TOPIC-7_p-15-17_The gender-loaded title of “Medical Men”
Most people don’t know that in the early 1900s, medical doctors in the US didn’t like being called “doctors”, which was more strongly associated with college professors and the ministerial title “Doctor of Divinity”, and they hated being referred to as a “man-midwife”. Instead they preferred being the descriptive title of “medical men”. A comment by no less an icon of obstetrical wisdom than Dr. J. Whitridge Williams demonstrates the nature of this gender issue:
“Have you ever considered,” he said, “the economical significance of the fact that three out of every five women are more or less incapacitated for several days each month, and that one of them is quite unable to attend to her duties?
Granting that the two sexes are possessed of equal intelligence, it means that women cannot expect to compete successfully with men. For until they are able to work under pressure for 30 days each month, they cannot expect the same compensation as the men who do so.” {Twilight Sleep: Simple Discoveries in Painless Childbirth; 1914}
During this formative period of American obstetric as distinct from its practice in other developed countries, the profession never doubted that Mother Nature, having blessed male MDs with the superior intellectual powers conferred by their “y” genes, meant it was their divine destiny to rescue the millions of white middle- and upper-class women who gave birth each year from a malicious Mother Nature. American obstetricians believed it was both their right and their duty to be in charge of female reproduction, which meant that they controlled all aspects of pregnancy and childbirth in the United States.
“A Review of the Midwife Situation” ~ Boston Medical and Surgical Journal, 02-23-1911, page 261 {*} Arthur Brewster Emmons, 2d, M.D., Boston and James Lincoln Huntington, M.D., Boston.
“… we believe it to be the duty and privilege of the obstetricians of our country to safeguard the mother and child in the dangers of childbirth.
The obstetricians are the final authority to set the standard and lead the way to safety. They alone can properly educate the medical profession, the legislators and the public.”
These outspoken and politically-active obstetricians concluded that childbirth could safely be described as a relatively normal aspect of reproductive biology in women of color, immigrants and the working poor. The sheer size of the average poor or immigrant families – as 15 or even 20 children – attested to that. However, these same influential obstetricians insisted that normal labor and spontaneous childbirth in the upper classes of (white) women had somehow become a “pathophysiology”, that is, a dangerously dysfunctional aspect of female biology.
Having concluded that the lower classes of working poor did not particularly need, nor were able to pay for obstetrical services, the profession turned its attention to middle- and upper-class white women, whose families could easily afford an obstetrically-managed hospital birth. This serendipitously coincided with the more advent-guard ideas about making childbirth more “modern” by identifying obstetricians (i.e. not midwives) as the preferred birth attendant for the wealthier and whiter classes of women.
Articles by obstetricians published in newspapers and women’s magazines and broadcast on the radio, all described pregnancy and childbirth in the “modern” American (i.e. white) woman to as a “nine-month disease that required a surgical cure”. As spokesmen for the obstetrical profession, they were outspoken and relentless in promoting the idea of “always a doctor, never a midwife”.
Having defined normal childbirth to be pathology, professional services associated with the ‘disease’ of childbirth was, without question, to legally become the sole “property” of the obstetrical profession. Since ‘new’ obstetrics was defined as a surgical specialty, the proper way to refer to childbirth as attended by “medical men” was now referred to as “the delivery”, a term that defined childbirth to be a sterile surgical procedure conducted by an MD trained in obstetrical surgery. This process began by putting labor patients to sleep with chloroform or ether and having the nurses cover the laboring woman with sterile drapes. Then the doctor stepped in to cut an episiotomy and extract the baby with the use of obstetrical forceps.
By defining childbirth as a pathology, the doctor was required to remove the placenta manually (i.e. to use his hand) instead of waiting for it to be spontaneously expelled. In order to detach the placenta from the uterine wall and bring it out in his hand, the doctor he had to put on a special sterile glove with a long cuff that went up to his elbow. Then he inserted his hand and forearm into the mother’s vagina in order to reach inside her uterus and peel the placenta off the inner surface of the uterine wall, grab the separated placenta with his fingers, and draw it out of the uterus and the mother’s vagina.
Last but not least, the surgical process of childbirth end when the doctor finished suturing of the episiotomy incision.
Note that childbearing woman were no longer described as “giving birth”, but seen as passive entitie whose baby was extracted from her unconscious body by forceps, and thus establishing that it was the doctor, and not the mother, who “delivered” the baby.
For healthy childbearing women, this was the most profound change in childbirth practices in the history of the human species!
