A 20th Century History of Birth

1914 – Twilight Sleep is developed. This technique involves injecting a laboring woman with morphine and then giving her the amnesiac drug scopolamine. Later it was found that morphine contributed to maternal deaths, and that scopolamine didn’t kill pain, only the memory of pain. Still the development was hailed as a breakthrough.

1915 – US maternal mortality is six deaths per 1,000, highest in the industrial world.

1917 – The nation’s first woman-centered birthing organization, the Maternity Center Association, is established in New York City (see "Rallying the Troops," page 60).

1920 – The majority of middle-class women in the US begin having physician-attended births in a hospital. Meanwhile, infant deaths from birth injuries increase by 50 percent.

1925 – The British-trained midwife Mary Breckenridge establishes the Frontier Nursing Service in the Appalachian Mountains of southeastern Kentucky, creating a new model for rural maternity care.

1931 – After statistics show that countries with midwife-centered obstetrical care have lower infant mortality rates, the Maternity Center establishes the nation’s first formal nurse-midwifery educational program at the Lobenstine Midwifery School in New York City.

1932 – US maternal mortality rises to 6.3 deaths per 1,000 and 7.4 deaths per 1,000 in cities. Twilight Sleep is still used for most deliveries.

1933 – The American Hospital Association develops an insurance program that eventually becomes the national Blue Cross Association, greatly increasing the affordability of hospital birth. British obstetrician Grantley Dick-Read publishes his landmark book, Childbirth Without Fear: The Principles and Practice of Natural Childbirth, the forerunner of the natural childbirth movement. In it,he proposes the then-novel idea that fearing the pain of labor increases the pain of labor; and if women were educated about what to expect during childbirth, they could better withstand its rigors. Dick-Reed thus becomes the first to advocate using controlled breathing and relaxation techniques during labor.

1939 – Sulfa antibiotics are introduced, lessening the death rates in hospital births.

The Frontier School of Midwifery and Family Nursing is established.

1940 – The use of total anesthesia during childbirth becomes the accepted "modern way" to give birth. Pediatricians begin advocating scheduled bottle feeding so that a baby’s food intake can be "scientifically" managed.

1943 – The Emergency Maternity and Infant Care (EMIC) program is launched, providing free hospital obstetric care to 1.1 million mothers and babies. Within three years, it will cover one of every seven births in the US, vastly increasing the rate of hospital births.

1946 – A major study at Yale New Haven Hospital shows that using Dick-Read-style techniques reduces the amount of anesthesia during labor.

1947 – The Maternity Center Association invites Dick-Read to the US for a well-attended lecture tour.

1949 – The first issue of the Child and Family Digest is published by Charlotte and Gall Aiken. Featuring articles by such natural-birth luminaries as Dick-Read, Ashley Montagu, and Niles Newton, it becomes instrumental in introducing natural birth to America.

1950 – Life Magazine publishes the article "Understanding Natural Childbirth at Yale University," instantly familiarizing millions of readers with Dick-Read’s relaxation techniques.

1951 – Two young French obstetricians, Fernand Lamaze and Pierre Vellay, travel to Russia to observe the so-called psychoprophylactic (mind-over-matter) obstetrical practices in use there.

1952 – Lamaze and Vellay introduce their version of psychoprophylactic obstetrics, which relies heavily on the use of distraction techniques during contractions. The most famous of these techniques involves structured, controlled breathing.

1955 – The American College of Nurse Midwives is established.

Fernand Lamaze attends the birth of his first American patient, Marjorie Karmel.

1956 – The La Leche League is founded by seven women at a church picnic. At the time, only 20 percent of US babies are being breastfed at birth.

Fernand Lamaze publishes Painless Childbirth. Pope Pius sanctions its use.

1959 – Thank You, Dr. Lamaze: A Mother’s Experience in Painless Childbirth is published by Marjorie Karmel.

1960 – The rate of cesarean births in the US hits about 7 percent.

The International Childbirth Education Association (ICEA) is founded to promote family-centered maternity care and "freedom of choice based on knowledge of alternatives."

Elisabeth Bing, a physical therapist, Marjorie Karmel, and Benjamin Segal, MD, found the American Society for Psychoprophylaxis in Obstetrics (ASPO), now called Lamaze International. The original ASPO manual reads (disconcertingly): "The woman should be encouraged to respect her doctor’s word as final [and] is responsible for controlling herself and her behavior."

1962 – Sheila Kitzinger’s revolutionary book, The Experience of Childbirth, is published in England. An anthropologist, Kitzinger introduces the idea that birth is a highly personal, sexual, and social event. She recommends the acceptance of labor pain and sees pain as a side effect of a task willingly undertaken – pain with a purpose.

1965 – The book, Husband Coached Childbirth, is published by Robert Bradley, an obstetrician who encourages fathers to become labor coaches.

1972 – Doris Haire’s booklet, The Cultural Warping of Childbirth, is published by ICEA. A well-referenced analysis of global birth practices, it marks a turning point in obstetric care.

The World Health Organization issues an official definition of midwifery, stating that midwives are independent’ practitioners and do not require a doctor’s supervision.

1973 – 99 percent of US births are physician-attended hospital births.

1974 – Only 29,413 births in the US are attended by midwives.

