Copyright by Deirdre Gae Doughty 2013

The Dissertation Committee for Deirdre Gae Doughty certifies that this is the approved version of the following dissertation:

Having a Baby the Natural Way: Primitive Bodies, Modern Women and Childbirth in Mid-Century America

Committee:

Laurie B. Green, Supervisor

Judith G. Coffin

Janet M. Davis

Megan Seaholm

Gunther Peck Having a Baby the Natural Way: Primitive Bodies, Modern Women and Childbirth in Mid-Century America

by

Deirdre Gae Doughty, B.A.; M.A.

Dissertation

Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of

Doctor of Philosophy

The University of Texas at Austin May 2013

Dedication

To my husband, Jeff, and to my children, William, James, and Henry, for the love, joy and support they have given me.

Acknowledgements

After so many years in the making, it gives me great pleasure to thank those who contributed to this project’s completion. Early in my graduate school career,

Judy Coffin, Desley Deacon, Kevin Kenny, Gunther Peck and Jim Sidbury provided vital encouragement and, in their example of fine scholarship and through their excellent teaching, continuously challenged me and fundamentally shaped my approach to the study of history. Desley Deacon supplied early enthusiasm, crucial feedback and important direction for my dissertation, as did Gunther Peck and, later, David Oshinsky. More recently my work has benefitted from the insightful suggestions and correctives of Janet Davis and Megan Seaholm. My greatest thanks and gratitude, however, go to my supervisor, Laurie Green. Her generous commitment to students, myself included, is invaluable. In my case, she not only proved an incisive and challenging critic, but also an unfailing mentor and constant supporter. My work is immensely better for her involvement.

I owe thanks to the Department of History at the University of Texas at

Austin for awarding me grants and fellowships, including the John M. Curtis

Dissertation Fellowship, which allowed me to focus on conducting research both in

Austin and in London. I am also very appreciative of the Department for allowing me to chart a non-traditional path to the completion of my degree as I juggled growing family obligations and my scholarly career. I owe thanks, too, to the helpful and

v professional staff at the Wellcome Library for the History and Understanding of

Medicine in London, England; at the Columbia University Augustus C. Long Health

Sciences Library; and at the Schlesinger Library at Harvard University. I am especially indebted to the InterLibrary Services staff at the Perry Castaneda Library at the University of Texas at Austin. They promptly and efficiently obtained for me the books that I could not find among UT’s amazing library holdings and also managed to track down obscure magazine articles, despite the fact that I often had only incomplete citations.

I am also grateful for the friendship, camaraderie and perceptive criticism of the members of my dissertation writing groups: in S.C.I.P.S., Marian Barber, Lissa

Bollettino, Sara Fanning, Sara Lucas and Rebecca Montes; and in a later dissertation group with Laurie Green, Leah Deane, Luritta Dubois, Kyle Shelton, Sarah Steinbock-

Pratt and Cristina Salinas.

Thank you to Brittany Smith who provided that all too rare and priceless service—childcare that was both absolutely dependable and also enriching and fun for my children—and in the process became a part of our family. I thank Claire

Tobin, Billy Doughty, Jack Thompson, Jennifer Thompson and Justin Thompson for years of friendship, advice, support and good times. Billy also provided excellent childcare and Justin graciously welcomed me into his home on a research trip to

NYC. My dear parents, Bill and Beverly Doughty, deserve special acknowledgement and appreciation. I cannot thank them enough. They not only unstintingly showered

vi me with love and encouragement, but also nurtured and fed my curiosity and imagination and, by example, taught me the value of learning and the importance of perseverance and hard-work. Both of them contributed tangibly and intangibly to the project that follows. My father introduced me to the joys of history at an early age; he also designed and built the database I used for my research at the Wellcome

Library. Childhood conversations with my mother inspired my lifelong interest in natural childbirth and her impressive diligence in completing two degrees as I was growing up showed me that successfully managing family and academic life was a possibility. She also provided essential childcare by accompanying me on my research trip to London.

My three bright and exuberant children, William, Jamie and Henry, were each born as I was researching and writing this project. Though their arrival slowed my completion, they brought balance, new perspective and boundless joy to my life. I wouldn’t have done it any other way. My deepest debt is to my husband and true partner, Jeff Thompson. His keen intellect and sharp wit have enlivened and enriched my life and my work immeasurably; his unwavering encouragement has seen me through my most doubt-filled hours. His selfless and ongoing financial support of our family and his willingness, on numerous lengthy occasions, to cheerfully shoulder all household and parental responsibilities made the completion of this dissertation possible. I don’t know that I can ever repay what he has done for

vii me, but I look forward to spending the rest of my life trying. To him and to our beautiful boys, I dedicate this work.

viii Having a Baby the Natural Way: Primitive Bodies, Modern Women and Childbirth in Mid-Century America

Deirdre Gae Doughty, Ph.D. The University of Texas at Austin, 2013

Supervisor: Laurie B. Green

As childbirth shifted from home to the hospital in earnest in the late 1930s, many women, reacting against what they saw as a dehumanizing, assembly-line approach to labor began to search for an alternative method involving conscious delivery and an emphasis on a positive experience for the mother. Natural childbirth provided one such method and by the 1950s had become the basis of a burgeoning social movement, spawning childbirth education organizations across the United

States and sparking an outpouring of both opposition and support in magazines, newspapers, and medical texts. Other scholars have generally analyzed these early stirrings of interest in alternative birthing practices in relation to what would later become the more activist and more explicitly feminist challenge to medicalized childbirth in the 1970s and 1980s. My dissertation moves beyond this focus to examine the origins of natural childbirth in late-nineteenth-century thinking on

“primitive” and “civilized” birth and then looks at the ways that physicians, pundits, journalists and mothers themselves reinterpreted and shaped that thinking during the post WWII years in the United States. Using photographs and articles from ix medical journals and the popular press, along with hundreds of letters and surveys from natural childbirth participants, I focus on three running threads. One, I examine the ways that advocates of natural childbirth relied on ideas of “primitive” versus “civilized” or “modern” birth—ideas deeply imbued with notions of bodily difference and class status. On a related point, I also look at the ways that women’s experiences of childbirth discursively marked their level of civilization or modernity. Two, I examine the fact that natural childbirth proponents paradoxically both associated the method with concepts of “nature” and “primitivity” and stressed its derivation from and basis in “modern science.” I look at how this alliance with

“modern” medicine constructed natural childbirth as a distinctly “modern” method.

Three, I analyze the ways that the rhetoric and theory of natural childbirth reflected contemporary understandings of femininity, as well as the ways that popular media representations of, and women’s participation in, natural childbirth helped to complicate and reshape these cultural perceptions.

x

Table of Contents

List of Figures ...... xiii

Introduction ...... 1

Chapter 1 Painless Parturition and the Overcivilized Woman: The Origins of Natural Childbirth ...... 24

Chapter 2 Modernizing “Civilized” Childbirth: American Childbirth Practice and Rhetoric in the 1920s and 1930s ...... 70

Chapter 3 Taking Labor Off the Assembly Line: Grantly Dick-Read and Natural Childbirth ...... 113

Chapter 4 “Having a Baby the New Way: Natural Childbirth, Modernity and the Domestic Ideal” ...... 149

Chapter 5 “The Most Controversial Issue in Modern Medicine”: Responses to Natural Childbirth ...... 204

Conclusion ...... 245

Bibliography ...... 250

xi List of Figures

Figure 2.1: Masked and Gloved Doctor ...... 77 Figure 2.2: Streamlined Nursery ...... 78 Figure 3.1: Birth of a Baby, 1938 ...... 119 Figure 3.2: Dr. Grantly Dick-Read ...... 126 Figure 3.3: "Jungle Motherhood" ...... 140 Figure 4.1: Masked Mother ...... 163

Figure 4.2: "Natural Childbirth" ...... 164 Figure 4.3:Pelvic Rocking ...... 165 Figure 4.4:Assembly Line Mothers ...... 166 Figure 4.5:Squatting Aids Housework ...... 170 Figure 4.6:"It's a Miracle" ...... 174 Figure 4.7:"Serene Waiting" ...... 177 Figure 4.8:Bearing Down ...... 180 Figure 4.9:Mother Awake ...... 181 Figure 4.10:Mother Unconscious ...... 182 Figure 4.11:Absent Mother ...... 183 Figure 4.12:Forgotten Delivery ...... 185 Figure 4.13:Forlornly Waiting ...... 190 Figure 4.14:No Road ...... 191 Figure 4.15:Labor at Home ...... 192 Figure 4.16:Universal Suffering ...... 195 Figure 4.17:Hard Work ...... 196

Figure 4.18:Joy, Part 1 ...... 197

xii Figure 4.19:Joy, Part 2 ...... 198

xiii Introduction

In 1953, Dr. Grantly Dick-Read, the so-called father of natural childbirth, embarked on a journey thru the countries of central and southern Africa to observe the childbirth practices of, as he put it, “those tribes which had retained their ancient customs“ as “the Africans least associated with Europeans.”1 In undertaking this childbirth safari and his search for untouched “Africans,” Dick-Read hoped to confirm his belief that “the civilized way of life (had) taken the power of naturalness” from women, turning childbirth into a painful, fear-filled experience. 2

After comparing “the processes of birth in the jungle” with those “among the white races” that he had “supervised in the modern city hospital,” Dick-Read determined, to his “great satisfaction,” that he was, indeed, correct.3 Birth among “primitive” women, he believed, remained “normal, natural” and pain-free.

This “African safari” validated for Dick-Read the basis of his method for

“natural childbirth”—a method that relied on education about the birth process and relaxation exercises during labor to relieve pain and that posited that, in his terms,

“civilized” women could “restore” pain-free birth by “relearning” from “primitive” women how to labor “without fear.” In order to achieve this natural childbirth,

1 Grantly Dick-Read, "Jungle Childbirth and Motherhood," Parents Magazine, July 1955, 44. Dick-Read did not legally hyphenate his name until 1958, a year before he died. Therefore, anything written before then refers to him as Grantly Dick Read. I have left those references unchanged, but refer to him myself and cite his written work using the hyphenated version of his name, Dick-Read. His method of natural childbirth was known as the Read Method and I refer to it as such. 2 Grantly Dick-Read, "Childbirth Without Fear and Without Pain; Condensation," Ladies' Home Journal, June 1957, 150. 3 Dick-Read, "Jungle Childbirth and Motherhood," 43. 1 however, “a woman could not make the mistake of thinking it easy.” He stressed that natural childbirth was, in fact, a “science” and it took “perseverance and serious application to acquire the correct approach and technique.” If a woman succeeded in this hard work though, her rewards were great—she achieved her “highest calling” and gained “perfect motherhood.”4

Dick-Read’s account of his travels and his description of his theory and the work and rewards involved with it were published in Parents magazine and the

Ladies’ Home Journal in the 1950s. That two different mass publication magazines chose to feature his work is indicative of the huge interest in natural childbirth then—an interest that Dick-Read had actually helped to foment a decade earlier with the publication of his book Childbirth Without Fear. The period between the mid-1940s and the mid-1960s, in fact, saw an outpouring of both opposition and support for the method in magazines, newspapers, and medical texts as well as the emergence of natural childbirth education groups across the United States.

Dick-Read’s articles do more than provide evidence of interest in his method, however. They also illustrate, in their contrast of “natural” “African” birth practices in the “jungle” with “civilized” “white” birth in “modern” hospitals, the deep reliance of natural childbirth theory on racialized notions of primitivity, civilization, and modernity. They also, in their emphasis on the “science” and learned “technique” of the method, indicate the degree to which natural childbirth, in spite of the method’s focus on the natural, was not, in fact, unmediated by medical science and authority.

4 Dick-Read, "Childbirth Without Fear and Without Pain; Condensation," 72, 150. 2 In addition, Dick-Read’s discussion of the rewards of motherhood for women reveals the important association between natural childbirth and ideals of femininity.

My dissertation examines how physicians, pundits, journalists and mothers themselves engaged with these interrelated conceptions of femininity, primitivity, civilization, modernity, and medical science in the context of natural childbirth.

