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We chose to focus on the history of childbirth in America as a whole in order to construct a clearer vision of how changes in women’s experiences of childbirth are connected to broader historical trends. We felt that the history of childbirth in America was overall a story of changing medicalization and female autonomy. Our research revealed a trend towards increasing medicalization as early as the 18th century, with men entering the birthing room, and as late as the mid-20th century, with the first notable anti-medicalization activism. While women sought ways to improve the safety and comfort during childbirth, these requests for intervention often resulted in an unintentional loss of autonomy for the woman. This unintentional loss of autonomy is highlighted by the consequences of the Twilight Sleep movement in the early 20th century. Although early trends in medicalization, as initiated by women resulted in less autonomy for women overall, increasing activism on the part of women as well as changes in social norms and values led to growing support for women’s choice in their childbirth experiences. This is made clear by the support for working women’s experience of childbirth as protected by the Pregnancy Discrimination Act of 1978. The general experience of childbirth in America has greatly improved over time in terms of safety and options for women. However, there is still progress to be made in order to provide more equitable and positive experiences for all.

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Mid 1700s: Male Physicians Enter the Child-birthing Room

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Mid 1700s: Male Physicians Enter the Child-birthing Room

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Prior to the mid eighteenth century, child birth was primarily a female centered event which often included a midwife who spent most of their time comforting the mother and waiting for the birth. Child birth was a social event not unplagued by the fear of infant and maternal death or life long physical disabilities. In search of an easier child birthing experience, some women invited physicians or “male midwives” to their births, as the practice of obstetrics began to take shape. Since men were offered educational opportunities denied to women, it was a fair assumption for women to believe that male physicians would be able to provide a safer child birthing experience than a midwife with no formal education. Further, male physicians were able to offer pain relieving drugs and used tools like forceps, which midwives did not have the training or knowledge to provide. This period marks the first significant change in child birthing tradition, and it occurred rather smoothly.

The shift in who women preferred to be present during childbirth significantly changed the traditions of at-home births in ways outside of the absence of midwives. First, it demonstrates a belief that physicians were superior to midwives and the traditional social support of other women resulting in a shift in expectations of what their “supporter” was responsible for. Midwives and other women traditionally stayed with the infant and mother after the birth to comfort and support them. When male physicians entered the scene, the experience of childbirth became an experience exclusively between a woman and her doctor. Second, it led women to specifically seek doctors who used pain relieving medicine and special child birthing instruments because those births seemed to be less painful and more successful. These types of practices, of course, were only available to those who could afford them. This ultimately created a socioeconomic gap in the types of childbirth experiences women of different classes could have. Further, many of these sought after practices such as bloodletting, opium use, and instruments like forceps and the crochet caused more harm than perhaps a “more natural” birth might have.

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Early 1800s          Bloodletting as a Childbirth Intervention 

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Early 1800s          Bloodletting as a Childbirth Intervention 

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Bloodletting, a practice in which physicians drew blood from patients in order to cure or prevent a wide range of illness and diseases, became one of the first and most popular medical interventions performed by physicians during childbirth in the 19th century. Physicians practiced this form of therapy long before the medicalization of childbirth in the United States in places such as ancient Greece, and perhaps originated in folklore (Siddall 1980). Yet, it makes sense that it wasn’t until the 19th century that bloodletting was adopted as a childbirth intervention because male physicians had just begun to enter the child-birthing rooms and bloodletting was not a midwifery practice. Additionally, bloodletting was a go-to method of medical intervention in the 19th century because there were no specific medications available (Siddall 1980). In all, bloodletting was believed to accelerate labor and relieve the pains and complications that came with childbirth and was routinely used as a medical intervention in childbirth until its abandonment in 1945, due scientific advances in physiology and pathology and increasing popular resistance to all venesection therapy Siddall 1980).

