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Dangerous Childbirth

From being a female-directed activity, where midwives had a monopoly over midwifery practice, male practitioners invaded the lying-in chamber particularly from the eighteenth century onwards, and became increasingly involved in normal childbirth. Birth was increasingly depicted as full of risk for mothers. This trend continued into the nineteenth and twentieth centuries. Experiences varied throughout Europe and North America, and seem to have been closely related to midwives’ success in obtaining legal recognition, a licensing system and training. As midwives strove to gain professional recognition, this also brought them into conflict with their traditional counterparts, the ‘handywomen’, themselves seen as a source of danger. The nature of childbirth changed in other ways, principally becoming more interventionalist, and at the turn of the twentieth century the shift to the hospital commenced, first steadily and then after the 1930s at an accelerated rate.

We will focus closely on one particular expression of the changes in childbirth practice and attendance, the richly-documented ‘American midwife debate’. At the turn of the century midwives still attended over half of all deliveries in most Western countries, but by 1930 the picture had changed dramatically. In the United States this reached an apogee: the midwife had been largely squeezed out, due to a vitriolic campaign waged by many influential medical practitioners, determined to wrest all midwifery practice away from the midwife, who was depicted as being dangerous, dirty and ‘un-American’. Childbirth was defined as ‘pathological’, requiring the attention of the obstetrician in hospital, with instrumental intervention becoming standard. The justification was that this form of childbirth assistance would improve conditions and maternal and infant survival rates. The reverse came to pass, as maternal mortality rates soared. By 1900 there was nowhere in the western world more dangerous to give place than the United States. The US was the extreme example, but many countries were sharing in this trend towards a male takeover of childbirth, hospitalization and increased medical intervention. We will also view sections of the 1931 film ‘The Forgotten Frontier’, depicting the experiences of the Kentucky Nursing Service.

Readings

Primary sources

* Extracts Jalland and Hooper, Women from Birth to Death, Parts 3.2, 3.4.

Film viewing: ‘The Forgotten Frontier’, 1931 (in seminar)

* Judith Walzer Leavitt, Brought to Bed: Childbearing in America 1750-1950 (1986), ch. 2.

* Jane B. Donegan, ‘”Safe Delivered,” but by whom?: Midwives and Men-Midwives in Early America’, in Leavitt, Women and Health in America, 1st edn, 302-17.

Nancy Schrom Dye, ‘Mary Breckinridge, the Frontier Nursing Service, and the Introduction of Nurse-Midwifery in the United States’, in Leavitt, Women and Health in America, 1st edn, 327-43.

* Joan Mottram, ‘State control in local context: public health and midwife regulation in Manchester, 1900- 1914’, in Hilary Marland and Anne Marie Rafferty (eds), Midwives, Society and Childbirth: Debates and Controversies in the Modern Period (1997), 134-52.

Ann Oakley, The Captured Womb: A History of the Medical Care of Pregnant Women (1984), esp. ch. 1.

Ornella Moscucci, The Science of Woman: Gynaecology and Gender in England, 1800-1929 (1990), ch. 2.

Jean Donnison, Midwives and Medical Men: A History of the Struggle for the Control of Childbirth (1977, new edn 1988), esp. chs 2, 3 and 4.

*Anne Witz, Professions and Patriarchy, Routledge, 1992, ch. 4.

Nicky Leap and Billie Hunter, The Midwife’s Tale: An Oral History from Handywoman to Professional Midwife (1993).

American midwife debate:

* Judith Barrett Litoff, The American Midwife Debate (1986) (extracts in box).

* Frances E. Kobrin, ‘The American midwife controversy: a crisis of professionalization’, Bulletin of the History of Medicine, 40 (1966), 350-63.

* Irvine Loudon, ‘Maternal mortality: 1880-1950. Some regional and international comparisons’, Social History of Medicine, 1 (1988), 183-228 or Loudon, ‘Midwives and the quality of maternal care’, in Marland and Rafferty (eds), Midwives, Society and Childbirth, 180-200.