The Realities of Elective Hospitalization for Childbearing Women & its Long-term Costs to Society
In 1914 Dr. J. Whitridge Williams’ published a book outlining a rather complex and multi-level plan to finance a new and much needed nationwide system of general or ‘community’ hospitals equipped to provide comprehensive medical and surgical services to every population center over 3,000.
To achieve such an expansive goal Dr. Williams invented a business model that, for the first time ever in the history of hospitals, was able to provide American hospitals with dependable and profitable revenue stream. Equally if not even more remarkable this could be achieved without any reliance on any tax-supported public funding; this was not an option since it would have been rejected out-of-hand by other doctors and organized medicine as “socialized medicine”.
What made this possible was Dr. Williams idea for dramatically expanding the “market share” of hospitals in a way that turned them into a profit-making business. This new plan required a number of coordinated and interlocking phases that began when individual hospitals physically added a new or expanded maternity ward and hired the necessary staff.
The next phase was a coordinated local and national public relations campaign to promote the patronage of a sufficient number of healthy women as maternity patients and paying customers. The last phase began when hospitals had recouped the expenses of the new maternity wards. Then they could begin using the new revenue it generated to upgrade, expand and equip itself as a general or community hospital capable of providing state-of-the-art comprehensive medical services to local citizens.
The final phase of Dr. Williams’ new business model for hospitals depended the on-going hospitalization of healthy maternity patients to fill up beds in their lying-in wards, which would guarantee on-going profitability. This is best understood by a statistic published about 15 years ago comparing income generated by various categories of patients. Care of the typical cardiac patient only contributed 5 cents (1/20th) for every one dollar of hospital profits, while services for a maternity patient generated 35 cents, or more than 1/3rd.
The obvious difference was the hospital’s cost for providing the complicated and expensive care required by those with major medical problems, versus the simple needs of healthy women and newborns, which mostly consisted of housing and feeding them and making sure they did not pick up a hospital-based infection.
At the time Dr. Williams invented this new business model for hospitals (1914) the interlocking and interdependent nature of these 3 phases would have been thought of as a ‘virtuous cycle’. Wikipedia refers to this phenomenon as a complex chains of events which reinforce themselves through a feedback loop, and can be either a virtuous or a vicious ‘circle’ or ‘cycle’. A virtuous circle has favorable results, while a vicious circle has detrimental results.
Clearly the feedback loop created by Dr Williams was intended for the most noble of purpose — financing a nationwide system of fully-functional hospital. But despite his best intentions, this self-perpetuating chain of events first and foremost depended on directly exploiting a healthy segment of the American population.
The stark reality of “elective hospitalization” of healthy women
To implement Dr. Williams’ plan, a public relations strategy was developed to convince families from the middle and upper classes that it was in the best interest of their healthy childbearing women to be electively hospitalized as maternity ‘patients’.
Unfortunately, the public relations aspect of Dr. Williams’ plan represented a ‘bait and switch’ scheme that include deception at many levels. While the overarching goal was Dr. Williams plan’s for generating revenue to finance community-based general hospitals, that never part of the public discourse. The biggest deception was the hidden agenda behind the PR campaign, which never revealed the purpose behind of Dr. Williams’ plan to electively hospitalize maternity patients, which was clearly financial.
In general, the word “elective” was interpreted to signify “protective” — the idea that pre-emptive hospitalization would protect mothers and babies from the rare but real dangers associated with childbearing. During the pre-antibiotic era (prior to 1945), every adult knew, or at least knew of, a mother or baby that died, or almost died during or after childbirth. A prophylactic form of hospitalization was particularly reassuring to first-time mothers and their families.
At the level of individual families, the most fundamental deception of the PR campaign was its silence on the nature of this elective hospitalization for the mother-to-be. The medical treatments and surgical procedures that were a routine part of hospital L&D was unimaginably different from what any childbearing woman ever experienced in her own home, when laboring and giving birth under the care of their midwife or family doctor.
