Monday, April 30, 2007

"A possible death sentence came with every pregnancy."

One of the most glaring deficiencies in the arguments of homebirth and "natural" childbirth advocates is the lack of even the most basic knowledge about the historical dangers of childbirth. Modern obstetrics has been so stunningly successful at reducing maternal mortality that many people actually believe that it has always been this way.

Judith Walzer Leavitt explores the ways in which this constant fear of death in childbirth, and the frequent experience of the deaths of sisters and friends in childbirth, shaped the lives of women in the 19th century. It illuminates the inherent dangers of childbirth in a way that the statistics cannot.

In Under the Shadow of Maternity: American Women's Responses to Death and Debility Fears in Nineteenth-Century Childbirth, Walzer Leavitt writes:
Maternity, the creation of new life, carried with it the ever-present possibility of death. The shadow that followed women through life was the fear of the ultimate physical risk of bearing children. Young women perceived that their bodies, even when healthy and vigorous, could yield up a dead infant or could carry the seeds of their own destruction... Nine months' gestation could mean nine months to prepare for death. A possible death sentence came with every pregnancy.
Walzer Leavitt is particularly concerned with the ways in which the experience of maternal death shaped women's lives and relationships:
Perhaps more valuable to our understanding of the reality of maternal death is the observation that most women seemed to know or know of other women who had died in childbirth. One woman, for example, wrote that her friend "died as she has expected to" as a result of childbirth as had six other of their childhood friends. Early in the twentieth century approximately 1 mother died for each 154 live births. If women delivered, let us estimate, an average of five live babies, these statistics can mean that over their reproductive years, one of every thirty women might be expected to die in childbirth. In another early-twentieth century calculation, one of every seventeen men claimed they had a mother or sister who had died as the immediate results of childbirth.
Homebirth and "natural" childbirth advocates are glaringly unaware of the reality of permanent disability due to childbirth:
In the past, the shadow of maternity extended beyond the possibility and fear of death. Women knew that if procreation did not kill them or their babies, it could maim them for life. Postpartum gynecological problems - some great enough to force women to bed for the rest of their lives, others causing milder disabilities - hounded the women who did not succumb to their labor and delivery. For some women, the fears of future debility were more disturbing than fears of death. Vesicovaginal and rectovaginal fistulas .., which brought incontinence and constant irritation to sufferers; unsutured perineal tears of lesser degree, which may have caused significant daily discomforts; major infections; and general weakness and failure to return to prepregnant physical vigor threatened young women in the prime of life. Newly married women looking forward to life found themselves almost immediately faced with the prospect of permanent physical limitations that could follow their early and repeated confinements.
Homebirth and "natural" childbirth advocates also seem to have no understanding that the notion of painless or "empowered" childbirth was completely made up in the 20th century. It is diametrically opposed to the way women actually viewed childbirth:
Women who had already had children were more likely than first-time mothers to worry about the possible aftereffects of labor and delivery. They remembered how long it took them the first time to recover from the birth, they remembered how they had suffered, and they were particularly loath to repeat the ordeal. As one woman wrote about her second pregnancy: "I confess I had dreaded it with a dread that every mother must feel in repeating the experience of child-bearing. I could only think that another birth would mean another pitiful struggle of days' duration, followed by months of weakness, as it had been before."

Apart from their concern about resulting death and physical debility, women feared pain and suffering during the confinement itself. They worried about how they would bear up under the pain and stress, how long the confinement might last, and whether trusted people would accompany them through the ordeal. The short hours between being a pregnant woman and becoming a mother seemed, in anticipation, to be interminably long, and they occupied the thoughts and defined the worries of multitudes of women. Women's descriptions of their confinement experiences foretold the horrors of the ordeal.

Josephine Preston Peabody wrote in her diary of the "most terrible day of [her] life," when she delivered her firstborn, the "almost inconceivable agony" she lived through during her "day-long battle with a thousand tortures and thunders and ruins." Her second confinement brought "great bodily suffering," and her third, "the nethermost hell of bodily pain and mental blankness. . . . The will to live had been massacred out of me, and I couldn't see why I had to. Another woman remembered "stark terror was what I felt most."

"Between oceans of pain," wrote one woman of her third birth in 1885, "there stretched continents of fear; fear of death and dread of suffering beyond bearing."32 Surviving a childbirth did not allow women to forget its horrors. Lillie M. Jackson, recalling her 1905 confinement, wrote: "While carrying my baby, I was so miserable... I went down to death's door to bring my son into the world, and I've never forgotten. Some folks say one forgets, and can have them right over again, but today I've not forgotten, and that baby is 36 years old." Too many women shared with Hallie Nelson her feelings upon her first birth: "I began to look forward to the event with dread-if not actual horror." Even after Nelson's successful birth, she "did not forget those awful hours spent in labor..."

Many women walked ...under the shadow of maternity, experiencing repeated and agonizing births in unrelenting succession with no relief throughout their fertile years. Many women suffered physical complications through their confinements that stayed with them the rest of their lives. For many women the physical hardships of childbearing determined the parameters of their lives and defined their social destiny. Although it is also true that childbearing and the ensuing motherhood held many happy times for women, it is the difficult part of the experience that created the boundaries within which most women had to construct their lives.
That is the reality of childbirth, not the airbrushed, made up fantasy of homebirth and "natural" childbirth advocates.


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