A Mother's Labor Day

Saturday, September 6, 2014

“Labor Day” takes on a whole different meaning when talking about the day a mother gives birth.  Over time, a medical approach to labor and delivery has developed which has dramatically changed the natural process of pregnancy and childbirth.    

  

In the pioneer days of Kewaunee County, women attended to the birth needs of expectant mothers.  Although medical schools proliferated in the east coast states after the War of 1812, there were few doctors in early Ahnepee and it was considered indecent by some for men to attend to women.  Childbirth was often faced with fear of death for both mother and child.

With the arrival of trained doctors, there was a shift among the urban middle class from using midwives to using doctors to attend to delivery.  However, that was not the norm for the rural poor of Kewaunee County. 

While midwives had been perfecting their craft and observing sanitation for hundreds of years, physicians unwittingly sometimes perpetuated deadly childbed fever.  Lack of hand washing between medical procedures was a leading cause of maternal death before Louis Pasteur identified the Germ Theory of Disease which called to light that bacteria and lack of sanitation were the main cause of puerperal fever.

       

By the late 1800s physicians were becoming more integrated into society and prejudice against the intelligence and capability of women was used to defame midwifery.  Midwives were not organized or in a position of power.  Doctors didn’t earn a lot of money but midwives made even less and were not considered professionals.  As a result, doctors began to take over about 50% of the nation’s births by 1900 and midwives were relegated to caring for women who could not afford a doctor.

Obstetric anesthesia became available around 1914.  Women sought to reduce childbirth pain.  Ether had been used as early as 1848 in Boston, but many women still suffered through the pains of childbirth.  Receiving chloroform during labor and delivery had become a status symbol long before, after it was used by England’s Queen Victoria.  In 1914, upper-class women in the eastern U.S. formed Twilight Sleep Societies.  The practice of Twilight Sleep, which involved using a combination of morphine for pain relief and scopolamine, an amnesiac which caused women to have no memories of giving birth, became a symbol of medical progress.  Ankle and wrist restraints were part of the process to keep women from injuring themselves under the influence of Twilight Sleep.    Only later were the negative effects for mother and baby publicized.

    

By 1920, midwives were still attending 20-40 percent of all births in many cities, sometimes practicing illegally where laws were passed to limit or eliminate their use.  Less than 5% of women gave birth in hospitals before that time. 

    

During the 1920s, doctors were being trained to aggressively treat women during the so-called pathologic process of childbirth.  Doctors took active control over labor and delivery.  Specialist obstetricians sedated women at labor’s onset, gave ether during the pushing stage, cut an episiotomy, delivered with forceps, then extracted the placenta, and gave medications for uterus contraction and episiotomy repair.  Between 1915 and 1929, infant mortality from birth injuries increased 40-50 percent.  These active interventions came to be routine by the 1930s when the American Board of Obstetricians and Gynecology was created.  To some degree American obstetrics is still under this medical paradigm but, fortunately, many people now question practices that have no medical necessity. 

    

Between 1921 and 1939, 30-50% of women (and 75% of urban women) gave birth in hospitals with the remaining women receiving home delivery care from midwives or doctors. 

Dr. Herbert V. Foshion

The transition of home to hospital birthing can be illustrated by the medical practice of Algoma’s doctor Herbert V. Foshion.  Dr. Foshion earned his Bachelor of Medicine degree after WW I and returned to Algoma to practice.  He and his wife Pearl were a home birthing team.

The couple made childbirth delivery visits throughout the county.  Pearl assisted by washing the newborn baby with cotton swabs and olive oil and later in Ivory soap while the doctor attended to the mother.  Mrs. Foshion filled out the birth certificate and cared for the newborn’s siblings.  Dr. Foshion charged $10 for a home delivery in the 1930s.   

Dr. Foshion recognized the need for a local hospital and established a small 10-bed operation—the first hospital in Algoma.  It essentially eliminated home visits for births among his patients.  After that time, most women were attracted to hospital birth which could help provide a more pain free experience than at home. 

Algoma Hospital

The 1950s gave rise to many developments in childbirth. By then, 88% of births occurred in hospitals.  The American College of Nurse Midwives was formed in the mid-1950s as was the La Leche League, the breastfeeding support organization.  Dr. Fernand Lamaze’s findings about childbirth preparation and pain management during labor and delivery were introduced to American women in the late 1950s.

Treating pregnancy and delivery as a medical condition rather than a normal life process has continued to evolve to create high levels of pricey physician intervention and even pricier hospital services.  Consider the number of women who undergo ultrasound exams to create sonograms today, the non-medically necessary cesarean deliveries performed, and the frequency of induced labor versus just a few decades ago.  The existence of medical insurance and availability of medical care, hospitals and their expensive medical equipment, medical malpractice liability costs for doctors, in addition to patient demand for services, all contribute to the current state of high intensity pregnancy and delivery care.      

Childbirth has not always been viewed as a peaceful experience but years of successful and failed practices have hopefully provided wisdom to the practitioners and helped eliminate the fear of labor and delivery for moms to be.  Yet, there is still work to be done to make Labor Day the best, natural, and safest experience possible for mothers and their babies.