Childbirth Recovery Almost Like the Old Days
With President Clinton’s signing last week of the 48-hour maternity bill, modern women no longer have to feel quite so much like the pioneers who delivered their babies in the back of the covered wagons and were ready to roll on the Overland Trail by dawn’s early light.
Instead, starting in 1998, they can stay at least 48 hours--a move applauded by most maternal health advocates, who maintain that the longer stay is vital for a healthy start for mother and baby.
Finding the best ways to give birth is crucial in stemming the maternal mortality rate, still termed unacceptable. In 1990, 10 women died for every 100,000 births in the U.S., according to the federal Centers for Disease Control and Prevention. That number is up from 1987, when 7.2 deaths occurred for every 100,000 births, although some experts say better efforts to identify the problem have contributed to the statistical increase. But in a report published in the journal Obstetrics & Gynecology, the CDC team also concludes that more than half of such deaths are probably unreported.
The history of childbirth in America is long, checkered and full of factions--not to mention peculiarities.
Few would dispute that the pioneer women probably faced the greatest challenge in recent history. About 20% or more of the women who crossed the continental U.S. between 1840 and 1870 were pregnant, says Lillian Schlissel, director of American Studies at Brooklyn College and author of “Women’s Diaries of the Westward Journey” (Random House, 1992). While their diaries contained detailed accounts of their lives on the trail, “the women avoided mention of pregnancy,” Schlissel says. Typically, the diaries would skip a few days and then a new child’s name would appear.
Amelia Stewart Knight, one of the women, writes for days of feeling sick and then mentions in one of the last entries that she has given birth to her eighth child.
While the women were considered hardy, there were other reasons to deliver quickly and get back on the road, Schlissel says: fear of the cholera epidemic and warring American Indians. “And everyone knew the story of the Donner Party,” she adds. “It was scarier to stay than to keep moving.”
At least six of the 103 women on the trail died in childbirth, estimates Schlissel, who says she can’t be certain of the exact number because “women were reluctant to write about the deaths of other women.”
Meanwhile, back in civilization, women of that era were being introduced to two new forms of anesthesia--chloroform and ether--to relieve birth pain. But many doctors had misgivings about this so-called advance, write Dorothy and Richard Wertz in their book, “Lying-In: A History of Childbirth in America” (the Free Press, 1977).
“Some feared the drugs would excite the laboring woman to voluble and unguarded actions that might be mistaken as eroticism, so that the woman would fear the doctor’s control over her behavior.”
Others thought birth pain was “a desirable evidence of the life force that ensures a mother’s love for her offspring, a kind of psychological imprinting,” the authors continue.
But when push came to shove, many women needed a little something to take the edge off the pain.
So it was no surprise when hospitals popped up promoting “twilight sleep.” This involved injection of morphine at the beginning of labor, according to the Wertzes, and then a dose of scopolamine (which caused the woman to have no memory of the pain). Once crowning occurred, a dose of ether or chloroform helped dull the pain still more.
By the early 1920s, hospitals became a “quiet place in which to rest,” the Wertzes write. And about 690 women died for every 100,000 births, according to the National Center for Health Statistics.
The movement to give birth in hospitals rather than at home was driven by the issue of safety, says Dr. William C. Andrews, past president of the American College of Obstetricians and Gynecologists and professor emeritus at Eastern Virginia Medical School in Norfolk. Hemorrhage was a big problem at the time. Control of pain, Andrews adds, was another driving force that moved childbirth into hospitals, where doctors could oversee administration of anesthesia.
For many years, hospitals remained quiet refuges for new mothers, as women who gave birth long ago remember.
Each time Flo Miller had a baby, she remembers settling in for a long hospital stay, most of it spent flat on her back. “They wouldn’t let you get up for a week,” recalls the 80-year-old Burbank widow, whose offspring are now 58, 55 and 53. “It was a time to rest, to get yourself together after the nine months,” she says, adding: “You did what the doctors told you.”
Gradually, childbirth became more of a “medical experience,” notes Barbara Katz Rothman, professor of sociology at the City University of New York. “In the United States, as it became more and more medicalized, that period of time after you give birth was framed as recovery from childbirth.”
While some births, such as ones via caesarean, require recovery, she says, healthy women who have vaginal births are overly “medicalized.” She believes the ideal approach for most is less hospitalization and more social services at home. What a new mom needs, she says, is someone to do the wash, watch other children and prepare meals.
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By the early 1940s, 376 women died for every 100,000 live births. And doctors had found what they thought was a better pain reliever than the ether and chloroform routine: spinal anesthesia that let a woman stay conscious but feel no pain from the waist down.
Not everyone went for this new approach. “The only way to keep them quiet was to drug them,” notes Doris Haire, a consumer advocate and president of the American Foundation for Maternal and Child Health, a New York organization dedicated to interdisciplinary research, and no fan of this new approach.
Like other women of her time, she opted instead for medication-free childbirth.
When Haire naturally delivered her first child, now 45, without medication, she caused quite a stir: “I had 35 nurses in the room, because they were told they might never again see a woman give birth without drugs.”
Natural-childbirth pioneers like Dr. Grantly Dick-Read were often misunderstood, sometimes making women feel like failures if they could not deliver without anesthesia. On the contrary, Dick-Read and other pioneers in the movement proposed trying to deliver without drugs, but did not promote withholding them if the pain got unbearable.
By the late 1940s and early 1950s, hospital stays were beginning to get shorter. “It was economics mainly,” Andrews says. The death rate had declined; more than 73 women for every 100,000 live births in 1950.
Sadie Kudick, a 71-year-old San Fernando Valley mother, delivered daughter Joan, now 47, and stayed five days, as recommended by her doctor.
By the time Evelyn Thomas, 63, of Sun Valley had her children, now 45 and 40, maternity stays had declined even more but were still lengthy by today’s standards. Says Thomas: “With my first, I stayed in about four days; with the second, I think about three days.”
Back in those days, she says, she never thought about choices, explaining that a do-as-your-doctor-says mentality was still firmly in place for her and her friends. “We had confidence in our doctors, probably more than we should have.”
Hospital stays didn’t shrink only because of the rising cost of a bed.
The practice of having women stay in bed for days was later discovered unwise, Andrews says.
“As a result, some women got blood clots,” he says, “a significant cause of death.”
Among natural-childbirth advocates, a keep-moving approach was also adopted, with mothers walking around during labor, sitting in warm water to ease the pain and delivering in anything but the traditional flat-on-the-back position.
By 1970, the maternal death rate was 21.5 per 100,000 live births. And women most disillusioned with medical intervention turned to birth centers.
It’s an option that still holds appeal for a minority of women, including Milbre Burch, 43, who stayed just five hours at the Natural Choice Birth Center in Pasadena after giving birth to her second child, now nearly 3 months old. Patients are called at home after discharge for a checkup, says Dr. Debra K. Grubb, the center’s founder, and a home visit is scheduled for the third day to check for jaundice and other potential problems.
An important goal at the center, Grubb says, “is to see people taking pleasure in giving birth. That’s missing most of the time in hospitals.”
