Childbirth is such a routine part of life that in some ways it can become invisible, especially historically. History, people often assume, is made up of major events, political elections, wars, etc. – not routine biological processes. But for something so invisible, it has made up a significant portion of the lives of women across time. Through American history, birthing women have advocated for the right to shape their own birth experiences, whether through home births surrounded by female kin or hospital births under twilight sleep. And the choices our foremothers made aren’t always the ones we might guess. Today, we present a history of childbirth in America.

Transcript for A History of Childbirth in America

Sarah: If you’ve ever been to a baby shower, you know that at some point, the conversation veers toward birth stories, where people swap stories about giant babies, stalled labors, emergency c-sections, prolapsed vaginas, and – yes, sometimes even fast & easy deliveries. Those stories serve several purposes – they prepare new parents for the numerous possibilities of childbirth and are a way for birthing people to bond, for instance. We often think about childbirth as a largely individual experience. After all, every birth is different and experienced by one birthing person. It’s also often private (at least in modern practice), involving some of the most intimate processes of the body. At the same time, we also tend to think that birth has always been the same – just a straightforward biological process. You often hear this come up in those baby shower conversations, actually: childbirth is a natural process! Your body knows what it’s doing! Women have been doing this since the dawn of time! And because of all this, it’s hard for us to think that something so individualized, so private, and so biologically true can be historically and politically significant.

Marissa: We’ve touched on this idea many times, but one of the most lasting mottos of second wave feminism is the personal is political, which argues that even private, individual, or intimate processes and experiences are loaded with political significance. And as scholars have shown in decades of research since the women’s movement, the personal is also loaded with cultural and historical significance. Our bodies are, and have been historically, the subjects of political debate. (I mean, if you’re not sure what we’re talking about, go listen to literally any of our episodes about sex or birth control or abortion.) Second wave feminists recognized not only that the personal is political referred to the political fight for reproductive justice, but also to the need to fight for better women’s health care. As part of the women’s health movement that we discussed in our episode on the myth of the midwife-witch, feminists focused on pregnancy and childbirth as particularly powerful experiences that needed to be reclaimed from the patriarchal control of male doctors. We also mentioned in that episode how at the same time that the women’s health movement was taking place, historians began writing women’s history, focusing on things traditionally associated with women that were previously considered historically unimportant, such as domestic life, motherhood, reproduction, care work, etc.

Sarah: One of these histories was Judith Walzer Leavitt’s classic 1986 book Brought to Bed, which is – as far as I know – the first book length social history of childbirth in America. Born out of the burgeoning scholarship of women’s history, Brought to Bed made the argument that birth was a social experience that changed over time, shaped by society and culture as well as by birthing women themselves. Far from an immutable fact of biology experienced privately, this new work revealed that childbirth was an experience loaded with gendered meanings influenced and shaped by women themselves. So today, by popular demand, we’re talking about the history of childbirth in America.

I’m Sarah

And I’m Marisssa

And we are your historians for this episode of DIG

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Sarah: Before we start, I think it’s important to be clear about the scope of this episode. The history of childbirth is immense. We simply cannot give you a comprehensive history of childbirth in one episode – I mean, you could have an entire podcast dedicated just to the history of childbirth. In this episode, I’m going to try to give a very introductory, very basic history of childbirth in America ranging from the 18th century to the early 20th century. I will not, in any way, shape, or form, do justice to those deeply nuanced and complex histories. White women’s experience with childbirth was not, and is not, the universal experience, and I don’t want anyone to get that impression from this episode. I’ll do my best to come back and do more histories on this topic in the future. But for now, we’re just going to scratch the surface, mostly using Judith Walzer Leavitt’s original and initial study on the topic as our guide.

Also, I want to acknowledge from the beginning that we recognize and honor the fact that cisgender women are not the only people who get pregnant, give birth, nurse babies, and provide nurturing care for children. The scholarship we’re relying on for today focuses on the experience of cisgender women, as far as the historical record can tell us, so I am going to use the term ‘woman’ and “she/her/hers” when referring to pregnant and birthing people. And finally, this episode will contain some descriptions of pregnancy loss, stillbirth, and traumatic births, so if you know those are triggering topics for you, you might want to skip this one.

