E25: A Peek at History - From Home to Hospital Birth

Embark on a time-traveling adventure as we review the captivating evolution of childbirth in the United States. From the intimate communal gatherings of the 1700s to the groundbreaking establishment of ACOG, discover how our foremothers' strength and resilience have been woven into the fabric of today's birthing practices, and learn about the pioneers like William Shippen who paved the way for these advancements.

Connect with your heritage and the stories that echo through your bloodline, recognizing the enduring power that has been passed down through generations. Join us on the Ordinary Doula Podcast for a journey that honors our past as we embrace the present.

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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier
Voiceover: Ryan Parker

Transcript

Speaker 1: 0:11

Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

Speaker 2: 0:52

Hello and welcome to the Ordinary Doula podcast. My name is Angie Rozier and I am your host, and I'm excited to be with you today. Thanks for spending a few minutes in listening to and thinking about something that I absolutely love, and today we're going to get into something that's kind of, I think, very interesting. First of all, though, I am on call for a client who's been flirting with active labor for about 12 hours now, so I may need to dash, and hopefully I can get through this recording before I have to go, and hopefully we have a great birth later today. So I love talking about childbirth, all things about childbirth. That's my passion in life. Maybe it's not yours, but you're here for a reason. You must be interested in something, and something that I love about it is the history. I think it's fascinating to look at the history. I love the history of anything really the history of each person, the history of a place, a building, a home, a policy, a country. You know we get some pretty big as we dial out some pretty big scale histories there, and I teach as part of our childbirth excuse me, our birth doula training. We have a specific session on the history of childbirth in the United States and I think it is so important when we to understand where we are, to understand where we have been and where we've what we've come through, how things have changed. So we're going to explore that a little bit today and look at a couple different shifts in this industry and how they have impacted childbirth in the United States and it was something that community got involved with. Since then we've learned. One of those shifts that we've made is learning to kind of isolate childbirth, so it's not a community event but people kind of do it more alone. But at the time in the 1700s people were giving birth on average to seven live children. So you know that might have been more than seven babies, but we were looking at about an average of seven births per person and from the records we can tell over 95% of those moms and babies were alive at birth. So when we look at mortality rates that's, the rate of death in childbirth we know at that time a lot more moms and babies were dying, but this is talking about the day the baby was born. Over 95% of them were alive and in that at the time, with just lifestyle and a lot of components of the time infection control, working with machinery and access to safe water and all kinds of things. Those mortality rates, you know, were pretty high. Up to one year of age and up to five years of age A lot of baby children were. A lot more children died than do today. Same thing with women after childbirth. And even today, as we look at mortality rates, a lot of the challenges may come not on the day the baby's born but in the next several days afterwards. So but from what we know we had, the vast majority of moms and babies were living at child, you know, that day the child was born.

Speaker 2: 3:55

So that's who is delivering babies was somebody that you knew. And in 1762, so this is, you know, before we were even a country there was a doctor named William Shippen who trained in midwifery in London. So a lot of our Practices and traditions and things came from Europe because that's where the people were coming from. So he was not born in colonial America but he trained In midwifery in London as a male, which was very unique. And in 1762, he opened the first obstetric practice in Philadelphia, pennsylvania. So I say obstetric very loosely, because that wasn't even a term. That was known Obstetrics. That wasn't an industry. At the time it wasn't a discipline in medicine, there wasn't a lot of disciplines in medicine at the time. But he started kind of getting interested in childbirth and he would sometimes involve the local midwives in Philadelphia in his training. Sometimes he would try to train them, sometimes he would learn from them. But he was kind of. That's the first record we have of someone kind of getting more formalized, well, interested actually, let's say more interested in it. So that was in the 1760s, and then of course we're going into the seven, the 1800s, and again still most babies are being born at home. There wasn't a lot of hospitals in our country so babies weren't being born in hospitals. And as we continue to move throughout, we're getting to 1828, right. So 1828 is the first time the word obstetrician was used. So the root for obstetrician is obstinate and the word obstetrician means to stand before, so kind of to block or stand in front of, which is kind of interesting. I think that's an interesting choice of words for this role. And so that was our first introduction to this new profession. Who is becoming aware of and interested in childbirth? Introduction to this new profession who is becoming aware of and interested in childbirth?