Specifically, I look at the complexities and contradictions within natural childbirth rhetoric and practice, both how and why they emerged in the early twentieth century and then how they changed and were both reinforced and contested in the postwar period. I focus on three running threads. One, I examine the ways that advocates of natural childbirth relied on ideas of “primitive” versus “civilized” or

“modern” birth—ideas deeply imbued with notions of bodily difference and class status. On a related point, I also look at the ways that women’s experiences of childbirth marked their levels of civilization or modernity. Two, I examine the fact that natural childbirth proponents paradoxically both associated the method with concepts of “nature” and “primitivity” and stressed its derivation from and basis in

“modern science.” I highlight the emphasis that promoters placed on this later aspect of the method and look at the ways that this alliance with “modern” medicine constructed natural childbirth as a distinctly “modern” method. Three, I analyze the ways that the rhetoric and theory of natural childbirth reflected contemporary understandings of femininity, as well as the ways that popular media

3 representations of, and women’s participation in, natural childbirth helped to complicate and reshape these cultural perceptions.

Throughout I pay close attention to the terms “primitive,” “civilized,” and

“modern.” My sources depended heavily on these terms from the late-nineteenth century to the 1960s to mark and define womanhood, as well as experiences and practices of childbirth and types of medical interventions. However, these terms were neither static nor uncontested. The designation “primitive,” for example, was most often used around the turn of the century in contrast to “civilized,” but by the mid-twentieth century “modern” generally took the place of “civilized” in that dyad—a dyad that then had different implications in the later context. These shifts in meaning and use of terms in the context of natural childbirth are part of what I examine in this project.5

Scholars who have looked at the early stirrings of interest in alternative birthing practices generally analyze them in relation to what would later become the more formal, more activist, and more explicitly feminist challenge to medicalized childbirth in the 1970s and 1980s.6 While, I, too, consider the

5 For stylistic reasons, in the remainder of the text I generally drop the cumbersome quotation marks when using the terms “primitive,” “civilized” and “modern” unless directly quoting my sources. I remain aware, however, of their freighted and context-specific meanings. 6 The main work to address natural childbirth in the postwar period includes Donald Caton, What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present (New Haven: Yale University Press, 1999); Margot Edwards and Mary Waldorf, Reclaiming Birth: History and Heroines of American Childbirth Reform (Trumansburg, N.Y.: Crossing Press, 1984); Margarete Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960 (Westport, CN: Greenwood Press, 1984); Richard W. Wertz and Dorothy C. Wertz, Lying-In: A History of Childbirth in America (New Haven: Yale University Press, 1989); Jacqueline H. Wolf, Deliver Me from Pain: Anesthesia and Birth in America (Baltimore: Johns Hopkins University Press, 2009). Rebecca Plant has a chapter on natural childbirth in the 1940s 4 relationship between postwar natural childbirth and later feminist birth reform efforts, my dissertation expands on this focus to examine the origins of natural childbirth theory in late-nineteenth century thinking on primitive and civilized birth and the ways that mid-century natural childbirth rhetoric and practice reinterpreted and shaped that thinking.

While other scholars of childbirth have noted Dick-Read’s equation of

“natural” birth with “primitive” women, my work is the first not only to analyze in depth the reliance of mid-century natural childbirth rhetoric and theory on these constructs, but also to elucidate the ways that this rhetoric worked to mark women themselves, through their experiences of childbirth, as “civilized” or “primitive” and

“modern” or “un-modern.” My work is also the first to place the rhetoric of mid- century natural childbirth within the much longer history of Western thought on painless, primitive birth and painful civilized birth.7 Dick-Read’s ideas in this area did not originate with him and his contemporaries. As some scholars of medicine and of race have shown, long before his ideas became prominent, Europeans and then Americans interpreted practices and experiences of childbirth as markers of primitivity and civility—designations that both drew from and reinforced through early 1960s and looks at it in relation to changing concepts of motherhood. Rebecca Jo Plant, Mom: The Transformation of Motherhood in Modern America (Chicago; London: The University of Chicago Press, 2010). Judith Leavitt discusses natural childbirth as part of the transition of fathers into the delivery room. Judith Walzer Leavitt, Make Room for Daddy: The Journey from Waiting Room to Birthing Room (Chapel Hill: University of North Carolina Press, 2009). Laura Ettinger looks at postwar natural childbirth in relation to the emergence of the profession of nurse-midwives. Laura Elizabeth Ettinger, Nurse-Midwifery: The Birth of a New American Profession (Columbus: Ohio State University Press, 2006). 7 Sociologist Sheryl Nestel provides an excellent analysis of the ways that later birth reformers, those in the 1970s to the 1990s, relied on the trope of primitive birth and drew from two prominent nineteenth-century publications on the subject. 5 conceptions of bodily difference and social status.8 Jennifer Morgan, for example, demonstrates that for early modern Europeans the issue of “savage” women’s seeming ease and lack of pain in birth was a central component in inscribing racial hierarchy and social standing.9 Arguing that the deep and enduring influence that ideas about primitive versus civilized birth had on natural childbirth in the mid- twentieth-century was due, in part, to their very longevity and utility,10 I link together and expand on this scholarship on medicine and race to trace the emergence of ideas about primitive versus civilized birth through to the late- nineteenth and early-twentieth century. 11 I then look at how this dichotomy

8 I refer here to Jennifer L. Morgan, "Some Could Suckle over their Shoulders: Male Travelers, Female Bodies and the Gendering of Racial Ideology, 1500-1770," The William and Mary Quarterly 54, no. 1 (1997). Jennifer L. Morgan, Laboring Women : Reproduction and Gender in New World Slavery, Early American Studies. (Philadelphia: University of Pennsylvania Press, 2004); Kathleen M. Brown, Good Wives, Nasty Wenches, and Anxious Patriarchs: Gender, Race, and Power in Colonial Virginia (Chapel Hill: Published for the Institute of Early American History and Culture by the University of North Carolina Press, 1996); Patricia Jasen, "Race, Culture, and the Colonization of Childbirth in Northern Canada," Social History of Medicine 10, no. 3 (1997); Laura Briggs, "The Race of Hysteria: 'Overcivilization' and the 'Savage' Woman in the Late Nineteenth-Century Obstetrics and Gynecology," American Quarterly 52, no. 2 (2000). 9 Morgan, "Some Could Suckle over their Shoulders: Male Travelers, Female Bodies and the Gendering of Racial Ideology, 1500-1770," 168. I wish to thank Jessica Luther for bringing Morgan’s work to my attention. 10 Morgan makes a similar argument concerning sexual stereotypes of African American women in the nineteenth and twentieth centuries—that the powerful nature of these stereotypes was due to the depth and utility of their roots in early European ideas and misconceptions about black female sexual and reproductive behavior. See Morgan, Laboring Women : Reproduction and Gender in New World Slavery: 7. 11 I am also influenced by Gail Bederman’s discussion of “civilization” as an “explicitly racial concept” that “denoted a precise stage in human racial evolution”—a stage that represented the pinnacle of evolution and followed the “more primitive stages of ‘savagery’ and ‘barbarism.’” See Gail Bederman, Manliness & Civilization: A Cultural History of Gender and Race in the United States, 1880- 1917 (Chicago: University of Chicago Press, 1995), 25. I am influenced, too, by Matthew Jacobson’s discussion of “civilization–as-whiteness and savagery-as-non-whiteness.” See Matthew Frye Jacobson, Whiteness of a Different Color: European Immigrants and the Alchemy of Race (Cambridge, Mass.: Harvard University Press, 1998), 145-49. 6 informed interpretations of natural childbirth rhetoric and practice in the mid- twentieth century.

I am also inspired by Carolyn de la Pena’s work on the drug-assisted twilight sleep method of childbirth of the early twentieth century. She argues that followers of the method believed that twilight sleep allowed the restoration of “natural, primitive” birth, because it placed women in an unconscious state, permitting their minds to rest while their bodies worked.12 I find that this focus on turning off the

“civilized” mind to allow the “primitive” body to labor naturally inheres in ideas of natural birth into the postwar period.

In addition to introducing an examination of the method’s reliance on class- based and racialized ideas of primitivity into the analysis of postwar natural childbirth, and looking at the endurance of the “civilized” mind/”primitive” body disconnect, I also provide a new interpretation of the method’s association with the changing concepts of “nature.” Other scholars, while they have noted the tendency of Dick-Read and other promoters of natural childbirth to reinforce the medical authority of doctors over childbirth, have tended to focus on the method’s emphasis on “natural” and have overlooked its strong reliance on and association with medical science. They have therefore characterized the method as one that embraced nature as a process preferable to—or even outside of—modern

12 Carolyn Thomas De la Pena, "Removing a Nail from the Lady's Foot: Twilight Sleep and the Struggle for "Natural" Birth" (M.A. Thesis University of Texas at Austin, 1996). 7 medicine.13 While this view of nature and natural childbirth did exist in the 1940s through the early 1960s it did not come to dominate until the childbirth reform movement of the 1970s. I find, instead, evidence that the equation of natural childbirth with modern science and medicine prevailed among supporters in the postwar period and that this had important implications for shaping representations, and marking practices, of birth in relation to notions of modernity.

My work also contributes to the discussion among scholars of childbirth and among scholars of women’s and gender history on postwar domesticity. The years spanning the mid-1940s and the mid-1960s were in some ways characterized by a

Cold War pronatalist, family-focused “reaffirmation of domesticity that rested on distinct roles for men and women.“14 This “domestic revival” reinforced, in part, what Betty Friedan decried in 1963 as the “feminine mystique,” an ideology that stressed female deference and fulfillment in the duties of home and motherhood. Yet historians have demonstrated that the era embodied more complicated understandings and practices of womanhood than that of the “domestic ideal.”15 In addition, as historian Nancy Walker points out, even the domestic ideal itself could

13 See Plant, Mom: The Transformation of Motherhood in Modern America: ; Mary Thomas, Post-war Mothers: Childbirth Letters to Grantly Dick-Read, 1946-1956 (Rochester, NY: University of Rochester Press, 1997), 23, 51; and Wertz and Wertz, Lying-In: A History of Childbirth in America: 178. 14 Elaine Tyler May, Homeward Bound: American Families in the Cold War Era (New York: Basic Books, 1988), xiv. 15 For examples of alternatives to the domestic ideal see Joanne J. Meyerowitz, Not June Cleaver: Women and Gender in Postwar America, 1945-1960 (Phliadelphia, PA: Temple University Press, 1994). 8 embody a variety of meanings. She argues that the “domestic” was a “contested and negotiated concept rather than a proscribed and stable one.”16

Some scholars of childbirth argue that portrayals of natural childbirth mothers in this period aligned with dominant cultural expectations for women to conform to middle-class ideals of feminine domesticity. Marguerite Sandelowski, for example, argues that natural childbirth was “informed by the feminine mystique, with its emphasis on the home, family, and motherhood” and thus it “served to highlight the extent to which a woman’s happiness in childbirth was vital” to her sense of self-worth and the “harmony of the family.”17 I find that while both representations of natural childbirth in the mainstream popular media and mothers themselves might have characterized childbirth as an important, fulfilling moment in a woman’s life, they complicated the notion of quiescent, femininity inherent in the domestic ideal by emphasizing women’s active, conscious participation in birth and their insistence on giving birth on their own terms. These findings both complicate Sandelowski’s argument regarding natural childbirth’s simple alignment

16 Nancy A. Walker, Shaping Our Mothers' World : American Women's Magazines, Studies in Popular Culture (Jackson: University Press of Mississippi, 2000), vii; Nancy A. Walker, Women's Magazines 1940-1960: Gender Roles and the Popular Press (Boston, MA: Bedford/St. Martin's, 1998). 17 Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960: 114; For a similar discussion see also Wertz and Wertz, Lying-In: A History of Childbirth in America: 181-86; Similarly Jacqueline Wolf notes that natural childbirth, in articles on the subject that featured “picture-perfect” images of mothers, “seemed to guarantee that women would maintain an appropriate appearance and countenance throughout labor” therefore upholding expectations for the domestic ideal. See Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 161. Wolf does acknowledge that natural childbirth images portrayed strong, confident women, especially compared to images of anesthetized birth, and she argues that these images were necessary to feminist birth reform, but she seems to place the occurence of such images only during the feminist birth reform movement of the 1970s. I argue that images and representations of women insisting on being awake and participating in birth, representations that first appeared in the 1940s, also worked to challenge the notion of quiescent postwar femininity. See Wolf, p. 158. 9 with the ideals of the feminine mystique and add to the evidence of a complex ideology of domesticity.

