In Part 1, “It’s Time for Birth Climate Change,” I explored the “White Horse Mentality” in which women are routinely “rescued” from labor. In this article, I’ll discuss the roots of this line of thinking, specifically as it was laid out by Dr. Joseph DeLee, a pioneer in the American Industrial Birthing System.
Since the beginning of time, Women’s connectivity to nature and their bodies has regularly fallen under the rhetoric of “evil.” From creation myths depicting Woman as evil temptress and dissident, to witch-hunts and burning women at the stake, women, especially those who’ve displayed their confident intuition too loudly, have been subjugated by predominant patriarchal systems.
At the turn of the 20th century as the push for hospital births in the U.S. took off, it’s important to bear in mind the social and political climate of that time. Women had very few rights, and in fact, not until 1920 did women win the right to vote in this country. Courageous Suffragists were rising up, often under direct opposition from their husbands and other male family members. Even female friends and family sat in quiet complacency, their trepidation and intimidation over the issues at hand a formidable barrier. Women had long been instructed of their place, their frailty, their need to be cared for by someone stronger and wiser (namely, men).
So it was a familiar rhetoric for Dr. DeLee to lean upon when, in his 1920 paper published in the first issue of The American Journal of Obstetrics and Gynecology, he described saving women from the “evils natural to labor.”
Five years prior he prefaced this paper with his discussion at the Sixth Annual Meeting of the American Association for Study and Prevention of the Infant Mortality in Philadelphia, regarding the requisite elimination of the profession of midwifery. (You can read the speech in its entirety over at The Unnecesarean.)
His discourse reveals a couple of blatant agendas:
Agenda #1: Establish Midwifery as Barbaric
Dr. DeLee actually refers to the Midwife as barbaric in opening his piece (“The midwife is a relic of barbarism.”) He goes on to elaborate on the evils of midwifery with an overt subtext of male supremacy in general.
“Even after midwifery was practiced by some of the most brilliant men in the profession such practice was held opprobrious and degraded….. If an uneducated woman of the lowest classes may practice obstetrics, is instructed by the doctors, and licensed by the State, it certainly must require very little knowledge and skill—surely it cannot belong to the science and art of medicine.”
Did you catch the way he juxtaposed the “brilliant men” and the “uneducated woman”? He does a couple of things here – first he establishes the distinct line between male and female intelligence; then in the last line begins to lay the framework for illustrating the archaicness and subordinate position of midwifery to technology and advancement. He is careful to continue to weave these two ideas together throughout his essay. He continues:
“The midwife is innocent of the trouble she causes and of the high mortality and morbidity among the mothers and babies. It is not her fault that she is allowed to practice such a delicate profession, carrying such direful responsibilities….”
In case he wasn’t overt enough, the role of Woman is laid out here, clearly. “It is not her fault.” Surely not. As he’s mentioned just previously, she is too ignorant and uneducated to understand such “direful responsibilities.” Again, his theme is birth as a science, and therefore work to be left to a competent man. (An interesting note to make here is that while DeLee attempts to paint a picture of the Midwife as one of high liability, during the years of DeLee’s protocol of managed labor – including “twilight sleep,” fundal pressure and forceps – the maternal and infant mortality rates sky-rocketed to all-time highs. See my post, here, which references the study.)
Further, he goes on to establish birth as evil:
“Certainly, having babies is a natural process, and, in the intention of nature should be a normal function, yet there is no one here who can deny that it is a destructive one. We all know that even natural deliveries damage both mothers and babies, often and much. If childbearing is destructive, it is pathogenic, and if it is pathogenic it is pathologic.”
For if one’s goal is to shift the paradigm of thinking in such a drastic fashion, fear almost always needs to pave the way. Let’s think about this. We have a couple of camps that this message was ripe for. First, there were the women who had severely internalized patriarchal oppression – who believed themselves lesser and weaker, and were therefore accustomed to being rescued. They, for one, wanted to believe the men who wanted what was “best for them”. The second camp were the suffragists and feminists. They had all kinds of ideas about liberation and what it might mean to be a woman freed from the confines of expected roles. The concept of birth without pain or work seemed like a liberating idea.
