In October 2014, Sarah Koenig released the first episode of her murder-mystery, hit podcast, Serial – a year’s worth of work to try and uncover a 21-minute-period of time. At the foundation of this 12-part series, Koenig shared, “It’s really hard to account for your time, in a detailed way, I mean…how’d you get to work last Wednesday? Was it raining? Are you sure? Did you go to any stores that day? If so, what’d you buy? Now, imagine you have to account for a day that happened 6 weeks back…” (Koenig, 2014). If you’re practicing the exercise, you may quickly realize how difficult recounting a single day in your life is – with one important caveat.
What Koenig quickly realized was that “if some significant event happened that day, you remember that, plus you remember the entire day much better” (Koenig, 2014). With that in mind, birth is a pretty phenomenal exception to our normal stream of consciousness and reality. We know that women with Alzheimer’s can recount their birth stories in detail even if they can’t recognize their child today (Clark, 2013, Introduction). Birth exists without exception – every person having been born from a viable pregnancy and a successful birth. It is a common thread woven into humanity that spreads across time, tradition, and location, but is often patterned and organized in ways that as Tina Cassidy says, “reflect the culture in which it happens” (Cassidy, 2006, p. 250).
In 1958, in the heart of Chicago, Illinois, among the ranks of middle-class American, my Catholic grandparents, James and Carolyn Lynn were expecting their first child. At 20 years of age and after one month of marriage, when my regularly-cycling grandmother’s period was late, her suspicions arose. After confirmation with her family doctor’s office, she was told she could be 3 weeks early or 3 weeks late of her LMP-based due date, April 2nd, 1959 – all were considered healthy and full-term.
When I asked about her care provider, there was no question who my grandmother would trust with such a precious time in her life – her lifelong family doctor, Dr. Chrzan. Not surprisingly, she had never heard of a home birth (outside of her own grandmother sharing stories of how babies were born in olden days) or midwifery (though the ACNM had been recently founded in 1955). This period preceded the advent of specialized obstetrical practice, and while her friends were all seeing the highly-recommended Dr. Chen, her loyalty was fixed on her “nice-looking” provider and anchored by much more than the details of his neatly-pressed, buttoned down shirt and cufflinks – prepared faithfully at each interaction.
At each 45-minute-long prenatal appointment, Dr. Chrzan checked vital signs, weight, fetal heart tones, asked how my grandmother was feeling, and did an internal exam from 4-8 months of pregnancy to check the baby’s positioning. While ultrasound technology was just sprouting into development, no such device made its way into my grandmother’s uncomplicated care (Cassidy, 2006, p. 173).
“When the apples ready, it will drop” still dominated much of my grandmother’s thinking and expectations, but by her doctor’s appointment on Monday, April 20th, Dr. Chrzan wanted to induce with castor oil by Wednesday. After his assessment that the baby was “low”, Dr. Chrzan believed my grandmother would go into labor soon. To my grandmother’s delight, labor contractions began at 7am on Tuesday morning. Her instruction was to wait until the contractions were 3 minutes apart to head into the hospital, but having heard stories of Jean across the street’s birth, my grandmother anticipated a much faster process to meeting her baby. My grandparents loaded their hospital bag and headed into the hospital at 9am.
When I asked my grandmother what she expected of childbirth in terms of sensation and pain, she told me, “Nobody tells you everything. They say ‘it’s painful, but it goes away.’ I knew it wouldn’t be a piece of cake, but I wasn’t afraid.” Considering that my extroverted, sociable grandmother had readily heard of Jean’s births, and no doubt many other family, neighbors, and friends, I was considerably surprised that she had never heard about Twilight Birth. It sounded almost as unheard of as a home birth – which is saying a lot in 1959 when nearly 100% of babies were born in the hospital and most women were fully sedated for their deliveries.
