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. 

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 21^st century (Shapiro 2012). 

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).  

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). 

 

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.

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.

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.

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. 

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.

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). 

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). 

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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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.

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). 

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).