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Historical practice, Hospital birth, Interventions

General routines in childbirth–changes since 1915?

How have attitudes towards women, birth and babies changed since 1915?

In searching for historical accounts of umbilical cord clamping, I found descriptions of hospital birth in The Physiology of the New-Born Infant: Character and Amount of the Katabolism, published in 1915 (Benedict & Talbot).

In this book, the ‘general routine’ at the Boston Lying-in Hospital during 1931 – 1915 is described as follows:

– Physician-directed birth

– Physicians ‘responsible’ for the baby’s transition – ‘forcing’ a sudden onset of respiration and clearing of fluid from nose and mouth

– Baby held by the doctor, away from the mother, usually for 6 to 8 minutes before cutting the cord

– The umbilical cord is ligated – tied off – after cutting

– Baby given a bath soon after birth, washed in soap and oils

– An excessive loss of temperature after birth and re-warming via artificial heat

– Baby wrapped extensively in hat, clothing and multiple blankets

– Baby given sugar and breast milk substitutes

– Women told their colostrum is insufficient for their baby

– Mother and baby treated or observed in separate areas of the hospital

– A pervasive belief that women are absolutely dependent on others to give birth and nurture their babies

– Experiments and unproven procedures conducted on women and babies

How many women today might recognise these attitudes and approaches towards the baby’s transition, gravity, amniotic fluid,  cord clamping, and breastfeeding?

Do any of your experiences correspond with women birthing in hospital in 1915?

In The Physiology of the New-Born Infant: Character and Amount of the Katabolism, Benedict and Talbot (1915) report on their investigation of 105 newborns to determine the normal gaseous metabolism of full-term and premature infants. Their experiments were designed to “secure adequate information regarding the normal metabolism of infants” as well as answer questions like: “Can the infant in the first week of life obtain sufficient nourishment from its mother, even a normal mother, to maintain its vital activities without loss of body substance?” (p. 9).

In addition to the information about umbilical cord clamping, this publication also provides disturbing examples of how class and gender discrimination skews scientific thinking, and the lack of ethical constraints in experimental research during this era.

‘Civilised’ women

The authors described ‘civilised’ women as completely incapable of nurturing their babies.

“No mammal mother is so completely incapacitated for carrying out the duties necessary to protect and nourish her young during the first few days after parturition as is civilized woman. On the first day after birth, the mother is usually absolutely dependent upon the ministrations of others. The infant must likewise share this dependency upon others. Even the natural food-supply of the parturient mother is extraordinarily small, for the total fuel value of the colostrum is insufficient during the first few days, even under the most favorable circumstances” (p. 8).

Clamping the cord after 6 to 8 minutes was standard practice

“The infant is delivered in the “case room” of the hospital… Ordinarily, after the baby is delivered, it is held up by the feet in order to drain the mucus from its mouth and throat. About one out of five babies is patted on the back to make it cry and in this way to expand the lungs” (p. 41).

“Usually the baby lies in the physician’s lap 6 to 8 minutes before the cord is cut” (p. 42).

“The cord is then cut, tied with two ligatures, and sterile dressings applied. These dressings consist of two sterile sponges, one of which is put around the cord and the other over the cord. The dressings are held in place by a gauze band placed over them. The infant is laid in a crib on its right side, with a blanket so folded about it as to cover the entire body, and with the feet slightly elevated, so that the mucus may continue to drain from the mouth…The baby is left in the crib for 1 to 2 hours after birth, while the nurse is caring for the mother” (p. 41). [see video at end of post for footage of nurse applying umbilical ligature and dressings – Germany, 1925)

Family of Man

“Family of Man” photographed in 1946 by Wayne F. Miller (father) of his son being ‘delivered’ by grandfather and obstetrician. Mother not shown.
Image sourced from http://www.smithsonianmag.com/arts-culture/Indelible-Images-Special-Delivery.html

Starving newborns and restricted breastfeeding

When Benedict, Talbot and other scientists of this era attempted to measure the character and amount of postnatal infant metabolism, the newborn was assumed to be starving or receiving an “admittedly deficient amount of nutrition from the small amount of colostrum available” (p. 11).

“Prior to birth the fetus is living on a rich food-supply which is brought by the maternal blood. Immediately after birth this supply is cut off and no food is thus derived from the mother. The infant then begins to starve, that is, to draw upon its reserve body-material until the mother’s breasts secrete enough food to supply its demands” (p. 8).

It is not surprising they assumed the babies were starving, since it was standard to separate women from their babies and significantly restrict breastfeeding. It was routine to withhold the first breastfeed until 8 hours after birth, with feeding time limited to only 3 or 4 minutes in duration, and the next feed not for another 6 hours, and so on…

“The infant is next taken to the “ward room” … and put in its crib, where it remains until it is nursed. It is first put to the breast 8 hours after birth and subsequently every 6 hours during the first 24 hours, the nursing period being 3 to 4 minutes. Some babies take hold of the nipple and nurse immediately, while others are lazy and have to be urged by the attendant. During the second day the baby is put to the breast every 4 hours and is left there 3 to 4 minutes. In the third 24 hours, the baby is nursed every 2 hours during the day and every 4 hours during the night, thus making, in all, 10 feedings. When the milk secretion is once established, i. e., when “the milk comes in,” the baby is left at the breast 10 minutes at each feeding” (p. 41).