Bloodletting rising as a method of medical intervention during childbirth in the 19th century was significant because it gave the inexperienced specialty of American obstetrics an edge compared to midwifery. Moreover, early obstetricians such as William P. Dewees and Benjamin Rush were able to establish the persuasive idea that allowed for further development in medicalized techniques that “only the discerning eye of the obstetrician could determine the bodily cause of civilised woman’s suffering; and only the toolkit of the obstetrician could provide her relief” through the popularization of bloodletting (Rich 2016, p. 68). Further, Dewees used racist justification to describe the differences in pain felt by civilized and uncivilized women during childbirth in order to justify bloodletting interventions as a remedy for his “civilized, delicate-wombed white patients” (Rich 2018, p. 69). Such justification upholds the inequalities found in obstetric care that live on to present day. Ultimately, the longevity of bloodletting as an accepted medical intervention in childbirth is significant because it highlights the true history of malpractice and the many lives of the patients that suffered the long-term ill effects (Siddall 1980).

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1827: First Published Successful C-Section

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1827: First Published Successful C-Section

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Although some historians claim that the first successful cesarean section in the United States was completed as early as 1794 by Jesse Bennett, this account was not recorded well, nor did doctor Bennett publish his success. Thus, it has become widely accepted that the first full account of a successful cesarean section was completed in 1827 by John L. Richmond in southwest Ohio. The concept of a cesarean section dates back to the ancient Romans, however they were exclusively used when the mother was expected to or had already died, and a vaginal birth was no longer an option. Doctor Richmond exhibited a similar approach on his patient whom he regarded to be obese and likely to die after being unable to diagnose what was causing her inability to birth the child vaginally. He opted to administer a cesarean section, knowing that there was a very slim chance of survival and that there would be no pain relief available to the patient during the surgery. After completing the incision and finding the infant to be abnormally large, he worked carefully to remove the fetus pieces from the patient’s abdomen. The surgery was a success and both the mother and infant survived without serious complications. Richmond published his successful procedure, however it received little attention and cesarean sections continued to be extremely rare in the 19th century, as it was seen as problematic to interfere with natural childbirth.

This account is important for a few reasons. First, it is unique for its time in that it was performed on a white patient in the northern part of the country, while most experimental procedures in obstetrics were taking place on enslaved women in the South. The success of this surgery was also important in providing slightly more confidence in a “last resort” option for emergencies in which patients could not deliver vaginally.  Since the administration of a cesarean section had previously almost assured the death of the mother, the survival of Doctor Richmond’s patient offered hope and perhaps shifted the expectation of what the outcome of the situation could be. Sadly, the majority of continued “research” on the subject of cesarean sections was performed mostly on Black or other marginalized women without their consent, and maternal death continued to be the most common outcome of the procedure. Cesarean sections continued to be avoided at all costs in cases where the mother’s life was valued, and they were not able to be performed with regular success until the discoveries of antiseptics and other surgical safety measures. Although Richmond’s success may not have caused an immediate change in the approach to childbirth, it certainly proved that the surgical removal of an infant was possible. Further, his publication sparked generations of continued research on the subject which would one day become one of the most reliable methods of childbirth for women.

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1847 - Beginnings of Obstetric Anesthesia

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1847 - Beginnings of Obstetric Anesthesia

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While it may seem obvious that physicians would want to do their best to relieve childbearing women’s pain, many social and philosophical reasons have complicated the debate and even the feminist perspective surrounding anesthesia. Some women view pain as simply part of the “natural” birthing experience, and others go further to cite biblical reasons that pain in childbirth is a natural punishment for women.

Pictured here is Fanny Wadsworth Longfellow, the first woman in the United States to give birth with the aid of pain relief. Queen Victoria also elected to do the same, but even then obstetric anesthesia was still not routine. As we’ve read, some physicians needed to justify their use of anesthesia by describing white women as more “fragile” than their African American or Native American counterparts. Currently, around 90% of women receive some sort of augmentation in childbirth, whether that be anesthesia, epidurals, or cesarean sections (Belkhir).

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1913                                            Twilight Sleep Movement

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1913                                            Twilight Sleep Movement

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The Twilight sleep movement constitutes a major turning point in the history of childbirth in the United States. Advocated for by “first-wave feminists”, Twilight sleep involved the administration of the drugs morphine and scopolamine during labor to manage pain and induce an amnesic state so that women would not remember childbirth (Skowronski 2015). However, women still fully experienced pain which lead to the use of Twilight sleep blindfolds and cribs, and the blindfold is picture below (Panazzolo & Mohammed 2011). The technique was used in Freiburg, Germany, and in 1914 McClure’s Magazine published a piece by two female journalists who had visited Germany and felt the Twilight sleep birth practiced there was far superior to birth in the United States (Skowronski 2015). American doctors refusal to adopt the German technique resulted in a movement led by mainly upper-class white women, who went on to found The National Twilight Sleep Association.

