    December 29, 2014 at 1:55 pm #

    I’ve often wondered what women who had severe tearing did back then. Was there any attempt made at repair? Or were you just like that the rest of your life?

    Btw, obstetric care hasn’t just helped us on pregnancy. My great-grandma lost her mother to a ruptured ectopic pregnancy, leaving her 13 children motherless on what was undoubtedly an agonizing way to die.

    • Sanveann
      December 29, 2014 at 1:57 pm #

      I meant to say not just during birth. Obviously an ectopic pregnancy is a pregnancy!

      • slandy09
        December 29, 2014 at 2:58 pm #

        No kidding. I had an ectopic pregnancy nearly six months ago, and I got shots instead of surgery because it was caught so early. Hooray modern medical care!

        • Sue
          January 1, 2015 at 8:03 pm #

          Wheat grass shots?

          • Dr Kitty
            January 1, 2015 at 9:16 pm #

            Methotrexate I’m guessing.

            A drug which can treat cancer, end ectopic pregnancies without surgery and has improved the quality of life of millions of people around the world with autoimmune conditions like Rheumatoid Arthritis, Ulcerative colitis and Sarcoidosis.

            It is on the WHO list of essential medicines, and it works by antagonising the metabolism of folic acid.

            It is one drug that is always useful to know about for people who like to talk about how all diseases can be cured with vitamins.

      • Young CC Prof
        December 29, 2014 at 3:10 pm #

        Preeclampsia used to turn into actual eclampsia. That’s a pretty horrible way to die…

        • fiftyfifty1
          December 29, 2014 at 3:39 pm #

          Yes, the fact that the word PREeclampsia even exists is due to modern medicine. Doctors figured out what signs frequently were present before the seizures and death hit. They developed systematic ways to search for these indicators and developed tests (blood pressure, urine tests, blood chemistries) to detect subtle warning signs even sooner. Then they invented ways to get the baby out when these warning signs were present (induction and CS) and developed meds to give to keep the mother from seizing until the baby could be delivered and meds to help the baby’s lungs mature if the preeclampsia developed remote from term.

          And all lay midwives have come up with is a completely debunked theory that it is “all the mother’s fault” for not eating enough protein. sheesh.

          • anotheramy
            December 29, 2014 at 4:16 pm #

            A friend of mine had pre-eclampsia and c-sections with 2 out of her 2 births, her Ob said had she lived in a time before modern medicine, she likely would’ve died during childbirth.

          • rh1985
            December 29, 2014 at 11:16 pm #

            I had pre-eclampsia and a c-section. I’m pretty sure my daughter and I would have died without access to modern medical care. I didn’t attempt an induction, wasn’t interested and so I don’t even know if I could have tried, but she was very high up when the doctor pulled her out so I don’t think she was coming out any other way.

          • Elaine
            December 30, 2014 at 10:11 am #

            A friend of my husband’s had ECLAMPSIA, no pre- about it, seized at 8 months pregnant. Her daughter was delivered by c/s. Both are fine now. I think it’s safe to assume that they’d both be dead without modern medical care.

          • mostlyclueless
            December 30, 2014 at 2:24 am #

            fiftyfity1 don’t be ridiculous. Pre-eclampsia isn’t caused by not eating enough protein, it’s caused by NOT TRUSTING YOUR BODY. Duh.

          • Sarah
            December 30, 2014 at 9:12 am #

            Um, no. It’s caused by not going to Lamaze classes.

          • Young CC Prof
            December 30, 2014 at 9:32 am #

            I thought it was caused by urine tests. True fact, it’s diagnosed far less often in women who don’t have their urine tested! *Sarcasm*

        • Allie P
          December 30, 2014 at 10:34 am #

          As Downton Abbey taught us all.

          • Dr Kitty
            December 30, 2014 at 11:04 am #

            Thankfully Downton has made it MUCH easier to explain to women why they were induced or had a CS “just because” their BP was up or the protein square on the dipstick was the wrong colour.

