Word Count 2901 ~ Jan 17 2025
Chapter 4: draft ~ The Exclusive Obstetrical Franchise in America and the 20th Century Gender War btw Midwifery and Obstetrics
Editor’s Note to self – this chapter is currently being edited but only about 1/4 done as of Jan 11,2025 @ 4:19 pm
Chapter 4 ~ In general, the obstetrical profession was not impressed with any of the arguments, whether they came from other physicians or midwives, for respecting the biology of normal birth, preserving the traditions of midwifery or seeking to improve the social conditions and health of the public.
Instead the watch-word was “full speed ahead”. Their strategies for increasing access to “obstetrical material” was highly successful and soon eliminated the ‘competition’ (midwives). Over the course of a few years, this paved the way for claims by the obstetrical profession that it was on the leading edge of scientifically manged childbirth, and only months away from being able to banish all the “sorrows” associated with childbearing with their new toys – an expending array of obstetrical drugs and surgical procedures.
Success, Sweet Success
Obstetricians erroneously assumed that childbirth conducted under sterile operating room conditions would eliminate the fatal streptococcal infection generally known as “puerperal sepsis“. In their minds this represented a permanent medical cure for this scourge, one that was so important to public health that it called for 100% hospitalization and 100% care of childbearing women by obstetrical surgeons.
From this perspective, it seemed only natural to doctors that childbirth conducted as a surgical procedure would offer the safest and best care. Unfortunately, this was a mistaken conclusion. During this pre-antibiotic era (prior to 1945) “puerperal sepsis” (also known as ‘septicemia’ or ‘blood poisoning’) was very often fatal. The more obstetrical interventions and invasive procedures that a laboring woman was exposed to, the higher the risk of maternal morbidity (intrapartum complications) and mortality (death).
In 1937 the very famous American obstetrician Dr. Guttmacher (one of the good guys and considered by me to be the most important obstetrician of the 29th century published his observation about the sub-par practice of obstetrics that at the time was the formal “standard of care’ for the American obstetricians.
As reported by Dr. G the increased death rate of operative deliveries started with the frequent pelvic exams associated with hospital labor, which inevitably exposed laboring women to the lethal bacteria (today referred to as “super bugs”) that inevitably concentrate in institutional settings and continue to be a source of fatal infections even today.
It is an unfortunate truism that the more frequently a new antibiotic drug is used, the more efficiently human-hosted pathogens develop “resistance” to it. But the untreatable effect of bacteria during the pre-antibiotic era — the many millenniums thousands-years-long was far worse — basically all of human history before 1945 when amputation of limbs and death were a frequent ‘fact’ of life”.
The inexplicable rise of hospital obstetrics during this pre-antibiotic era
In operative deliveries, the exposure to virulent pathogens was combined with the tissue trauma that went with the routine use of episiotomy, forceps, the manual removal of the placenta and suturing of perineum.
When childbirth was being conducted as a series of invasive surgical procedures, the single biggest danger during this pre-antibiotic era was “iatrogenic” — the life-threatening complications of a fatal hemorrhage during or immediately following “the delivery” and delayed fatalities from sepsis.
In the case of death from sepsis, a happy and apparently healthy new mother who was so excited about her new baby and so pleased with her new status as a mother would get feverish on the third day after delivery. She would soon complain of a really bad headache, then start having terrible chills, become unable to eat or drink. Over the next 48 hours, she would start having hallucinations, expressing great worry about her baby and asking for it to be brought to her so she could breastfeed. If not physically restrained, she would get out of bed and walk around the halls talking jibberish. By the 6th day she would be unconscious, and on the 7th day slip into a deep coma that she never recover from and stop breathing.
Obstetrical “delivery” in the US, circa 1910, as series of surgical procedures
When normal birth was attended by an obstetrically- trained surgeon, it was conducted in a specially equipped operating room as a series of surgical procedures.
From the early 1900s to the 1960s in highly populated urban areas, and as late as the 1980s in the Deep South and rural hospitals, all white laboring women were given repeated injections of Twilight Sleep drugs during labor. This was a powerful drug combination of the amnesic-hallucinogenic drug scopolamine ** and a strong narcotic. early in the 20th century, this would have been morphine. The morphine would be replaced by Demerol from the 1960s to through the 1990s. By the early 2000s, bigger hospitals would have replaced narcotic “shots for pain” with epidural anesthesia.
**Editor’s Note –> scopolamine was also known to be used as a “date rape drug during the 1990s
During this very long period of obstetrical history in the US, there was never anything the legal profession would recognize as “informed consent” for any aspect of hospital labor and birth-related care. This was the case in regard to being repeatedly medicated with Twilight Sleep drugs for the many hours of a normal labor. It preceeded by having every “normal” childbirth be routinely conducted as a surgical procedure referred to by doctors as “the delivery”.
Obstercial “delivery” — what the rest of the world would describe as “feather-bedding”, which is also known as “make-work”
In 1910, “normal” childbirth — that is, mothers giving birth under their own power as a spontaneous biological event — was destined to be replaced by obstetrically-managed “delivery”, which was formally defined by the obstetrical profession as a “surgical procedure” to be “performed” by the doctor on a labor patient who’s been rendered unconscious chloroform or other general anesthesia.
As soon as the mother-to-be was unconscious, the routine surgical process began. This was a sequence of surgical interventions that began with the physician cutting a ‘generous’ episiotomy, followed by extracting of the baby from the mother’s inert body with the use of the obstetrical forceps, then the manual removal of the placenta, and finally suturing of the perineal incision and any tears.
Maybe Move
A brief aside on the mostly male obstetrical profession’s relation to the genitals of childbearing women:
In the 1970s, I was an L&D nurse in Orlando, Florida, at Orange Memorial Hospital. This now called Orlando Regional, is where all the casualties from the Pulse Nightclub mass-casualty-event were treated. I also worked for several more years in the L&D unit at Holliday Hospital just two blocks away.
One evening shift I was the circulating nurse for a delivery under general anesthesia that was being attended by one of our particularly misogynist obstetricians. While he was suturing one of those infamous “generous episiotomies that he was famous for (at least among the L&D nursing staff), and the mother was still deeply unconscious under the anesthetic, he told me a story about the husband of one his OB patients who came to him complaining that:
“After my wife had the baby, having sex with her is like walking into a warm room”.
Then he asked the doctor what could be done to restore the “virginal quality” of her vagina?
According to this doctor, he told the husband that his wife “should have had her babies by C-section, that way her cunt would be forever new”.
He was proud of his “naughty” vocabulary and expected be to be equally entertained by his witty repartee.
***************** end editing today, Jan 12, 2025 @ 3:18 pm**************
~ Return to topic ~
In this deeply drugged state, all our white labor patients were only “semi-conscience”. If one of the nurses ask what their name was, they would look at you the for a few seconds and then close their eyes and fall back to sleep without answering.
The pharmaceutical effect of these TS drugs was a temporary (thus reversaable) lobodomy. It rendered the patients legaly unable to make any medical decisions about her care. This meant she could not refuse tt be medicated with TS drug cooctail or to be delivered under a general anestheic.
For safety’s sake hospital protocols required that labor patient medicated with Twiligt Sleep drugs (which were given to all white labor patient) were automatically confined to their beds and “out of it” for the rest fo their labor.
However, about 10% of otherwise normal healthy childbearing women had a paradoxical reaction to the drug “scoplamine” that one of the true drugs in our Twillight Sleep medication.
when the time came for the baby to be born, they were moved
that included the “manual” delivery of the placenta. This meant the surgeon donned a special sterile glove with an unusually long cuff that almost reached his elbow. the that was the 4th (or last Putting gloved hands, surgical instruments or needle and thread into the mother’s birth canal (especially when these instruments cut or bruised her tissue) created the ideal conditions to carry hospital pathogens up into the sterile cavity of the uterus where the raw surface of the recently delivered placenta offered bacteria the perfect pathway into the mother’s blood stream. The stress of anesthesia and added blood loss associated with episiotomy, operative delivery and manual removal of the placenta all weakened the mother’s immune system and made her more vulnerable to lethal infection. The lack of effective antibiotics sealed her fate in all too many cases — 23,000 maternal deaths in 1918, the majority of them cause by or complicated by streptococcal septicemia. As documented earlier, surgical birth and manual delivery of the placenta (or manual exploration of the uterus after delivery by putting a gloved hand up inside the mother’s vagina and uterus) vastly increased the rate of puerperal sepsis and the rate of maternal deaths.
Unfortunately it was equally easy to conclude that these bad outcomes validated the idea that childbirth itself was intrinsically pathological. However, the actual the problem was the application of emergency interventions to normal circumstances. This false association fueled the campaign to further medicalize childbirth by reinforcing the idea of normal childbirth as dangerous – so dangerous that women died even when “delivered” by doctors and surrounded by the gleaming stainless steel and surgical sterility of an operating room. In the minds of both the lay public and the medical profession, this was interpreted as indisputable proof that normal childbirth was inherently pathological. Without realizing it, obstetrics had become bound by the laws that governed the very error it aimed to correct.
It must be noted again that male domination of public life was the ground of being for these ideas, which actually reflect the gender-biased worldview of the 16th, 17th, 18th, and 19th centuries. By the early 20th century the opinion of the obstetrical profession was that traditional midwifery was a relic of a bygone era – the bad old days — in which mothers and babies died while midwives stood by unable to help because they lacked the training of a physician-surgeon. In the minds of the medical profession that was brought to an end in the early 1900s when doctors forced midwives out of the “childbirth business” and convinced childbearing women to have their babies delivered in hospitals by physicians.
An example of just how long-lived and pervasive this prejudice is, is revealed in a contemporary article published in 1975 in the New York Times Magazine, contrasting modern obstetrical services with the historical care of midwives. It characterizes physicians as saving mothers from the “dangers” of midwifery care:
“In the United States … in the early part of this century, the medical establishment forced midwives, who were then largely old-fashioned untrained “grannies”, out of the childbirth business.