1975 – Suzanne Arms publishes Immaculate Deception, providing a compelling account of the modern over-medicalization of childbirth and its implications as a women’s issue. Ina May Gaskin’s Spiritual Midwifery illustrates the excellent outcomes of community-based homebirth midwives on The Farm, a communal group in Summertown, Tennessee.

1976 – Maternal-Infant Bonding by Marshall Klaus and John Kennell shows the significance of physical contact between parents and newborns during the critical hours after birth.

Mothering magazine is founded.

1977 – A major study by Lewis Mehl, MD, concludes that homebirths are safer than hospital births when good nutrition and prenatal care are present.

1978 – The US cesarean rate approaches 18 percent.

The Seattle Midwifery School is founded.

1979 – The American Academy of Pediatrics and the American Medical Association approve an anti-home-birth resolution. Illustrating the growing debate about birth methods in the US, the American Public Health Association simultaneously concludes that "births to healthy mothers can occur safely outside the setting of an acute-care hospital."

1980 – 98.3 percent of US births are physician-attended, hospital births.

The Institute of Medicine of the National Academy of Science, the Office of Technology Assessment of the US Congress, and the National Commission to Prevent Infant Mortality all officially support the development of midwifery.

1981 – Episiotomy: Physical and Emotional Aspects, edited by Sheila Kitzinger, provides the first critique of the routine practice of episiotomy.

1982 – The Midwives Alliance of North America is formed to unify midwives regardless of their educational or philosophical background. In Labor: Women and Power in the Birthplace by sociologist Barbara Katz Rothman delineates the two increasingly divergent models of modern childbirth: the midwifery model and the medical model.

1984 – The National Association of Child Bearing Centers (NACC) is founded. As of 1998, 49 free-standing birth centers are accredited by NACC. Within weeks, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists issue a joint statement: "Until scientific studies are available to evaluate safety in freestanding [birth] centers, the use of such centers cannot be encouraged."

1986 – Nancy Wainer Cohen publishes Silent Knife on the politics of cesareans and the medical evidence to support vaginal births after cesareans. She receives 100,000 letters from readers, and she coins the acronym VBAC.

The magazine Midwifery Today is founded.

1988 – There are 132,670 midwife-attended births in the US.

1989 – Two major scientific studies are released in December, one in the New England Journal of Medicine and one in The Journal of Reproductive Health. Both studies conclude that low-risk women delivering at freestanding birth centers are no more likely to have poor birth outcomes than are low-risk women birthing in hospitals. Birth centers in fact have a lower rate of cesarean birth, less neonatal mortality, and no maternal mortality.

1990 – The US cesarean rate tops 25 percent, and 95 percent of US births are doctor-attended hospital procedures. The book Safer Childbirth by British statistician Marjorie Tew shows overwhelming evidence for the relative safety and superiority of skillful midwifery and homebirth.

1991 – About 5 percent of US hospital births are midwife attended. By comparison, more than 33 percent of births in the Netherlands are midwife-attended homebirths, and infant mortality there is well below that of the US.

1992 – Alandmark study-"Does Episiotomy Prevent Perineal Trauma and Pelvic Floor Relaxation?" – in the Online Journal of Current Clinical Trials shows that routine episiotomy does more harm than good. Doulas of North America (DONA) is founded by Penny Simkin, Marshall and Phyllis Klaus, John Kennell, and Annie Kennedy after a number of new studies demonstrate improved obstetrical and psychosocial outcomes during doula-attended births. In Birth as an American Rite of Passage, anthropologist Robbie Davis-Floyd describes the cultural influences and rituals associated with birth and how they influence birth outcomes and personal experiences of childbirth. The British House of Commons Health Committee publishes a report entitled "Changing Childbirth" that concludes: "The policy of encouraging all women to give birth in hospitals cannot be justified on the grounds of safety …. Hospitals are not the appropriate place to care for healthy women."

1993 – Lamaze International ratifies a new birth philosophy that states (more compassionately than their 1960 training manual): "Birth is normal, natural, and healthy. Childbirth educators empower women to make informed choices in health care, to assume responsibility for their health, and to trust their inner wisdom."

1994 – 5.5 percent of all US births are midwife attended.

1995 – The US rate of cesarean births drops slightly, to 20.8 percent; the VBAC rate rises to 35.5 percent. By comparison, Norway has a 54.1 percent VBAC rate. Lamaze International holds a summit of birth advocacy groups to help implement a new, more-natural birth philosophy. This meeting becomes the genesis of the Coalition to Improve Maternity Services.

1996 – The first major initiative of the Coalition to Improve Maternity Services, the Mother-Friendly Childbirth Initiative, is officially ratified by 25 prominent international groups. (See "The Journey’s End," page 63.)

1997 – Most insurance carriers begin covering midwifery care for hospital or birth-center births (but not for homebirth). All states by now license certified nurse midwives and about 25 percent license direct-entry midwives.

1998 – The rate of midwife-attended births is now growing at a high and rising rate, showing a 45 percent increase since 1982. The rate of midwife-attended hospital births is rising even more sharply, increasing by 1,000 percent since 1975. A study in the Journal of Epidemiology and Community Health shows much lower infant-mortality rates for births attended by certified nurse midwives.

2000 – If WHO and most of the globe’s other birth advocacy groups have their way, the world will soon see much lower rates of cesareans, much higher rates of prolonged breast-feeding, and healthier mothers and children. The future looks bright!

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