        • Anaesthetist
          December 30, 2014 at 6:43 pm #

          this is a rare book that went on sale a few years ago by an accoucheur/obsetrician/physician practicing during the 1600s – essentially a doctor often called in by midwives when the birth had already gone wrong.just anectdata, probably not for the fainthearted as it can be a bit graphic but an astonishing read

          the descriptions of haemmorhage, eclampsia, difficult births, sepsis, stroke are recognisable by todays physicians but the terrifying bit is the acceptance of ‘just having to wait and see’ and the inevitable deaths because they could do little in the situation

  12. Sarah
    December 29, 2014 at 1:48 pm #

    Thank God for modern obstetric care.

    • January 7, 2015 at 10:04 pm #

      God is the last entity you should thank for modern obstetric care……”he” is the one who originally cursed women with horrible childbirth’s, no?

  13. Mel
    December 29, 2014 at 1:48 pm #

    Hell, you can tell how far we’ve come just by doing a lightweight perusal of literature.
    Books where one or more people die or nearly die due to childbirth complications – and it’s a minor plot detail.

    Anne from Anne of Green Gables – had some sort of labor complication with her first daughter who died; nearly died after her third son and was incapacitated for a long time (baby nearly died as well)

    The mother in Sarah Plain and Tall who died after birthing Caleb.

    Dorothea in Middlemarch by George Elliot – nearly died birthing her first son.

    Mrs. Poyser in Adam Bede by same author – her daughter is 3 and the mother is still unable to do most chores around the house due to complications.

    • Mel
      December 29, 2014 at 1:50 pm #

      I read a commentary on Jane Austin’s books. When Austin was young, she wrote about love marriages between people in their early twenties (Pride and Prejudice; Sense and Sensibility). Then, her brother married for love. His wife died birthing their 14th child. After that, her heroines got much, much older (late 20’s in Persuasion and Something Abbey).

      • MLE
        December 29, 2014 at 2:48 pm #

        I think Carherine in Northanger Abbey was pretty young.

        • MLE
          December 29, 2014 at 2:49 pm #

          And by Carherine I mean Catherine. They didn’t have cars in those days.

          • anonymous
            December 29, 2014 at 4:29 pm #

            Catherine was very young and Northanger Abbey was the first book Jane Austen wrote, just the last published. The only older heroine I can recall is Ann from Persuasion. I think JA was pretty well aware of the facts of life when she started out.

            Charlotte Bronte died of hyperemesis.

          • Guestll
            December 29, 2014 at 5:05 pm #

            Charlotte Bronte’s death is now posited by some to have occurred as a result of hyperemesis. But it could have been typhus, typhoid, TB, cholera – no one knows for sure. Life expectancy in that neck of the woods in that era was approximately 25.

            More Catherines:

            Catherine Earnshaw in Emily Bronte’s Wuthering Heights dies in childbirth.

            Catherine Barkley in A Farewell to Arms, dies in childbirth.

          • DebraB
            December 29, 2014 at 5:16 pm #

            I’m reading Frances Hodgson Burnett right now, and many of the characters have have mothers who died in childbirth (not just Sara Crewe.) I’ve read seven or so works, and only two didn’t have this. Little Lord Fauntleroy was lucky. One adult novel had two women with miserable pregnancies, one of whom barely survived. And that one was a second wife. Guess what happened to the first one and the baby?

          • Guesteleh
            December 29, 2014 at 10:04 pm #

            You don’t even need to go very far back in history to find examples. A major plot point in a 1931 film revolved around a woman’s fear of giving birth at home because her mother died in birth. The husband moves heaven and earth so she can give birth in the hospital with a real doctor:

          • Amy M
            December 30, 2014 at 9:54 am #

            Downton Abbey….

          • Liz Leyden
            December 30, 2014 at 2:22 pm #

            Whale Rider starts with a woman and a baby dying in childbirth (in a modern hospital).