According to Cassidy, “although the class of hospital patients may have changed in the first half of the twentieth century, the culture inside maternity wards did not. Women often were treated shamefully, with little regard to their own wishes” (Cassidy, 2006, p. 63 ). Words like “shame” were never attached to my grandmother’s re-telling of her birth story – though, she did not appreciate the pubic shave upon admittance. After her first cervical check of 3 cm in triage, my grandmother was taken to a labor room separated by curtains from other laboring women with my grandfather at her side. My grandfather stayed there until delivery, and while he felt bad for her agony, was of little help and support. In her own words, “there was nothing he could do for me” – partner-supportive, and specifically, husband-coached childbirth education had not yet been rolled out by the Bradley Method. (Couples would have to wait until 1965 for those tools.)
Whether my grandmother realized it or not, “hospitals, in an effort to eliminate perpetual infections, had become rigid and methodical. The obstetric ward’s obsession with sterility had changed birth entirely” (Cassidy, 2006, p. 65 ). Not surprisingly then, my grandmother labored on a steel bed and struggled to relax on it. Unlike the stories depicted in the Ladies Home Journal of November 1957, my grandmother’s body lay untethered by wrist, leg or shoulder straps, but with each rhythmic contraction, her body tensed. While the Natural Childbirth movement was just revving up, with the work of Grantly Dick-Read gaining momentum in the United States and Europe, my grandmother never mentioned being offered medication, or quite frankly, having a choice in the matter. Her drug-free labor was not inspired by the Feminist movement at the turn of the century, and it did not incorporate Lamaze-styled breathing techniques (that were hot off the press that year) nor visualization and hypnosis (to later come into vogue of the Hypnobirth Method after the 1980’s).
By 6 cm, her water still hadn’t broken, and needed to be ruptured artificially. “That’s when things really started moving along”, and Dr. Chrzan was called in. Instead of arriving with an injection and bandaging her eyes with gauze and ears with cotton, Dr. Chrzan took his post at the end of the bed and waited for the baby’s head to become visible. With DeLee ideology present long after DeLee’s death in 1942, birth continued to be viewed as a disease and it was standard practice to apply forceps with episiotomy as part of the normal birthing process. My grandmother was no exception.
At 7:58 pm on Tuesday, April 21st, my grandmother delivered a 9lb 5.5 oz baby girl, my Aunt Donna. Once she was born, Dr. Chrzan immediately cut her cord, and the nurses suctioned out her nose, weighed her and took her measurements, gave her a bath, applied eye ointment, and put her in an incubator. The afterbirth took about 5-10 minutes to be passed, and after my grandmother was “all sewn up”, my grandfather returned to visit my grandmother and meet his newborn daughter. He’d return for visiting hours each night after work from 7-8 pm and a nurse would roll my aunt to the window for him to see his baby, protected by glass, and therefore, from (outside) infection and disease.
While the staff laid my aunt on my grandmother’s abdomen for a couple minutes following the birth, my grandmother didn’t get to hold her until the next day. Instead, that first night’s primary goal was making it down the hallway to use the bathroom. My grandmother was determined to make the journey on her own and leave the hospital on time the coming Saturday. By 1944, following hospital crowding from World War II, the Journal of the American Medical Association reported that women benefited from walking around within three to four days after birth (Cassidy, 2006, p. 223). Clearly, this was now a significant benchmark – one my grandmother met enthusiastically to have her and her baby home by the weekend.
Though the hospital staff encouraged breastfeeding and recognized its benefits for the baby, their top priority was helping my grandmother recover from childbirth – consequently, something inhibited by the demands of her new baby. For this reason, my aunt did not room-in with my grandmother, and instead, was brought in from the nursery a couple times each day to nurse. Despite the rise in popularity of Freudian psychology, it would be prudent to assume that someone else was meeting the needs of my newborn aunt.
The staff tried to teach my Aunt Donna how to suck, helped my grandmother with her latch and encouraged my grandmother to feed on demand instead of a strict every-four-hour feeding schedule (something that was further inspired by her Dr. Spock magazine subscription) (Cassidy, 2006, p. 64). By Saturday’s homecoming, it seemed my aunt’s breastfeeding demands were constant. My grandmother got no relief and felt frustrated by the now hourly feeds. She lamented that her baby wasn’t eating enough, and after 3 weeks, instead of phoning Mary White of La Leche League, my grandmother rang Dr. Chrzan and said she was done. He put in a prescription to help dry up her supply, and the switch to formula was conveniently made. Now, my aunt slept for much longer periods of time, and my grandmother was thrilled that her baby was well-fed and could have her nutritional needs met by other helping hands.