By 1915, American physicians were more receptive to Twilight sleep and began offering it to women who asked for it (Leavitt 1997). The irony of the movement was embodied in women’s proclaimed desire to have more control over their birth experience but sought to achieve this by taking medicine that would essentially give complete control to a physician during childbirth. The death of a prominent Twilight sleep advocate during childbirth and growing questions within the American medical community about safety led to a decline in popularity and use of the method in the United States by 1915 (Leavitt 1915). The movement did however facilitate an increased acceptance of pain relief methods during childbirth, while also moving birth into hospitals and increasing medicalization.

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1939 - Half of all Births Occurred in Hospitals

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1939 - Half of all Births Occurred in Hospitals

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Throughout time, midwives have provided the majority of maternity care around the world, however, the late 1800s and early 1900s represented a time of change. The medical profession was shifting its professional basis. Organized schools of medicine replaced apprenticeships as the preferred method of learning and obstetrics was included as an area of study.

Physicians in the U.S. organized the American Medical Association in 1847, which sought to promote the wellbeing of its profession. For the first time, under the influence of the AMA, states passed laws regulating who could practice medicine. In general, this was a benefit to healthcare consumers, as it helped keep unqualified people from claiming to practice medicine, and it lead to the accreditation of medical and other professional schools. However, in the early 1900s these laws nearly put an end to the practice of midwifery as physicians sought the "business" of caring for pregnant women, using the medical practice acts to limit the activity of midwives. These conditions as well as the promise of pain medication lead to 50% of American births occurring in hospitals by 1939.

Physicians and hospitals also recognized that if a positive relationship was established with a pregnant woman, it would influence where she sought care for herself and her family for a lifetime. This provided another motivation to seek pregnant women as clients and is still a motivation today.

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1952 - 1953                                    First Scripted Pregnancy and Childbirth on Television

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1952 - 1953                                    First Scripted Pregnancy and Childbirth on Television

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December 8, 1952 marked the first popularized celebrity pregnancy shared with the public through the American sitcom, I Love Lucy. Following suit, the popular television sitcom also aired the first scripted childbirth on January 19, 1953. Lucille Ball, who played the protagonist, Lucy Ricardo, of the show, was pregnant with her second child, coinciding with her character’s first pregnancy on the show (Roberts 2021). The first episode debuting her pregnancy, “Lucy is Enceinte,” depicts Lucy receiving confirmation from her doctor that she is, indeed, “going to have a baby” or “enceinte,” as the word “pregnant” was not part of polite discourse (Rothman 2016). The episode ends with Lucy revealing the news to her husband, Ricky Ricardo, on his show, where he seems to already be convinced that the baby will be a boy. Consecutive episodes pave the way to the iconic episode that is depicted in the attached image, “Lucy Goes to the Hospital,” where Lucy’s journey to the hospital and into labor does not go as planned. In the end, Lucy gets to the hospital in time for the delivery of her and Ricky’s baby boy, “Little Ricky.” Coincidently, Monday, January 19, was also predetermined to be the day that Lucille Ball would give birth to her own baby (Bor, 2013).

These two episodes, bookending the seven week series of episodes with titles such as “Pregnant Women Are Unpredictable” and “Ricky Has Labor Pains,” that make up the storyline of Lucy Ricardo’s pregnancy journey and climatic delivery of a baby boy, are significant for many reasons. In all, the depiction of Lucy Ricardo’s pregnancy and journey into labor on I Love Lucy marks origins of such instances becoming popular storylines in American Entertainment. Additionally, specific scenes and lines in the episodes provide real implications on traditional gender roles and the medicalization of childbirth. For example, the picture depicted above from the episode, “Lucy Goes to the Hospital” includes a scene where Ricky, Fred, and Ethel, rehearse for when Lucy will walk into the room and say “the time has come.” Contrary to their efforts, they prove unprepared for when the time does come, and a chaotic and comedic scene arises in which the situation seems to be about everyone else’s well-being besides Lucy’s. Further, Lucy seeks word from her doctor to confirm her pregnancy and gives birth in a hospital setting, where everything seems to turn out alright in the end. These details both dramatize and normalize the experience of a medicalized birth in 1950s America, which ultimately illustrates women’s submissive role in pregnancy and childbirth. At the same time, scripting pregnancy and childbirth was an important step in removing some of the stigma surrounding pregnancy and childbirth discourse in American popular culture. Moreover, all of these implications become serious when they are able to reach such a large audience on television. For instance “Lucy Goes to the Hospital” reached 44 milion viewers, compared to the 29 million viewers who tuned into Dwight D. Eisenhower’s televised inauguration the following day (Bor, 2013).