On a related note, most scholars who look at natural childbirth in the postwar period, though they see it as an important prelude to the later feminist birth reform movement, stress its focus on achieving a positive and satisfactory experience of birth, rather than an empowering one.18 Some even see it as

“distinctly antifeminist” in its focus on achieving satisfaction through childbearing.19

Supporters of natural childbirth did primarily seek a positive birth experience.

However, I find that they openly defied medical dictates and social conventions in order to achieve the childbirth experience they wanted and insisted on active participation in and control over the births of their babies. In doing so, they demonstrated agency and, in some cases, empowerment.

Though my project focuses on natural childbirth in the mid-twentieth century, it necessarily begins, in the first two chapters, with an examination of the origins and development of natural childbirth philosophy and rhetoric and the social and medical context of childbearing that supporters of natural birth opposed.

Just as Dick-Read did, many in the nineteenth century associated painless and easy

18 Plant, Mom: The Transformation of Motherhood in Modern America; Wertz and Wertz, Lying-In: A History of Childbirth in America. The exception here is Edwards and Waldorf, Reclaiming Birth: History and Heroines of American Childbirth Reform. The authors see “stirrings of protest” in the postwar period, but focus on only a few birth reform leaders rather than the mothers who chose natural childbirth. See Edwards and Waldorf, pp. 29-68. 19 Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960: 136. 10 births with “primitive” peoples (primitive almost always meaning non-white or ambiguously white and/or lower or working class.) By contrast, the childbirth experiences of so-called civilized women—civilized almost always meaning middle- and upper-class white—were depicted as acutely, even unbearably, painful.

However, beginning in the late-nineteenth century, some, worried about declining birth rates among native-born Americans in the face of massive immigration, began to look for ways to ameliorate agonized, painful birth.

Influenced by changing conceptions of the origin and purpose of pain, as well as by theories of neurasthenia that emphasized the ill effects of urbanization, mechanization, and the increasingly fast-paced character of everyday life on the mind and body, many medical authorities and social pundits began to see childbirth pain in women as the result of the damaging condition of civilization itself, rather than as something biologically inherent to their race and class.20 They believed that the seemingly easy, painless births of primitive women, by contrast, were “natural” and normal and began to look for ways that would allow civilized women to experience childbirth in this “natural,” easy, painless manner. The Twilight Sleep

Movement of the 1910s, which was taken up by suffragists concerned not with the birth rate but with the emancipation of women from the trials of childbirth, represented the first concerted attempt by American women and their doctors to return the “natural” birth experience to “civilized” women through emulation of

20 “Civilization,” an historical concept that changes in meaning over time, means here both the highest level of advancement along a continuum of human social evolution and an advanced state of technological and scientific progress. 11 “primitive” birth. The method achieved the result of “natural” birth by using drugs to render the mother semi-conscious and unaware during birth, thus disconnecting her mind from the process and allowing her body to labor “naturally” on its own.

That a relationship between primitive, civilized and natural permeated the thinking of those involved in childbirth in the twentieth century is not altogether surprising. The search for a “natural” process unadulterated by civilization was not confined to practices of parturition. Historians have demonstrated the pervasiveness of anxiety in late-nineteenth and early-twentieth-century America about perceived failings of civilization and suspicions of the ill effects of modernity on the mind and body.21 However, my work shows that these concerns about civilization, in relation to dysfunctional childbirth, continued well into the mid- twentieth-century, albeit with important changes.

Certainly, as birth moved into the hospital in the 1920s and 1930s—a move, in part, ushered in by the hospital-based drug regimens of Twilight Sleep and its promise of pain-free labor and delivery—doctors and social pundits remained concerned about pain and dysfunction in childbirth among white middle- and upper-class, or “civilized,” women. At the same time many also believed that the level of medical care that a woman received during childbirth was “an index of the

21 For example see Bederman, Manliness & Civilization: A Cultural History of Gender and Race in the United States, 1880-1917; T. J. Jackson Lears, No Place of Grace: Antimodernism and the Transformation of American Culture 1880-1920 (New York: Patheon, 1981); Roland Marchand, Advertising the American Dream: Making Way for Modernity, 1920-1940 (Berkeley: University of California Press, 1985). 12 advancement of that civilization.”22 Concerns over dysfunctional civilized birth were complicated during this era, then, by reports that placed the United States near the top in a list of maternal mortality rates in “civilized nations.” This ranking called into question America’s level of civilization, a worry exacerbated as America moved into the Depression and more women encountered levels of poverty and malnourishment that impacted healthy childbirth and raised infant mortality rates.

Significantly, these worries over America’s level of civilization and the damaging effects of civilization on childbirth occurred during an era when

Americans in general held medical science, perceived as a product of civilization, in very high regard. Primed to believe in the promise of medicine through mainstream popular media coverage of medical breakthroughs and “heroic” doctors, the general public showed a tremendous enthusiasm for medical progress from the late- nineteenth century into the 1960s.23 Paradoxically, then, even as some worried about the damaging effects of civilization on childbirth, many came to believe that civilization offered its own remedy to dysfunctional birth in the form of medical technology and pain-reliving drugs. Increasingly women who gave birth in the hospital—and by 1940 fifty-five percent of all women did—underwent a routine series of procedures that involved administration of pain-relieving drugs, unconsciousness at delivery, and the removal of the newborn to a nursery where it remained except for rigidly scheduled feeding times. Like Twilight Sleep, which

22 Howard Wilcox Haggard, Devils, Drugs, and Doctors: The Story of the Science of Healing from Medicine-Man to Doctor (New York and London: Harper & Brothers, 1929), 3. 23 Bert Hansen, Picturing Medical Progress from Pasteur to Polio: A History of Mass Media Images and Popular Attitudes in America (New Brunswick, N.J.: Rutgers University Press, 2009), 10. 13 some doctors actually still used, these methods worked to turn off a woman’s mind and allow her body to work “naturally.” This drug-assisted hospital birth, or

“streamlined birth” in the words of the day, promised pain-free, efficiently managed birth and proved a major motivation for women to seek “modern” hospital birth. 24

Thus, a new narrative of birth emerged—that of “modern” birth”—alongside the different, but related, narrative of civilized birth.25 In this newer narrative, modern medical intervention in childbirth overcame the damaging effects of civilization in childbirth and users of these modern interventions were implicitly marked as modern themselves.

This shift in rhetoric was highlighted by the emergence, at the same time, of a new understanding of the birth experiences of lower class and African American women. Amidst concerns over maternal mortality, medical authorities began to acknowledge, in popular and medical texts, that women in these groups did experience painful, difficult birth, rather than the easy birth of primitive women.

However, discussions of their dysfunctional births did not include the remedy of modern medical intervention. Even as the majority of births moved to the hospital,

24 Strikingly prevalent in the popular and medical literature during this period, the term “modern” as it is used in my sources in the 1930s through the 1960s, could mean, by my interpretation, many things: 1) of the present time, not old; 2) of, or having the characteristics of, a rationalized, industrial society or process; 3) representing, or having a faith in, progress through science, technology, and expertise; or 4) any combination thereof. I use “modern” here and when discussing the postwar period to mean a combination of definitions (2) and (3). 25 I see the notion of civilized birth as being rooted in ideas of physical and mental degeneration, that is, the experience of civilized birth was located in the body. Civilized women, the thinking went, experienced pain and danger during childbirth because of physical and mental changes brought about by their higher level of civilization. Modern birth, by contrast, was more about access to modern medical science and technology. Modern women were able to override the physical and mental debilitations caused by civilization through the use of modern medical technology. 14 many women in rural and urban working-class areas had limited access to medical care and generally, whether by choice or circumstance, had their babies at home under the care of a lay or professional midwife.26 Because they bore their children in a non-medicalized setting without a doctor in attendance, birth among these often lower class and African American women was portrayed not as primitive, but as outside of the modern, as were the women themselves—a characterization, as we shall see, that lasted well into the 1960s.

World War II and its aftermath wrought social and cultural changes that affected anew the choices that women had in giving birth, as well as what they perceived as desirable in that situation. As the tenor and strength of anxiety surrounding the threatening aspects of modern technology shifted, Americans, in general, sought solace with a renewed focus on home and family, which occurred along with a tremendous spike in the birthrate, and an emphasis on the fulfilling aspects of domesticity and motherhood for women. Though ideas about how to achieve painless “natural” birth had been around since the mid-nineteenth century, it is in this context that we first see intense interest in the method known as natural childbirth. Americans in the postwar period continued to hold modern medicine in

26 See Neal Devitt, "The Transition from Home to Hospital Birth in the United States, 1930- 1960," Birth and the Family Journal 4(1977); Barbara Ehrenreich and Deirdre English, Witches, Midwives, & Nurses, 2nd ed., Contemporary Classics. (New York: The Feminist Press at CUNY, 2010); Ettinger, Nurse-Midwifery: The Birth of a New American Profession; Gertrude Jacinta Fraser, African American Midwifery in the South: Dialogues of Birth, Race, and Memory (Cambridge, Mass.: Harvard University Press, 1998); Linda Janet Holmes, African American Midwives in the South, ed. Pamela Eakins, The American Way of Birth (Philadelphia: Temple University Press, 1986); Judy Barrett Litoff, American Midwives, 1860 to the Present (Westport, Conn.: Greenwood Press, 1978); Susan Lynn Smith, Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America, 1890-1950 (Philadelphia: University of Pennsylvania Press, 1995). 15 high regard. Indeed the need for improved pharmacology and new medical practices during World War II both facilitated the development of advances in these areas and increased the esteem that many held for doctors and hospitals. However, at the same time, the horrors of World War II and the introduction of nuclear warfare exacerbated feelings of anxiety regarding technological modernity and effected a widespread sense of alienation. Many sought to rectify these feelings with meaningful personal experience.27 As hospital births became the norm, some women began to be unhappy with drug-assisted birth. Rather than perceiving benefits in “streamlined” birth, they referred to the impersonal, dehumanizing effects of “assembly-line” birth that served to mechanize the process of childbearing, as well as to rob the mother of the supposedly psychologically important and personally fulfilling experience of witnessing the birth of her baby. Within the context of both widespread esteem for medical science and feelings of anxiety about the menacing and degrading effects of science and technology, they sought instead an alternate solution—one that was medically-based and “modern,” in that it relied on an expert-devised, rationalized system and represented progress in medicine, but that would nevertheless allow them to actually experience pain-free, easy birth and remain awake and aware throughout labor and delivery.

The method of Grantly Dick-Read provided one such solution. Like his predecessors in obstetrical medicine, Dick-Read was concerned with ways that the

27 For discussions of postwar anxiety and the search for authentic personal experience see Philip Joseph Deloria, Playing Indian, Yale Historical Publications. (New Haven: Yale University Press, 1998), 129-33; and Douglas C. Rossinow, The Politics of Authenticity: Liberalism, Christianity, and the New Left in America (New York: Columbia University Press, 1998), 2-5. 16 “civilized” or “modern”28 mind interacted with the “natural” physical process of childbirth—and, as we saw in his childbirth safari, he looked to “primitive” birth as the model for natural birth. Unlike others, however, who believed that drugs represented the best way to allow a mother’s body to labor productively, Dick-Read believed that in order to restore the supposedly painless experience of primitive women a mother should forgo drugs as much as possible and focus instead on reeducating her mind to eliminate fear and on practicing relaxation techniques during labor to disconnect the mind during childbirth. In facilitating a conscious, personal experience of birth, Dick-Read’s method became the basis of an intense interest in natural childbirth during the postwar period. It is this postwar interest in natural childbirth—the rhetoric and representations surrounding it, as well as the actions and reactions of both the supporters and detractors of the method—that forms the basis for my last three chapters.