          • anonymous
            December 29, 2014 at 7:39 pm #

            Elizabeth Gaskell and CB’s relatives clearly believed that she died from complications of hyperemesis — it is not a modern theory.

          • Guestll
            December 29, 2014 at 8:11 pm #

            What Mrs. Gaskell and others may have believed it just that — beliefs. The cause of CB’s death is unknown. Could have been HG, but it’s not a certainty, typhus under the circumstances was just as likely, if not more.

      • Allie P
        December 30, 2014 at 11:52 am #

        Anne (27) still married for love. Northanger Abbey was the 1st book Jane wrote. It was just published last, and Catherine was 17. Emma was only 20 and Fanny of Mansfield Park was 18 at book’s end. Elinor of S&S was 19, Lizzie of P&P was 21. I don’t see any correlation, let alone evidence of causation.

    • Amy
      December 30, 2014 at 5:47 pm #

      I’ll chime in. Remember A Tree Grows in Brooklyn? Aunt Sissy had ten dead babies and then faked a pregnancy to adopt her husband’s love child with another woman, then got pregnant again and finally delivered a living child after insisting on having the baby with a doctor in a hospital.

  14. December 29, 2014 at 1:21 pm #

    Excellent post!

  15. anotheramy
    December 29, 2014 at 12:38 pm #

    Homebirth advocates like to say childbirth is safer now because of germ theory/ better sanitation, not b/c of obstetrics. What’s the correct answer to that?

    • Stacy48918
      December 29, 2014 at 12:57 pm #

      How about “In what way do antibiotics help an obstructed labor?”

      Or any other of the myriad issues that can be detected, managed and treated with modern obstetrics.

    • Amy M
      December 29, 2014 at 1:01 pm #

      Certainly those things help, but better sanitation and an understanding of germs isn’t an OR with a trained surgeon who can get the baby out in minutes. Of course, if we didn’t understand germs, surgery would be a death sentence, but regardless, lack of surgery can be a death sentence as it is.

    • fiftyfifty1
      December 29, 2014 at 1:25 pm #

      The big killers of babies and mothers have nothing to do with germs or sanitation:
      obstructed labor
      post partum hemorrhage
      placental insufficiency/cord problems
      Rh factor incompatibility
      clotting disorders

      • Trixie
        December 29, 2014 at 10:55 pm #

        That’s a good point about Rh factor. Without birth control and with an Rh+ husband, I’d be losing babies leeft and right.

    • moto_librarian
      December 29, 2014 at 1:32 pm #

      They like to bring up MRSA, but hospital-acquired MRSA is extremely rare on the maternity ward. It’s far more likely that a pregnant woman will bring community-acquired MRSA into L&D than the opposite, yet that’s used as a reason to have a home birth.

      Anti-vaxxers make these same arguments as well. Better sanitation and nutrition are responsible for an end to VPDs (and if you believe that, I have a bridge I’d like to sell you).

      • Young CC Prof
        December 29, 2014 at 1:39 pm #

        Indeed, most maternal/neonatal infections come from bugs that colonized the mother before labor ever started. A lot of those bacteria are pretty harmless, unless you happen to, say, get them jammed into your mouth before you’re an hour old, or have a wide-open uterus and mildly suppressed immune system. Same sort of thing that can invade any deep wound.

        And let’s not forget maternal/neonatal tetanus. That used to be a big one, and in some places still is. Sterile cord kits help a lot with the neonatal version, vaccinating women is the only sure way to prevent maternal tetanus.

      • Liz Leyden
        December 30, 2014 at 1:21 pm #

        Better sanitation made polio less common, but more dangerous.

    • Amy Tuteur, MD
      December 29, 2014 at 2:51 pm #

      Better sanitation IS medicalization. Prior to the advent of modern medicine, no one worried about sanitation.

