Up until the mid 1900's, women usually had their babies at home and learnt about childbirth from their mothers, grandmothers, sisters, female friends and local wise women. The birth attendant was usually a lay midwife, a woman who had learnt to deliver babies through years of experience attending other women's births. In these times, the midwife (meaning 'with woman') mainly used natural approaches (and plenty of patience) to care for women. These included towels soaked in hot water as heat packs for the pain relief (hence the saying "we need hot water and towels"), herbs from plants and home remedies.
Labour and birth were accepted as normal and young girls could hear and witness women labouring and giving birth before it was their turn to do so. Birth care incorporated the emotional needs of the labouring woman, which continued as practical help and support into the early months of the baby's life. Men were generally not involved, sitting nervously outside, or continuing normal activities, leaving it all to the women.
Women often laboured in upright positions, squatting, standing or leaning forward to give birth. Illustrations of these active positions are found in many cultures dating back thousands of years. Egyptian, Turkish, Aztec, Chinese, and Japanese artworks clearly depict what is now termed 'active birth'. It is now well-recognised that labours tend to be faster, less painful and are less likely to need intervention if women are allowed to move around and remain upright (if they wish) during labour and birth.
From the 14th to 17th centuries, many women healers and lay midwives were hunted and executed as witches. Around this time the medical profession started to become established. Women were barred from the university medical training and 'uneducated' midwives were marginalised. With the discovery and widespread use of forceps in the 1700's, male doctors started to become more involved in birth. They laid claim to the fact that they alone could deliver babies (and their mothers) from 'difficult births'.
Queen Victoria of England had a male doctor for her 7th baby in 1853. She was one of the first famous women in history to use chloroform during labour (although ether was first documented in the United States in 1847). The use of breathable pain relief by Queen Victoria set the scene for having a male doctor attending births to be fashionable. However, only upper class women could afford this.
Doctors could ease pain with medications and sometimes shorten the labour by using forceps. Both these interventions confined women to their beds, usually lying on their back most of the time. Being in bed also made it easier for the doctor to see what was happening and to intervene if necessary, which they frequently did. It wasn't long before these procedures spread routinely throughout the Western world.
By the early 1900's doctors started using medications that could be injected into the woman's vein for pain relief (usually morphine and a muscle relaxant scopolamine). This was referred to as 'twilight sleep', which could be induced by a combination of many different types of general anaesthetic drugs. The drugs were usually administered towards the end of labour, causing the woman to become unconscious and often producing amnesia (forgetting the birth). However, twilight sleep practices were discontinued when it became apparent that the drugs were not always safe for mother or baby.
During the 1800's, lying-in hospitals started to become the preferred place to have a baby. When this happened, infections after childbirth (known as childbirth fever) became the main cause of women dying in relation to childbirth, although no one could work out why for some time, as until 1880 there was no knowledge of bacteria and sterile techniques. Then Dr. Semmelweis worked out that if doctors washed their hands after performing autopsies and before visiting women in childbirth, infection rates decreased dramatically!
By the mid 1900's just about all women gave birth in hospital, virtually using a total medical approach. Strict hygiene became paramount, with masks, gowns, enemas and pubic hair shaving becoming routine (now obsolete practices, because we know they do not prevent infection). Women lay in recumbent positions with their legs in stirrups and procedures of 'control' were cemented into the psyche of how women should be cared for when having a baby.
Women often laboured alone, or in a room with other labouring women and were not told what was going on, nor why. They 'did as they were told' and accepted whatever interventions (or pain relief) the doctor or midwife gave them, often without explanation. Birth became a scary and lonely experience, now being passed onto daughters and granddaughters, often influencing how they approached the birth of their own children.
By the 1960's routine 'actively managed labour' (or medical interventions used to manage labour) began to be questioned. This coincided with the rise of the women's liberation movement, increasing women's awareness of their needs and responsibilities when labouring and giving birth. By the 1970's, fathers started to be allowed into the birth room (usually as an observer only - "Just stand over there in that corner, please!")
The natural birth movement of the 1980's aimed to bring birth 'back to basics' and humanise the experience again. Parents started to question the need for the blanket approach to medical interventions and slowly breakthroughs came, with more and more women and their partners taking greater control over the birth of their babies. Many women wanted to be more active and expressed the desire for physical and emotional support from their partners. The role of the partner moved from being just an observer, to physically helping the woman deal with her labour pain, using things like massage and providing emotional encouragement. This has helped bring fathers closer to their children. In recent years, many siblings have also become involved, making birth an important family event. One that many women see as a rite of passage.
It was around the 1980's that the concept of childbirth education for women and their partners flourished. Parents sought information about what to expect, and how to deal with labour and birth (and parenting). Childbirth education today aims to provide up-to-date information on all aspects of the labour and birth (whether this be natural or by Caesarean) as well as pain relief options and support strategies. In recent years, parenting classes have also come into vogue, as most parents can no longer rely on extended families for support and to teach them about caring for their new baby.