The History of Hospital Births in the U.S.

Image by Cincy Birth Stories

As Dr. Marsden writes, women are “important and valuable” human beings, not machines, and not containers for making babies (Marsden 2001). Women are the ones giving birth, bringing new life into the world, experiencing and transitioning between two different worlds within the span of just hours. As such, some would argue that women should be treated as the highest of beings, capable of not only giving birth without largely unnecessary medical interventions used to make the doctor’s schedule easier, but also of showing the world that birth is not a medical event, but an animalistic and primitive and beautiful one? Due to the earthly biological nature of birth, the best outcomes come from women feeling safe and comfortable, and laboring on her own time. "By medicalizing birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman's state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result is that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what non-medicalized birth is. The entire modern obstetric and neonatological literature is essentially based on observations of medicalized birth." (World Health Organization 1996). In direct opposition to this, birth is an entirely autonomic nervous system function, and can not be controlled by either the mother’s consciousness nor a doctor’s efforts.

Initially the change in providers was due to women demanding doctor-attended births at home, as they saw doctors to be superior to the midwives who had been around since the beginning of time. This was in large part due to the patriarchal society pointing their fingers at midwives for having deals with the devil. After all, at the time it was still widely believed even in the newly formed America that power and wisdom flowed from God, to kings, to noblemen, to the highest of society. It is notable that doctors in Europe at the time were court appointed noblemen; they did not have anything resembling the medical education doctors today have (Feldhusen 2000). “How [then] could these women (midwives) be privy to the literal secrets of life and death? …If this knowledge didn’t come from God – and it obviously had not, as it had clearly bypassed the kings and noblemen – then it must have come from the devil” (Drichta & Owen 2013). At the same time around Europe and in America, “new” technologies and inventions were being discovered (most were actually improvements on ancient Egyptian and Arabian devices), and doctors needed women to test them out on.

Worldwide, women have been birthing in hospitals as a standard for roughly 100 years. That’s only three generations! Even more interesting is that the mass transition to hospital began as so many things do – as a status symbol (Drichta & Owen 2013). Hospitals have been in place for mothers who were of higher risk almost as long as educated doctors have been around, but women can all thank Queen Victoria for hospitals becoming the gold standard for birthing babies. (She’s also the reason we wear white wedding gowns!) In 1853 Queen Victoria heard of a doctor whose wife went through labor with Chloroform that she inhaled to considerably lessen the intensity of her contractions. Victoria then decided there was no need for a queen to feel any pain during birth. Early feminists applauded Queen Victoria for taking control of her birth, and began to claim it was their right to birth without pain. However, it was still typically only the very wealthy who could afford the “luxury” of the hospital and more importantly to them, of the pain relieving drugs (Wolf 2012).

In 1900, about half of all births were attended by a doctor at home, leaving midwives to only women of lower social and economic standings; 35 years later, only fifteen percent of home births were attended by a midwife (Scott 2013). Also in 1935, thirty-seven percent of births occurred in hospitals – an astronomical leap from less than five percent at the turn of the century (Feldhusen 2000). In 1938, all hospital births were done under “twilight sleep” in which women went to the hospital and were put into slightly less than a medically induced coma using morphine and scopolamine, waking hours or even days later to their newborn babies (Block 2008). In the 1970’s women were given a more recognizable alternative to the earlier versions of pain relief in either a spinal anesthetic or a pudendal block. Almost immediately following this standard application of the epidural, c-section and infection rates began to skyrocket (Feldhusen 2000). Despite this, most women still had the opinion that being in the hospital with a doctor was the safest option. After all, the hospital had doctors with new medical degrees and boasts of sterility. However, a large number of women also began learning gynecological care (25% of medical students were now women) and encouraged the revival of midwifery. “The conflict over homebirth proved to be one of the most bitter between the medical profession and the women’s movement. While no state forbade homebirth, ACOG [The American College of Obstretians and Gynecologists] actively discouraged it. Doctors who participated in homebirths by offering backups in emergencies were threatened with loss of hospital privileges and even their medical licenses” (Feldhusen 2000). This is still true today as ACOG refuses to publish any study on homebirth but the now-outdated one that did not differ between planned and unplanned homebirth. In 1980, only 1.1 percent of the American population birthed their babies at home; in 1994, 5.5%. This rate has continued to yo-yo over the years – in 2011, the homebirth rate was 1.26% (MacDorman, Mathews, Declercq 2014), in 2012 it was 0.98%, in 2014 it rose to 1.5% (Doyle 2014). It is currently sitting at around 4% (DeClercq & Stotland 2019). Only recently have women begun to question their options, their outcomes, and their doctors. The majority of modern women opting for home births are in their 30s and generally are more likely to be professionals with years of advanced education behind them (Drichta & Owen 2013).

---

*Block, Jennifer. Pushed: the Painful Truth about Childbirth and Modern Maternity Care. Da Capo, 2008.

*DeClercq, Eugene, and Naomi Scotland. “Planned Home Birth.” UpToDate, 15 Jan. 2019, www.uptodate.com/contents/planned-home-birth.

*Doyle, Kathryn. “Out-of-Hospital Births on the Rise in U.S.” Scientific American, Reuters, www.scientificamerican.com/article/out-of-hospital-births-on-the-rise-in-u-s/.

*Drichta, Jane E., and Jodilyn Owen. The Essential Homebirth Guide: for Families Planning or Considering Birthing at Home. Gallery Books, 2013.

*Feldhusen, Adrian E. “The History of Midwifery and Childbirth in America: A Time Line.” Midwifery Today, 20 May 2019, midwiferytoday.com/web-article/history-midwifery-childbirth-america-time-line/.

*McDorman, Marian, et al. “Products - Data Briefs - Number 144 - March 2014.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Mar. 2014, www.cdc.gov/nchs/products/databriefs/db144.htm.

*Scott, Maiken. “How Did Birth Move from the Home to the Hospital, and Back Again?” WHYY, WHYY, 13 Dec. 2013, whyy.org/segments/how-did-birth-move-from-the-home-to-the-hospital-and-back-again/.

*Wagner, Marsden. “Fish Can't See Water: The Need to Humanize Birth.” The Need to Humanize Birth... By Marsden Wagner., Journal of Gynecology and Obstetrics, 2001, www.wonderfulbirth.com/Services/ViewServices.asp?Ref=2312.

*Wolf, Jacqueline H., and Jacqueline H. Wolf. Deliver Me from Pain: Anesthesia and Birth in America. Johns Hopkins University Press, 2012.

*World Health Organization. WHO revised estimates of maternal mortality: a new approach by WHO and UNICEF. Geneva, WHO 1996; report no. WHO/FRH/MSM/96.11