Marissa: Childbirth is such a routine part of life that in some ways it can become invisible, especially historically. History, people often assume, is made up of major events, political elections, wars, etc. – not routine biological processes. But for something so invisible, it has made up a significant portion of the lives of women across time. Take, for instance, the women of the Holyoke family: Mary and her daughters Susanna and Judith. Mary Vial Holyoke married in 1759, and for the next 23 years, she gave birth 12 times. If you look at a pie chart of this part of her life, it’s divided into nearly perfect thirds: one third of that period she spent pregnant, another third nursing, and a final third ‘free from reproductive duties.’ If our calculations are correct, she spent 108 months of her life pregnant – roughly nine years. Her daughter Susanna bore 8 babies during the first 20 years of her marriage; Judith bore 8 in 18. The rest of the women of the Holyoke family bore between two and ten children. (The one who had two only stopped there because she died after only two years of marriage.) And don’t forget that for each of those pregnancies, women then spent at least 12 months (often more) nursing their babies, meaning that literally decades of their lives were dominated by reproductive labor.

Sarah: Numerous pregnancies and births, often in rapid succession, was perhaps the most ubiquitous experience of womanhood. But while childbirth might have been ubiquitous, it wasn’t routine – as Leavitt states, it “cast a shadow” over women’s lives. Women understood intimately that pregnancy and birth held deadly potential. Cotton Mather, the Puritan minister, warned women in a widely distributed sermon that when they conceived, they “ought to know, your Death has entered into you.” Women had to prepare throughout their pregnancy for multiple potential outcomes: the arrival of a newborn that would require a cradle and swaddling; a stillborn that would require burial; and even her own death, which would leave her family (perhaps with a new baby) without a matriarch. This example isn’t American, and it’s much earlier than the time period we’re largely focused on, but I still think it’s so illustrative of this phenomenon: in 1622, Elizabeth Jocelin had a perfectly healthy pregnancy. Nevertheless, she knew the risks inherent in childbirth, and prepared for her own death: she made a sheet to be buried in and started composing a letter to her unborn child full of motherly advice in case she did not survive the baby’s birth. It turned out Jocelin was prescient: though her pregnancy was normal and the birth uncomplicated, she nevertheless died of puerperal fever. (Puerperal fever was the common name for uterine infection and sepsis that was usually caused by the introduction of bacteria into the genital tract by doctors with unclean hands and tools.)

Marissa: Women, even those who had never had a child, knew that childbirth could be deadly. Almost all women would have known someone who had died during or after birth, and of course many women would have experienced the loss of a mother, sister, or other female relative from childbirth. Sarah Jane Stevens was terrified during both her pregnancies in the late 19th century because her own mother had died during childbirth, and wrote often of her fears to family members and physicians. Her brother, a doctor, tried to reassure her that their mother’s death was because of medical errors – and that those errors would never happen to Sarah Jane – but this didn’t ease her mind. Some women weren’t terrified but pragmatic regarding the risks of birth. Clara Clough Lenroot wrote in her diary about her hopes for her baby should Clara not survive its birth, instructing anyone who consulted her diary to allow her mother and sister to raise her baby. When Clara did have her baby, and both were healthy and happy, her husband added a little note in her diary: “Dear Clara, ‘mamma and Bertha won’t have to take care of your baby, thank God!”[1] When Ellen Regal wrote to her brother about their sister Emma’s pregnancy in 1872, she referred to the birth as the “Valley of the Shadow of Death that she must soon enter.” A young women named Nettie Fowler McCormick wrote in wrote a prayer in her diary: “O God preserve my life to my husband & children!”[2]

An engraving of young mother sits and looks at her baby who is asleep in the crib
An engraving of young mother sits and looks at her baby who is asleep in the crib | Wellcome Collection

Sarah: Many women even prepared informal wills to help them feel prepared, just in case they did not survive their deliveries. Bessie Rudd wrote a letter to her husband about her preparations: “I have everything in order & fixed to my mind, should any unforeseen Sorrow come to me. You know we must think of all things, Edward, and have everything in readiness. I sometimes think I am ready to die, though Life was never dearerto me than now, with you to live for & help along life’s pathway.” Sadly, women also had to emotionally prepare for the very real possibility that their baby might die, at its birth or sometime later in childhood. It wasn’t uncommon to lose a baby and be pregnant again within weeks or months; it also wasn’t uncommon to lose an older child while pregnant. The emotional toll that all this would take just cannot be overstated. Sarah Hale, the mother of famous 19th century orator Edward Everett Hale (best known for giving a zillion hour speech before Lincoln gave the Gettysburg Address) reflected on her child bearing years on her 25th wedding anniversary: “I have borne eleven children, and have been permitted to keep until this day sever – one blossom of hope, just dawned upon this world, lived but a brief hour, and was transplanted by the all knowing Creator into his gardens of joy. Another remained with us for seven months, learned to return smile for smile, and was just beginning to show the germs of intelligence when a short space of suffering and anxiety was closed by our laying him away in the dark chamber, which was then but a few paces from the nursery where we had cherished and nourished him. Then came another bright cherub – our darling “other Susie”  – bright and hopeful and promising with her earnest and deep glance, and her thoughtful spirit, and in her seventh year, it pleased God to take her from us … three weeks had past away after her death, when another little girl was given us – she has been spared to this time, is like, very like her sister, God grant that she may be long spared to us, and be so trained here that she may be joined to the “other Susie” in heaven. Since then another little girl has been given and taken, and now there are seven here, and four awaiting us on the other side of Jordan.”[3] I know that’s a long quote, but I couldn’t help but share it – I think it’s a powerful reminder of the emotional risks involved in pregnancy, childbearing, and mothering.

