Introduction to the Birth Scene

The 20th Century was a time of momentous change in childbirth. We must not overlook the lessons of this extraordinary period in the history of birth.

From the beginning of human birth until very recently--a span of millions of years--babies were born at home with the assistance of an experienced relative or midwife. Women supported other women in birthing. Suddenly, in the 20th century, the situation was reversed: birth away from home, without family, in hospitals, and under the supervision of men!

In the United States, 1939 was the turning point when more babies were born in hospitals than at home. Since then, the percentage has risen steadily to about 98%. During the same period, the percentage of births attended by midwives had plummeted to 10% by 1935. Historically, the profession of midwifery was decimated by a campaign waged by American medicine. In the sixty years left in the 20th century, as midwifery shrank, obstetrics expanded to dominate birth. As a consequence, mothers lost both intimate knowledge and confidence about giving birth, and the personal meaning and quality of childbirth was radically altered.

The psychological problems created by this new way of American birth, although scarcely acknowledged, have been legion. Babies born in hospitals found themselves in a high-tech environment that was too cold, too noisy, too bright, and too big for them. Handling of babies was efficient but aggressive, pain was inflicted routinely; babies were separated--or isolated--from their mothers, while caregivers introduced the babies to bottles instead of breasts! Medical priorities were different from, and often in conflict with those of mothers, fathers, and babies. The majority belief among medical professionals was that babies came into the world with no sense of pain, no real emotion, and no real mind to interpret anything happening to them. This tragic miscalculation still taints the rituals of obstetrical birth in many parts of the world today.

During its resurgence in the 1900s, obstetrics was constructed on a foundation of what we can now describe as a false psychology which treated babies as sub-human or pre-human beings. These unfortunate ideas were also woven into the fabric of neonatology, the new branch of medicine organized to deal with extremely fragile babies born dangerously premature. Neonatal Intensive Care Units were man-made inventions to house these babies who were not expected to feel anything, remember anything, or learn anything from how they were being treated. As 19th century ideas about baby brains continued to profoundly influence 20th century medical practice, it was inevitable that babies became victims of unintended assault because of the core scientific beliefs held by their caregivers. In many locations, these unintended assaults are diminishing today as new research in medicine and psychology makes its way into the protocols of practice in birth rooms and in neonatal intensive care.

In the Birth Scene sector of the website, we will highlight the long-neglected psychological dimensions of the perinatal experience for all concerned--mothers fathers, babies, and caregivers. Pregnancy powerfully shapes families, attitudes, and self-esteem. In our technological culture, pregnancy is still treated as a disease rather than a natural experience of healthy women. This continued medicalization of birth has deep psychological consequences. Authorities--doctors, nurses, or childbirth educators--who exercise influence if not jurisdiction over birth--can easily intimidate and undermine the natural authority of women to give birth in freedom, fully informed, in locations they choose, and with caregivers they prefer. In the column “The Mother-Friendly Childbirth Initiative” you will find a systematic articulation of values celebrated by APPPAH and many other organizations deeply concerned about maternal-infant well-being in the new millennium.