Without information to the contrary, it was natural for childbearing families to assume the hospital’s lying-in would provide same kind of supportive care during labor that they normally received at home from their midwife or family doctor, but with added advantage that medical treatment would be immediately available should a problem or complication occur.
In the mind’s eye, this ‘comprehensive’ form of care as provided by elective hospitalization would naturally still include the presence of family and friends and the assurance of one’s midwife or GP. Everyone involved would all be magically relocated to a pleasant and comfortable room in the hospital, and the mother’s spontaneous labor and normal birth would proceed just as it would at home.
However if they should need something else, nurses would be available to help; should there be a medical problem or complication, then a shout-out would bring the doctor on the run. Whatever the problem was, the winning combination of doctors, nurses, and hospital resources would swiftly and expertly handled it, and all would be well.
At this time, less than 5% of all women gave birth in hospitals, and then only because a very serious medical complication. In fact, the more wealthy one was, the more one avoided hospitals at all costs (even having surgery performed in one’s home), since hospitals were considered to be dirty and dangerous places with no privacy and very bad food.
For the 95% of women who did not have any identified medical problem, laboring and giving birth in their own home the norm. This included the continuous supportive presence of family and close women friends. Whether the birth attendant was a midwife or a doctor, both types of practitioners were usually present throughout the hours of active labor; both normally encouraged women to move about in labor and make right use of gravity, especially during the pushing phase. “Patience with nature” was the watchword of the day.
Elective hospitalization categorically eliminated each and every one of these ‘normal’ aspect of labor and birth in one felt sweep, and replaced them with a long list social, medical, and surgical interventions and invasive procedures.
Midwives were the first thing to go, as midwifery care in any form was totally and permanently eliminated from hospital maternity services. The medical profession had two complaints about midwives. First, they provided physiologic care based on supporting normal biology (instead of medically managing it). Physiological care in any form had recently become a ‘no-no’ in medical circles.
Second, midwives were not educated as medical doctors and since childbirth was “now considered, in intelligent circles, to be a surgical procedure” (Dr. JWW, 1911) it would be scandalous to let an uneducated ‘handy-woman’ attend ‘cases of childbirth’.
Dr. Williams and other doctors and textbooks authoritatively decreed childbirth to be a patho-physiology, that is, a pathological aspect of biology that routinely sacrifices childbearing women the way salmon are sacrificed during spawning. According to the best experts of the time, physiologically-based care of laboring women was at best old-fashioned and inadequate, and at worst, it was downright dangerous. The saying coined at the time (still in use today) is that “Mother Nature is a bad obstetrician“.
The next thing to go for the hospitalized maternity patient was support during labor by family members or friends. In fact the any presence of anyone who was not on the hospital staff was strictly forbidden, no matter how brief.
With the support by midwife and the mother-to-be’s family gone from the picture, all that was left as a potential caregiver and provider of psychological support was the labor patient’s ‘attending doctor’. Unlike midwives and the old-fashioned GP, doctors providing maternity care to hospitalized labor patients did not attend to the physical and emotional needs of the mother during the long hours of her labor. This kind of “women’s work” was the nurse’s job, as was notifying the doctor when the end so he could come back and ‘deliver’ the baby. The literature of the day describes this period of time as “the waiting period before the doctor is called”.
Without the personal presence of comforting humans, the pain and psychic stress of labor was ‘managed’ medically, as every labor woman was received a series of frequently repeated injections. These shots contained a strong narcotic (morphine or demerol) and the Twilight Sleep drug ‘scopolamine”, which has a hallucinogenic effect and also produces profound amnesia. Since the planned care of these hospitalized mothers-to-be also included the use of general anesthesia (ether or chloroform), they also were not allowed to either eat or drink (NPO or ‘non-per-os’), no matter how many days they might be in labor.