After the weekend, my grandfather returned to work, and regular rounds of grandmothers came to help with the baby. In the first few weeks postpartum, my Great Grandma Scheier would do laundry (including cloth diapers before they were carefully crafted into “all-in-one” options), cook, and bring the baby to my grandmother when Aunt Donna woke up. Besides the baby’s one-month check-up, going out was highly discouraged until the baby had been christened (something my grandmother almost missed due to her episiotomy recovery and pain). Fortunately, if questions or concerns arose, Dr. Chrzan could always be reached by phone and would graciously respond.
Since this was before the 1960’s and ‘70’s, and the dawn of mental health and attention for postpartum mood disorders, my grandmother, and many other women, relied on a mother, sister, or friend to come over and help. Conversations among friends included comparing personal experiences and determining if any of your own were out of the ordinary. Unable to afford a second car, it’s quite fair to assume that this support network was critical in how my grandmother healed both physically and emotionally postpartum.
As I struggled to complete an unbiased interview of my grandmother’s first childbirth (despite my grandfather telling his in-laws, “You better enjoy your granddaughter because she will probably be your only grandchild. Carol is never doing this again!” they did go on to have three more children), I was struck by how vivid and matter of fact my grandmother’s birth story was. Funny phrases (like the one I just mentioned), the graphic depiction of clinging to the iron rails of her bed with each contraction, the wondering if her baby would ever come as laboring women were rushed out before her again and again, the fear when my grandfather started praying over his rosary beads, the sadness of when my grandfather was ushered out (despite Michel Odent’s thoughts on the matter), the emptiness accompanied by the newly-expelled placenta, the weeks of frustration trying to meet the demands of her newborn baby are all aspects of her birth story that stuck out to her, and therefore, to me as well.
Circling back to Koenig’s point – for the amount of detail my grandmother recounted, it is incredible that this is a story that happened 59 years ago. It is easy for me to look at it “behind the (nursery) window” and say just like the Houston mother who visited her friends in the hospital, “I can’t believe that grown people let this happen to them,” but that wouldn’t do justice to my grandmother’s birth or the birth culture that she had her babies in (Cassidy, 2006, p. 227). From where she sits, episiotomies are how doctors help you have your baby and prevent you from more serious tearing. In her mind’s eye, today, her birth would’ve been a Cesarean section – a way longer recovery than the 3 weeks following my Aunt Donna’s birth she was pressed to sit on an intertube for relief.
Obviously, our conversation unearthed something in my grandmother too. Just as in her early postpartum days, she delved back into her community for support – now reachable via her iPhone – and her own investigation of the 1950s was underway. My Aunt Jeanne, a best friend of my grandmother since high school, had three of her five babies born breech vaginally. My grandmother, knowing my opinion of her episiotomy, quickly rambled about how those babies would’ve been born by Cesarean today. She’s not exactly wrong. “Between 1970 and 1978 cesarean breech deliveries in the United States jumped from 11.6 perfect to 60.1 percent. Today, almost all breeches born in American hospitals are by C-section, in part because the malpractice risk is too great and most obstetricians are no longer proficient in the delicate art of delivering them naturally” (Cassidy, 2006, p. 119 ).
While I’m not here to write about vaginal breech birth, or episiotomies or Cesareans at length, what I found enlightening was how we all look at time from wherever we fall in it. While Cassidy remarks that our culture shapes our birth, I would argue that our culture’s view of itself is deeply embedded in the birth culture of other times. I look back at the perineal trauma that dominated much of 20th century obstetrics, and my grandmother looks forward to see that it could have been her uterus severed instead – both of us fixated on how fortunate we are to have given birth when we did. As much as I hate to agree with Cassidy, perhaps in closing I can’t help to with this one take-home point from her book, Birth – “if only we’d known how skeptical we should have been. And should still be.” (Cassidy, 2006, p. 253). Wherever your birth falls in history, it’s fair to say, that the past has given us many tools and insights, but the future leaves plenty of room for improvement.