In Chapter One, I trace the origins of ideas about primitive, painless birth versus dysfunctional civilized birth and then look at late-nineteenth- and early- twentieth-century methods to restore primitive, natural birth to civilized women

This chapter culminates in a discussion of the method of Twilight Sleep—its emergence in the 1910s from the discourse of neurasthenia, and its basis in the

28 My sources during this period tended to use the terms “civilized” and “modern” interchangeably. While “civilized” connoted a level of advancement along a continuum of social evolution and “modern” a level of advancement along a continuum of scientific and technological advancement, the two conditions were seen to go hand in hand. Both terms were used in contrast to “primitive,” a term that implied a lack of both social and technological advancement. 17 belief that modern (over)civilization caused a degeneration of childbearing.

Promoters of Twilight Sleep, a childbirth method that used drugs to blot out the memory of labor and make the mother unconscious during delivery, characterized a birth as “natural” if the “overcivilized” mind was “turned off” during labor to allow the “primitive” body to work unimpeded.29 I argue that this belief—that civilization made birth dysfunctional for women, and that only through restoring primitive function by circumventing the civilized mind could modern women enjoy a natural, that is, easy, pain-free delivery, was crucial to shaping the ideology of natural childbirth in the mid-twentieth century.

Chapter Two analyzes shifts in the rhetoric of primitivity, civilization and modernity in childbirth within the context of the transition from home to

“streamlined,” drug-assisted birth and concerns over high US maternal mortality and sees the 1920s and 1930s as important transitional years between the Twilight

Sleep era and the natural childbirth era of the postwar period. “Streamlined” or

“modern” birth offered a type of birth based on the methods of medical science that rivaled the easy, pain-free experience of “primitive” women by disconnecting the mind during labor and delivery. I argue that this had important ramifications for the development of natural childbirth—not only because it was “streamlined” birth that natural childbirth supporters reacted against, but also because supporters of natural childbirth used a similar model to restore natural, primitive childbirth to civilized

29 De la Pena, "Removing a Nail from the Lady's Foot: Twilight Sleep and the Struggle for "Natural" Birth." 18 women. They, too, sought to disconnect the civilized mind from the body with the aid of modern medical science—but with limited, or no use of, drugs.

Chapter Three shifts to focus on the period from the mid-1940s to the mid-

1960s—where the focus remains until the end of the dissertation. Here I analyze the theory and rhetoric of Dick-Read’s method of natural childbirth to argue that his reliance on and understandings of the notions of “natural” primitive birth versus painful modern birth worked to assign meanings of race and class to the concept of modernity. In addition his rhetoric, in its emphasis on male medical authority and the importance of childbirth and motherhood to women, reinforced a particular construction of postwar modern American womanhood that aligned with the dominant conception of the domestic ideal—it posited that women should find fulfillment as wives and mothers and nowhere else.

At the same time, while Dick-Read looked to the example of “natural” primitive birth as an antidote to the dehumanized, mechanized process of assembly- line birth, he nevertheless constructed an elaborate medical theory regarding the origin and resolution of childbirth pain and promoted a structured system of physical and relaxation exercises to achieve natural birth. In this respect he developed and promoted a modern medical intervention to correct the pain- inducing effects of civilization.

In Chapter Four my analysis of representations of natural childbirth in the mainstream popular press reveals that the association between the method and medical science went beyond Dick-Read’s theory and rhetoric. Promoters of natural

19 childbirth, too, though they rejected the so-called modern, assembly-line characteristics of medically managed anesthetized birth, often described the method in terms that emphasized its use of the “latest” medical advances and “scientific” theories. They did not portray a “back to nature” experience, but rather one that was squarely positioned within the context of modern, medical science—a portrayal that is not surprising given Americans’ high regard for science and medicine during this era. This alliance of natural childbirth with modern medicine defined it as a modern method and its users as modern themselves—a designation that connoted technological advancement and individual agency. Because representations of natural childbirth focused exclusively on white, middle-class women, they help to define “modern” womanhood as white and middle-class. This construction of

“modern” femininity is highlighted by contrasting it with the single representation of non-white, lower-class birth in the mainstream popular press during this period—a representation that portrays African American birth as outside of modernity rather than as the painless, easy birth of a primitive woman.

Chapter Four also looks at the way that representations of natural childbirth both adhered to and complicated notions of the domestic ideal. I argue that while representations of natural childbirth did emphasize fulfillment in motherhood, they also featured women determined to achieve conscious participation in childbirth and focused on women who were awake and active during the birth process—in contrast to representations of anesthetized birth which, if they showed the mother at all, revealed women who were absent from the births of their babies. Thus

20 representations of natural childbirth challenged notions of female deference and provided evidence of a complex ideology of domesticity.

Where Chapter Four looks at journalist representations of natural childbirth and discussion as it took place in popular magazines and other media, Chapter Five focuses directly on the mothers themselves and their words and actions expressed in letters reproduced in magazines and in hundreds of letters written to Grantly

Dick-Read and the Boston Association of Childbirth Educators. It analyzes the

“storm over natural childbirth,” that is, the controversy surrounding the method that persisted throughout the postwar period and the explosion of women’s action—writing letters, talking with friends, and forming childbirth education groups—that surrounded natural childbirth during this period.30 I argue that disagreement over natural childbirth was about more than how women should give birth. For many, what was at stake was how to define modern femininity.

Participants on both sides of the debate drew from multiple, often similar, understandings of natural childbirth to construct a variety of often contradictory meanings of the method and characterizations of the women who chose it. The controversy surrounding natural childbirth was also one about control. Though by no means an overtly feminist response, as it often was in the 1970s and 1980s, to medical control over women’s bodies, natural childbirth nevertheless represented a challenge to many doctors who had become used to absolute authority in dictating

30 Quote from M.J.E. Senn, "Storm over Childbirth: The Most Controversial Issue in Modern Medicine," McCalls, February 1963. 21 the procedures through which their unconscious patients gave birth. Natural childbirth mothers during the postwar period pushed for childbirth on their own terms and insisted on being conscious and active within the delivery room, often physically fighting with medical attendants to achieve their goal, and thus threatening male medical authority. Their words and actions thus reveal a more complicated construction of postwar modern femininity than that of Dick-Read’s deferential mother ideal.

In researching and writing this dissertation a number of sources proved useful. Grantly Dick-Read’s published work, as well as his personal correspondence, provided the basis for my understanding of his theory, its reliance on racialized ideas of primitive birth, and his conceptions of femininity and motherhood. Medical journal articles and childbirth manuals provided both the perspective of other medical authorities and evidence of contemporary theories and practice of childbirth. The Maternity Center Association of New York City (MCA) administrative correspondence and records allowed me to understand how ideas regarding natural childbirth were formed, disseminated, and interpreted. These records also provided valuable information into midwife-assisted natural home birth among working-class mothers in New York City. Most important, however, were the prolific number of popular magazine and newspaper articles on natural childbirth published during the postwar era, as well as the over seven hundred letters women, and some doctors, wrote to Grantly Dick-Read and to the Boston Association of Childbirth

22 Educators (BACE). These materials provided a wealth of personal perspectives, both critical and supportive, as well as popular representations and perceptions of natural childbirth from the mid-1940s to the mid-1960s. They also demonstrated the level of interest and controversy in the method. Perhaps most significant, in looking at the letters and closely reading magazine articles and photographs I was able to see agency, even defiance, among supporters of natural childbirth in the postwar period, as well as more complex representations of the domestic ideal— where others who did not have access to the material or did not use them so extensively, did not.31

In looking at what these materials tell us about the origins and expansion of natural childbirth in the postwar period, my dissertation not only explains the beginnings of this subsequently influential movement in women’s health, but also reveals the important cultural implications of natural childbirth’s reliance on ideas of primitive versus civilized birth and the ways that practices and representations of childbirth marked modernity—or lack thereof—and contributed to constructions of femininity in the social context of mid-twentieth-century America.

31 Marguerite Sandelowski, for example, published her book before the Dick-Read correspondence was available. She provides an excellent analysis of the medical discourse surrounding natural childbirth and its alignment with the ideals of the feminine mystique and ultimately argues that “it is simply inaccurate” to depict “women and physicians as adversaries” over natural childbirth in the postwar period. Mary Thomas, in her introduction to an edited collection of women’s letters to Grantly Dick-Read also notes that this correspondence provides an important corrective to Sandelowski’s analysis. See Thomas, Post-war Mothers: Childbirth Letters to Grantly Dick-Read, 1946-1956: 7. Even authors who support the view that the postwar period saw protest for natural childbirth, found little evidence, because they did not have access to the Grantly Dick-Read correspondence, of a “record of women making strident demands, or any demands at all” towards obstetricians. See Edwards and Waldorf, Reclaiming Birth: History and Heroines of American Childbirth Reform: 42.

23 Chapter 1-Painless Parturition and the Overcivilized Woman: The Origins of Natural Childbirth

In June 1914, two women, Marguerite Tracy and Constance Leupp, published an article in McClure’s Magazine on a German method of childbirth known as

Twilight Sleep. Twilight Sleep, they explained, was “a light sleep,” induced by the injection of two drugs, in which the “patient loses the power of recollecting immediate events and sensations, while still remaining susceptible to suggestions and in full possession of muscular powers” during labor. This approach to childbirth necessitated that the attending physician possess a high level of training and skill and it almost always required the resources and facilities of a hospital. The result was a seemingly painless, “natural” birth process that left the highly sensitive women of the modern age free from the “nervous exhaustion” that usually attended non-Twilight Sleep births. 1

Tracy and Leupp’s article set off an extraordinary wave of inquiry and heated debate. It garnered such interest, in fact, that some described it, hyperbolically, as

“about the only subject not smothered by the European war.”2 White middle- and upper-class women across the country wrote to McClure’s asking for more information on the method and demanded to know why it wasn’t available in the

United States. Though it had been briefly available in the first decade of the twentieth century, since then most American women had had to travel to a clinic in

1Marguerite Tracy and Constance Leupp, "Painless Childbirth," McClure's Magazine, June 1914. 2Constance Leupp and Burton Hendrick, "Twilight Sleep in America," McClure's Magazine, April 1915. 24 Frieburg, Germany to avail themselves of Twilight Sleep. Subsequent articles on the topic appeared in most of the nation’s major newspapers and women’s magazines.

In a flurry of editorials, treatises, and letters in the prominent medical journals,

American doctors rushed to condemn the method, on the grounds that it was dangerous, costly, or too time consuming; or to ask, themselves, for more information. Ultimately, many physicians found patient demand for Twilight Sleep so strong that they began to offer the method in the United States and thus, along with the women that they treated, helped to usher in a new age in childbirth—one that was based in the hospital and came to rely on drugs to relieve the pain of childbearing. Though the Twilight Sleep period actually lasted for little more than a year, it therefore represents a significant turning point in the history of childbirth.