Speaker 2: 6:16

In 1860, so I'm going to fast forward several decades we had the Civil War going on and the Civil War was a catalyst for a lot of fields of medicine, actually hospitals themselves included. So the Civil War with, as we know, both sides of this conflict, were all citizens of our country. So everywhere, the North, the South, all regions had to deal with injured soldiers and what they were going to do about that. So for the nursing profession, for hospitals, for doctors, this is a really steep training ground for medicine. And a lot of advances came after the Civil War in medicine, hospitals being one of them. So 1888 was the first time that ACOG was organized. So that's the American College of Obstetrics and Gynecology, which is alive and well today. It's well over 100 years old. That's the first time that that was established.

Speaker 2: 7:08

And a lot of these movements were done in cities. They were done in urban areas. They were done a lot in our cities like New York, pennsylvania, where we had folks of elite status who would seek out this type of care rather than get the care that for generations women had had in from their own families and communities. So it kind of became a status symbol to seek out a different way to give birth and along with that came developments right, became innovation in childbirth inventions, interventions started coming into play and these introduced their own set of challenges and problems which we didn't always account for. And at the time we were not doing ethical human research right. We didn't test things extensively or cautiously or ethically before they were used on humans.

Speaker 2: 8:03

So there's a lot of trial and error kind of a dangerous time if you're working with the quote unquote experts who are trying the new things, and one of those going back to the 1500s, forceps started being used in France and it was very much a status symbol if you were going to have forceps used at your delivery and they right away had some challenges like do we use this at every delivery or just some deliveries? Same thing with interventions that would come up in the 1800s and into the 1900s Like, okay, how do we implement this? Does every case need this? And we still deal with that today. We're still kind of grappling with all right, what interventions are needed, what's truly needed, and we've come a long way on doing better research preparation on interventions. But they've always caused extra challenges. Sometimes They've prevented some things. There's a popular perception that there's greater safety the more interventions that were used, and that's not always the case, as is true today as well used, and that's not always the case, as is true today as well.

Speaker 2: 9:06

So ACOG comes around in the 1800s and at this time in 1900, 95% of babies are born at home in our country. So that's almost everyone. Babies are still born at home. Hospitals are cropping up, medical schools are becoming more organized and cropping up and also specializing in some things. So by 1920, 50 to 80% of babies were still being born at home. So the vast majority of babies are still being born at home. That's a wide range, 50 to 80%. And that depended on the region you lived in. Were you near a city, large city, urban area? Were you in a rural area? What was your access and what was your racial and ethnic background as well? So that had a lot to do with the wide range.

Speaker 2: 9:57

I'm going to jump forward to 1940. Our numbers are now shifting from 50 to 80%. 20 years earlier Now we're 45 to 70%. This is right before World War II. 45 to 70% of babies are still being born at home. And then things really start to pick up. We have World War II. Things change Again. Wars change things. It's kind of interesting in medicine and in a lot of other areas. So by 1950, so we've got you know baby boomers are starting to be born. Urbanization people are leaving farms and going to cities.

Speaker 2: 10:34

So within a 10 year period, from 1940 to 1950, 10 to 45% of babies are being born at home, where 50 years earlier we were 95%, now we're 10 to 45%. That range is pretty wide and it still accounts for where you live, who you are, what's your racial and ethnical background and access to hospitals, both logistically and economically. Then by 1960, just 10 years later, 95% of babies excuse me, 97% of babies are being born in hospitals. So we had a 3% home birth rate in 1960, whereas 60 years before it was totally flipped. So the industry had done a lot of work and actually there's a lot of policies passed. There's a lot of laws passed that kind of pushed people out of home birth towards hospital birth. There was marketing campaigns, there was a lot of kind of derisive efforts to limit the power and the access of home birth midwives who had been delivering babies for, you know, millennia at that time. So a pretty huge shift in our country from 1900 to 1960.

