Childbirth is distinctly different than any other discipline of modern medicine: Unlike every other medical specialty, humans have been giving birth for as long as– well, for all of human existence. As modern medicine started to really develop at the turn of the 20th century, childbirth– once looked at a normal life process– was taken over by doctors who at first really didn’t know at all what they were doing and had very little actual understanding of the female body or birth. That either the mom or baby made it through the process of birth in early hospitals was often a matter of luck.
I joke sometimes in class that so much of what’s wrong with birth in the US, with our rising maternal morality rates, is thanks to the arrogant, misogynistic, vain, and ignorant decisions made by men of the medical establishment since at least the 1850s. Who came up with the idea that episiotomies should be routinely done without evidence to prove their claims? Men. Who decided, without any evidence otherwise that once a mom had a cesarean, all births should be cesareans after that? A man–in 1912. And I’m not saying this to make a generalization that men are terrible, but to point out so many aspects of modern birth came from those without any real knowledge of the process. Once medical research really kicked in in full force in the 1950s, we saw some outcomes in maternity care improve, but not always. Here’s where I strongly suggest that you read Tina Cassidy’s fantastic book Birth: The Surprising History of How We Are Born. If you want to know the full play by play of modern maternity care–this is the book you need to read.
The reality is, while there are a few things that can be measured and quantified about pregnancy and birth (hypertension really being one of the most obvious situations, followed maybe by cholestasis of pregnancy), many doctors who provide maternity care struggle to fully grasp that birth can be really hard to study. However, just because some aspects about birth can be difficult to study or quantify, that doesn’t mean that evidence-based maternity care doesn’t exist–because it does. In addition to the 6 Healthy Birth Practices as laid out by Lamaze International, other strong resources and proponents of evidence-based care can be seen in the Report from 2008 called Evidence-Based Maternity Care: What It Is and What It Can Achieve and in the joint consensus statement Safe Prevention of the Primary Cesarean Delivery from ACOG and SMFM, originally published in 2014 and reaffirmed this year.
I am a strong proponent of intellectualism. Our shift to anti-intellectualism in all facets of life is more than a little disturbing. And while I can’t address everything in the world, I can go through some of the aspects of maternity care in the US and abroad, explain where they originated, what the original motivations were, and place those beliefs in the continuum between fact and fantasy. This post is an introduction to what I hope will be a interesting project. The next couple of posts will cover the rise of early birth “methods”…and then see where that takes us.
Are you ready? Let’s do this.