In the late 1970s, access to unmedicated and physiologically-manged normal childbirth via the legacy practice of midwives providing care in non-medical settings (i.e., PHB) was so extraordinarily influential that the entire hospital industry/obstetrical profession reversed course.
Twilight Sleep drugs, general anesthesia and routine use of episiotomy, forceps and manual removal of the placenta were first introduced in the early 1900s, when the perspective of the obstetrical profession was that childbirth itself was a pathological aspect of biology. This generated policies that naturally and consistently ratcheted up the medicalization of labor and birth in healthy women.
Unfortunately, these laboring women narcotized, given repeated doses of hallucinogenic and amnesic drugs and ultimately rendered unconscious with general anesthesia. Adding insult to this institutionalized injury, when these medicated women reported their distressing experiences, their accounts were deemed unreliable based on the effect of the drugs.
However, letters by whistle-blowing L&D nurses published in Laddies Home Journal in the 1950s confirmed their accounts and in addition described the routine abuse of laboring women by physicians and L&D staff that we now would consider criminal. But the occasional and unorganized social pressure of the small number of dissidents was politically inadequate and made only the tiniest dent in the armor of obstetrics, mainly in a few upscale New York City hospitals who offered classes in ‘natural childbirth’ and allowed a few select women to remain unanesthetized during their medicalized ‘delivery’.
In large and small hospitals across the rest of the country, obstetrics continued to be an practiced as if it were a private all-male club that make up its own rules and did as it saw fit, and believing that only obstetricians could possibly know what was best for childbearing women. Obstetrics was in essence practiced as veterinary medicine, in that it treated laboring women as pets with no say in the treatments the were forced to endure.
However, the renissaance of midwifery due to Ina May and Steven Gaskins, as well as other remarkable pioneer women such as exchanged the 60-plus years of for “awake and aware” childbirth. This was the beginning of curtains, rugs, blond wooden cabinets secreting medical paraphernalia, and finally husbands and eventually other family members including children at labors and births
Home birth midwives can and should the take credit for triggering the biggest positive change in American obstetrical practices. The last big since the adoption of scopolamine (Twilight Sleep) as the standard of care in 1912. Unfortunately the job of transforming childbirth practices will not be done until healthy women with normal pregnancies can reliably receive physiological management as the universal standard of care from all types of birth attendants (obstetricians, FP docs and midwives) and in all setting (home, hospital and birth centers).
However, women as midwives and mothers have been caught in a Mexican stand-off for the last 30 years. Obstetricians and medicalized management in hospitals was and continues to be pitted against midwives and physiologic care in OOH setting. Its pretty obvious that the stance of obstetrics is ‘never the twain shall meet’/ hell-no-we-wont-cooperate and you can’t make us.
For the last 100 years the maternity department had been the cash cow of the hospital business. Hospital depend on revenue generated by the elective hospitalization of heathy maternity patients to keep the lights on, depend on the recommendations of maternity patients as ‘satisfied customers to keep their beds full.
Doctors are not ever going to sign up for lessons in how to provided non-medical management. The only way to change with thinking and eventually reform medical educate and obstetrical practice is for other things to change so dramatically that they decide its a good idea for them to make these changes.
In order to reform the way obstetricians managed normal childbirth, midwives are going to have to make physiologic childbirth in birth centers into the new “hot” thing by creating a middle ground — birth centers — that does not seem ‘scary’ and has a lot of to recommend it. I like Constance’s description of a birth centers as a wonder opportunity for women to labor and give birth in a mother-baby-family friendly “Bed and Breakfast”. The fact these qualify for Medicaid-MediCal reimbursement means that the 85% of healthy women with normal pregnancies actually have access, for the first time in a hundred years, to reliable and cost-effective physiologic childbirth services.