PETER: We're back with BackStory, the show where history steps up to the microphone. I'm Peter Onuf.
BRIAN: I'm Brian Balogh.
ED: And I'm Ed Ayers. Today on the show, we're looking at a few of the basic assumptions we have about child birth today and asking how things in the past have been different.
BRIAN: I've got a pretty good idea of what birth looks like today. You've got your doctors, you've got all kinds of specialists waiting in the wings and you have lots and lots of machines just beeping away. I have a hunch, though, that that's not what things have been for most of American history. I want you to tell me what the history of birth was really like before we got to all this technology.
ED: That's a pretty bold statement, Brian, to guess that we didn't have big electronic machines back in the days before we had electronic machines. I like when you venture beyond your comfort zone of the 20th century there.
BRIAN: Yeah, yeah. I know.
ED: Now it turns out, we can answer that question in pretty stunning detail because of the meticulous diary kept by a midwife from 200 years ago named Martha Ballard. We know about that diary because of the remarkable work of a historian from modern times, named Laurel Thatcher Ulrich. About twenty years ago, she published a groundbreaking book about Ballard's work as a midwife in rural Maine. It covered the years between 1785 and 1812 and that was a harrowing time, certainly to have a baby. Especially, perhaps, in rural America. I sat down with Ulrich to talk about the challenges of delivering babies in such a challenging time.
LAUREL ULRICH: Working with a diary of an 18th century midwife, I was really surprised. The birth itself was pretty uneventful in her diary. Most of the time, things went very well. The difficulty was, you know, going on a floating cake of ice across the river to get to a mother or falling off her horse or being in the middle of a rainstorm and mud. So the challenge, for her, was getting there.
ED: And I guess before she could go to get there, word had to get to her in some way, too, right? That must have been [crosstalk 00:16:06].
LAUREL ULRICH: So it's a lot of running back and forth.
ED: Right, right, right. And how many times would she have done this?
LAUREL ULRICH: Well, she delivered over the course of her career more than a thousand babies.
ED: Oh gosh.
LAUREL ULRICH: And maybe the high point would be fifty babies in one year.
ED: Would a woman think, going into childbirth almost every time, that she might not come back out the other side?
LAUREL ULRICH: I think so but remarkably, in the thousand births that Martha Ballard officiated at, she didn't lose a single woman at delivery. The fact that these deliveries were spread out and they took place at home, meant that there was a lot less danger of infection. The thing that happened when deliveries moved, well, there were deliveries in hospitals in the 18th century, but only for the indigent. And people died rampantly because infection would spread. People didn't have an understanding of a sepsis at all. Things weren't sterilized, there was no germ theory. And so if a physician, for example, were using instruments and delivering a number of women using the same equipment, germs could spread rapidly.
ED: This remarkable record raises a question. If she was literally batting a thousand, why did midwives decline in favor of doctors and when does that happen?
LAUREL ULRICH: Well that is a fascinating story. Midwives actually persisted in the United States almost to modern times but among educated, middle class, urban families beginning in the 19th century by 1840s and '50s, more and more people were using physicians. And there was a belief in scientific advancement among these people even though actually there was no scientific advancement, we know. But there was a hope for that.
ED: Kind of a placebo effect on a social level, right?
LAUREL ULRICH: Yeah. Yeah. This was an era where specialists are going to do things better, people felt. I think there are really factors that are far more important. One of them is that the medical profession changed. In the 18th century, when Martha Ballard was in her practice, doctors were gentlemen who relied primarily on book learning. They certainly didn't want to get their hands dirty. Medicine became a more empirical occupation. People were interested in evidence in practice, actually getting involved. And doctors learned to behave like midwives. That's kind of opposite what we think. We tend to think, oh, it was the aura of science but actually, I think it was doctors learned to have a gentle, nurturing manner and they would come to the home and they would be comfortable with the women. Some people think fathers, first attended deliveries maybe as doctors began to officiate. That may or may not be so in every place but you do get a little bit more engagement of husbands and fathers in the 19th century than in earlier periods.
ED: Laurel Thatcher Ulrich is a professor of history at Harvard University. So guys, the story that Laurel Ulrich tells brings us to the turn of the 20th century. Here's something surprising. Even then, half the births in America are still delivered by midwives. And, even if they are delivered by doctors, the vast majority of births are still taking place at someone's home. It would take another four decades to 1938 before half of American births took place in hospitals. And here's the most amazing stat. Between 1938 and 1955 we went from 55 percent hospital births to 99 percent hospital births. So Brian, can you tell us how that came about? Why did it take so long for hospital births to catch on and once they did catch on, why had they held on so tenaciously?
BRIAN: Well, it's a pretty complicated story, Ed.
ED: Well, I'll go boil some water and we'll settle in.
BRIAN: Exactly and if you'll excuse the pun, it's a push pull factor here. Here's what the push into hospitals was from. People were moving to cities at increased pace. They were losing some of those networks that they had relied on and they did not have the family and the midwives available in an urban setting that they had had in those rural settings and so this pushed them to hospitals. What pulled them? After World War 2, the reputation of scientists in general just soared and of course doctors had now invented medications like penicillin. Frankly, experts were never more revered than the period roughly 1950 up to 1970, '80.
ED: I hope you'll indulge me in a brief moment of autobiography. When I was born, my mom and dad were 20, 21 years old and they lived way up in the mountains of North Carolina. I was born in January. And through a driving snowstorm, my dad drove a pick up truck 40 miles with my mom in it to Asheville, North Carolina so that I could be born in a hospital. So, you know, it seems like a funny, accepting this risk of driving off the side of a mountain with pick up trick with cinder blocks in the back, so it would be heavy so that I could be born in a hospital.
BRIAN: To get to those beeping machines.
ED: Yeah, exactly. Now that's 1953 which puts it smack in the middle of this trend. It's interesting to know that even we live in history.