WuOBs_by-Topic#2 ~ Overview
The disturbing story of obstetrics in America from 1910 to 1980
Page #10 in 41 p. file
Overview ~
American obstetrics purposefully turned healthy women into the patients of a surgical specialty and normal childbirth into a surgical procedure. The consequence was the most profound change in childbirth practices in the history of the human species.
The story of why, what, and how this happened is lengthy, complicated, ethically disturbing and extremely depressing.
It pains me to write this, but the 12-point bulleted paragraph below describes what was done in simplified language, and the why, including the obstetrical profession’s motives and goals and the interventionist policies and practices of hospital-based obstetrical practice. This highly interventive model of obstetrics was promoted by the American obstetrical profession as the “standard of care” for normal childbirth during the first 30 years of the 20th century.
- To distinguish American obstetrics as separate and distinct from midwifery, they declared that obstetrics in the US, unlike its European counterparts, was a new brand surgical specialty and that normal childbirth was now considered to be a surgical procedure
- To eliminate what they saw as “illegitimate” competition between obstetricians and inferior “female practitioners” (i.e. midwives), they declared themselves, as MDs, to henceforth have a legal monopoly over all forms of pregnancy and childbirth services
- Over time this newly-elevated status allowed the obstetrical profession to greatly increase the income of doctors who attended births
- They legally categorized childbirth in middle- and upper class (white) women to be a patho-physiology, and publicly described sexual reproduction in this class of human females to be “a nine-month disease that required a surgical cure”
- After defining normal childbirth as a pathological process in middle- and upper-class white women, the next logical step was to insist that this economically well-off demographic be electively hospitalized for childbirth
- Because childbirth was defined as a ‘surgical procedure’, the laboring women was isolated in a special “sterilized” ward; husbands and family members were not allowed to stay with or even see their wife during labor or to be present at the baby’s birth
- Normal childbirth as a pathology in this demographic was conduct as a series of medical interventions, starting with routine use of the Twilight Sleep drugs (narcotics and the hallucinogenic and amnesic scopolamine); since these drugs left each labor patient in a semi-conscious stupor, these women were never allowed to get out of bed during labor; sometimes this required the use of four-point leather wrist and ankle restraints attached to the bed posts
- The birth of the baby was conducted as a series of invasive surgical procedures that began with general anesthesia and included the routine use of obstetrical forceps to compensated for the inability of an unconscious woman lying flat on her backs to push effectively; the routine use of forceps was also seen as necessary to maintain the obstetrical provider’s skill in using forceps in emergent situations where they actually became a life-saving procedure
- The elective hospitalization of well-off middle- and upper-class women” during labor, the conduct of the surgical procedure of “delivery”, and the subsequent 14-day “lying-in” period for both mother and baby, created a brand new and highly profitable revenue stream for any hospital that already had, or put in new a “lying-in” (i.e. maternity) ward
- Dr J. Whitridge Williams specifically promoted the idea that existing hospitals should add lying-in wards or open a small “lying-in hospital” as a way to generate income that would then to be used to upgrade their facility into a full-service general hospital with modern medical technology;
- The routine use of Twilight Sleep drugs and “the delivery” as a surgical procedure done under general anesthesia was a ‘selling point’ to promote the patronage of middle and upper class “modern” women, whose family could pay for a hospital birth and 14-day postpartum stay for mother and baby
- The new income generated by maternity patients allowed the hospitals to spend money on “capital-intensive” equipment and renovations, such buying a new x-ray machine, industrial autoclave, and other expensive medical equipment, purchase microscopes and other equipment for a new clinical laboratory, upgrade its surgical suites with ceramic tiled walls and floors, mechanical operating room tables, and powerful overhead electric lights
- Some proportion of these hospitals were able to use the dependable income generated by the healthy women that patronized their “lying-in” (i.e. maternity) wards to eventually elevate the status of their institution to that of a “general hospital”; thid made comprehensive healthcare available to the population of an entire geographical region by being able to provide “state of the art” services to both genders and all ages that included life-saving diagnostic, emergency, medical, surgical, obstetrical, pediatric in-hospital services
The bulleted account above describes what was done and why; the next chapter focuses on how these goals were achieved.