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I Love Lucy - Lucy Goes Into Labor (This is it!)

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1960s                                    Popularization of the Lamaze Method in the United States

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1960s                                    Popularization of the Lamaze Method in the United States

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The Lamaze method of childbirth, also known as the “psychoprophylactic technique,” was popularized in the United States through the publication of Thank You, Dr. Lamaze: A Mother’s Experience in Painless Childbirth by Marjorie Karmel in 1959 (Rothman 2016). In her book, Karmel praises the birthing technique popularized by French physician Dr. Fernand Lamaze, who observed childbirth practices by midwives in the Soviet Union. More specifically, Karmel highlights her own experience adopting the Lamaze method for her second child, and how she was given tea and encouraged to walk around while in labor. In all, the Lamaze method sought to eliminate pain in childbirth through more natural methods, like the methods highlighted by Karmel, and other exercises such as breathing techniques and abdominal massages that often had correlated classes to educate mothers and partners about the Lamaze method. Importantly, the Lamaze method, although viewed through a lens of natural practices, was ultimately about a science of pain management that would work in conjunction with obstetric care (Rothman 2016).

First, the publication of Karmel’s Thank You, Dr. Lamaze: A Mother’s Experience in Painless Childbirth in 1959 was significant because it introduced the Lamaze method of childbirth to the United States, which is still used by expecting mothers today. For instance, Elisabeth Bing, a physiotherapist, read Karmel’s book in 1959 and immediately contacted her to learn the Lamaze method for herself, which led to the founding of the American Society for Psychoprophylaxis in Obstetrics (ASPO) in 1960, known as Lamaze International today (Zwelling 2000). While the Lamaze method is still used in many births today, there have been notable implications since the origins popularized childbirth practice. For example, language from ASPO training courses reinforces the passive roles that women held during childbirth along with the losses that women ultimately faced in attempt to gain autonomy over their reproductive health: “In all cases the woman should be encouraged to respect her own doctor’s word as final...It is most important to stress that her job and his are completely separate. He is responsible for her physical well-being and that of her baby” (Rothman 2016, p. 109). Further, men often acted as “labor coaches” in the Lamaze method (Rothman 2016). In addition, the Lamaze method introduced the rhythmic “puffing and panting” that characterizes and perhaps caricatures, the portrayal of birth in popular media (Rothman 2016). In a way, the popularization of the Lamaze method of childbirth in the United States in the 1960s gave women more choice in how they wanted to give birth, but this particular method ultimately reinforced women’s submissive role in childbirth and traditional gender roles throughout a woman’s process, which in turn, further influenced the portrayal of childbirth in popular media.

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1970s                     Midwifery and Anti-Medicalization Activism  

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1970s                     Midwifery and Anti-Medicalization Activism  

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Spearheaded by Ina May Gaskin and other influential writers and midwives, the 1970s brought about a new home birth and midwifery movement. In the wake of very influential counterculture movements in the late 1960s and early 1970s, Raven Lang would publish The Birth Book, Ina May Gaskin would publish Spiritual Midwifery, and Rahima Baldwin Special Delivery (Kline 2015). These books were important works that encapsulated some of the antimedicalization sentiments of feminist activists at the time.