      • Young CC Prof
        December 29, 2014 at 3:10 pm #

        And quite a few home birth folks still don’t worry about sanitation. (Like water birth, possibly in a pool that was sitting out for days…)

        • Samantha06
          December 29, 2014 at 3:32 pm #

          And water that has poop in it.. such a lovely, sanitary place for their baby to be born in… barf..

          • Amy M
            December 30, 2014 at 9:54 am #

            There’s probably barf in the water too.

          • Samantha06
            December 30, 2014 at 7:21 pm #

            And urine too.. a medley of body fluids all the way around..

  16. MLE
    December 29, 2014 at 12:26 pm #

    This is interesting and informative even for the historically aware. But to the NCB advocates to whom these descriptions would come as a surprise due to their general ignorance astounding lack of imagination, I say uh duuuuhhhhhhhhhhhhhhhhhhhhhhhhhhh.

  17. Trixie
    December 29, 2014 at 12:23 pm #

    Going back through the family tree, we found one ancestor who was the only one of 8 children to make it past age 2. I can’t imagine.

    • Stacy48918
      December 29, 2014 at 12:57 pm #

      That’s so awful. 🙁

    • Cobalt
      December 29, 2014 at 1:47 pm #

      My grandfather traced our genealogy back to 1704. The survival rate to age 5 prior to 1900 was less than half in many generations.

    • Sanveann
      December 29, 2014 at 3:36 pm #

      I’ve done genealogy for several years. Occasionally I have to take breaks because seeing the number of dead babies, children and young women just gets terribly upsetting.

  18. December 29, 2014 at 12:07 pm #

    Tremendous post. Even today more than a few women are still haunted by their births and can describe them much the same as those foremothers you quoted. Often because of a lack of access to the high quality obstetric care and state of the art pain relief that women deserve. Those who lobby to “demedicalize” birth fail to realize the tremendous investment in health and well-being that medicalized birth is for both women and their children.

  19. Dr Kitty
    December 29, 2014 at 12:03 pm #

    Thank you for another great post Dr T

  20. Guesteleh
    December 29, 2014 at 12:03 pm #

    I’ve made this argument often with regards to birth control. How can women be anti science when science gave them the greatest gift possible: safe birth control. The advances women have made would not have been possible without the ability to control their fertility.

  21. Angharad
    December 29, 2014 at 11:50 am #

    I absolutely agree with this. I’ve thought a lot about what would have happened to me if I had been pregnant before modern medical care. I was induced at 39 weeks due to my blood pressure spiking to 160/80 (from a baseline of around 130/60 throughout my pregnancy). Without medicalized childbirth, would I have ended up with seizures and a possibly dead baby? Or died myself? Then during delivery my little one was not tolerating labor well. Her heart rate dipped to about 70 with each contraction. My nurse paged my OB and they ramped up the pitocin and I had an instrumental delivery and my baby was born purple but healthy. While my OB was concerned about both my blood pressure and the heart rate decelerations and took appropriate actions to care for me, I never got the impression that my life or my baby’s life were actually in danger. But I think that 100 years ago, almost certainly my baby and possibly I would have died. Every day I am grateful that I had good prenatal care, an epidural so instead of intense pain I could focus on my baby), and competent assistance with the delivery.

    • Amy M
      December 29, 2014 at 11:56 am #

      Oh, I’ve thought about that too. Of course, I never would have gotten pregnant wo/medical intervention (I’d have been that barren aunt everyone talked about in hushed whispers). But, assuming I could have gotten pregnant, and it was the same pregnancy I had—yeah, both the babies and I would likely not have survived.

    • RNMeg
      December 29, 2014 at 3:01 pm #

      Count me in as one who would probably have died (and certainly would have lost my baby). She was acynclitic and OP, and my labor was long and resulted in a c-section when my cervix failed to dilate. That is, if I had even survived to have this pregnancy, since I’d had an ectopic pregnancy 2 years before. Without modern obstetrics, my husband would be a widower, and my house wouldn’t be cheerfully cluttered with toys. From the bottom of my heart, thank you.

