The just came out with a paper saying that the ‘fathers of obstetrics’, William Hunter and William Smellie were actually serial murders. Until now, history describes them as anatomists who gave us the first ‘scientific’ basis for obstetrics and midwifery. They lived over 250 years ago and are still highly regarded as pioneers in the field of obstetrics. Smellie designed and developed forceps and other obstetrical instruments and they ‘wrote the book’ on anatomy of childbirth.

They strongly believed that the study of anatomy was the key to preventing maternal mortality during childbirth and apparently were fierce competitors motivated by ego and personal rivalry. During their research they studied the corpses of pregnant women and their fetuses. The paper is questioning how they could have possibly gotten the number of pregnant corpses of a specific gestational age without selecting women and then having them murdered. “There is great suspicion about the abundance of undelivered ninth-month corpses procured, dissected and depicted in the anatomical atlases of Smellie and Hunter.” Although it was a time of great violence and unrest, it was rare for mothers-to-be to die or be murdered soon before they were due to give birth. Young women from the country were their targets as there are many documented ‘disappearances’ of pregnant women around the time they were practicing.

There actually was suspicion of Smellie in 1755 and “as a result Smellie and Hunter both halted their research, both presumably fearing trial and execution,” although Hunter – who used his links to powerful families to ensure no investigation was ever undertaken – resumed ordering murders, about once a year, in 1764.” “Anthony Kenny, a gynaecologist in London for 40 years until his retirement in 2007, said: “These two guys are my heroes. The idea that they could have been involved in the murder of subjects is absolutely staggering.” Kenny is now the curator of the museum of the Royal College of Obstetricians and Gynaecologists. “They were the first proper obstetricians in the country because of their pioneering work practising what was then still a new branch of medicine.”

I love it…”new branch of medicine”, but whatever-that’s a whole other conversation. This is simply staggering! Of course now there are people coming out of the woodwork saying that it just couldn’t be! These men were fine, upstanding citizens. Doctors, with impeccable integrity…..Perhaps we’ll never know if they did indeed murder for the advancement of their status and prestige in the name of science, but given what I know about medicine, and the egos that are drawn to the profession, I wouldn’t be surprised.

Apparently, men have been writing the books (literally) on birth since the beginning even though they knew little about it, and were unable to attend childbirth for many hundreds of years or more. Not surprising. Having read many feminist books about the anthropology of birth, this is not news, but just the little she spoke about it in the interview shows that she has done her research. We can see medical involvement in birth evolve before our very eyes!

One point she brings up in the interview is that before the natural birth movement that reached its pinnacle in the 1970′s, women were demanding twilight sleep during birth and it was a feminist stance to demand that they don’t feel a thing during labor. It was their right. In the 1970′s, it became a feminist issue to have a natural birth, on their own terms and be present for it all. And now the pendulum swings……

The conclusion Ms. Hutter Epstein comes to is this: The issue is not pain medication or no pain medication. For decades, perhaps even millenia (I need to read the book) certain women have been dissatisfied with their doctor patient relationships and have demanded the opposite of what has been proposed to them thus creating a gradual swing in cultural thought around labor and birth. (See? My point all along. If women have power nowhere else, they can have it during birth.)

This is why it’s important in this day and age that midwives, nurse-midwives and doctors all be able to practice within their scope of practice, without restrictions and threats of legislation against one another. There are birthing women for every type of birthing practice and there should be truth and transparency about all the different approaches so women can make informed decisions about how they would like to (ideally) birth. Institutions build on a patriarchal platform like the AMA (and dare I say the ACNM) are fighting for more than their piece of the pie by putting down the ‘less educated’ practitioners. I think the evidence is pretty clear. Outcomes are nearly the same, and if anything, the medicalized ‘safe’ birth by ‘the most educated’ is in fact the least safe.

Assisting birth is learned best hands-on. It is a natural process that sometimes requires intervention which may or may not require classroom education. These organizations are missing the point, even after all these years. Women want choice. Some want an epidural after their first contraction. Some want a c-section on a certain date without ever going in to labor. Some want a natural hospital birth, some want a home birth- and everything in between. Many do not get what they want, but it should only be due to the circumstances of their particular birth situation, not because of lack of choice.

Perhaps Ms. Hutter Epstein’s book will open up a dialogue. Birthing women have been through countless atrocities and lack of power or choice at the hands of the medical profession and their interventions with birth. Medicine has also done great things and saved many women’s lives. Still, the maternal mortality rate is not what it should be, and we still need to be looking at why and try not to repeat mistakes made in the past, and identify mistakes we are making in the present. We need to be constantly and vigilantly looking at what works, and what doesn’t and grow and change and put our egos aside, our degrees in a drawer, and come to the table together to give birthing women the best possible care based on a combination of evidence of what works and what kind of birth they want.