Speaker 2: 11:47

So fast forwarding to modern time. I was looking at some numbers. They're a couple years old and they're kind of coming from the middle of the pandemic. Our home birth rate has hovered around 1% as a country for quite a while. It also varies depending on where you live. Certain states have higher and lower than 1%, for sure. Some states have Over 4%, some have less than half of a percent, but for the country, for the whole nation and 2022, it's about one and a half percent of babies are born out of hospital, 1% being born at home and 0.5 or half a percent being born in birth centers, and so a pretty huge shift that we made in a short amount of time, with lots of technological developments, for sure, lots of medical developments. Our whole country changed as we industrialized, as we became much more technological, as we got a lot more information. Things shifted for sure.

Speaker 2: 12:49

So I want you to consider your family story and in your family history. How far back you have to go in your family story to see home birth. I guarantee you it's there. There might have been people in your family, in your family stories, who were home birth midwives Definitely people who were born at home. Maybe your grandfather, great-grandfather, grandmother, great-grandmother was born at home. That was quite common of the time. So, as we look about, look at this history, where are we today? And this is an ancient process childbirth. We put a lot of modern filters onto it, a lot of modern expectations, and as we see this rapid shift over the last century in our country, I think it's important to look at where you are with that. Where do you align with that?

Speaker 2: 13:40

There's a lot of things, a lot of processes, a lot of services, if you will, that are available to pregnant people today and kind of consider for yourself what of those makes the most sense to you. And there are providers who provide great care, but that care looks different for different people. As we look at what home birth midwives used to do, it was everything right. So, if we look at the role of a home birth midwife over 100 years ago was to be the obstetrician or the doctor. Right, they were the nurse, they were the doula, they were the postpartum doula, they were the pediatric nurse, they were the pediatrician, they were the NICU team, they were the childbirth educator, they were the respiratory therapist, they were the IBCLC, their lactation consultant. They filled many roles, wore many hats on one woman Pretty incredible. And now that is a multi-billion dollar industry. All those roles we just articulated are a multi-billion dollar industry and our very big medical system today. So kind of interesting where we were and where we are. Now.

Speaker 2: 14:54

There's a great documentary called All my Babies on YouTube. It's about a midwife named Mary St Cloud. She was the midwife in the South, a black midwife for decades and she is, if you've watched that, she's a really good figure to show what childbirth was like at the time, where she lived kind of in rural, poor America and she was a fading role In some of our states, most of our states. For a long time there were thousands, thousands of midwives who would deliver babies right in their own communities and with policies and practice, changes and laws they kind of got edged out of all of that. Some pretty sad, super tragic stories there as we lost that part of our culture and we've kind of like the pendulum has swung really far from where we are. But Mary St Cloud is an awesome example of that. There is her full documentary is about an hour a little less. There are also on YouTube some really short quips that are like six minutes to give you a good picture of what that is, but there's a lot of midwives who share the same story as Mary St Cloud. So shout out to those midwives of yesteryear how totally incredible they were in their communities and how they laid the landscape for our country and how childbirth was conducted in our country. Another interesting note Frank Sinatra. If you know Frank Sinatra, he's an amazing American singer.

Speaker 2: 16:25

His mom was a midwife in her community and she was from another country. She immigrated from Italy and lived in Italian neighborhoods and communities in New York and, as happened so often with immigrants, people from other countries would turn to those they trusted, often from the same country that they were from. So she was an Italian midwife in an Italian neighborhood in the 1900s when the vast well, a pretty good amount of babies were being born at home. Now in New York we're probably having a lot of hospital options, but she served those people in her community who were probably had lack of resources and lack of access to um, you know, with lack of economic access to things. So I want you just to consider reach back in your family stories, see what you dig around, see what you can find. Where were your, those who came before you, where were they born? Guarantee you, some were born at home, so it's kind of a little tiny picture of history.

Speaker 2: 17:23

We'll dive into other historical aspects in other episodes, but I want to just touch base on this one. Thank you so much for being here today. I want you to take just a moment and touch in with yourself, like touch in with the essence of who you are, think about yourself, ponder well, consider and ponder on what you think about things. But just take a moment, take some deep breaths, take a still moment, a quiet moment, calm things down, touch in with yourself and with the essence of who you are, find the power that's there, because there is a lot of power inside of you. Thanks for being here today. Again, this is Angie Rozier with the Ordinary Dulo Podcast, and we will see you next time.

Speaker 1: 18:16

Thank you for listening to the Ordinary Doula podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth.