Around the 1930s, most women switched from giving birth at home with a midwife, to giving birth at a hospital with an obstetrician. Unfortunately, at this point in history, women were still better off delivering at home. In the 1930s, 1 in a 150 pregnancies resulted in maternal death. As a result, many changes were made in the field of obstetrics. Procedures were standardized and doctors were more carefully trained. By the 1950s, the maternal death rate was lowered to 1 in 2,000. Today it’s about 13 in 100,000 (roughly 1 in 7,692).
Most of the progress made in the obstetrics field has been made in the 20th century, particularly in the latter part of the century. Prior to the 20th century, the birthing process and methods of intervention did not change very much. Cesarean section has been around since seventh century BC Rome, though it was reserved for saving the infants of mothers who had died in labor. Anesthesia and antisepsis appeared in the nineteenth century. Antisepsis was responsible for dramatically reducing the rates of maternal and fetal death, since up until that point infection was rampant and responsible for many deaths. Forceps delivery has been around since the seventeenth century.
In the early 1900s, a better method of sewing up the uterus came about, making cesarean a more viable option. The Apgar score, developed in 1953, was responsible for significantly lowering infant mortality rates. Babies that would have been left to die before were now given extensive care with the discovery that their condition could improve with techniques like oxygen and warming. Scoring encouraged doctors and midwives to improve their practices in order to raise their scores. Cleaner hospitals and better hygiene have also lowered rates of infection. Ultrasounds became common practice in the 1980s. Electronic fetal-heart-rate monitoring and IV fluids are virtually required in hospital deliveries.
Today, obstetric interventions are much safer than they were 75 years ago, and yet, one must wonder if these interventions are always necessary. It seems that it has gone to the other extreme from a century ago, with cesarean rates close to 30% and Pitocin being used in half of deliveries. Obstetrics has gone beyond minimizing fatalities through intervention and has made childbirth a streamlined, standardized process. Many mothers end up feeling like they have no control at all anymore. It’s no wonder we’ve seen a recent trend in home birth and the use of midwives. Is there any middle ground?
What is your opinion on obstetrics as it stands today?