Birth Series - Part 1: A Very Biased Birth History
When it comes to birth, it tends to be incredibly biased. On one side, you have the people for medical births in hospitals and on the other stands the people who favor unmedicated births outside of the hospital. But there's more than just those two options (we'll get to that in a future post) so how did we get to become so polarized? You can't understand the biases of birth without talking about the history of birth...and what a tumultuous history it is.
In the beginning, birth was all woman. It was common practice for pregnant women to give birth surrounded by her female family and deliver her baby with the assistance of a midwife, which literally means "with woman". Cut to the 1700-1800s, a time where only men could be doctors and most barbers were surgeons (they used many of the same tools so they combined the trades. Would you like a haircut with that amputation?) Doctors stayed out of birth, only being called upon when surgery was required to extract already dead fetuses. That is until money could be made. With the invention of the forceps, birth in hospitals increased. Unfortunately, so did mortality rates. Boys with toys, amIright?! See, the very first hospitals weren't very clean. With no knowledge of things like germs and cross-contamination (going from an autopsy straight to a birth? Sure, why not?), infection was almost guaranteed and with infection came death and women giving birth were no exception.
The design for forceps hasn't changed much but thank goodness their usage has!
Here's where I'm going to a give a strong opinion that might have some people shouting "Feminist!" - women were doing fine until men got involved. Sure, deaths happened in childbirth - there was no Medical Board to set standards of practices and there weren't crazy ideas like washing your hands before sticking them inside someone but it's pretty clear to me that this isn't a home birth vs hospital birth issue. Male doctors created devices and practices to "help" with birth - episiotomies, forceps, twilight sleep births (an extremely horrible practice of literally knocking women out with a combo of morphine and scopolamine which caused no memory of the birth), and drugs but they had no understanding of birth. I feel like women were used as guinea pigs in a way - male doctors were doing procedures on bodies they knew nothing about, changing natural occurrences so they could be valued.
Back to the history lesson! In the 20th century, doctors waged a full on war against midwives, claiming that not only was birth in a hospital a very high brow sort of excursion but that midwives were only for the poor. Midwives tended to be black or of poorer means and a propaganda campaign against midwives and their "voodoo" ways exploded. The irony was that it paid to be poor - midwives were having a higher success rate in regards to infant mortality rates. Obstetrics was widely being practiced and a set of "norms" came out as to what was to be expected during childbirth, setting the tone for normalizing interventions and cutting down labor times. By the 1950s, 90% of births were in a hospital under the care of a doctor.
Not the kindest portrayals, huh?
Today birth is still biased. When researching for these Birth Series posts, I did a TON of research. I'm talking days, people! And do you know what I found? Not much. Birth seems to be the most unstudied subject...sort of. It's almost impossible to find a completely unbiased study done about birth. I couldn't find one after hours of searching but I have faith they're out there. Why are they hard to find? Because doctors do studies to benefit hospital birth and midwives do studies to benefit out of hospital births. No one dares to cross the bias line, each advocating strongly for their cause. And when you do come across scholarly articles, there seems to be a lot you have to read between the lines for you to get the entire picture. Take this 2015 birth study done in Oregon; they found that home births have an infant mortality rate of 3 times that than in a hospital...but what they don't mention is that this study was done with some midwifes that didn't have the proper training or licenses and also took into account completely unattended births. This study kept coming up again and again but the findings are skewed and ultimately go against every other study about infant mortality rates in low risk home births.
Reliable data is hard to come by. Infant mortality rates by the CDC don't specify home vs hospital or what inventions and risks were involved. Interventions are so common that it's impossible to find data on whether or not they were necessary for the birth. Home birth transfer rates are impossible to find and hospitals don't specify high risk vs low risk births. How is someone trying to decide where and how to birth going to get the best information for her? No wonder it's confusing to decide when you have doctors foolishly stating that supporting home birth is "propagating junk science" or reading horror hospital stories where women were mistreated. It's easy for women to get lost and forget to read between the lines and end up on one side of the bias or the other. Ultimately my point is this - the bias line needs to be crossed. When it comes to birth, we should all be on the same side.