Baths and temperature loss

The general routine of the Boston Lying-in Hospital involved a tepid (or cool) bath at birth. The authors describe this bath as “in all cases, a very important means of reflexly starting the respirations” (p. 25). However, based on the results of their experiments, the scientists discovered that the baby’s loss of body temperature from the birth-bath was excessive. They considered that the “important” practice of lowering the baby’s temperature could be “carried too far…[and] be of too long duration” (p. 25).

“As regards the low temperatures after the birth-bath, they are for full-term and strong infants obviously considerably lower than is considered the rule. Vierordt reports a temperature fall on account of birth and birth-bath at an average of 1 C; a fall of 1.7 C ” comes very rarely,” but with delicate infants it may amount to even 4.7 C. In my experiments the normal children [receiving a bath]… show in one-half hour and 2 hours after birth a temperature which is 4 C. or more below normal” (p. 25).

Where the experiments involved the baby not being given a bath at birth, the fall in temperature was about 1 C (compared to 4 C. or lower with bath).

Sugar solutions

The authors include the 1904 work of Danish Professor Hasselbalch, who describes the practice of feeding the baby a spoonful of cane-sugar solution shortly after birth. In personal communication with the authors, Hasselbalch writes how feeding sugar to babies after birth was traditional in Denmark:

“The midwife gives the child a teaspoonful or two of a weak cane-sugar solution (strength of solution quite accidental) after the child is washed and before it is put to bed. We suppose the reason to be that the child should not be starving until the mother has milk enough for it. Generally the administration of cane-sugar is not repeated, as the role of the midwife is now over and the nurse’s work begins” (p. 16).

The administration of sugar is seen as desirable, for the ability to raise the baby’s temperature after the cooling effect of the baths.

“Of all the elements of nutrition sugar is digested by the infant the most quickly and the most easily, and doubtless causes a rise in temperature very much to be desired, because of the cooling-off at birth and during the birth-bath” (p. 30).

 

Experimentation

In the 126-page publication, there are many different experiments performed on the babies. To measure physiological and pathological weight loss, temperature regulation, and changing nutritional intake over the first weeks of life, the experiments included:

– keeping the babies in a respiratory chamber (apparatus) to measure and alter the gases of respiration

– deliberately lowering the babies temperature with cold baths or in the respiratory chambers to measure differences in metabolism

– fasting babies from birth to measure the consumption of stored glycogen and fats (a baby assumed to have died from hemorrhagic disease had been fasted)

– repeatedly waking babies by banging on the metal chambers that encased them, to stimulate artificially higher rates of metabolism

– causing a baby to cry “violently for about 17 minutes” to measure increases in metabolism (the distress was created by prolonged exposure to temperatures of 24C and lower)

– frequent rectal temperature readings

– deprivation of contact with mother, skin contact and breastfeeding

1915 vs 2015?

Undoubtedly many things have changed since 1915!

A notable change in standard practice is the timing of umbilical cord clamping. It was the general routine in 1915  to leave the umbilical cord intact for at least 6 to 8 minutes after birth.

(By leaving the cord alone for over 6 minutes, practitioners could witness the “observable biology” of placental transfusion, neonatal transition and normal umbilical cord closure. Sadly, these opportunities have been lost for most modern, clinically trained birth practitioners. Immediate cord clamping has replaced descriptions of normal human physiology and anatomy in student textbooks, and for many years has been standard teaching and practice.)

What I found most interesting reading this publication was thinking about the attitudes and rituals that haven’t changed much:

– many women are still directed and controlled by others in childbirth and feeding their babies

– the position of the baby immediately at birth, and contact between mother and baby, is still often directed by hospital policy, myths about placental circulation and cord clamping rituals

– there are still many hospitals that treat newborns as biohazards, bathing them with soaps at birth and separating mother and baby for  monitoring, measuring and ‘necessary’ re-warming

– the routine interventions of hospital birth can still have a considerable (perhaps greater?) impact on normal lactation and infant feeding behaviours

– experiments and unproven interventions are still commonly performed on women and babies.

In 2115, what will people think of our depictions of childbirth – in textbooks, case studies and popular media?

What will they think of our ‘general practice’ and experiments on pregnant, birthing and lactating women and their children?

About Kate Emerson

Kate Emerson, BA (sociology/politics) Kate is a clinical student pursuing her interest in neonatal transitional physiology and clinical cord clamping practices. She produces media to increase the level of awareness about delayed cord clamping for parents, students and interested practitioners. Please visit www.cord-clamping.com to read more.

Discussion

4 thoughts on “General routines in childbirth–changes since 1915?

  1. I’m hoping they’ll be wondering why so many labours were induced and why having a sweep of the membranes was a routine part of care.

    Posted by Karen Ramsay | June 30, 2012, 2:48 am
  2. Isn’t history fascinating? There are so many changes in ‘fashion’ in childbirth and how women have been ‘managed’ or ‘supported’ through the process. Little of the ‘care’ has been evidence informed. You are so right about the routines of hospital births interfering in the process, both of birth itself and the vitally critical first hour after birth. As more information is made known about imprinting and programming of the fetus/neonate in those preciously important times, then hopefully, practice will change for the better. Thanks for this fascinating overview of a part of our history.

    Posted by Carolyn Hastie | June 30, 2012, 9:34 pm
  3. i totally agree with what’s been written here. thank you for providing and sharing the post.

    Posted by Antonieta | July 6, 2012, 8:17 pm
  4. I”m wondering how many people in 2115 will wonder how only 30-50% of the women in 2015 had surgery to get the baby out and whether women and their midwives will have to go into hiding to have a truly physiologic birth…

    Posted by Cathi | August 21, 2012, 10:50 pm

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