      • Amy
        December 29, 2014 at 5:39 pm #

        I could have written this post almost word for word. And yet, I had NCB advocates telling me I could have avoided a c-section if I’d been brave enough to have a home birth.

    • carr528
      December 29, 2014 at 3:16 pm #

      I would have never been born if not for medical care. I was three weeks late, and my mom was in labor for over 48 hours before the doctor decided to do a c-section. My skull and my mom’s pelvis were just not made for each other.

    • just me
      December 29, 2014 at 4:16 pm #

      Me too. My first would’ve been stillborn or severely brain damaged instead of a healthy 4 year old today. Vci, vasa previa, cord around neck, heart rate kept decelerating with contractions so I kept having to change position. Without monitoring I wouldn’t have known to do so. Plus sunny side up so without vacuum she may not have come out in time.

    • Dr Kitty
      December 29, 2014 at 5:07 pm #

      I would have died at birth 150 years ago.
      Maybe my mother would have died too.
      Her waters broke at 42 weeks. No labour by 24 hrs.
      So we could have died from chorioamnionitis.
      Then, after she was induced her cervix didn’t dilate and my head stayed high and free. So we could have died from obstructed labour, because even with pit nothing was happening.
      Then my heart rate plummeted and she ended up have a crash section. So I definitely would have died.

      But let’s say I died and she survived, and let’s say she survived the birth of her next two children (who, in reality, were both ERCS at 38 weeks and one of my sisters died from a congenital abnormality within 24hrs) my youngest sibling was an unstable transverse lie…safely delivered by ERCS.

      So…best case scenario, my mother would have one live child from four pregnancies, with high odds of having died from infection or obstructed labour delivering her first or fourth baby.

      She’s probably the world’s biggest supporter of medicalised childbirth, and she’s someone who had a crash GA section, a failed spinal converted to a second GA section (because she could feel them cutting). When the spinal worked for her third section and she was finally awake for the birth, she watched her baby being resuscitated and die the next day.
      That’s birth trauma, but she’s never kidded herself that the alternatives were better.

    • Liz Leyden
      December 29, 2014 at 9:24 pm #

      My son was frank breech. He might have survived childbirth 100 years ago because there are techniques to turn breech babies, but he might have been left with cerebral palsy or intellectual disabilities.

      My daughter was transverse. She also has HLHS. Basically, the left side of her heart never developed. It was diagnosed prenatally, so we were able to prepare for a 250-mile trip to give birth (which ended up involving a helicopter ride) and open-heart surgery when she was 2 days old (and again at 6 months old). Forty years ago, babies with my daughter’s condition didn’t survive more than a day or two after birth. One hundred years ago, if she had survived birth, she would’ve died within days.

      I developed post-partum pre-eclampsia. By the time I went back to the hospital, 10 days postpartum, my b/p was in the 170s, and got as high as 192/100s. After 2 days in the hospital I was released on b/p meds. One hundred years ago I would’ve seized and died.

    • SporkParade
      December 30, 2014 at 6:55 am #

      I never have anything to contribute to these “let’s compare how we would have died” conversations. My husband survived being a surprise second twin and his mother survived being frank breech (both were unmedicated vaginal deliveries). They are an NCBer’s wet dream, both of them. Of course, if you ask them, you would have to be totally insane to not go straight to scheduled C-section for twins and/or breech presentation.

      • SporkParade
        December 30, 2014 at 6:55 am #

        How do I edit? I meant to say “footling breech.”

        • The Bofa on the Sofa
          December 30, 2014 at 10:03 am #

          How do I edit?

          You need an account

          I meant to say “footling breech.”