Marissa: It’s not all that easy to get good statistics on maternal mortality rates during the 18th and 19th century, but in general, mortality rates gradually decreased over the course of the nineteenth century, leveling off around the turn of the 20th century, and then starting to go in the other direction. Most available statistics start in the early 20th century. Leavitt found that “deaths from maternity-related causes at the turn of the twentieth century were approximately 65 times greater than there [were] in the 1980s.” (Reminder, this book was published in the late 1980s.) To look at it another way, in the early 1900s, one in 154 women died in childbirth. But it was actually worse than that: considering that women almost always had more than one pregnancy, and Black and immigrant women often had upwards of 4 or 5 pregnancies, the mortality risk went way up. If a woman had five pregnancies, her risk went from 1 in 154 to 1 in 30.

Sarah: And even setting aside the risk of death for mother and baby, there was still the inevitability of pain and suffering. Women were afraid of the pain, and worried that they would be weakened and unhealthy after their birth. These fears compounded with the knowledge that pregnancy couldn’t be avoided. While some women knew of ways to limit their fertility, others didn’t have the knowledge or ability to prevent conception and found themselves pregnant again quickly after traumatic births. Agnes Reid lamented getting pregnant again after her first child was born: “I confess I had dreaded it with a dread that every mother must feel in repeating the experience of child-bearing. I could only think that another birth would mean another pitiful struggle of days’ duration, followed by months of weakness, as it had been before.”[4] This was experience that men often just couldn’t really understand. Clara Lenroot’s husband – the one who wrote in her diary to say she had survived childbirth – also wrote in her diary about his shock at the ordeal she had been through. “Everything is all right, but at what cost? My dear wife, what you have suffered and you have been so brave! I have seen the greatest suffering this day that I have ever known or ever imagined!”[5]

Marissa: All of this is important context for understanding how childbirth changed between the 18th and 20th century. In the 18th century, birth was entirely the domain of women. Babies were virtually always born at home – sometimes the mother’s home, sometimes an ancestral home – and in the setting that the laboring mother chose. (There are some exceptions, though moreso in Europe, where “lying in” hospitals were developed for working class women could sometimes get medical care in labor). Women learned how to prepare for birth and the arrival of a baby through their female kin networks, and when labor began, they didn’t call for the doctor, but for “the women,” sometimes called “gossips.” Among the women that were summoned was the midwife, typically a local woman who had learned how to deliver babies and care for laboring women through informal apprenticeships with older women, often a female relative. But in addition to the midwife were female friends and relatives, who did everything from holding the laboring mother’s hand to bringing food and drink to telling stories to providing emotional support. The only time a doctor (always male) was called was if the birth went very badly. Midwives had a very non-interventionist approach to birth – most often, their job was to sit with the laboring mother until birth was imminent, then help guide the baby out. Occasionally the might prepare the perineum and cervix or give suggestions about what he mother should do to speed labor (walking, squatting, etc). Most births are long and pretty boring, so they were a time when women gathered and socialized, sometimes over a stiff drink.

A black and white lithograph image of William Shippen
William Shippen in 1736 | Public Domain / Wikimedia Commons

Sarah: But in the late 18th century, the world of the all-female birthing room began to change. To illustrate that change, let’s use the example of Dr. William Shippen, Jr. Shippen was born in Philadelphia in 1736, and followed his father into the practice of medicine. He studied medicine in Philadelphia, and then refined his medical education in London and Edinburgh before returning to Philadelphia in 1762 to begin his practice. While in London, Shippen learned the practice of midwifery (soon to be called obstetrics to differentiate it from what the traditional female midwives did) from the “man-midwife” Dr. Colin Mackenzie. During this period in Europe, influenced by the Enlightenment, medicine was professionalizing and becoming more ruled by the principles of science. Physicians, who were becoming the authority figures over the human body and its medical needs, began to consider the fact that birth was the one medical event that didn’t fall under their authority. Man-midwives were those first male physicians who  began to specialize in delivering babies, largely out of the belief that midwives were unclean, untrained old crones who had no place presiding over an important medical event. So Shippen learned from the first of what we’ll come to call ob-gyns, and then brought that knowledge back with him from Great Britain.

