Digital Book Discontinued Birth Choices v1.1 | Page 8

Childbirth in the United States
Over the last century in the United States, cultural norms and advancements in medical care have
changed the way birth typically happens. As parents, you will be navigating diverse choices for your
birth, and it is helpful to understand how current standard practices developed and how they are
continuing to evolve.
Before the 1900s: Physiologic Birth Mid 1900s: Beginning to Reevaluate
For most of human history, women gave birth at
home with the support of a midwife and female
family members. Birth was viewed as a normal
biological event. Often, birth was uneventful,
although lack of understanding of the importance
of hygiene,
and the
absence of
advanced
medical
care for
emergencies,
contributed
to higher
mortality
rates than in
modern day. A movement began that was aimed at reducing
fear through education and promoting alternative
options for managing pain. Some women began
to insist on having an unmedicated birth and a
support person. Twilight sleep was replaced with
pain medications with fewer side effects, and
eventually, epidurals became the favored option
for medical pain management. Some women
began to be more involved in decision-making
about their care.
Early 1900s: The Medicalization of Birth
Step 1: Understand the Context
Cesarean sections have higher rates of
complications and more risks than vaginal births.
Historically, they were done only when required
for the health of the mother or baby, but they
started to become widely overused. For over a
decade, the cesarean rate steadily climbed.
35 35
30 30
The pendulum began to swing toward
medicalization in the early 1900s. Doctors and 25
hospitals began offering “twilight sleep” to
20
laboring women, using medications that reduced
15
pain and caused amnesia, so women did not
remember the experience. The appeal of pain
10
relief, along with the status symbol of giving birth
5
with a doctor in a hospital, led to a sharp rise
in hospital birth rates, making birth a profitable 0
business. Hospitals implemented policies and
procedures to make birth as controlled and
efficient as possible, including banning husbands
and family members from the birthing room.
Improvements in hygiene and medical practices
lead to improved outcomes for mothers and
babies. However, there were serious side effects
from twilight sleep for both mother and baby, and
the birth experience was traumatic for some.
6
Late 1900s: The Cesarean Epidemic
25
20
15
10
5
0
1995
1995
2000
2000
2016
2016
Cesarean rate
Cesarean
Primary
rate cesarean
Primary
rate cesarean
VBAC
rate rate VBAC rate
Source: ACOG Obstetric Care Consensus: Safe Prevention of the Primary Cesarean
Delivery; CDC National Vital Statistics Report: Births: Final Data for 2016
At the same time, women who were good
candidates for a vaginal birth after cesarean
(VBAC) were unable to find a provider or hospital
who would allow it and consequently had repeat
cesareans, driving the rate even higher.