This resulted in a state of semi-consciousness for most women, but a few became so agitated or even combative that they had to be put in four-point leather restraints. This was to prevent them from falling out of bed and bitting or otherwise hurting the nursing staff. This totally eliminate any opportunity (or even any ability) for women to move about in labor (walk, get in the shower, etc) or make right use of gravity during the pushing phase. “Patience with nature” was NOT the watchword of the day!
Last but of enormous importance was the very realistic concern by doctors, nurses and hospitals administrators over hospital-based contagion — the dreaded epidemics of ‘childbed fever. Before the discovery an anti-microbials (sulfa – first available in 1932) and antibiotics (penicillin – first available tin the US in 1945) there was absolutely NO effective way to treat these virulent infections.
During the immediate period being described (1910 to 1930), one third of maternal deaths in maternity patients were the result septicemia. The origin of these fatal infections were primarily iatrogenic (medical provider) or nosocomial (hospital-based). Scrupulous avoidance of anything that might carry germs from one patient to the next — the hands of doctors and nurses, equipment, supplies, vectors of infection like door hands, facets, trash bins and hundreds of other likely and unlikely ‘culprits’ had to be avoided or eliminated.
The idea of ‘auto-genesis’ — a mostly false assumption that these fatal epidemics of hospital septicemia were the result of bacteria that women brought into the hospital on their person – germs in their vagina or gastrointestinal tract. This is the origin of the classic “prepping” that every labor patients was subjected to while being admitted to hospital’s labor & delivery room. Among other things (such as showering, sterile hospital gowns and thigh-high leggings), this included pubic shaving and repeated administration of soapsuds enemas in a misguided and ultimately unnecessary attempt to eliminate hospital-acquired infections.
what it meant to be a hospital maternity patient during most of the 20th century included all of these “add-ons” — imposed social isolation, the aforementioned “prepping”, narcotics, amnesic and hallucinogenic drugs, the was all part of .
@@@Without any understanding of the consequences of their decision, these mothers and babies were exposed to an intensely medicalized type of service that introduced a host artificial and unnecessary risks.
This included the routine use of Twilight Sleep drugs, general anesthesia, episiotomy, forceps, manual removal of the placenta and often extensive suturing of the episiotomy incision. This represented the most profound change in childbirth practices in the history of the human species.
For the express purpose of generating profitable revenue for hospitals, healthy women and their normal unborn and newborn babies received care that did not serve their interests or practical needs. The complex feedback loop of new lying-in wards and elective hospitalization of a healthy population, all based on the ‘hidden agenda’ of financially underwriting a new hospital system (even though that was itself a good thing), made this into ‘vicious’ rather than the virtuous cycle the Dr. Williams and others envisioned.
Unfortunately, the methods chosen in 1914 to achieve this dubious goal was a full-on propaganda campaign. Dr. Williams claimed that spontaneous childbirth in the economically targeted class of paying customer, no matter how healthy the woman, how normal the pregnancy or normal the labor, was characterized as pathologically painful, so much so that the laboring woman might go mad and have to be committed to an insane asylum if she was not giving Twilight Sleep drugs during labor and general anesthesia during the birth. and/or unconscionably dangerous failure to medicalized their normal labors and births and to remain in the hospital during a normal postpartum-neonate period, was . in that depends on the patronage of a healthy population that does not need (or in many cases, want) the medicalization of normal labor and birth and the and thus does itself receive .
Today the idea of hospitalizing and medicalizing a healthy segment of society in order to generate a new revenue stream to finance a system of upgraded community hospitals would be seen as a .
Its detrimental consequences over the course of the 20th century are also undeniable — immediately and for .
Still in use today, the harm of this cycle continues to be irrefutable, as is seen in our national Cesarean rate of 33%(some hospitals as high as 70%) with no associated improvement in neonatal outcome. This century-long legacy of routinely medicalizing healthy women also give us a 60% rate for inducing or speeding up labor with drugs. There is an increasing number of premature and preterm births, and increasing rate of maternal mortality (from 8 deaths per 100,000 in 1982 to a high of 17 per 100K in 2007).
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At the time the public relations aspect of Dr. Williams’ plan was first being implemented, it represented a ‘bait and switch’ scheme that include extreme deception at many levels. Perhaps the first and in many ways the most fundamental was an unspoken assumption by childbearing families on the nature of this ‘elective hospitalization’.
People naively believed the hospital’s lying-in would provide same kind of supportive care during labor that they normally received at home from their midwife or family doctor, but with added advantage that medical treatment would be immediately available should a problem or complication occur. This was a particularly comforting thought to first-time mothers-to-be.
At this time, less than 5% of all women gave birth in hospitals, and that was only because of serious medical complications. For the other 95%, care during labor in their own home typically included the continuous supportive presence of family and close women friends. Whether the birth attendant was a midwife or a doctor, both practitioners were usually present during the bulk of active labor; both normally encouraged women to move about in labor and to make right use of gravity, especially during the pushing phase. “Patience with nature” was the watchword of the day.
The assumption by the general public was that a hospital lying-in service replicated this type of physiologic care, with the afore-mention ‘safety’ of hospitals to intervene in complicated birth. But a great number of important things got “lost in translation”, as support for normal biological processes was replaced by routine use of medical interventions.
This long and remarkable list stated by totally eliminating the midwife, and/or midwifery care in any form — physiologically-based care was deemed to be old-fashioned and inadequate at best and at worst, downright dangerous. The next thing to go was support during labor by family members or friends. In fact the any presence of anyone who was not on the hospital staff was strictly forbidden, no matter how brief.
With both midwife and family out of the picture only the doctor was left as a caregiver and provider of psychological support. But unlike midwives, MDs only ‘delivered’ the baby, they did not attend to the physical and emotional needs of the mother during the long hours of her labor. The literature of the day describes this period of time as “the waiting period before the doctor is called” (to perform the ‘delivery’).
Instead of the personal presence of comforting humans, the pain and psychic stress of labor was ‘managed’ by giving every labor woman a series of frequently repeated injections of strong narcotics and Twilight Sleep drug ‘scopolamine”, which produces amnesia and has a hallucinogenic effect. Since resulted in a state of semi- consciousness in most women while a few became agitated, even combative and had to be put in four-point restraints to keep them from falling out of bed of hurting the nursing staff. This totally eliminate any opportunity (or even ability) for women to move about in labor or make right use of gravity, especially during the pushing phase. “Patience with nature” was NOT the watchword of the day!
and a great concern over hospital-based contagion and scrupulous avoidance of anything that might in any way carry germs from one patient to the next.
In the 101 years since “Twilight Sleep: A Simple Discovery in Painless Childbirth” was published, and Dr. Williams’ plan was implemented at a national level, there has been a wholesale indoctrination of society. This PR campaign specifically targeted at the middle and upper-classes to entice healthy childbearing women electively patronize the lying-in wards of their local hospital.
Unfortunately, the methods chosen in 1914 to achieve this dubious goal was a full-on propaganda campaign. Dr. Williams claimed that spontaneous childbirth in the economically targeted class of paying customer, no matter how healthy the woman, how normal the pregnancy or normal the labor, was characterized as pathologically painful, so much so that the laboring woman might go mad and have to be committed to an insane asylum if she was not giving Twilight Sleep drugs during labor and general anesthesia during the birth. and/or unconscionably dangerous failure to medicalized their normal labors and births and to remain in the hospital during a normal postpartum-neonate period, was . in that depends on the patronage of a healthy population that does not need (or in many cases, want) the medicalization of normal labor and birth and the and thus does itself receive .
Today the idea of hospitalizing and medicalizing a healthy segment of society in order to generate a new revenue stream to finance a system of upgraded community hospitals would be seen as a .
Its detrimental consequences over the course of the 20th century are also undeniable — immediately and for .