Marissa: When Shippen returned, he became the first anatomy lecturer in the United States, specializing in lectures on the anatomy of pregnant and birthing women. Eventually, Shippen opened a private midwifery practice in Philadelphia, selling his birth services to wealthy white women in the city. Shippen’s practice was hugely successful, and he became the go-to obstetrician for Philadelphia’s elite. It’s worth asking here: why on earth did women, who had birthed forever surrounded by women and attended by women, suddenly begin seeking out male physicians to attend their births?

Sarah: There’s a certain appeal today to romanticizing the world of birth before the entrance of the man-midwives and obstetricians. As women today advocate for the right to determine their own birth experiences and push back on the control that obstetricians wield over labor and delivering options, there’s a temptation to think that before medicalization women were empowered by the all-female, noninterventionist, traditional birthing room. In that view, the entrance of male obstetricians is a hostile takeover by the medical patriarchy. That’s the interpretation that appeared, for instance, in the pamphlet we discussed in our episode on the myth of the midwife-witch by Barbara Ehrenreich and Dierdre English called “Witches, Midwives and Nurses.” This interpretation made sense given the frustration and anger that many feminists felt having had their birth experiences controlled by medical authority. And largely, that wasn’t wrong – scientific doctors did want to push out the midwives, move birth out of those all-female spaces, and assert their authority over this medical event. But it wasn’t quite that simple.

Marissa: The reality is that women wanted to hire male birth attendants. For one thing, being able to hire a male doctor – one skilled in the elite field of anatomy and trained in the finest schools in Great Britain – became a status symbol. But there are two other reasons that are more specific to the experience of childbirth. Think about everything we’ve talked about over the beginning part of this episode: each pregnancy came along with fears about the pain of childbirth and the not-insignificant risk of death for both mother and child. Midwives were skilled, but they were there to attend the birth, intervening only when absolutely necessary – and if things went sideways, there was very little they could do. Male doctors offered two things that midwives just could not: pain relief and forceps. While today, those things are demonized as symbolic of the medicalization of childbirth, they were gratefully welcomed by nineteenth century women.

Sarah: Forceps were first invented in the 16th century in Europe by a family of barber-surgeons, probably by Peter Chamberlen, who served as an early man-midwife to several royal women. Generations of Chamberlens served royal barber-surgeons in the French and English courts. The family kept the forceps within the family, meaning that they were really only used at royal births. In the 18th century, when the Chamberlen forceps came to light to the public, Scottish man-midwife William Smellie took the earlier tool and refined it, making them shorter and more curved and bringing them into wider use. Even as the Smellie forceps became more standard, the tool was not used by midwives, as the use of such instruments, along with therapies like bloodletting and administering heavy medications, was considered the domain of trained physicians. Once doctors like William Shippen began providing obstetrical care in early America, the use of forceps became more common in the US. And I want to be clear: forceps weren’t necessarily pleasant. Forceps could cause lasting damage to the cervix or uterus if used improperly. Women didn’t love them because they were comfortable or risk-free. Rather, it was because forceps could mean the difference between a difficult but successful birth or a dead baby. Trigger warning – this is graphic. I’ll keep it brief, but if you’re sensitive to this kind of thing, you might want to skip ahead a minute or two. Without forceps, if a baby was stuck in the birth canal or pelvis (whether because of a strange presentation, large head, small pelvis, etc.) there was no way to get the baby out without killing it. If a midwife recognized that the baby could not be delivered, and the mother’s life was in danger, she needed to call in a doctor, who would have to perform a craniotomy on the fetus and remove the baby in pieces. As risky as forceps might be, they could save a mother from this deeply traumatizing birth experience.