          At least you didn’t say footlong

          • SporkParade
            December 30, 2014 at 10:45 am #

            Oh, but NCBers would love having a footlong birth! You know what they claim about eating during labor. 🙂

          • The Bofa on the Sofa
            December 30, 2014 at 11:32 am #

            How about Frank Caliendo doing an impersonation of Jeff Goldblum…

            I like hot dogs, you know. They’re very, very good. I like hot dogs. Mustard, ketchup, relish, all kinds of things. Chili dogs are good. Cheesy dogs are even better. Wait a second. I’m a vegetarian.

          • Young CC Prof
            December 30, 2014 at 11:24 am #

            Baby better be more than a foot long. Foot and a half at least, I think.

  22. Susan
    December 29, 2014 at 11:50 am #

    That’s where the “Human Rights in Childbirth” campaign gets it wrong. They should be advocating for access to life saving care not the rights of women to any sort of substandard care they can dream up. It’s really revolting to me in a world where women and babies still truly suffer death and disability that the right to water birth is called a human rights issue.

    • Young CC Prof
      December 29, 2014 at 11:52 am #

      HRiC isn’t fighting for the rights of pregnant women, they’re fighting for the rights of midwives and quacks.

      • Samantha06
        December 29, 2014 at 2:04 pm #

        That’s the damn truth!!

        • just me
          December 29, 2014 at 9:59 pm #

          Yeah… I was excited about that Christy turlington charity until I went to the website and found all kinds of “overmedicalization” of birth crap.

          • Samantha06
            December 29, 2014 at 11:09 pm #

            Puh-leeze… if any of these folks ended up in an emergency situation with their labors, I bet they’d be begging for that “medicalized” birth…

    • Captain Obvious
      December 29, 2014 at 12:27 pm #

      Now if they would be arguing that Homebirth midwives is better than a century ago, than fine. But they take it too far and say it is as safe or safer than hospital birth. I’m sure everyone knows this, that EDC was relatively “recently” changed to EDD to better define contemporary gestation, and avoiding the “confinement” stigmata.

      • Samantha06
        December 29, 2014 at 2:10 pm #

        “But they take it too far and say it is as safe or safer than hospital birth.”

        I had this conversation recently with a doula in the hospital. Of course, she spouted the standard NCB/homebirth rhetoric… “but women have been having babies at home for centuries”, and of course my reply was, “and they died…”

  23. moto_librarian
    December 29, 2014 at 11:46 am #

    When I experienced serious complications immediately after birth, I was scared. Everything was handled coolly and competently by my CNM, L&D nurses, anesthesiologist, and the attending OB, but I still remember that feeling in the pit of my stomach when the midwife said “You’re bleeding more than I would like.” I don’t have any illusions about the dangers of childbirth in the absence of modern obstetrics. I know that I would have died without the medicalization of childbirth, and I am grateful for it. Even with prompt treatment, I wasn’t sure that I ever wanted to have another child. I had flashbacks about the pph and manual exam for weeks afterwards. If I had not stayed on my antidepressant during pregnancy, I am quite certain that I would have developed PPD. I cannot even imagine how terrifying it must have been for women to spend nine months wondering whether or not they and their babies would come through the process safely.

    • Amy M
      December 29, 2014 at 12:03 pm #

      Which I think brings up another point: PPD. I imagine its mostly diagnosed in women in Western cultures, but surely it can’t be a new thing. Women who survived childbirth, but ended up damaged, and/or lost the baby certainly could have become depressed. How likely is it that PPD would have been recognized and treated?

      I read the Yellow Wallpaper—that seemed like a clear case of PPD. I can’t remember if they carted the woman off to the looney bin or what, but I know that did happen, in Western cultures anyway. I have no idea how women’s mental health is addressed, if at all, in places like Afghanistan.

      • moto_librarian
        December 29, 2014 at 12:27 pm #

        I think that PPD surely occurs in the developing world, but there are no resources to diagnose or treat it.

        • Amy M
          December 29, 2014 at 12:31 pm #

          Sure—and if women are 2nd-class citizens or worse, why would anyone give a thought to their mental health? Even in the US, women’s mental issues (in general and wrt pregnancy) are not taken as seriously as they should be.