The books published in the 1970s and subsequent counterculture movement brought about some tangible changes in birthing practices for women. In 1970, the rate of hospital births was at a record high of 99.4%, however by 1977 the percentage of non-hospital births had more than doubled (Kline 2015). While still constituting a very small number of total births, these out of hospital births highlighted the desires of women to have more autonomy in their birth experiences. Physicians and American College of Obstetricians and Gynecologists openly condemned the home and alternative birth movement, decrying it as an “anti-intellectual anti-science revolt” (Kline 2015). In the spring of 1977, the home birth movement reached a new height with a conference hosted by the newly formed National Association of Parents and Professionals for Safe Alternatives in Childbirth. At the conference, speakers discussed the future of childbirth and envisioned it’s move back into the homes of women. Over 40 years later, this vision has not been realized. Ina May Gaskin has continued to advocate for home births and still practices as a midwife in Tennessee. Both she and the home birth movement remain influential and the rate of home-birth has grown steadily in the 21st century (Shapiro 2012).

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The Pregnancy Discrimination Act of 1978 was an amendment to the previously existing Civil Rights Act of 1964. It was passed in response to a Supreme Court case in 1976, General Electric Company v. Gilbert, in which the Court held that the exclusion of pregnancy-related benefits from the company disability plan did not violate the Civil Rights Act of 1964 as it currently stood. The Pregnancy Discrimination Act extends to protect people from discrimination “on the basis of pregnancy, childbirth, or related medical conditions.” This means that employers are required to provide the same accommodations for disability or leave caused by pregnancy and childbirth, as they do for other disabilities or sick leave. For example, a woman who underwent a cesarean section would be allotted the same amount of sick leave as another employee who also had a major surgery.

The significance of the Pregnancy Discrimination Act of 1978 goes beyond the basic idea that the female experience of pregnancy and childbirth can be equally detrimental to their physical health as any other disability. This act demonstrated federal support for mothers in the workforce (at least at some level) and ultimately called out the sexist policies which previously existed in many workplaces. For pregnant women or women hoping to become pregnant, the security of their job throughout the process of pregnancy, childbirth and recovery allowed them to take the necessary steps for their health with confidence. Similarly, it might encourage women to choose what kind of birth experience they want based on their personal preferences, rather than the effects it could have on their ability to get back to work as soon as possible.

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1980s-                                      Popularization of the Epidural

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1980s-                                      Popularization of the Epidural

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The epidural is a popular form of pain-relief during labor. It was first used by a Spanish military surgeon, Fidel Pagés in 1921 (Skowronski 2015). The technique was pioneered in the United States by John Bonica, an American anesthesiologist (Skowronski 2015). Bonica actually first tested the technique of epidural analgesia on his wife, who had preciously been administered ether anesthesia and experienced life-threatening complications as a result of use.

It was not until the 1980s that the epidural became more commonly used in the United States (Humenick 2000). Increasingly, the epidural was presented to women as a way to be alert and awake during childbirth without having to experience the pain that came with it. Today there are two types of epidurals that are commonly used – the standard epidural and the combined-spinal epidural (Panazzolo & Mohammed 2011). A standard epidural involves the use of a catheter to carry anesthetic to the part of the body experiencing pain, numbing a patient from their waist down (Panazzolo & Mohammed 2011). A combined-spinal epidural, which is also referred to as a “walking epidural” is administered directly through the spine and allows a patient to be more flexible and mobile during labor (Panazzolo & Mohammed 2011). Epidurals have increased in popularity in recent years, with 71% of women receiving them as of 2018, a ten percent increase from the rate of 61% in 2008 (White 2018).

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1992                            Founding of Doulas Of North America (DONA)

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1992                            Founding of Doulas Of North America (DONA)

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Founded by a cohort of five maternal-child health experts in 1992, DONA, now DONA International, introduced a new method of childbirth for women to adopt: hiring a doula. Stemming from the Greek term for “servant,” a doula is one who works with women and families birthing in hospitals, birth centers, and at home, providing them with physical, emotional, and information support before, during, and just after birth (DONA International; Torres 2015). Unlike physicians and midwives, doulas do not practice medical interventions to assist in childbirth and are not licensed nor educated to do so. Women may hire doulas for reasons such as seeking help with creating a birth “plan,” gaining knowledge on the birthing process, resisting coercion into medical interventions, reclaiming the bodies of women of color, facilitating interaction between laboring women and their partners, and coping with difficult situations during the birthing process in general (Nash 2019; Torres 2015). Today, there are 13,000 certified doulas through DONA International practicing in 56 countries around the world (DONA International).