Antique forceps
Smellie-type obstetrical forceps, United Kingdom, 1740-1760 | Wellcome Collection

Marissa: Ugh, ok, no more forceps. Let’s talk about pain relief instead. Next to the fears of death, Judith Walzer Leavitt says that “pain was probably the single part of birth most hated by birthing women.” Women described even healthy, normal birth experiences as near-death experiences because the intensity of their pain. When Dr. Shippen attended the births of elite Philadelphia women, he didn’t have much to offer in the way of pain – certainly no epidurals in the late 18th century – but he could offer opium, both straight and prepared in alcohol in the form of laudanum. In 1799, Dr. Shippen attended the birth of Sally Drinker Downing, daughter of the wealthy Drinker family. Sally had a history of difficult births, and was very agitated. In an attempt to calm her, relieve her pain, and move labor along, Dr. Shippen gave Sally 80-90 drops of laudanum. (He also drained 14 oz of blood, but that’s a story for another day.) When the laudanum didn’t do the trick, he gave her “three grains” of opium.[6]

Sarah: These opiates weren’t ideal. They were, it probably goes without saying, very heavy sedatives and painkillers, and could cause as many problems as they solved. But in the mid 19th century, other sedatives became available, specifically chloroform and ether. Both were administered through inhalation, and when appropriately administered, would relieve pain without entirely incapacitating or ‘knocking out’ the laboring woman. Ether and chloroform came into use in the late 1830s, and late in the decade, they were occasionally (and experimentally) being used in childbirth. Soon, women more generally learned about the existence of these forms of pain relief and enthusiastically requested it from their doctors. It was actually doctors who were hesitant to dole out the drugs. Philadelphia doctor Charles Meigs, for instance, worried about the safety of the drugs, saying “should I exhibit the remedy for pain to a thousand patients in labor, merely to prevent the physiological pain, and for no other motive – and I should in consequence destroy only one of them, I should feel disposed to clothe me in sack-cloth, and cast ashes on my head for the remainder of my days.”[7] For him, the chance of losing one patient to the new and relatively unstudied drugs wasn’t worth it. Meigs though, it should be said, also believed that birth pains were “a desirable, salutary, and conservative manifestation of life force” – not really for any misogynistic or religious reasons, but because he believed that births went more smoothly when women were in tune with their contractions.

Marissa: In 1848, Walter Channing, an elite Boston physician, conducted a survey among area doctors to assess their feelings about ether in childbirth. He found that nearly all doctors reported that their patients were aware of the existence of ether and they often asked for it – but that they only actually administered it when their patients outright demanded it. But as the decade went on, doctors who did administer ether began to publicly report that it was successful, encouraging more doctors to use it. News traveled among women, too. When a Dr. Allen of Massachusetts arrived at one woman’s house, he found that she had been laboring for twelve hours and was convinced she was dying – he administered chloroform and safely delivered her baby shortly thereafter. The woman was so relieved that she told all her friends that “with chloroform, it was nothing to have babies” and that she was now happy to plan for another. As word spread among women, they put increasing pressure on their doctors to provide pain relief, and soon it was in much more common use. Not every doctor was crazy about using it for every patient, but others used it at every birth where it was requested and reported that it was a real game changer.

Sarah: But ether and chloroform wasn’t without risk or complication. One thing that posed a challenge was dosing. Ether and chloroform were both administered in kind of haphazard ways – they were typically dripped onto a napkin or handkerchief held over the patient’s face while they breathed in the fumes. That required an extra set of hands, though, and most doctors just didn’t have that – so they sometimes used the laboring women as a kind of self-anesthesiologist. One doctor explained that “if there is no one present to assist me in the final stages of labor, I have the expectant mother hold a drinking glass with the bottom filled with cotton and upon which the chloroform is poured then have them hold the glass over their nose. When their hands become unsteady and the glass falls away from the nose, I know they are sufficiently asleep to give them relief and I continue to accelerate delivery.”[8] Another doctor described a sort of juggling act of drug administration, pulling the cork of the chloroform bottle out with his teeth if his hands were busy, y’know, with baby stuff. It could also be a way for other women in the birthing room to stay involved, holding the soaked handkerchief for the doctor. Another risk was that pain relief had the potential to slow labor down, make it hard for women to control their muscles for effective pushing, or knock a patient out entirely, all of which could result in increased use of birth tools like forceps. But when administered properly, it could relax women and make birth a less desperate, terrifying experience. One doctor described a woman who upon “the first inhalation burst out in a beautiful song, and continued singing one after another until her babe, a large boy, first child, was born.” That certainly sounds nicer than the horror stories we talked about at the beginning of the episode!