“Cross-national comparisons from the World Health Organization and the Organisation for Economic Co-operation and Development clarify that many other nations are doing a better job with measures such as perinatal, neonatal, and maternal mortality, low birthweight, and cesarean rates. Nonetheless, per capita health expenditures for the United States far exceed those of all other nations. These outcomes, together with costly, procedure-intensive care, have been called the “perinatal paradox: doing more and accomplishing less.”

“Comparing current maternity care practice and performance in the United States to lessons from the best available research and to performance benchmarks reveals large gaps.”

The report found that “consistent with common patterns of innovation in medicine (McKinlay 1981), obstetric practices such as episiotomy (Graham 1997) and electronic fetal monitoring (Graham et al. 2004; Hoerst and Fairman 2000) were adopted prior to adequate evaluation. Many practices that are disproved or appropriate for mothers and babies only in limited circumstances are in wide use. Use of specific maternity practices varies broadly across facilities, providers, and geographic areas. This is primarily due to differences in practice style and other extrinsic factors rather than differences in needs of mothers and newborns.” As I have mentioned before, because of the way doctors are trained in US medical schools, the values of “autonomy” of practice reign supreme over evidence. This, coupled with a culture of medicalized birth where most woman believe that birth should take place in a hospital have created a very expensive and unnecessary reality that costs the US government billions of dollars a year in maternity care. Medicaid pays for 42% of the birth-related expenses in the US.

“With over 4.3 million births every year, childbirth is the leading reason for hospitalization in the United States, exceeding such prevalent conditions as pneumonia, cancer, heart failure, bone fracture, and stroke.”

“Hospitalization is by far the largest component of health care costs, and hospital charges for the current style of childbirth are considerable. Combined hospital charges for birthing women (about$44 billion) and newborns (about $35 billion) totaled $79,277,733,843 and far exceeded charges for any other condition in 2005 (Agency for Healthcare Research and Quality 2008). 49 percent of all hospital procedures performed on all individuals aged eighteen to forty-four were obstetric procedures, and six of the fifteen most commonly performed hospital procedures in the entire population involved childbirth. These include medical induction, manually assisted delivery, and other procedures to assist delivery repair of current obstetric laceration, cesarean section circumcision, fetal monitoring, and artificial rupture of membranes.” Midwifery practices use these medical interventions sparingly and only when absolutely necessary-keeping the cost of labor and delivery down, and the outcomes the same or better than medicalized birth.

“The national cesarean rate rose by 50 percent from 1996 to 2006, setting a new record each year from 2000 onward. From 1990 to 2005, the proportion of medically induced labors rose by 135 percent, from 9.5 percent to 22.3 percent
the most common gestational age among singleton births in the United States fell from forty to thirty-nine weeks.” The drop in gestational age means an increase in health care costs to care for premature babies. The higher instances of c-section always mean longer hospital stays, greater chances of complications arising from major surgery and a much greater cost to US taxpayers.

Additionally “women who gave birth in U.S. hospitals in 2005 reported high rates of numerous new-onset physical and mental health problems in the first two months after birth, with many problems persisting to six months or more postpartum.” I attribute this to negative birthing experience, and a medical model of care (where doctor patient relationships are superficial, brief and generally unsupportive). There is already evidence that a midwifery model of obstetrical care where midwives build true relationships with their clients and are offer support during and after pregnancy really work and add to maternal wellbeing. As the saying goes…..it takes a village to raise a child. Well, it also takes a village to birth a child and deal with the often trying time of major adjustment right after the child is born. No one should do it alone, and with a midwife, no one will.

I had always heard that at our local hospital birth was a big money drain. Our unit (women’s services) was a liability rather than a money maker. With these statistics, I am perplexed. It sounds like hospitals and doctors would be losing a large revenue source if normal birth was moved out to the home or to birthing centers. What the general public doesn’t know or talk about is that we as US tax payers are paying for nearly 50% of these births through Medicaid, and allowing the doctors to perform unnecessary tests and interventions at alarming rates just jacks up the bill and makes birthing women feel scared and out-of control.

Of course the American Medical Association (AMA) is a huge, and strong lobby. And now, as sanctioned by our own lovely Supreme Court, they can lobby to their hearts content to keep their agendas intact. Their agenda includes limiting (or in a perfect world, eliminating) midwifery, or keeping us on a very short leash. Using fear, and baby-hating propaganda, they have systematically led women to believe that they are unable to birth effectively without intervention or drugs, that they are ‘selfish’ and irresponsible if they demand a birth experience on their own terms, and that birth outside a hospital is dangerous and reckless. These ideas and beliefs are now firmly entrenched in our society and it’s going to take a village to change people’s minds.

Thankfully, there are many women who value midwives and midwifery and home birth or natural birthing practices. Our own organizations are making efforts toward transparency in birth through things like The Birth Survey, and midwife-friendly reports based on evidence. If evidence-based practice does gain support and ground with the US government and the people, only then will we be able to start a real dialogue about what birthing practices are best for women, babies and the US pocketbook.