Which of course leads us to…
Agenda #2: Establish Obstetrics as The Necessary White Horse
“… If the doctors recognized the dignity of obstetrics she could not exist. Engelman says: “The parturient suffers under the old prejudice that labor is a physiologic act,” and the profession entertains the same prejudice, while as a matter of fact, obstetrics has great pathologic dignity—it is a major science, of the same rank as surgery.”
“After what has been said it is superfluous to dilate on this point. Obstetrics is a major science. It requires the highest kind of skill in addition to much knowledge to do even tolerable work.”
The comments I throw into this section, if one can isolate them and look past the blatant misogyny in the process, are purely hilarious. Have you ever heard of “short man’s disease?” Well, it’s pretty Man Club, but that’s the point here, right? The thought behind the comment is that short men tend to feel less masculine than those of average height, and so their behavior is characterized as overtly “macho” in order to compensate for their lacking height. This paragraph, specifically the last line with the phrases, “pathologic dignity,” “major science,” and “same rank as surgery” seeks in the same way to over-compensate for what was lacking in scientific / medical respect of this new and proposed transformation of obstetrical practice.
“It is a general complaint of obstetric teachers that young physicians will not adopt obstetrics for their specialty. That the work is hard, that obstetrics is a jealous and exacting mistress, is appreciated, but neither deters the young man, because the science and art of obstetrics are the most interesting and gratifying in medicine……”
I just can’t quite move on without pointing out his metaphor – “..obstetrics is a jealous and exacting mistress...” Interesting that he would choose the least desirous traits in a woman – jealous, exacting (controlling), mistress – to apply to obstetrics. Why does he do this? I think it would be more surprising if he didn’t. His discussion consistently holds to the theme of degradation, and while I find his context abhorrent, I do commend him on his consistency and creative and culturally recognizable language.
The paragraph continues…
“….What does deter him, and it may be said without disparagement, is the fact that his arduous labor and sacrifice of time, of comfort and self, are not appreciated and requited with respect and remuneration… “
Ah. Men need to be appreciated. Not only appreciated, but shown proper respect, and thus, paid accordingly. Again, this reflects the dominant male culture. Male privilege brings with it a sense of entitlement, specifically respect, and in the climate of the early 1900’s, especially a subservient respect from women. It is actually quite disturbing to think about the practice of obstetrics springing up under this auspice. And I think it is imperative that we do consider it in this light. (You may enjoy my follow-up article where I examine this aspect in more detail.)
He summarizes his points well, in closing:
“I am heart and soul opposed to any measure which is calculated to perpetuate the midwife….”
Perpetuate: to preserve from extinction or oblivion.
“…In educating her we assume the responsibility for her; we lower standards, we prostitute ideals, we compromise with wrong and I for one, refuse to be particeps criminis. We, for the lesser evil, lose the greater good.”
Leaning heavily upon language characterizing the sinful woman, his conclusion further clarifies and isolates his target. Laden with paternal overtones, he goes well beyond establishing the Midwife as inept by indeed criminalizing corroboration with her.
So Dr. DeLee, in paving the way for a new kind of birthing system, needed to establish the basis for such drastic change. He brilliantly orchestrated the foundation of an oppressive system that we still operate under today – paternalistic patterns so pervasive, they’ve filtered into roles that are inherently woman-centered (i.e. midwives and even doulas find it challenging to escape the dynamic of savior-on-a-white-horse).
Whenever I hear someone talk about how far we’ve come in birth, I can’t help but think about the roots of birthing oppression, and how evident, albeit a bit more muted, the colors bleed today. Sure, we’ve escape the confines of “twilight sleep” and physical restraints, but birthing women are still regularly overpowered. I hear it every time woman explains, “my doctor won’t (or will) let me ______.”
Who should be in charge of this system, anyway? And what will it look like to collectively take birth back?