Marissa: But toward the turn of the 20th century, as anesthesiology became its own field and more women came to have high expectations of pain relief, doctors began trying to find a more efficient form of pain relief – something that might work faster, earlier, and with more standardized administration. For some doctors (especially women, who were slowly but surely entering the profession) it seemed almost like malpractice that there weren’t better alternatives for laboring women. Take for instance this, written by a female doctor in 1908: “I know of no suffering that is more dreaded by our sex thatn that which confronts them as they heroically take their lives in their hands down into the very shadows of death itself in order that they fulfill the plans of the Creator in populating this world of ours! … Is it necessary that such suffering be endured?”[9] If I didn’t tell you the date, that quote would sound *just* like the ones from the beginning of this episode, where women wrote their fears about dying in childbirth. For some doctors, it seemed anti-modern that better alternatives still hadn’t been developed. So scopolamine-morphin, introduced to the US from Germany in the 1910s, seemed like the long-awaited modernization. Scopolamine, which produced the condition that came to be popularly known as “twilight sleep,” could be administered very early in labor, and eliminated pain while also puting women into what is called an “amnesic state.” In this state, women would not form a memory of the time they were under the effects of the scopolamine-morphin.

Sarah: In the best case scenario, scopolamine-morphin removed all the fear and pain from the experience from childbirth. In 1914, a Mrs. Cecil Stewart described her experience with the drug: “At midnight, I was awakened by a very sharp pain. The head nurse … gave me an injection of scopolamine-morphin … I woke up the next morning about half-past seven … the door opened, and the head nurse brough in my baby … I was so happy.”[10] Using this drug, a woman more or less went to sleep and woke up (feeling fantastic, according to its biggest boosters) to a cute baby and no recollection of the dreaded event. But twilight sleep birth was … complicated. Just because a woman didn’t remember it when she woke up didn’t mean her body didn’t actually experience the birth. Women thrashed and screamed in pain, but weren’t psychologically ‘present,’ so they couldn’t control their movements or their muscles. Because of this, they needed to be carefully observed and restrained throughout the birth process. They were placed in kind of ‘crib-beds,’ that had curtains and walls that kept them from flinging themselves out of bed (or even getting up and walking around in some cases). When the baby finally entered the birth canal, they were typically brought out using forceps and other tools, since women couldn’t control their muscles to effectively push.

Marissa: In the early 20th century, twilight sleep was controversial – and not necessarily for the reasons that we, today, think of twilight sleep as controversial. In today’s culture, twilight sleep has come to represent the zenith male doctors’ attempts to control the natural processes of women’s bodies by medicalizing childbirth. But in the early 20th century, it caused controversy because – not unlike ether and chloroform – women wanted it and doctors were reluctant to provide it. In 1914, McClure Magazine published an article by two women (with no medical training) describing the German use of scopolamine and criticizing sexist American doctors for failing to keep up with cutting edge science. They claimed that American doctors relied too much on forceps, which caused birth injuries and infections, while German doctors provided women natural, instrument-and-pain free births. (They believed that twilight sleep meant for less forceps use – which is not necessarily the case.) Middle and upper class white women rallied to the cause, and articles repeating the argument of the McClure’s piece proliferated in popular magazines and newspapers. Women believed that doctors were withholding scopolamine because of their traditional and sexist belief that women should feel the pain of childbirth, or perhaps just that they couldn’t be bothered. Two of scopolamine’s biggest boosters, Marguerite Tracy and Mary Boyd, claimed that doctors didn’t use twilight sleep simply because it “took too much time.”

A black and white photograph of a white woman facing away from the camera, holding a chubby white baby  over her shoulder
An image from Marguerite Tracy and Mary Boyd’s Painless Childbirth : A General Survey of all Painless Methods with Special Stress on “Twilight Sleep” and its Extension to America, 1917 | Wellcome Collection

Sarah: In defense of the doctors, the science on the safety of scopolamine was not clear. Some individual doctors and medical journals lauded it, while others warned it was too risky and not well studied. Some doctors were early adopters, like Dr. James Harrar who traveled to Germany to be trained in scopolamine administration, who confidently stated that “if the male had to endure this suffering, I think he would resort very precipitously to something that might relieve the pain.”[11] On the other hand, major medical journals were warning that the drug was dangerous. The Journal of the American Medical Association (JAMA) declared that “this method has been thoroughly investigated, tried, and found wanting, because of the danger connected with it.”[12] Some journals did both: the journal American Medicine published some 9 articles in support of twilight sleep and also editorials warning that the drug was potentially dangerous.