The important story of women’s push for Twilight Sleep and the influence it had in the shift to drug-assisted hospital birth is well documented.3 Most historians, however, have done little more than mention one of the more fascinating and seemingly contradictory aspects of Twilight Sleep—the fact that based on pain- relieving medication and modern medical intervention though it was, many of its followers and promoters considered it a natural approach to birth.4 To those of us in

3 See Donald Caton, What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present (New Haven: Yale University Press, 1999); Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750 to 1950 (New York: Oxford University Press, 1986); Margarete Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960 (Westport, CN: Greenwood Press, 1984); Richard W. Wertz and Dorothy C. Wertz, Lying-In: A History of Childbirth in America (New Haven: Yale University Press, 1989); Jacqueline H. Wolf, Deliver Me from Pain: Anesthesia and Birth in America (Baltimore: Johns Hopkins University Press, 2009). 4 The one major exception to the scholarship is Carolyn Thomas De la Pena, "Removing a Nail from the Lady's Foot: Twilight Sleep and the Struggle for "Natural" Birth" (M.A. Thesis University 25 the twenty-first century, most of whom are accustomed to defining natural childbirth as the antithesis of a medically and technologically defined event (that is, at the least, as a birth conducted sans pain-relieving medication and with as little technological interference as possible), the early twentieth century interpretation of

Twilight Sleep as “natural” is startling. Equally surprising, perhaps, is the fact that

Twilight Sleep has much in common with the natural childbirth of the mid-twentieth century. At the very foundation of Twilight Sleep is the belief, deeply grounded in early-twentieth-century conceptions of race and class, that the conditions of civilization had caused birth to become pathologically painful and dangerous for white middle- and upper-class, or “civilized,” women. “Natural,” “primitive” birth— seen as the province of non- white or ambiguously white, poor rural or laboring women—was a pain-free and easy undertaking in this view. Promoters of Twilight

Sleep felt that if one could simply “turn off” or “disconnect” the mind during

of Texas at Austin, 1996). De La Pena’s excellent thesis informs much of my understanding of the relationship between “primitive,” “civilized” and “natural” birth and Twilight Sleep. She argues, in part, that misconceptions about the “natural” ease of “primitive” Native American birth caused “civilized” American women to consider their own painful birth experiences abnormal. They believed that Twilight Sleep allowed —because it placed women in an unconscious state, permitting their minds to rest while their bodies worked—the restoration of “natural” birth. In this chapter I expand on her argument to highlight the race and class associations surrounding natural birth, linking the late-nineteenth-century dichotomy between primitive and civilized birth to a much older discourse of race and difference in childbirth and enlarging her focus to look at associations of “natural,” “primitive” birth with groups (African American, immigrant, working class) beyond Native Americans. I also argue that while others in the late nineteenth- and early-twentieth-century who were interested in restoring natural birth looked to physical solutions, the emphasis that Twilight Sleep supporters placed on disconnecting the mind from the body during labor endured. The racialized and class notions of primitive and civilized birth, along with the emphasis on disconnecting the mind from the body, I argue, were fundamental in the development of natural childbirth in the mid-twentieth century. I am indebted to Desley Deacon for bringing De La Pena’s thesis to my attention. See also Sandelowski in Pain, Pleasure and American Childbirth, 9-11 for a discussion of “civilized” birth in the context of Twilight Sleep and the fact that advocates of the method considered it “natural.” 26 childbirth, the body would work naturally and thus “normal” birth could be restored. This belief, that civilization or modernity robbed women of normal birth, and that only through emulating primitive childbirth by circumventing the civilized mind could modern women enjoy natural parturition, continued to underpin natural childbirth thinking through the mid-twentieth century.

This chapter traces the emergence of ideas about primitive versus civilized birth through to the ways that those ideas were reshaped by late nineteenth- and early twentieth-century anxieties about “overcivilization” and then looks at the application of these ideas in the natural childbirth methods of that era. I argue that conceptions about primitive versus civilized birth, as employed in Twilight Sleep and other “natural” childbirth methods of the period, were crucial to shaping the ideology of natural childbirth in the mid-twentieth century.

Savage Childbirth and Civilized Pain

Dr. Frank Newell, writing in 1907, summed up the thoughts of many of his contemporaries when he delineated “two distinct types” of obstetrical patients: “the one seen in hospital practice…largely composed of women of foreign birth, who have not been subjected to…the high requirements (nervous and mental demands) of modern civilization and the other in…private practice, who have been subject to those influences.” The former group, or as Newell put it, the “working woman,” reached adulthood as a “strong, healthy woman,” Newell related, and underwent pregnancy and childbirth safely and without “reacting unduly either to the pain or

27 muscular effort which she undergoes.” The latter group, on the other hand, the

“civilized woman,” was “unfit to withstand any serious strain” and when in labor

“pain of even moderate degree (was) apt to be endured badly and to cause an undue amount of exhaustion, both nervous and physical”—exhaustion that often resulted in later nervous breakdowns and fear of bearing further children. Ultimately, Newell believed, modern medicine must find a different way to treat this new kind of patient, “the overcivilized type,” for the “life and health” of that entire class of women was at risk.5

Setting aside for a moment the issue of perceptions of childbirth experience in the early-twentieth-century, Newell’s language here illustrates much about the way that he and his contemporaries, both medical and the general public, thought about race and class. That he is distinguishing between the two “types” of women along divisions of class is explicit. He noted that one group, the “working woman,” was “seen in hospital practice”—meaning that limited financial resources forced them to rely on the low-cost or free services of a hospital clinic. The other group, the

“civilized,” woman could afford to give birth in a “private practice.” Here “civilized” women were clearly part of the middle- or upper-class. Newell’s use of the term

“civilized” also connoted race, however. Based on a scale that marked human racial advancement from “savagery” to “barbarism” to the pinnacle, “civilization,” the

5 Franklin S. Newell, "The Effect of Overcivilization on Maternity," American Journal of the Medical Sciences 136, no. 4 (1908): 533-36. Judith Leavitt notes that “Newell’s perceptions that the robust health of working women contrasted to the frailty of affluent women is more evident rhetorically in the medical literature…than it is in the case reports.” Nevertheless, “it seems to have informed the ideology behind many physicians’ treatment of their female patients.” Leavitt, Brought to Bed: Childbearing in America, 1750 to 1950: 68. 28 word “civilized” at the turn-of-the-century marked the bearer of the term as belonging at the highest stage of human racial evolution, a stage which, so far, presumably included only whites of Northern European descent. Civilization, in other words, and the state of being “civilized,” implied whiteness. Contemporary readers, familiar then with the class based and racialized concepts of civilization, knew that Newell’s description of difficult “civilized” birth pertained only to white middle- and upper-class women. Newell’s description of “women of foreign birth” is also implicitly racialized. If whites alone had reached the highest level of civilization, then those outside the realm of “modern civilization”—here Newell’s foreign-born women—must necessarily be non-white. Their experience of easy birth not only marked their position on the scale of civilization, but it marked their racial position as well. 6

Newell’s differentiation here of body and birth experience within racialized and class based categories of civilization—his equation of easy birth with

“uncivilized” foreign born, working women and difficult birth with “civilized” native- born, white women—was part of a much larger discourse on women’s difference that goes back to Europeans’ earliest contact with Africans and Amer-Indians.

Europeans and Euro-Americans had a long-standing tendency to mark their own

6 For a discussion of “civilization–as-whiteness and savagery-as-non-whiteness” see Matthew Frye Jacobson, Whiteness of a Different Color: European Immigrants and the Alchemy of Race (Cambridge, Mass.: Harvard University Press, 1998), 148. For a discussion of the racial aspects of the discourse of civilization see Gail Bederman, Manliness & Civilization: A Cultural History of Gender and Race in the United States, 1880-1917 (Chicago: University of Chicago Press, 1995), 25; and for a discussion of the race and gender components of social evolutionary theory see Louise Michele Newman, White Women's Rights: The Racial Origins of Feminism in the United States (New York: Oxford University Press, 1999), 22-55.. 29 civility and others’ primitivity (as well as their own whiteness and others’ blackness) through comparison of gender customs and actual and perceived differences in sexual and reproductive behavior. As historian Jennifer Morgan argues, descriptions of women’s labor—both productive and reproductive—became particularly useful for categorizing racial difference. 7 English travellers, for example, accustomed as they were to an indoor domestic focus for women’s work, interpreted women’s prominent role in agricultural fieldwork in West Africa as evidence of a brutal life of hard labor and counted this as a mark of African savagery.

By the seventeenth century, colonial and travel literature was rife with descriptions of African women as overworked drudges—a description that not only marked them as different from their European counterparts, but also highlighted a supposed propensity for bodily strength and hard manual labor.8

Travellers to the Americas similarly interpreted native women’s work as evidence of difference and primitivity, noting that Indian women performed all the menial labor, while the men engaged in activities—hunting and fishing—that were

7 See Jennifer L. Morgan, "Some Could Suckle over their Shoulders: Male Travelers, Female Bodies and the Gendering of Racial Ideology, 1500-1770," The William and Mary Quarterly 54, no. 1 (1997). Morgan argues that through “a rubric of monstrously ‘raced’ Amerindian and African women, Europeans found a means to articulate shifting perceptions of themselves as religiously, culturally, and phenotypically superior to those black or brown persons they sought to define” in order to “mark European national identities and inscribe racial hierarchy” and that the issue of “savage” women’s pain in childbirth, or lack thereof, was a central component of these narratives. See Morgan, pp. 168, 171. See also Patricia Jasen, "Race, Culture, and the Colonization of Childbirth in Northern Canada," Social History of Medicine 10, no. 3 (1997); Kathleen M. Brown, Good Wives, Nasty Wenches, and Anxious Patriarchs: Gender, Race, and Power in Colonial Virginia (Chapel Hill: Published for the Institute of Early American History and Culture by the University of North Carolina Press, 1996); Laura Briggs, "The Race of Hysteria: 'Overcivilization' and the 'Savage' Woman in the Late Nineteenth-Century Obstetrics and Gynecology," American Quarterly 52, no. 2 (2000). 8 Brown, Good Wives, Nasty Wenches, and Anxious Patriarchs, 115. 30 deemed, in Europe, the leisure pursuits of the aristocracy. In the minds of Europeans and Euro-Americans, the overworked “squaw-drudge” marked Indian savagery in contrast to the presumed civility of Europeans who sought to protect women from strenuous labor.9

But even more indicative, at least for early modern Europeans, of difference than the work women did, were the bodies used to do that work. Images, both written and visual, of monstrous physicality—sagging breasts, for example, so long that “some… could suckle over their shoulder”—and of licentious and promiscuous female sexual behavior pervaded the travel literature of early modern Europe, helping to inscribe race through descriptions of physical difference and primitivity.10 One of the more powerful and enduring of these descriptions of bodily difference were accounts of the supposed ease of “savage” birth. This misconception—that of painless, primitive birth—was a constant theme in

European and Euro-American travel and missionary literature for over 300 years.11

9 Ibid., 58. See also Jasen, “Race, Culture and the Colonization of Childbirth,” 387 and David D. Smits, "The 'Squaw Drudge': A Prime Index of Savagism," Ethnohistory 29, no. 4 (1982). 10 Quote in John Atkins, A Voyage to Guinea, Brasil, and the West-Indies (London: Caesar Ward and Richard Chandler, 1735), 50. See Morgan, Laboring Women, 12-47 for a discussion of the ways that early modern descriptions of women’s bodies and labor helped to mark race, nationality and civility. 11 The question of whether indigenous women in Africa and the Americas suffered less in childbirth than European women must remain unanswered—in addition to the difficulties inherent in measuring the subjective experience of pain, the contemporary accounts that exist were recorded almost exclusively by males who had no access to the female world of childbearing. Patricia Jasen, notes, however, that the recorded reminisces, for example, of female native elders in Northern Canada over the last century describe a tradition of using herbs and diet to overcome the pain and potential danger of childbirth-suggesting that some so-called “primitive” women did experience pain—and that they were often assisted during labor and delivery by female helpers, though solitary births did occur. See Jasen, "Race, Culture, and the Colonization of Childbirth in Northern Canada," 384. 31 In 1553, for example, the English translation of A Treatyse of the Newe India provided this representative description of Amer-Indian birth by Amerigo Vespucci: the women “refuse no laboure al the whyle they are with childe. They travayle in maner withoute payne, so that the nexte day they are cherefull and able to walke.”12

Roughly two hundred years later Andrew Graham made this observation of Native

American pregnancy and birth:

The pregnancy of a woman does not excuse her from domestic duty. She assists with the others on every occasion; indeed they have none of those disagreeable symptoms which afflict the delicate European in such circumstances, and the American has also the advantage in parturition, their pains being very light and soon over. As a proof of this I can affirm, that women have been taken in travail while on a journey; and they only drop behind the company, bring forth the little stranger, tie it up in a cradle, and carrying it on their backs, proceed to overtake their companions as if nothing had happened. The malediction denounced on our general mother seems here to be repealed, or at least greatly mitigated.13

These descriptions of hardy, active pregnancies and easy labor, like the stereotype of overworked drudge, emphasize the physical endurance and ability to work (the women in question work all through pregnancy) of native women, but the most salient feature is the fact that they experience no pain during labor and are able to quickly and easily resume their regular tasks after birth. These accounts also highlight, at least implicitly, contemporary perceptions of European birth. Most

Europeans and, later, Euro-Americans anticipated childbirth with great dread and fear of pain, injury and death. However, most accepted the biblical dictate that

12 Sebastian Munster, A Treatyse of the Newe India, trans. Richard Eden, March of America Facsimile Series (Ann Arbor University Microfilms, Inc., 1553; repr., 1966). 13 Andrew Graham, Andrew Graham's observations on Hudson's Bay, 1767-91, ed. Glyndwr Williams (London: Hudson's Bay Record Society, 1969), 176-7. 32 women must suffer a life of pain and sorrow in childbirth as punishment for Eve’s transgression with the serpent. “Eve’s curse” made women’s suffering in parturition inevitable, but this suffering also marked them as Eve’s descendants.14 The experience of difficult and painful childbirth then became an important marker of the child bearer’s Christian civility. As civility became associated exclusively with white (northern) Europeans and Euro-Americans, painful childbirth not only marked one as civilized but also as white.

