Before physicians entered the field of birth, laboring women were primarily attended by midwives. These were women who had experience in dealing with birth. Friends and family of the laboring woman would come to her home and encourage her and help ease her through the birth. Then afterward, these women would continue help her until she was ready to take over her household duties again. Serious physicians felt it was beneath them to attend a birth. There is much about the inner workings of birth that cannot be measured by scientific means, and thus was considered superstitious.
Of course, many women feared birth because the Church had drilled into women that birthing would bring them near to death and that they should make their peace with God before labor started. Undoubtedly, this did nothing to help women see birth as a natural process that functions beautifully! It may be noted that they failed to point out that God did not curse women to bear pain in childbirth! If one reads the text (Gen.3:17) carefully, it could be noted that God said that pain would be increased! Pain, or as many think it would be more accurately translated, hard work was already a part of the picture of birth. This is not unfairness to women, but rather seems to function as a warning system to begin the preparations for the birth of a child.
As people began to revere science above natural processes, medical schools began to teach doctors about birth. Still, midwives controlled the majority of births, calling on doctors only with complicated births. Cesareans were only done to save the life of a baby during or after its mother's death.(The Birth Book, pg 16) Soon, however, people began to think that those who had degrees could improve upon the natural design of birth. Consequently, women began seeking out doctors for their childbearing services. Forceps became the norm for birth, which made lying on the back necessary for birth--a trend we are still trying to overcome! With the use of forceps, an episiotomy became necessary.(The Birth Book, pg 16)
Midwives at this time were being driven out of business by lack of clients and the forcing of licensure. Licensure was intended to make midwives safer. But, instead, it drove them out of business. Birth had gone from being overseen by midwives who trusted in God's design of women, who empower women to birth in the normal way, who took the time to let birth run it's natural course, to physicians, most of whom were male at that time, who felt that nature was insufficient, God's design was faulty, and time was of the essence and tried to improve on the design.
The driving factor behind women seeking these services was the offer of what was thought to be a safer birth, and the search for pain-free childbirth without risks. In hindsight, both of these assumptions were false. Today there is still the search for these things, but it is still a promise that cannot be made. Pain-free childbirth, when it is attainable, is still very risky to the mother, the baby, or both.
By the 1940's, the standard was set, with hospital birth being thought to be the ideal. The idea was that at the hospital the doctor had all the "tools of the trade" handily available. Unfortunately, this was and continues to be a major downfall of hospital birth, as well. Included in those tools were medications, forceps, surgical instruments, confinement to bed, enemas, pubic shaving, arm and leg restraints, and hospital nurseries with rigid schedules. Birth was seen as an illness that required medical attention.
By the 1960's women began to want some control over their bodies during birth, opening the door for childbirth preparation classes. In the 60's and 70's, a change began to take place--the admittance of the father in the delivery room. The first person to work for this change was the late Dr. Robert A. Bradley. It was an uphill battle, but thanks to Dr. Bradley, a father can now be present at the moment of his baby's birth.
Since then, a growing number of women have turned their back on the medical model of birth and have begun to return birth to the place where it started--the home. Also, there is a middle choice, that being the free-standing birth center that is being widely embraced by women who feel comfortable in an out-of-hospital setting, but for a variety of reasons may feel that their home is not ideal. These women had looked at the statistics and standard hospital practices, and came to the conclusion that the most responsible thing for them to do was to birth at home. Among the stats that began causing this change was the fact that between 1970 and 1990, surgical birth soared from 5% of all births to 25-30% of all births! Did the reproductive organs of 30% of the population suddenly stop functioning properly? No, in many cases it is the fear of a lawsuit on the part of the doctor that "causes" a cesarean. There is a saying among OB's: "The only C-section I get sued for is the one I DON'T do."
Women are learning to be wise consumers and are beginning to be careful about choosing a birth attendant carefully. Healthcare providers are no longer blindly trusted, but are being questioned about their standard practices. This can do nothing but good for the birth scene. The future of birth may, indeed, be bright.
Executive Director -- NaturalChildbirth.org