Marissa: Frustrated with doctors slowness to adopt the drug, middle and upper class American clubwomen formed the National Twilight Sleep Association. (Clubwomen were Progressive era reformers who used their role as women, mothers and wives to improve society.) The NTSA’s leaders included women doctors like Dr. Eliza Taylor Ransom and Dr. Berta van Hoosen and political activists including Rheta Childe Dorr of the Committee on Industrial Conditions of Women and Children and Mary Ware Dennett, of the National Suffrage Association and later the National Birth Control League. These women saw the fight for twilight sleep as part of the fight for other civil rights. The right to a more comfortable and less terrifying birth experience, they believed, was part of the fight for freedom, human rights, and bodily autonomy.  The NTSA sponsored rallies across the United States and staged smaller events in department stores, “between the marked-down suits and the table linens” where they could gain the attention of working class women. Typically a woman would share her experience with scopolamine as a way of making the drug feel more ‘real’ to those who wouldn’t be reading about it in the pages of McClure’s. Frances Carmody became a common twilight sleep speaker, telling audiences: “I experienced absolutely no pain. An hour after my child was born, I ate a hearty breakfast, the third day I went for an automobile ride. The Twilight Sleep was wonderful!”[13]

Sarah: Sadly, this movement for twilight sleep was dealt a blow when the same Mrs. Carmody died in childbirth in August 1915. Even though her doctors and husband insisted to the press that Frances’s death had nothing to do with scopolamine, because Mrs. Carmody had been such a twilight sleep booster and then died in childbirth, it nevertheless made people skeptical of the drug’s safety. Nevertheless, women continued to pressure doctors to provide scopolamine as an option for pain relief. It’s not that women were stupid, or desperate to avoid discomfort, but rather than they wanted to have the right to choose their birth experiences for themselves. In this way, even though twilight sleep seems so different from older birthing traditions, Progressive era women’s activism about twilight sleep was actually right in line with the actions of earlier generations of women, who had made their own birthing choices.

Marissa: We mentioned before that women under twilight sleep needed to be restrained in crib-beds and kept under watchful eyes at all times. Scopolamine also required injections at regular intervals after their first dose early in labor, which meant that women had to be in a place where doctors and nurses were close at hand – in other words, the hospital. The NTSA and the demand for twilight sleep helped bring about yet another revolution in childbirth: the move from birthing at home to birthing in the hospital. As we also mentioned before, nearly all women gave birth at home before the 20th century, with the exception of charity hospitals and medical school maternity wards, which provided free care for working class and poor women. When man-midwives like William Shippen entered the profession in the late 18th century, they were still being hired by an individual woman and her family and invited into her home. And even as far back as that time, male physicians complained about the lack of cleanliness in the home setting. Doctors complained that women refused to stay in one position on a Kelly pad, a rubber sheet designed to flow blood and other fluids away off the bed and away from the patient. They complained about the difficulty of crawling all over large beds to administer ether or to access the birth canal with forceps. They complained that being in the home – where nervous husbands sat downstairs and women attendants watched carefully – made it impossible for them to prepare women for birth by shaving them and washing the genital area with antibacterial soaps. Birth in the home, to put it simply, gave women too much control and doctors too little.

Sarah: The advent of germ theory led to doctors becoming incredibly scrupulous about antisepsis. In most cases, it meant diligent handwashing and instrument sterilization, clean sheets and garments, and use of a sterile Kelly pad – all of which was difficult in a private home. Some insisted on shaving and washing patients with antibacterial soap. Others took this even *more* seriously, insisting that women be cleansed inside as well as out through the use of enemas and anti-bacterial douches, and even laying a bactericide-soaked towel over the crowning baby’s head. All of this was really only possible in the hospital. The president of the American Gynecological Society wrote in 1898 that “women in well-conducted lying in asylums [hospitals for birthing women] are far safer from puerperal infection than those who are attende in their own houses, even though they be brown-stone fronts.” In other words – women were safer from post partum infections in hospitals, even charity hospitals, than they were in their own homes, even nice homes. Hospitals were cleaner – therefore safer – and could offer pain relief in the form of twilight sleep.