Early modern European ideas explaining “primitive” women’s absence of pain in parturition are important both for how they shaped and how they differ from later narratives of childbirth. In general, two major theories accounted for their lack of suffering. One theory considered her place—or lack thereof—within the

Christian domain. Just as European women’s pain and suffering was proof that she was descended from Eve, native women’s painless, easy births, read as an exemption from Eve’s curse, must mean they were not her descendants—an exclusion from the collective family tree that marked non-European’s lack of civility.

The other common theory likened indigenous peoples, particularly those in the New

World, to the animals with whom they shared the wilderness. Childbirth came easy to indigenous women, the thinking went, because of their animal-like self- sufficiency, bodily strength (maintained through an active and strenuous, if not overly burdensome, way of life), and instinctual reliance on and communion with

14 See Brown, Good Wives, Nasty Wenches and Anxious Patriarchs, 19; Morgan, Laboring Women, 36-37; Caton, What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present: 100-01. 33 the forces of nature. In the 1770s Englishman Edward Long, in a description of

African women’s childbirth in Jamaica, captured both the, by then, centuries-old inclination to equate native women’s behavior with that of wild animals, as well as the equally long-lived tendency to interpret their supposedly easy births as an immunity to Eve’s curse: “Their women are delivered with little or no labour; they have therefore no more occasion for midwifes than the female oran-outang, or any other wild animal. . . . Thus they seem exempted from the course (sic) inflicted upon

Eve and her daughter.”15 Both the animal-like behavior of these women, as well as the implication that they are not Eve’s daughters, and therefore not of European descent, marked them as uncivilized or primitive.

Travellers and explorers in early nineteenth-century America, building on early modern ideas, also marked difference through a discourse of civilization and primitivity based on gendered comparisons of labor and the body. Childbirth practice and experience continued to be an area ripe with contrasts. Difficult, dangerous, painful childbirth, associated almost exclusively with native-born white women, marked those with that experience as “civilized.” Easy, pain-free birth, the thinking went, belonged to Native Americans, those of Asian and African descent, and sometimes lower-class and/or immigrant laborers and thus marked them as

15 Edward Long, "History of Jamaica, 2, with notes and corrections by the Author" (I774), Add. Ms. I2405, p364/f295, British Library, London quoted in Morgan, “Some Could Suckle,” 189. See also Jasen, "Race, Culture, and the Colonization of Childbirth in Northern Canada," 387. Jasen argues that the “squaw-drudge” stereotype helped to reinforce the belief that native women were animal- like because it rested on the idea that they were treated like animals by their men, in contrast to European women “for whom civilization meant protection from base aspects of life.” See also, Brown, Good Wives, Nasty Wenches and Anxious Patriarchs, 58 and Cynthia Eagle Russett, Sexual Science : the Victorian Construction of Womanhood (Cambridge, Mass.: Harvard University Press, 1989).143. 34 primitive. In 1805 Meriwether Lewis (of Lewis and Clark fame) related, in a tale that differs only slightly from Graham’s earlier descriptions of Native American birth

(and indeed, that varies little from the narratives of “squaw” birth that would be retold countlessly for the next 150 years), how a female Indian in his employ halted in the midst of their march, set off on her own to give birth and “in about an hour… arrived with her newborn babe and passed us on her way to the camp apparently as well as she ever was.” He goes on to speculate that:

The facility and ease with which the women of the aborigines of North America bring fourth their children is reather (sic) a gift of nature than depending as some have supposed on the habitude of carrying heavy burthens on their backs while in a state of pregnancy… (T)he snake Indians possess an abundance of horses, their women are seldom compelled like those in other parts of the continent to carry burthens on their backs, yet they have their children with equal convenience, and it is a rare occurrence for any of them to experience difficulty in childbirth.16

The belief that the indigenous women in North America bore children with

“facility and ease,” was clearly widespread enough that here Lewis simply added his opinion to what seems to be an established discussion over the reasons for easy

“primitive” birth—a discussion that apparently favored native women’s burdensome lives as the probable explanation, and thus harkens back to the theory concerning their strenuous, animal-like existence. Lewis, seemingly oblivious to the fact that he himself was requiring strenuous work from this woman, suggested that the apparently easy births of Indian women must be a “gift of nature,” since the woman that he described has an easy birth, despite the fact that she has apparently

16 Meriwether Lewis, William Clark, and et al., "The Journals of the Lewis and Clark Expedition," (August 26, 1805), http://lewisandclarkjournals.unl.edu/journals.php?id=1806-09-04. 35 avoided the laborious life “of those in other parts of the continent.” Lewis’s description here not only marked native women as different from their European- descended counterparts—as primitive—but also emphasized their place in the natural world, a trait that will become increasingly important in late- nineteenth- and twentieth-century narratives of painless childbirth.

The following diary entry from Susan Shelby Magoffin, a traveller on the

Santa Fe Trail, suggests that Euro-American women, too, interpreted easy birth as a mark of primitivity. Magoffin, who described enduring “much agony and severest of pains” during labor and then sinking “into a kind of lethargy” after a birth on the

Trail, was amazed at the contrasting experience of a Native American woman who gave birth in a room below her at about the same time:

My experience was very different from that of an Indian woman…She gave birth to a fine healthy baby…and in a half an hour after she went to the River and bathed herself and it…Never could I have believed such a thing, if I had not been here…(S)ome gentleman…has often seen them immediately after the birth of child go to the water and break the ice to bathe themselves! It is truly astonishing to see what customs will do. No doubt many ladies in civilized life are ruined by too careful treatments during childbirth, for this custom of the hethen (sic) is not known to be disadvantageous, but it is a “hethenish custom.”17

Unlike Lewis, Magoffin attributed the ability of the Native American mother to quickly leave her childbed (Magoffin seems to have been “confined” for 4 days after her birth), not to “nature” but to “custom.” Though she considered that “ladies in civilized life” may be treated too carefully during childbirth and Native American

17 Susan Shelby Magoffin, Down the Santa Fe Trail and into Mexico : The Diary of Susan Shelby Magoffin, 1846-1847, ed. Stella M. Drumm (Lincoln: University of Nebraska Press, 1982), 68. Italics hers. 36 customs are not “disadvantageous,” she stressed the “hethenish” aspect of their childbirth practice—a move that highlighted their lack of Christian civility, but implied her own. Magoffin’s account of childbirth, like Lewis’s, affirmed the

“savagery” of Native Americans at the same time that it confirmed white Euro-

American civility.18

An 1852 letter from leading suffragist Elizabeth Cady Stanton to fellow suffragist Lucretia Mott also illustrates the pervasiveness of the association of easy, painless birth with “primitive” women. Writing to announce the birth of her fifth child, a large and “vigorous” baby weighing nearly twelve pounds, Stanton described her short and easy labor—lasting only fifteen minutes—and how she was able to get up immediately after the birth to change her clothes. The next day she was able to take a drive and by the third day she was “dressed and about the house as usual.”

Stanton was clearly aware that her birth experience was not considered the norm for women of her race and class, but was associated instead with “uncivilized” women. She quipped, “Am I not a savage almost, for what refined, delicate, genteel, civilized woman (would) get well in so indecently short a time?”19 Stanton mocked the ideal of the “civilized” woman through her example of “savage” birth.

18 See De la Pena, "Removing a Nail from the Lady's Foot: Twilight Sleep and the Struggle for "Natural" Birth," 19-21; Sylvia D. Hoffert, "Childbearing on the Trans-Mississippi Frontier, 1830- 1900," The Western Historical Quarterly 22, no. 3 (1991): 283-86 for discussion of the ways that Euro-American women contrasted their birth expereinces with those of Native American women to affirm their own civility. 19 Elizabeth Cady Stanton and Susan B. Anthony, The Selected Papers of Elizabeth Cady Stanton and Susan B. Anthony, ed. Ann D. Gordon (New Brunswick, N.J.: Rutgers University Press, 1997), 212.emphasis hers 37 Descriptions of and comparisons to the easy, pain-free births of Native

Americans predominated in the popular and medical childbirth narratives throughout the nineteenth century. Beginning in the mid-nineteenth century, a period characterized by growing industrialization and nativist worries over the resulting influx of immigrant workers, evidence suggests that beliefs about easy, painless primitive birth in lower-class and immigrant groups had also become culturally pervasive—indicating the degree to which the notion of primitive by this time took in degrees of whiteness and class, in addition to the longer association with non-whites. In an 1849 passage on the Water-Cure Treatment, for example,

Mary S. Gove Nichols stated, “The common Irish, the middle classes of the Scotch, the Indians, the slaves at the south, and others who might be mentioned, have little suffering in child-bearing.”20 Here Nichols lumped together groups using terms of race, class, and national origin, but they all had one thing in common—their lack of

“suffering in childbearing.” Given the pervasiveness of the association of easy, pain- free birth with primitive women, Nichols here implicitly racialized and marked the

“common Irish” and the “middle classes of Scotch” as primitives like the “Indians.”

Nichols also included the “slaves of the south” in her discussion of painless childbearing. This equation of African American women with primitive birth was also common during the mid-nineteenth century. Slave owners and medical

20 Mary S. Gove Nichols, Experience in Water-Cure : A Familiar Exposition of the Principles and Results of Water Treatment in the Cure of Acute and Chronic Diseases (New York: Fowlers and Wells, Publishers, 1849), 74. For a similar list and description of “Indians, lowers orders of Irish, and slaves at the South” see Henry Daggers, Childbirth: Its Pains Greatly Lessened, Its Perils Entirely Obviated (New York: Henry G. Daggers, 1845), 7. 38 professionals who treated enslaved women tended to believe that Africans and those of African descent escaped the suffering and complications associated with

Euro-American birth.21 This belief persisted into the post-bellum period. Dr. John

Dye, in his 1871 book on painless childbirth, for example, noted that it was “well known that the slave women of this country required very little or no attention at confinement.”22 A medical essay by Joseph T. Johnson, physician and founding faculty member at Howard University, is particularly revealing. Titled “Apparent

Peculiarities of Parturition in the Negro Race, with Remarks on Race Pelves in

General,” the essay summarized obstetrical data for “the histories of two thousand negro labors.” Johnson, a white obstetrician who worked extensively with

African American patients at Freedman’s Hospital and was known for his liberal views on racial integration in the medical profession, undertook the survey, he stated, to explain why so few of his African American cases resulted in “puerperal complications.” Using language evocative of that used by Lewis and Magoffin to describe Native American birth, he wrote that, like the “natives of South Africa,” parturition for “the negro women of the United States” was “an act of nature and not of disease” and that their “period of convalescence” was “proverbially short and uncomplicated.”

Indeed, as Laura Briggs has pointed out, so powerful was this ideology that

Johnson interpreted evidence to the contrary as an anomaly. In noting that

21 See Marie Jenkins Schwartz, Birthing a Slave: Motherhood and Medicine in the Antebellum South (Cambridge, Mass.: Harvard University Press, 2006), 166-67. 22 John H. Dye, Painless Childbirth (Buffalo 1884), 52. 39 puerperal convulsions of eclampsia—a potentially life-threating condition associated with high blood pressure and other risk factors—occurred in his sample at a much higher rate than among whites, he wrote, “This ratio among negroes seems above the average, not only of the whites, but much above their own average.” He went on to state, using the language of civilization and primitivity, that puerperal convulsions were the result of “nervous hysterical peculiarities” and that the “strong-nerved, ignorant negro women of America” were immune to this condition because of their inability to “receive impressions upon their nervous system which would seriously affect a more delicate organization. They do not suffer from ‘nervousness,’ one of the fashionable ailments of the present day.” 23 In

Johnson’s mind African American women were simply unable to have eclampsia— their “primitive” strength and lack of sensitivity, conditions of their tendency to

“natural” birth, precluded the complications that “civilized” women endured during childbirth.