        • Dr Kitty
          December 29, 2014 at 4:49 pm #

          Plenty of cultures believe new mothers are vulnerable to possession by spirits, demons or fairies, which will then cause them to reject their infants, neglect themselves, sicken and die.

          Pretty sure that is what we understand as PPD.

      • Guesteleh
        December 29, 2014 at 6:00 pm #

        It was called hysteria:

      • Medwife
        December 29, 2014 at 9:31 pm #

        I found a horrific story in my family tree of a woman who had four (or five?) stairstep babies, and her husband then died when the youngest was six months old. She killed one of her kids in what sounds to me like an obvious case of postpartum psychosis, not that anyone identified it in the 1700s (the case was described in a local newspaper).

        Modern medicine brought us birth control. I can’t imagine how many lives it’s saved.

        • anon
          January 5, 2015 at 11:27 pm #

          I remember seeing an episode of Call the Midwife about a woman who was pregnant with many young kids already and filled with complete despair- something about that REALLY drove home how incredibly, profoundly lucky I am to have the control I do. That something probably being my newly-minted status as a mom of three when I saw the episode, and feeling beyond overwhelmed by what I had on my plate. The thought of not being able to laugh dramatically and pronounce myself done was honestly terrifying.

          And that third child is another in the long list of children who wouldn’t be here without modern medicine. He arrived after 40 weeks of entirely uneventful, textbook-perfect pregnancy, to a mom who had two entirely uneventful, textbook-perfect deliveries (surely a PERFECT candidate for home birth!)….completely tangled in his cord, after numerous HR decels to the 50s. If he survived delivery prior to continuous fetal monitoring, it would not have been in good condition. He is nearly two years old and never stops moving, and the labor and delivery unit where he and his sisters were born will get a card from me on his birthday this year, just like they did last year, because they saved his life when most MB advocates would have sworn it never would have needed saving.

    • caiss
      December 29, 2014 at 6:36 pm #

      Traumatic experiences during childbirth are more likely to lead to PTSD (Posttraumatic stress disorder) than PPD. Although PPD may be secondary (and women with depression during pregnancy are more vulnerable). The two are often confused, and PTSD following childbirth is often misdiagnosed as PPD. Even as recent as 20 years ago this was not acknowledged or labeled as such.

  24. no longer drinking the koolaid
    December 29, 2014 at 11:40 am #

    My great grandmother died the day after giving birth to a preterm son. There is an old medical term listed on the death certificate that means complete exhaustion to the point of emptiness to describe his passing. Best I can figure on her cause of death was chorioamnionitis. She had already had 3 full term babies.
    I have not heard of a woman dying of chorio in decades.

  25. Young CC Prof
    December 29, 2014 at 11:31 am #

    Medical care in childbirth, both lifesaving treatments and pain relief, is a MAJOR feminist issue. It has been since the 19th century.

    Becoming a mother and studying the reality and the culture of childbirth have turned loose my inner furious bra-burning feminist.

    I’m furious first of all that so many women still lack access to the best care. If you look at global statistics, the countries with the worst maternal mortality are not the poorest ones, but the ones where women have the fewest rights.

    Second, I’m furious that the feminist movement has been so successfully co-opted, and that women in wealthy countries are being encouraged to shun the best possible medical care, and being flat-out lied to about what is and isn’t good care.

    • moto_librarian
      December 29, 2014 at 11:51 am #

      This. We live in a society of such privilege that women can brag about having a baby without pain relief when so many continue to spend their entire pregnancies wondering whether or not they and their children will come through childbirth unscathed. The only reason that women in the developed world can claim that natural birth is “empowering” is because they have the privilege of having choices about how they give birth. With easy access to epidural anesthesia, c-sections, EFM, uterotonics, blood products, etc. we can pretend that giving birth without them is some sort of achievement. It’s not, and we need to figure out ways to make birth safe for ALL women.

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