Still in use today, the harm of this cycle continues to be irrefutable, as is seen in our national Cesarean rate of 33%(some hospitals as high as 70%) with no associated improvement in neonatal outcome. This century-long legacy of routinely medicalizing healthy women also give us a 60% rate for inducing or speeding up labor with drugs. There is an increasing number of premature and preterm births, and increasing rate of maternal mortality (from 8 deaths per 100,000 in 1982 to a high of 17 per 100K in 2007).
At the time the public relations aspect of Dr. Williams’ plan was first being implemented, it represented a ‘bait and switch’ scheme that include extreme deception at many levels. Perhaps the first and in many ways the most fundamental was an unspoken assumption by childbearing families on the nature of this ‘elective hospitalization’.
People naively believed the hospital’s lying-in would provide same kind of supportive care during labor that they normally received at home from their midwife or family doctor, but with added advantage that medical treatment would be immediately available should a problem or complication occur. This was a particularly comforting thought to first-time mothers-to-be.
At this time, less than 5% of all women gave birth in hospitals, and that was only because of serious medical complications. For the other 95%, care during labor in their own home typically included the continuous supportive presence of family and close women friends. Whether the birth attendant was a midwife or a doctor, both practitioners were usually present during the bulk of active labor; both normally encouraged women to move about in labor and to make right use of gravity, especially during the pushing phase. “Patience with nature” was the watchword of the day.
The assumption by the general public was that a hospital lying-in service replicated this type of physiologic care, with the afore-mention ‘safety’ of hospitals to intervene in complicated birth. But a great number of important things got “lost in translation”, as support for normal biological processes was replaced by routine use of medical interventions.
This long and remarkable list stated by totally eliminating the midwife, and/or midwifery care in any form — physiologically-based care was deemed to be old-fashioned and inadequate at best and at worst, downright dangerous. The next thing to go was support during labor by family members or friends. In fact the any presence of anyone who was not on the hospital staff was strictly forbidden, no matter how brief.
With both midwife and family out of the picture only the doctor was left as a caregiver and provider of psychological support. But unlike midwives, MDs only ‘delivered’ the baby, they did not attend to the physical and emotional needs of the mother during the long hours of her labor. The literature of the day describes this period of time as “the waiting period before the doctor is called” (to perform the ‘delivery’).
Instead of the personal presence of comforting humans, the pain and psychic stress of labor was ‘managed’ by giving every labor woman a series of frequently repeated injections of strong narcotics and Twilight Sleep drug ‘scopolamine”, which produces amnesia and has a hallucinogenic effect. Since resulted in a state of semi- consciousness in most women while a few became agitated, even combative and had to be put in four-point restraints to keep them from falling out of bed of hurting the nursing staff. This totally eliminate any opportunity (or even ability) for women to move about in labor or make right use of gravity, especially during the pushing phase. “Patience with nature” was NOT the watchword of the day!
and a great concern over hospital-based contagion and scrupulous avoidance of anything that might in any way carry germs from one patient to the next.
In the 101 years since “Twilight Sleep: A Simple Discovery in Painless Childbirth” was published, and Dr. Williams’ plan was implemented at a national level, there has been a wholesale indoctrination of society. This PR campaign specifically targeted at the middle and upper-classes to entice healthy childbearing women electively patronize the lying-in wards of their local hospital.
Unfortunately, the methods chosen in 1914 to achieve this dubious goal was a full-on propaganda campaign. Dr. Williams claimed that spontaneous childbirth in the economically targeted class of paying customer, no matter how healthy the woman, how normal the pregnancy or normal the labor, was characterized as pathologically painful, so much so that the laboring woman might go mad and have to be committed to an insane asylum if she was not giving Twilight Sleep drugs during labor and general anesthesia during the birth. and/or unconscionably dangerous failure to medicalized their normal labors and births and to remain in the hospital during a normal postpartum-neonate period, was . in that depends on the patronage of a healthy population that does not need (or in many cases, want) the medicalization of normal labor and birth and the and thus does itself receive .
Today the idea of hospitalizing and medicalizing a healthy segment of society in order to generate a new revenue stream to finance a system of upgraded community hospitals would be seen as a .
