Origin of Everything

S1 E11 | FULL EPISODE

Why Do Women Give Birth Lying Down?

When it comes to giving birth, the first image that comes to mind is a woman lying down on her back, but this wasn’t always the case. In fact the origin of the position we now most associate with women giving birth started as a procedure to remove gall stones in 18th century France. So how did this position become the gold standard for bringing newborns into the world?

AIRED: December 05, 2017 | 0:07:28
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TRANSCRIPT

If you're like me, your social media is filled with pictures of beaming parents, and

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in the midst of that postnatal glow, I bet you haven't stopped to wonder: when

did women start giving birth lying on their backs?

Now I've heard a slew of pregnancy related myths, from the position of the baby bump

predicting a newborn's gender, to the size of a mother's nose indicating the imminent

arrival of a bouncing bundle of joy.

But I have to admit, the idea of women delivering in any position besides lying on their backs

never occurred to me as a particularly hot button issue.

Perhaps it's because most women in the US give birth in hospitals, where being in a

bed is considered the standard procedure.

And if most of us think about every birth scene we have ever witnessed, either in popular

media or in real life, we probably conjure up images of a woman in a hospital bed with

nurses and doctors positioned at her feet, ready to catch a new baby as it enters the

world.

But it turns out that this wasn't always the case.

And that's because male doctors weren't always involved.

Because while women have been having babies since...humans, they weren't usually going

to the hospital for births until the 20th century.

So if you're like me and secretly addicted to the series Call the Midwife, then you've

probably wondered:

What were women doing during childbirth before hospital births were commonplace?

Well before the hospital, home birth was the norm, with most women being attended to by

midwives and female family members.

And that's because people's suspicions of hospitals were pretty well founded.

According to Professor Melissa Thomasson at the University of Miami (and our previous

video on US healthcare!) hospitals functioned primarily as almshouses for the poor until

the 20th century.

This included 19th century maternity hospitals that were primarily used for poor women, whether

married or unmarried, and women in urban locations who needed a place to deliver.

By the 18th & 19th century, physicians (primarily men) were being trained in delivering babies,

and introduced the use of forceps, ether, and chloroform to speed up deliveries and

reduce pain.

Which side note never use any of these near a pregnant woman.

So although maternity hospitals provided essential services to poor women, they also served as

places where doctors used women from vulnerable populations to examine "difficult births"

as case studies for future work.

But because of cross contamination in many hospitals, you had as much chance of getting

out of there alive as an unattended teen wandering into the woods durings a horror movie.

Early medicine relied heavily on an apprenticeship system, where a young student would work under

a practicing doctor and receive training before eventually graduating to taking care of patients

of their own.

But by 1910 with the release of the Flexner report on the status of medical schools in

the US, medical training improved through standardization, increasing the number of

well trained and qualified physicians.

As for birthing positions, these varied based on time period and location.

According to ancient historian Valerie French, when Greek physician sora-nuss reported on

the practices of childbirth and midwives in the 2nd century AD, he noted that women often

gave birth in a chair sitting up.

And this was a special chair with a crescent shaped hole in the seat to...well you get

the picture.

Birth stools with a similar designs were used until as late as the 18th century.

And many home births encouraged women to use various squatting, sitting, standing, or upright

positions.

That's because the same muscles used to squat are pretty much the same muscles used

to push out a baby, and some argue that our old friend gravity can play an important role

in moving things along.

Oddly enough these are the same muscles used for a much less joyous occasion: bowel movements!

This gross fact is probably why giving women in labor enemas was considered common practice

in the early to mid 20th century, although it's mostly considered unnecessary and unhelpful

today.

Other positions for childbirth included curling on your side, and yes, lying on your back

with knees brought up towards your chest to help with birth.

But the lithotomy position, the phrase used to describe being on your back with your feet

up in stirrups, wasn't the only standard for women in labor.

It varied from delivery to delivery based on the needs of the women in labor and their

newborns.

So giving birth was a pretty every day procedure that took place mostly at home, not the hospital.

And most women were attended to by midwives and female family members, not male physicians.

But that all changed in the 20th century.

In 1900, only 5% of all births took place at the hospitals in the US.

By 1939 around 50% of births were taking place in hospitals around the country.

But in the early days of childbirths shifting from homes to hospitals, it's not entirely

clear if this reduced or increased the risk of fatality for either mothers or infants.

In fact, until the late 1930s, outcomes for mothers and babies stayed relatively the same

as they were before the hospital became the norm.

So that brings us to our next question:

Why did women start flocking to hospitals for a procedure that used to be largely confined

to the home if the outcomes weren't much different?

An d whAny d arwhe y moarste mostof theofm tlyheinm g lydoinwng ?do

Seems like the answer here is one part improvement of medical intervention and one part convenience

but not for who you'd expect.

In 1937 sulfa drugs (the first successful antibiotic before the use of penicillin in

the 1940s) saw a marked improvement in outcomes for patients who delivered in hospitals.

With this innovation, hospital births started to become safer than at home births, and the

improved outcomes drew more women to deliver there than at home.

In their book Lying In: A History of Childbirth in America Dorothy and Richard Wertz write

about the shifts in American childbirth practices after the Civil War and into the 20th century:

"...Doctors were on the lookout for trouble in birth...In line with that perception, doctors

increased their control over the patients during labor and delivery, rendering them

more powerless in the experience to participate in birth.

Women acceded to the doctors' increasing control because they also believed that their

methods would make birth safer."

(Wertz and Wertz 136)

So as childbirth in hospitals picked up speed in the 20th century, doctors had more say

and control over what happened in the delivery room.

The lithotomy position was originally used for the removal of bladder stones.

In 17th century France, obstetrics and lithotomy were combined and it's postulated that this

is when the reclining position was incorporated into some births.

But it wasn't necessarily because this is the easiest position to give birth, but rather

a hangover from a few different practices.

When male physicians and surgeons began attending to female patients during labor in the 18th

and 19th centuries, modesty was a huge concern for both parties.

As a result, some physicians had women lie on their backs and covered their patients'

legs, so they could feel what they were doing but not actually see any sensitive parts.

But the literature on birthing positions remained unclear even into the early 20th century,

with many relying on either the lithotomy position or positions where women are lying

flat on their backs because this was what a lot of doctors recommended.

But in the latter half of the 20th century women in the US began to push back (for lack

of a better term) and other birthing positions began to be adopted once again, including

women sitting upright, lying on their sides, or squatting.

And because births are varied and unique, some positions work better for some women

than others.

It's all a matter of the right fit.

So how does it all add up?

Well if we look at the timeline, the lithotomy position emerged as a concern for modesty

mixed with medical intervention in the 18th & 19th centuries.

But hospital births, and thus lithotomy, didn't become the norm in the US until the early

20th century.

And that's because as women started looking to hospitals and physicians as a safer alternative

to home births, physicians gained more control in the delivery room.

And so while most representations of childbirth today focus on women either lying back or

sitting up in bed, women haven't always considered that the only position.

But this is a video about medical history, not medical advice, and so you should definitely

rely on the advice of trained professionals when deciding which birthing option works

best for you.

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