The founding of DONA International led to the formation of other doula nonprofits and companies, which allowed for the spread of this relatively new trend to be a new method of birthing for women to choose from. While hiring a doula is seen as a relatively new trend, for DONA International was founded only 27 years ago, this childbirth trend capitalizes on traditional practices by commodifying care and intimacy (Torres 2015). If the woman in labor’s support system and knowledge bank have been shifted from family and friends to objective strangers, what does that say about the value of trust that birthing women hold in natural support systems today? Further, when care is overwhelmingly seen as an innate characteristic of women, it is not regarded as a learned skill, which is one side effect of the complexity of the expertise and education that doulas hold (Torres 2015). Additionally, doulas viewed through the lens of saving black and other marginalized women from the crisis of their childbirth experience sometimes fail to acknowledge that the true crises lie within the medical institutions, not within marginalized women’s bodies (Nash 2019). Further, medical institutions are not the only source of inequality, for the doula practices themselves are not equal. In fact, capitalization and commodification of non medicalized birthing strategies has led to striking pay gaps and motives between doulas who work for companies and doulas who work for free or little pay (Nash 2019). While a doula’s relationship with a woman and her family most closely mimics the support systems found in traditional birthing processes, DONA International’s claim on their website that navigating pregnancy with a doula is like navigating a “foreign country” with a “travel guide,” shows that this non medicalized birthing  trend that aims to support, inform, and advocate for women--often by women--ultimately works to combat the side effects that medicalization has brought to the birthing process, such as the diminishing autonomy that women possess over their own birthing processes and the increasingly disconnected relationships that women have with their own bodies.

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Muchas veces nos toca acompañar ahí, en ese océano en el cuál se sumerge la mujer recién parida. En ese puerperio abrumador, donde su identidad queda confundida y aplastada por el derrumbe que originó el ingreso a la maternidad. Y entonces se nos plantea otra vez el...

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Once you complete your DONA International doula training you'll have all of the knowledge and skills you need to get out there and start serving pregnant people and new families. Then It's time to find those first three certifying families to support! It can be...

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This past year has been a tumultuous one for most people. The emergence of COVID-19 turned our world upside down as our loved ones fell ill, our children schooled from home and our employment changed in major ways. It was, and still is, a time of drastic adjustment,...

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In early 2020, when COVID-19 began to spread across the world, and most hospitals and birth centers revised their visitor policies, many doulas scrambled to offer their clients the best support they could over the phone via FaceTime, or through a webcam set up in...

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Doula Training and Doula Certification - DONA International

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Want to become a doula? Want to find a doula? Join us to launch your new career, learn about the doula field or connect with professionals worldwide.

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Late 20th & 21st Centuries                 Black Maternal and Infant Mortality Activism

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Late 20th & 21st Centuries                 Black Maternal and Infant Mortality Activism

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Combating the Black maternal and infant mortality crisis has prompted continued activism over the past several decades (McDonald 1997). Current data from the Centers for Disease Control and Prevention show that in the United States, Black women are 3 to 4 times more likely to die due to pregnancy related complications than White women (Lockhart 2018). Disparities in birth outcomes have remained an issue in the 21st century despite improving access to medical care in the United States, suggesting structural and interpersonal racism must be addressed in discussing the current crisis (Lockhart 2018). More recently, the crisis has received new attention with the growth of the Black Lives Matter movement (Lockhart 2018). New organizations and activist groups, like the Black Mamas Matter Alliance, have formed to “Change Policy, Cultivate Research, Advance Care for Black Mamas, and Shift Culture” (Black Mamas Matter Alliance 2021).

To combat these disparities, maternal activists have sought to “rescue disadvantaged mothers from their increasing social isolation” by promoting community empathy and support among Black women (McDonald 1997). The framework of empathy has been integral to creating an activist movement that operates across class lines within the Black community (McDonald 1997). This vision is embodied by more recent public health initiatives, aptly named “home-visiting programs”, which have been implemented in cities like Milwaukee, Wisconsin to combat stark maternal mortality disparities (Carpenter 2017). These programs seek to promote community support and have shown to be effective in academic study (Carpenter 2017).

