Historical mistakes of the medical model of childbirth

We have been discussing treatments used by obstetricians without having been adequately researched first, a crime they often accuse midwives of committing. Various practices, from dangerous drugs to harmful diets, have been prescribed before there was enough scientific evidence to back them.

Ambrose Pare, 1509-1589, a surgeon with the obstetric skills of his time wrote, of podalic version, "...he must lift him (the baby) up gently, and so turn him that his feet come first--then little by little turn the whole body from the womb." We now know that breech positions, while not a medical emergency, do increase the risk of complication. Moreover pulling the baby from the womb is considered dangerous because of the risk of injury to the infant. Pare also believed in using nipple shields of lead to prevent cracked nipples--which we now know could have caused lead poisoning to nurselings.

In the 1940s American doctors nearly starved their pregnant patients, believing low protein diets would keep the baby small, which would reduce complications in pregnancy and birth. Today many doctors encourage high protein intake as a way to prevent pre-eclampsia, though it seems diets supplemented with protein are associated with higher instances of pre-eclampsia. Peter Nathanielsz, PhD, MD, a researcher details the lifelong healthcare implications of this (cardiac, stroke, and diabetes) in his book, "Life in the Womb: the Origins of Health and Disease."

In the 60s and 70s, vitamin and mineral supplements were prescribed during pregnancy, such as vitamin A. High concentrations of this vitamin can cause birth defects, so prescribing supplements wasn't a great idea. Women should avoid eating liver and its products because that is where animals store vitamin A. Yet, at that time, liver was promoted as an ideal food for a pregnant lady.

Iron is prescribed to build up haemoglobin, but the capsules can cause gastro-intestinal irritation, nausea, diarrhea, and constipation which puts the mother at a risk of dehydration and may hurt her nutritionally.

From Rediscovering Birth, "In 1913, 15,000 or more American women died in or around childbirth and nearly half of the deaths were from 'childbed' or puerperal fever. Women who gave birth in hospitals were especially likely to develope puerperal fever because doctors examined their patients without washing their hands. The cause of puerperal fever had already been discovered many years before, in the mid-1800s, by Dr. Oliver Wendell Homes in America, and also by Dr Agnaz Semmelweis in Austria." Obstetricians knew that the cause of childbed fever was insufficient sanitation, yet they still continued to go from patient to patient, often doing internal exams, without washing their hands. Was it too inconvenient?

By 1939 more than 75% of births were in hospital and by 1960 close to 100%, but birth was no more safe. The major cause of death was still sepsis. Breathing the same air, being in close proximity, laying side by side with other women spreads germs. These women could be sick with any number of ailments and contagious for a while before being diagnosed. Not to mention, the typical postpartum woman bleeds for six weeks. If we are all in the same room, bleeding and breathing together, bacteria is abundant, and germs are flying around everywhere. Exchange of bodily fluids is one of the surest ways to pass viruses from one person to another, and coming into contact with another woman's blood is not healthy nor is breathing the same air as a person with chickenpox.

In the 1930s, doctors in England were still using forceps in 50% of deliveries, which made birth dangerous. We now know that forceps cause fetal injury and maternal tearing.

Perhaps the most shocking story is that of the C-section, which is nothing new. Crude attempts were made as far back as 715-673 BC. In the Dark Ages, a woman's chance of survival after C-section was 50/50. Today outcomes are more favorable because of sterile equipment and newly available knowledge and technology, though vaginal birth is still vastly superior to C-section. Clearly C-section was not researched scientifically prior to its being used to treat emergencies, for I doubt any scientist would back a practice with a coin-toss outcome.

We are lead to believe that medicine is always scientific, that physicians always follow evidence-based medicine, and that they have our best interest in mind (and heart.) Granted, and we women are forever grateful, that many of the advancing practices in the care of the birthing woman and baby that save lifes have evolved this way. However, not every technique and treatment used throughout history to aid birth has been a good idea, nor has every practice been researched before put into use. Some very useful practices are overused and abused. We need to remember these mistakes and the prices paid for them by families across the globe. We must call for an honest look at what really is scientifically based in the medical model of childbirth today.

Dr. Mayer Eisenstein, MD, JD, MPH, medical director of Homefirst in Chicago, IL, now the largest physician- and midwife-attended homebirth practice in the nation says that, "Obstetrics, which is really a combined philosophy, business, and religion, does not have science as its base," and he continues, "Obstetricians practice much more philosophy than science. Pregnant women are tested, medicated, and operated on to excess every day by this profession in an unethical and dangerous way. This unscientific medicine is dangerous to us as a nation. Our maternal and infant mortality rate is unacceptable for a society as sophisticated as ours. We produce more premature infants than any other country with our interventionist technology and then praise ourselves for saving some of their lives."

written by Heather B. in collaberation with Janel Martin-Miranda

http://www.umanitoba.ca/outreach/manitoba_womens_health/hist1.htm
http://www.thehistoryof.net/history-of-childbirth.html
Sheila Kitzinger, "Rediscovering Birth"