Though Johnson’s essay reveals a connection to long-standing beliefs about the nature and difference of civilized and primitive, white and non-white, birth, it also illustrates a shift in thinking about what might cause these differences and a distinction in how pain and complications in childbirth were interpreted. Though the explanation of “Eve’s curse” to explain the suffering of “civilized” women was

23 Joseph T. Johnson, "Apparent Peculiarities of Parturition in the Negro Race, with Remarks on Race Pelves in General," American Journal of Obstetrics and Diseases of Women and Children 5(1875): 90-91, 93-94.Interestingly, today African American genetic heritage places one in a high- risk group for eclampsia, indicating that Johnson’s statistics might have been representative after all. See also, Briggs, “’Race’ of Hysteria,” 259-260 for discussion of Johnson’s unwillingness or inability to interpret his data as evidence of difficulty in African American birth. 40 not abandoned by the general medical and lay community until the late nineteenth century, as early as 1806 a few medical authorities had begun to openly speculate that pain and disease, rather than being an inevitable aspect of civilized Christian childbirth, was caused by physiological differences between primitive and civilized women and that these differences, or changes, were brought about by civilization itself.24 Dr. William P. Dewees wrote, “however easy the act of Child-bearing (sic) may be, among savage tribes and certain individuals in various states of society, we find it among others an operation of great pain and frequent danger.” He goes on to pinpoint, after a lengthy discussion of the anatomy and processes of the uterus, what he thinks is the exact source of pain in labor: physical changes in particular muscles of the uterus due to “civilization and refinement.” Since pain in childbirth has “its origin in the changes produced by civilization,” he believed, “pain then, must be regarded as disease.”25 Though it would be decades before his line of thinking caught on, Dewees’s essay foreshadowed the philosophical paradigm that was fully in place by the end of the nineteenth century: Childbirth pain in civilized women, many believed, stemmed not from Eve’s transgression against God, but from

24 This idea, of course, was always already implicit in accounts of the strenuous, “natural,” lives of indigenous people. 25 William P. Dewees, Essay on the Means of Lessening Pain and Facilitating Certain Cases of Difficult Parturition (Philedelphia: John H. Oswald, printer, 1806), 7, 38, 43. Dewees’s thoughts on the pain of childbirth are part of a much larger shift in thinking about pain in general. Influenced by the Enlightenment focus on observation and scientific inquiry, European and Americans, beginning in the late 18th century went from believing that pain was an unknowable and inevitable part of life and that suffering could even bring an individual closer to God, to seeing it as a secular condition that was part of the natural world, one that could be classified, quantified and managed. See Caton, What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present: 94-106; Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 39-40. 41 physiological changes caused by the condition of civilization. Because pain in childbirth was not part of women’s “natural” state it must not therefore be “normal.”

Speaking in a “lecture to the ladies” in the mid-nineteenth century, Elizabeth

Cady Stanton reflects another aspect of this emerging paradigm:

If you suffer, it is not because you are cursed of God, but because you violate his laws…the pains of maternity are no curse upon (woman) kind. We know that among Indians the squaws do not suffer in childbirth. They will step aside from the ranks, even on the march, and return in a short time bearing with them the new-born child..26

Here Stanton, revealing the cultural prevalence of the notion of painless, primitive birth, believed that “the pains of maternity” were not actually due to a curse of God (Eve’s curse), but rather because, unlike the “squaws” who “do not suffer much,” one did not follow God’s laws for healthy living. Like Dewees she saw the pain of childbirth as stemming from physiological changes due to a life of refinement—a lifestyle she considers a violation of God’s laws. She made this point clearer by going on to discuss the fact that because she led an active, outdoorsy life as a child and “never compressed (her) body out of shape” she was “vigorous and healthy” and “suffered very little” during the births of her first four children.

Resolving that it was unnecessary to suffer at all during her fifth pregnancy, she

“dressed lightly, walked every day, (and) lived as much as possible in the open air.”

As a result, she stated, her fifth child “was born without a particle of pain.” She ended by stating, “I know this is not being delicate and refined, but if you would be

26 Elizabeth Cady Stanton quoted in Martin L. Holbrook, Parturition without Pain: A Code of Directions for Escaping from the Primal Curse (New York: Wood & Holbrook, 1874). 112. 42 vigorous and healthy, in spite of the diseases of your ancestors, and your own disregard of nature's laws, try it.”27

Stanton spoke during a period when, as we shall discuss further in the next section, Americans were preoccupied with the declining health of white middle- class women, a decline blamed on the inactive and indulgent lifestyle of civilization.

As a remedy to this ill-health she suggests an active, outdoor life and she holds up the “squaws’” easy birth as an example of what comes from following “nature’s laws.” In addition to illustrating a shift to thinking, like Dewees, that pain was not necessarily part of women’s natural state, Stanton also illustrates here a shift from simply seeing the supposedly painless birth of “primitive” women as a mark of savagery and an experience that was unattainable for civilized women to one that civilized women could—and should—strive for. Implicit in her discussion is the thought that civilized women, too, were capable of birthing like the “squaw.”

Dewees’s formulation of childbirth pain as abnormal would ultimately pave the way for an ongoing medical search for ways to eliminate suffering in labor—for if pain was an abnormality, a disease, it could (and should) then be treated.28

Concurrently, the view, as illustrated by Stanton, that the easy, painless birth experience of “uncivilized” women might be attainable for all, pointed childbirth

27 Ibid., 113. Stanton’s focuses on her “vigorous and healthy” lifestyle to highlight the 28 As will be evident in my discussion of Twilight Sleep the medical search for pain relief in childbirth was often patient driven. Also, evidence indicates that women and their birth attendants across cultures, and throughout history, sought to alleviate the pain of childbirth through use of herbs, charms, chants, prayer and position during labor. The difference in the nineteenth- and early twentieth-century search for pain relief was that the focus tended to be on complete elimination of pain in a medical context. 43 authorities in the direction of “primitive” birth in their search for painless methods of parturition.

Concomitant with, and related to, new ideas regarding the nature and cause of childbirth pain, were emerging theories regarding the conditions of civilization and the effects they had on individuals. Beginning in the mid- nineteenth century, popular and medical literature on health showed a preoccupation with a decline in the physical and mental fitness of “civilized” Americans. Men apparently harbored a tendency to weakness and effeminacy that affected their work productivity; but women seemed especially affected, with a propensity for hysteria and “female troubles” impacting their ability to bear and raise children. In 1855 Catherine

Beecher, a champion of women’s health reform, decried what she saw as an increasing tendency to poor health:

Every year I hear more and more complaints of the poor health that is so very common among grown people, especially among women. And physicians say, that this is an evil that is constantly increasing, so that they fear, ere long, there will be no healthy women in the country.29

A survey that Beecher conducted among her friends, polling them about their friends’ health, revealed numerous “invalids” and those of “delicate” and “feeble” constitutions with a tendency to headaches, nervousness, and “pelvic disorders.”

29 Catharine Esther Beecher, Letters to the people on health and happiness (New York: Harper & brothers, 1855), 9. 44 Many respondents noted that they knew “not one healthy woman in the place.”30

Beecher attributed this decline in health, most common, she thought, in the “more wealthy classes,” to a lack of exercise and fresh air from being cooped up in the

“dark rooms and alleys of a city,” excesses in diet and dress, and nervousness caused by over-stimulation and an “overworked brain.”31 Though she did not explicitly say so, Beecher described here conditions stemming from modern urbanization and industrialism and associated with the attendant increase in the wealth of the middle class.

Five years later, Augustus K. Gardner, a prominent reform-minded doctor, echoed Beecher’s concerns in his essay, “The Physical Decline of American Women.”

The contemporary American woman, he stated, was “a haggard creature, dull-eyed and sallow, pinched in form, an unfit mother, not a helpmeet, but a drag on the energy, spirits and resolution of her partner in life.”32 The “Indian woman of this country” and the “slave (women) of the South,” Gardner noted, were physically robust and equal to men in their “muscular vigor” and ability to labor. The

“civilized” woman, however, exposed as she was to the “damning influences of civilization,” was victim to unhealthful fashion (corsets and heavy skirts) and an

30 Ibid., 124-127. 31 Ibid., 28, 56, 58, 88, 105. 32 Augustus K. Gardner, "Physical Decline of American Women," in Conjugal Sins Against the Laws of Life and Health and Their Effects upon the Father, Mother and Child (New York: J. S. Redfield, 1870), 199. This article was originally published in The Knickerbocker, 55, no 1(Jan 1860), 37-52. 45 over-indulgent, indolent lifestyle. In ameliorating hardship, civilization was, in fact,

“kill(ing) by kindness.”33

As America moved into the Gilded Age, an era characterized by an increasing pace and growth of urban industrial life and great class conflict, many medical experts and social pundits had no doubt that civilization lay at the root of epidemic white, middle class American ill health. In 1881, George Beard popularized this thinking and facilitated a shift in its interpretation, in his highly influential publication, American Nervousness. According to Beard, symptoms of nervousness or

“neurasthenia” (defined as a “deficiency or lack of nerve force”)34 accounted for all of the indications of frail health that Beecher, Gardner and others had noted.

Indeed, so powerful and all-inclusive was neurasthenia that it could cause numerous

(Beard lists over seventy) other symptoms too, including “pathological” pain and difficulty in childbirth.35 Beard explicitly linked the “development and very rapid increase in nervousness” to “modern civilization” (characterized by “steam-power, the periodical press, the telegraph, the sciences, and the mental activity of women”), asserting that, “Civilization is the one constant factor without which there can be no nervousness, and under which in its modern form nervousness...must arise inevitably.”36 Every person had a finite store of “nerve-force supplying all the organs of the body” and “when new functions (were) interposed in the circuit, as

33 Ibid., 203-204. 34 George Miller Beard, American Nervousness: Its Causes and Consequences (New York, NY: G. P. Putnam's Sons, 1881), vi. 35 Ibid., 78. 36 Ibid., vi. Italics mine. 46 modern civilization” constantly required, “there (came) a period…when the amount of force (was) insufficient” to keep all of the organs operating properly.37 However, only a “fraction of American society…the brain-workers,” were susceptible to nervousness. The “majority,” the “muscle-workers” remained unscathed because they had “little education” and did not “strive for honor.”38 Neurasthenia was a disease of the American middle-class.

The disease, however, not only pertained to class. The theory of neurasthenia, as a disease of civilization, relied on the same racial theories of bodily difference that theories of pain in childbirth did, specifying (and marking) two types of bodies—one, strong, insensate, and dark; the other frail, highly sensitive and white. Indeed, like so many of his contemporaries, Beard used the notion of the apparently easy and painless childbirth experience of Native American women to indicate their “savage state,” repeating, as so many others had, the tale of an Indian woman halting her chores, leaving the group and then returning an hour later with her new baby to resume her duties. This and other examples illustrated, Beard argued, that “savage” women were “not delicate, sensitive or weak.” Indeed, “the squaws” were so different from “the tender and beautiful women of the white races, that they seem to belong to another order of creatures.” He also repeated the common belief in the hardy, insensitivity of the “Southern negro.” Describing them as “a bit of barbarism at our door-steps,” Beard wrote that “of nervousness and of

37 Ibid., 98-99. 38 Ibid., 96-97. 47 nervous diseases…they know little more, or no more, than their distant relatives on the banks of the Congo,” but in “sustained, continuous, unbroken muscular endurance…they surpass the whites.”39 These “savages,” along with “muscle- workers” in general, only rarely succumbed to nervous disease. The “white” women of “modern civilization” on the other hand revealed their limited “measure of nerve- strength” in their need for prolonged bed rest in the postpartum period and in the

“unnumbered woes” including perineal lacerations, uterine prolapse, hysteria, and insanity, that befell them as a consequence of giving birth. Significantly, the lack of sufficient nerve force was more predominate among civilized women than among civilized men, presumably because their reproductive systems placed a drain on their reserves that men did not endure: “In civilized lands, women are more nervous, immeasurably, than men and suffer more from general and special nervous diseases.”40 White women’s reproductive capacities then both illustrated, in their experience of difficult childbirth, their tendency to neurasthenia, and contributed to it.