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21st Century: 1 of 5 Birth Processes are Induced

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21st Century: 1 of 5 Birth Processes are Induced

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Since 1990 the proportion of births resulting from an induced labor has doubled, and many of these inductions have been performed “for no apparent medical reason” (Brody, 2003). American women and their doctors alike have been electing to expedite the labor process primarily for convenience’s sake. One doctor described the current medical climate as “consumer-driven”; many working women prefer to get their pregnancies over with on a specified date, and several other women simply become concerned when spontaneous labor doesn’t occur on or near their due date (Brody, 2003). Similarly to the high C-section rate in America, researchers also hypothesize that the high induction rate is also drive by physician’s fear of lawsuits and fears around fetal distress.

The drug shown, Pitocin, is the most common form of birthing augmentation in America as of 2011 (Belkhir). Pitocin is a synthetic version of the chemical oxytocin and helps induce labor contractions. While Pitocin is generally prescribed to help speed up the birthing process, it also tends to lead to higher childbirth costs and perhaps even health risks (Brody, 2003). Part of both of these aspects is the fact that the need for cesarean deliveries is greater after induction. Additional research needs to be done; many doctors still believe that spontaneous labor is the best possible option. When there is medical reason for induction, of course, the potential benefits “greatly outweigh” the risks, however (Brody, 2003).

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21st Century: High Cesarean Delivery Rate (1/3 births)

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21st Century: High Cesarean Delivery Rate (1/3 births)

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Modern-day America boasts the highest cesarean rate in the country's history, with the CDC reporting that 31.7% of deliveries in 2019 occurred in this fashion. For context, this is a large increase compared to even the very end of the 20th century, where the C-section rate was 20.7% in 1996; from 1996 through 2009 the cesarean rate increased by 60%. Additionally, the number of elective C-sections has also risen in recent years, constituting for around 2.5% of births today (Johnson, 2008).

Many explanations for this recent change center around medicalization and potential financial incentives for obstetricians. As we’ve discussed in the past, the introduction of fetal monitoring led to an increase of cesareans out of physician fear; present-day physicians may still be concerned about receiving lawsuits over a mishandled pregnancy. Additionally, many hospitals have begun to view childbirth as a means for profit. Obstetricians are paid more for performing C-sections, and hospitals in general receive thousands of additional dollars per surgery.

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The 2013 Superior Court of New Jersey case Plotnick v. Deluccia answered the long awaited question of “Does a woman have the right to decide who is in the delivery room as she gives birth to a child?” In this case the mother argued that she had a right to privacy in the birthing room and that the presence of the father would cause concern for detrimental stress on the mother and child. The father argued that he would suffer “irreparable harm” should not not be notified of, or present at the birth. The court referenced the decisions of Roe v. Wade and Planned Parenthood v. Casey which established female autonomy over their bodies and the ability to pursue an abortion without notifying the “father.”  They ruled that the father of the child is permitted certain rights after birth, however he does not hold a legal right to be present during childbirth, nor is the mother required to inform the father when she is in labor. The court equated childbirth to any other medical procedure on an individual and held that the woman’s right to privacy was indeed protected by the law. They further reference the historical changes in society in which fathers were not regularly present for childbirth within the last forty years.

This case shows significant support for women and mothers and their wellbeing during childbirth. It recognizes the unique experience of childbirth as only involving the mother and child. It also emphasizes the physical health of the mother and child and prioritizes their health over the argued “emotional bond” between father and child. The ruling also provides additional rights to the mother over the father prior to the birth of the child. Although the court specifies that after the child is born the rights over the child should be regarded as equal, custody battles still tend to disproportionately favor mothers over fathers. Some may view this decision as a way to perpetuate the idea that mothers are more important to their children than fathers since the father in this case was also denied the ability to complete the “best interest evaluation” prior to the child’s birth. Ultimately, this case focuses on the individual rights of the mother and her experience with childbirth, placing the focus purely on the woman rather than the father or child.

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“Anesthesia in Childbirth.” Omeka RSS, collections.countway.harvard.edu/onview/exhibits/show/introduction/anesthesia-in-childbirth.

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