Marissa: Starting in the 1920s and 30s, women began to see hospitals as emblematic of all the cutting edge medical care,  turned from wanting to control individual aspects of their birthing experiences and instead toward choosing the right doctor, who would take care of everything. The magazine Hygeia told readers to “see an obstetrician early – he will take care of the rest.”[14] Other magazines published horrifying stories about women who died in childbirth because they clung to old fashioned ways instead of seeing a specialist and going to a hospital. Social reasons also drove women to hospitals. In the mid-20th century, women were not necessarily surrounded by the same networks of women that their grandmothers had had. It wasn’t just finding a midwife to be present at the birth, but also someone to care for the postpartum mother and baby. As one woman wrote, “sure, it would be nice to have babies born at home! But who is going to bathe the baby, bring the mother’s tray, change her sheets?”[15] (It goes without saying that the new father is clearly not expected to do any of those tasks – and actually was probably at work, anyway.)  Without those traditional networks of women around her, a woman who gave birth at home would likely need to be up and cooking, cleaning, and caring for older children within hours of delivering a newborn. In addition to pain relief, cleanliness, and scientific medical care, hospitals could provide nursing care and a chance to rest.

Sarah: A description of birth in the 1930s went like this: “Arriving at the hospital, she is immediately given the benefit of one of the moden analgesics or pain killers. Soon she is in a dreamy, half-conscious state at the height of a pain, sound asleep between spasms. She knows nothing of being taken to a spotlessly clean delivery room, placed on a sterile table, draped with sterile sheets; neither does she see her attendants, the doctor and nurses, garbed for her protection in sterile white gowns and gloves; nor the shiny boiled instruments and antiseptic solutions. She does not hear the cry of her baby when he feels the chill of this cold world, or see the care with which the doctor repairs such lacerations as may have occurred. She is, as most of us want to be when severe pain has us in its grasp, asleep. Finally, she wakes in smiles, a mother with no recollection of having become one.”

Marissa: To us today, this sounds like a horror story. And of course, there are scary elements: this is a story about a woman separated from any loved ones or support people, at the whim of medical authorities, in the thrall of a medication that leaves her in a dreamy – maybe nightmare-like – state. But at the same time, she is relieved of the pain of childbirth, which caused fear and anxiety for so many generations of laboring women. As Judith Leavitt argues, “women did not view the stay in the hospital as a time when they lost important parts of the traditional birth experience, but rather as a time when they gained protection for life and health, aspects of birth that had been elusive and uncertain in the past. They gave up some kinds of control for others because on balance, the new benefits seemed more important.”[16] But – I bet you can see this coming – the hospital did not exactly deliver on all its promises. Maternal mortality did not improve in hospitals – in fact, mortality rates from home birth were consistently lower than hospital births between 1900 and 1950. Hospitals, far from being sterile utopias, were actually full of germs, which doctors and nurses carried from patient to patient. Maternal mortality rates eventually did go down, but not because of the move to the hospital – antibiotics, introduced in the 1940s, finally provided a way to combat postpartum infections.

Even if they escaped infection, women recalled negative experiences with hospital births –  the terror of being strapped to beds under sedation, being left alone in cold delivery rooms, and then being at the mercy of a string of strangers.

Sarah: So was the move to the hospital good or bad? Was the medicalization of birth good, or bad? Was the introduction pain relief in childbirth good, or bed? Well – as we always say – it’s complicated. Home births provided more freedom of choice, familiar surroundings, and the possibility of support people – but also  became increasingly difficult in a practical sense. Hospital births provided the perception of cleanliness and medical expertise, not to mention pain relief – but could be disempowering and alienating. It’s unsurprising, then, that starting in the 1960s, birth became a common topic of discussion in feminist conscious raising groups, where women shared their frustrations and fears about birth. Women shared their terrifying experiences with twilight sleep and feelings of lack of control with Betty Friedan, who published them in her classic 1963 feminist text, The Feminine Mystique. As women became aware that their bad experiences weren’t isolated events, but rather a results of the patriarchal medical system, feminists began to demand better from their doctors. They experimented again with birthing at home and founded feminist birthing centers, where they could have the benefits of both medical science and the traditional support of networks of women, as well as control their birthing positions and have freedom of movement. Since the 1970s, medicalized childbirth and its counterpoint, homebirth, have been ever at odds. But if there is a throughline, it’s this: since the earliest days of women bearing children in the United States, they have sought one thing – choice.

Sources

Leavitt, Judith Walzer. Brought to Bed: Childbearing in America, 1750-1950. New York: Oxford University Press, 1986.


Notes

[1] Leavitt, 21.

[2] Leavitt, 80.

[3] Leavitt, 18.

[4] Leavitt, 32.

[5] Leavitt, 21.

[6] Leavitt, 40.

[7] Leavitt, 117.

[8] Leavitt, 121.

[9] Leavitt, 128.

[10] Leavitt, 128

[11] Leavitt, 133.

[12] Leavitt, 133.

[13] Leavitt, 131.

[14] Leavitt, 175

[15] Leavitt, 177.

[16] Leavitt 181


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