Birthing – Yesterday, Today, and Tomorrow
Back in the 1940’s having a baby was a scary event for mothers. Mother’s called their doctors when they thought they were in labor. The doctor determined if Mother should come to the hospital. When mothers arrived at the hospital the nurse prepared her for Labor and Delivery. The nurse gave the mother an enema. This was done to keep fecal material from contaminating the vaginal area. The nurse then shaved the perineal area of pubic hair. Pubic hair was believed to be a source of bacteria. Fathers were allowed to be with the mother but had no idea what to do or how to support the mother during the difficult laboring time.
Nurses would occasionally preform vaginal examinations to determine the progress of the labor. Nurses would start an IV and infused normal saline to keep mother hydrated. Mothers were not allowed to drink fluids or eat food for fear of aspiration during labor.
Labor pains became more frequent and more intense as labor progressed. Mothers had to stay in bed. A bedpan was provided if necessary or a Foley catheter was inserted.
If labor was not progressing, the nurse administered Pitocin to make contractions more intense and frequent. If labor pains became too intense then the nurse administered pain medication and if labor continued to be painful, the doctor preformed an epidural. This was a big relief for the mother. She no longer had pain during contractions. The mother’s job or laboring was over and the nurse and doctor became responsible for the birth of the baby.
When delivery was imminent, the woman was “wheeled in” to the delivery room where everything was sterile. Mothers were prepared for delivery by putting their legs into the “stirrups” and the stirrups were spread apart as far as possible so that the doctor could have full view of the perineal area. The perineal area was scrubbed down with antiseptic soap. Then the legs were draped with sterile drapes. The nurses and doctors dawned sterile gowns with bonnets that covered their hair and slippers to cover their feet. It appeared that everyone was preparing for nuclear war rather than delivering a baby.
The doctor made a laceration of the perineum to allow the infant more space to be born. Everyone was yelling and nurses were pushing on baby’s rump. The infant may have wondered what sort of life he was about become. It was safe and warm in the mother’s womb and probably became reluctant to “face the inevitable!.
But in spite of his reluctance to enter the outside world he was delivered by these funny looking people.
He was turned upside down and slapped on his behind and everyone was joyous except him. He was placed on a cold hard surface and nurses continued to make him cry with their rubbing and beating on his feet.
He was then wrapped and given a quick look at mother and whisked off to a nursery where there were more funny looking nurses putting awful stuff in his eyes and giving him an injection. The infant had to endure this awful outside world. Where was Mommy? Where was Daddy?
He then had to endure the bath. This was awful. Soapy water was used to clean him up and shampoo his head. Baby was cold and screamed with indignity. The nurse then wrapped him up like a burrito and put him in a crib while waiting to see and be with Mommy. He searched with his hands and mouth to find mother but she wasn’t there.
When everyone got cleaned up, baby was introduced to Mommy and Daddy. Mommy began to feed baby this awful stuff called formula with a bottle and nipple. Mommy made him swallow formula until his stomach hurt – so he vomited.
We’ve come a long way since 1940 – or have we? We’ve decided not to prepare for delivery with an enema or shave the perineum. That is the extent of our advancement in labor and delivery.
We still use Pitocin to strengthen contractions which perpetuates longer labor and more painful contractions. We still counteracte the painful labor with an epidural. We still garb up. We still stimulate baby to breath with vigorous stimulation. We still wrap babies in burritos and still give babies baths to ‘clean them up’ before mommies can have their babies. We still feed them formula – way too much initially and force them to take formula every 3-4 hours.
Mother’s and obstetrician have learned how to speed this process up and diminish the pain and that is with a Cesarean Section. Obstetricians spend more time leaning of how to do a Cesarean Section then learning how to deliver an infant vaginally. After all, he gets more money for a surgical procedure, cuts his liability, and spends less time with Mother for “Elective C-Sections.” Mother can elect to determine the infant’s birthday and when to have a baby with her busy schedule, oblivious to the fact that this is not good for the baby or the mother. The C-section prohibits mothers to give further births vaginally because of the risk of uterine rupture. If VBAC or TOLAC is considered, it becomes a high risk delivery.
It’s time to get back to Basics – real basics before the 40’s. The Maternal Friendly Initiative has been proposed to do just that. Cut down on episiotomies, C-sections, and the “obstetrical stirrups.” It’s time to allow the mother to take fluid and eat food during labor after all “labor” is work and requires hydration. Further allow her to be “up and about” during labor to allow the infant to naturally turn and descend the birth canal. Obstetricians, obstetrical nurses and hospitals will need to make changes to comply with the Maternal Friendly Initiative as well as the Baby Friendly Initiate. Changes are hard but may be worth it for the safety and attachment of Mother and Baby.