Maternal and infant mortality was appallingly high in those days. As the developing specialty of obstetrics attacked the problem, women were persuaded to have their babies in hospitals, and to be delivered by physicians….
Today it is rare for a woman to die in childbirth and infant mortality is (low)…” [Steinmann, 1975]
It should be noted that the article begins by making a false association between the care of midwives and the high rate of maternal mortality at the turn of the century and ends by making another false association, this time between the historical elimination of midwifery by the organized medicine and the modern-day record of maternal safety.
The “Disappeared” – Midwives and Mentally Competent Adult Women
When the tradition of midwifery and its practitioners got ‘disappeared’ in the first decades of the 20th century, the problems created went way beyond the loss of employment opportunities for midwives. A physician-centric configuration of maternity care had an even greater impact on childbearing women, who were no longer related to as sentient being or accorded the rights of mentally competent adults. They too were ‘disappeared”, to be replaced by the role of a narcotized labor patient hidden behind forbidding doors which declared “No Admittance”.
By changing childbirth from a biological act “performed” by the mother, to a surgical specialty, the mother was virtually eliminated from the equation, no longer an active participant in her own birth. As a “surgical patient” she was not authorized to have any part in the decision making process. As a ‘not-doctor’, she was “unqualified” to make what were now defined as “medical” decisions. All aspects of the mother’s care were to be determined by “standard procedures”, medical protocols and other medical customs over which she had no control and no opportunity for input.
After admission to the hospital she was put to bed, shaved, given an enema and then put to sleep with massive does of narcotics. She labored under the influence of narcotics, which eliminated the need for any on-going labor support. It also make her legally unable to make decisions in their own behalf. Hours or days later, when the baby was ready to be born, she was “delivered” under general anesthesia. As an anesthetized patient lying unconscious on an operating table with legs in stirrups, she was vulnerable to unnecessary and often harmful forms of obstetrical care such as the use of episiotomy and forceps.
Because husbands and other family did not fall in the category of “authorized personnel”, they were excluded from labor wards and deliveries rooms. Thus there was no one to advocate for or even to witness to these events, much less make a truthful report of them to the outside world. However, evidence was still plentiful that medicalization of healthy women was harmful to them and their babies.
In 1931 the White House conference on Child Health and Protection by the Committee on Prenatal and Maternal Care studied care by midwives as contrasted to physicians. Testimony of the White House conference concluded:
“…that untrained midwives approach and trained midwives surpass the record of physicians in normal deliveries has been ascribed to several factors. Chief among these is the fact that the circumstances of modern practice induce many physicians to employ procedures which are calculated to hasten delivery, but which sometimes result in harm to mother and child. On her part, the midwife is not permitted to and does not employ such procedures. She waits patiently and lets nature take its course.” (original emphasis, Reed 1932)
“Midwives have small practices and time to wait; they are expected to wait; this what they are paid for and there they are in no hurry to terminate labor by ill-advised operative haste.” [1937-A]
“The diagnostic ability of midwives is generally good and in the case of many, remarkably excellent. In this respect, the average midwife is fully the equal of the average physician.” [Dr. Van Blarcom; 1913]
Dr. Louis Dublin, President of the American Public Health Association and the Third Vice-president and Statistician of the Metropolitan Life Insurance Company analyzed the work of the Frontier Nurses’ midwifery service in rural Kentucky. On May 9, 1932 Dr. Dublin made the following public statement on the documented safety of home-based birth services provided to indigent women by professional midwives:
“The study shows conclusively that the type of service rendered by the Frontier Nurses [care by professionally-trained midwives] safeguards the life of the mother and babe. If such service were available to the women of the country generally, there would be a savings of 10,000 mothers’ lives a year in the US, there would be 30,000 less stillbirths and 30,000 more children alive at the end of the first month of life.” [Editor’s Note – this describes 60,000 babies and 10,000 mothers —70,000 preventable deaths — every year for want of appropriate, non-interventive maternity care]
Obviously the author of the NY Times piece trashing midwives did not include the testimony of White House Conference in 1931 or the report by Dr Dublin in 1932 in his background research For sure he would not have agreed with the following conclusion as drawn by someone who did indeed “do his homework” on the topic.
“Clearly the midwife seemed to be the safest birth attendant” [Dr. DeVitt, MD; 1975]
All evidence to the contrary, the obstetrical profession was dead set on curing the ‘the midwife problem’ once and for all. Between 1910 and 1920, a concerted and sustained effort by organized medicine was able to reduce the rate of midwife-attended birth from 50% to 13% percent. This completely destroyed the profession of midwifery on the northeast seaboard, although a few hardy individuals continued to practice in a low profile or underground fashion. After 1930 the only intact category of midwives were black or ‘granny’ midwives in the racially segregated south, where many white doctors refused to care for women of color.