Because the theory of neurasthenia and the discourse of overcivilized childbirth relied on the same race and class based concept of civilization (placing white native-born, middle-class Americans at the top of an evolutionary hierarchy),

39 Ibid., 184-185, 189-190, 76-77. See also Briggs, “’Race’ of Hysteria,” 247, 249-250. Briggs asserts that this “doubled discourse of women” in which white women were characterized as “weak, frail, and nervous” and “non-white women and poor people were described as strong, hardy, and prolifically fertile…had profound consequences for medicine and science: the frailty and nervousness of one group provided the raison d’être of obstetrics and gynecology, while the insensate hardiness of the other offered the grounds on which they became the experimental “material” that defined its progress.” 40 Ibid., 207. 48 and because difficult childbirth could be a symptom (or cause) of neurasthenia, the discourse of nervousness also helped to reinforce ideas of race and class and pain in civilized women. Modern civilization caused a depletion of nerve force and it was this depletion, many believed, that caused pain in childbirth or made it unendurable; in circular fashion, pain in childbirth could also cause a further depletion in nerve force, leading to or worsening neurasthenia. This only occurred, however, in women whose nerves, because of the effects of modern civilization, were particularly sensitive; women of African or Native American descent, along with working-class and immigrant women were not affected.

Of particular issue in worries over neurasthenia, women’s declining health, and pain and disability in childbirth was anxiety, reflected in the popular press, over the increasing “sterility” of Americans. This fact was presumably revealed in the dropping birth rate of white, middle-class women.41 First noted in the 1860s, the problem was given a name—“race suicide”—in 1901 amidst massive immigration from southern and eastern Europe and was tied to concerns that the immigrant birth rate was swamping that of the native-born. During this same period white women began to enter universities and colleges in unprecedented numbers. Many linked the decline in white fertility to women’s increasing demand for higher

41 See for example, George J. Engelmann, "The Health of the American Girl as Imperilled by the Social Conditions of the Day," Annals of Gynaecology and Paediatry 4(1891); Francis A. Walker, "Immigration and Degradation," Forum, August 1891; John S. Billings, "The Diminishing Birth-Rate in the United States," Forum, June 1893; George J. Engelmann, "The Increasing Sterility of American Women," Journal of the American Medical Association 37, no. 14 (1901). 49 education, citing statistics that revealed that over half of women who had graduated from college in the 1880s still had not married a decade later.42 Some explicitly connected the education of middle-class women and the declining birth rate of this sector of society to neurasthenia. In 1891 prominent obstetrician George

Engelmann lamented the ill-health of the “girl of the great middle class” which he blamed for women’s later “enfeebled vitality” and the inability of the “mothers best fitted to produce capable children” to “perpetuate the race.”43 Using the terms of neurasthenia he argued, “To over-brainwork and nerve-exhaustion in the large middle class of girls, to over-nerve-pressure in education and labor we must look for the great causes” of the declining birthrate. These conditions, he insisted must be addressed “for the care of woman is the care of the nation; the good health, mental, moral, and physical, of the woman and mother, is the very foundation of our national growth and prosperity.”44 Engelmann’s focus is on preventing ill-health in girls before it impacted childbearing, but his statements reveal anxiety over all about the effects of neurasthenia, a disease of civilization, on the reproduction of the white middle class.

Others blamed neurasthenia and fear of childbirth for the declining birthrate.

As George C. Mosher, looking back to the late nineteenth century, put it in 1921, “the alarming decrease in the size of the families in this country in the last forty years”

42 Newman, White Women's Rights: The Racial Origins of Feminism in the United States: 88- 89. 43 Engelmann, "The Health of the American Girl as Imperilled by the Social Conditions of the Day," 330, 93. 44 Ibid., 329. 50 was due to the fear of “physical suffering and mental terror” that women “must endure in giving birth to a child.” The effect “demoralize(ed) the nervous and vital forces” and rendered the “hypersensitive” modern woman unfit for childbirth. It was therefore imperative to alleviate neurasthenia and to eliminate pain and suffering from parturition in order to ensure the continuation of the “race.”45

As medical professionals worried about the effects of overcivilization on childbirth for the “better classes” and looked to eliminate complications and pain in labor, they began to actively analyze parturition in its “natural” state, in bodies that had not been affected by civilization. They had only to turn to countless historical and contemporary accounts of “savage” birth for examples. By the early 1880s the medical and lay childbirth literature abounded with articles and manuals that referenced and catalogued the painless, efficient birth practices of “primitive” people around the world. Best known of these works, and, indeed one of the key sources for accounts of primitive birth in childbirth manuals well into the twentieth century, was George Engelmann’s 1882 publication, Labor Among Primitive Peoples.

In it Engelmann, the author who later linked women’s “imperiled health” and consequent infertility to neurasthenia, revealed a long-standing interest in civilization’s effects on parturition. A founding member of the American

Gynecological Society and its president in 1900, Engelmann intended for his book, “a comparison of the crude methods of Primitive Peoples…with the teachings of

45 George Clark Mosher, "Ten Years of Painless Childbirth," Transactions of the American Association of Obstetricians and Gynecologists 34(1921): 87-88. 51 scientific obstetrics,” to be “above all instructive and important.”46Drawing on the dominant themes of the discourse of civilization, this work categorized non-white and, in some cases, poor rural and immigrant, women as “savage” or “primitive.” In particular, Engelmann detailed the birth practices of the “yellow, black, and red races” and drew most of his examples from the “North American Indians,” the

“Blacks” of Africa and the “southern negro,” “half-breed Mexicans,” and the Japanese.

For these “primitive” people birth was painless and easy: “Among primitive people, still natural in their habits and living under conditions which favor the healthy development of their physical organization, labor may be characterized as short and easy, accompanied by few accidents and followed by little or no prostration.”47 For example, the “squaw” of the “Modoc Indians—a tribe which has been little affected by the advance of civilization”—labored for an hour or less. However, for those who were in “closer contact with the whites” or who had attained a higher level of civilization “the more trying (did) the ordeal of childbirth become.” This was the case for the “half-civilized” Mexican Indians, whose labors were three to four hours long. 48 In the mind of Engelmann, primitive women possessed a natural, insensate hardiness and relied on instinctual postures, such as squatting during birth, to aid in the delivery of their children. The lack of these qualities in civilized women

46 George J. Engelmann, Labor Among Primitive Peoples (St. Louis: J.H. Chambers & Co., 1882), xvi. 47 Ibid., 7. Irvine Loudon notes that Engelmann’s theory regarding easy primitive birth was “based on rumor and assertion.” There is no evidence that he knew how many complications during labor or how many maternal deaths were associated with the groups he described. See Irvine Loudon, Death in Childbirth : An International Study of Maternal Care and Maternal Mortality, 1800- 1950 (Oxford: Oxford University Press, 1992), 342. 48 Ibid., 8-9. 52 suggested an unnatural degeneration caused by the conditions of civilized life—“its dissipations, and the follies of fashion…the idle life led (which caused a “relaxed condition of the uterus and abdominal walls”)…and the languid neurasthenic condition of the subjects in civilized life.”49

Above all Engelmann, and those who referenced his work in the decades to come, hoped that his extensive compendium of “primitive” birth practices would serve as a model for civilized women and childbirth practitioners. He was especially keen to encourage women to “use their instinct” to assume efficient upright postures, rather than the common recumbent position, during delivery of the child.

As proof of the benefit of these positions, Engelmann cited the practices of

“uncivilized” people:

The care with which the parturient women of uncivilized people avoid the …modern obstetric position, at the termination of labor, is sufficient evidence that it is a most undesirable position for ordinary cases of confinement; and…the thinking obstetrician will soon confirm the statement…made by the ignorant but observing savage, by Negro and Indian, that the recumbent position retards labor and is inimical to easy, safe, and rapid delivery.50

Englemann did not simply describe, as other narrators of childbirth did, the lack of suffering that “primitive” women supposedly evidenced. Instead he enjoined his readers to actively follow what he saw as the “instinctual” or natural way to birth. In a major shift in thinking, the “primitive,” not the “civilized,” person became the authority—at least in the realm of childbirth—and the “primitive” birth experience became the standard to which to aspire. “Civilized” women could

49 Ibid., 10. 50 Ibid., 149. 53 accomplish easy, painless childbirth—but they must learn from and emulate the

“primitive” to do so.51

Returning then to Frank Newell’s classification of obstetrical patients in 1907 we see that his assertion—that white civilized women were “unfit” for childbirth, while “foreign born, uncivilized” women bore children with ease—reflected a contemporary understanding of childbirth experience as part of a class based and racialized, hierarchical process of civilization, an understanding that had its roots in a centuries-old tradition of equating civility with white nervous sensitivity, and primitivity with non-white (non-American) hardiness and destitution of feeling.

What was different from earlier, pre-1850 understandings of pain in childbirth was

Newell’s contention that the civilized, or, in his thinking, “overcivilized,” experience of childbirth was pathological and something to ameliorate. Like neurasthenia (and as a symptom of neurasthenia), painful difficult childbirth, though it continued to mark one’s place at the top of a racialized hierarchy, was an unfortunate side-effect of the conditions of civilized life. Influenced by decades of lamentations over the decline of American women’s health and anxiety regarding the effects of “over- civilization” and “nervousness” on birth and the birth rate of white middle- and upper-class Americans, many late nineteenth- and early-twentieth-century medical authorities agreed with Newell that the “civilized” experience of childbirth was

51 See also De la Pena, “Removing a Nail from the Lady’s Foot,” 30-39 for a specific discussion of the shift from seeing Native American birth as “primitive” to seeing it as “natural.” 54 pathological. The question became one of how to “restore” easy, painless “primitive” birth to civilized women.

Restoring Natural Childbirth

As early as 1845 we find evidence that both doctors and women, believing that pain in childbirth was not natural, looked for ways to return painless birth to civilized parturients. Quoting Dewees, the doctor who, as we saw, first noted that pain in childbirth was abnormal, Henry Daggers notes in Childbirth: Its Pains Greatly

Lessened, Its Perils Entirely Obviated that “Pain in childbirth (is) a morbid symptom, the consequence of artificial modes of life and treatment.”52 Daggers quotes another, a Mrs. Gove, as saying that, “The functions of gestation and parturition are as natural as digestion; and were mankind brought into a natural and healthy state, we have reason to believe that these functions” would have little pain. 53 Daggers advises that instead of becoming “victims of civilization” women who follow a “suitable regime” consisting of a simple, mostly fruit and vegetable diet, plenty of exercise in the “open air,” and particular forms of bathing, can achieve safe and easy birth.54

By the late nineteenth century those interested in achieving “natural” painless birth could choose from several how-to manuals on the subject.55 In these

52 Daggers, Childbirth: Its Pains Greatly Lessened, Its Perils Entirely Obviated: 3. 53 Ibid., 6-7. Almost certainly “Mrs. Gove” refers to Mary S. Gove Nichols, author of Experience of the Water-Cure in 1849. 54 Ibid., 7, 28-30. 55 See for example Holbrook, Parturition without Pain: A Code of Directions for Escaping from the Primal Curse; John H. Ruttley, Nature's Secrets and the Secrets of Woman Revealed (San Francisco, CA: Published by J.H. Ruttley, 1875); Dye, Painless Childbirth; Alice B Stockham, Tokology: A Book for Every Woman (Alice B. Stockham & Co., 1887); Emmet Densmore, How Nature Cures, Comprising a 55 books, the emphasis was on the belief that while natural birth was painless, civilized women suffered in childbirth because of physical degeneration due to the sedentary, urban lifestyles and unwholesome diets of civilization. Thus, if they rectify these unhealthy habits, they will eliminate pain during labor. In his 1874 manual,

Parturition without Pain; A Code of Directions for Escaping from the Primal Curse,

Holbrook quotes a “high authority” as saying that “parturition itself, according to the general testimony of travellers, interferes much less, and for a shorter period, with the healthy action of the body and mind among savage nations than among the luxurious daughters of artificial life." Holbrook notes that another authority believed “that the bearing of children may, and ought to become, as free from danger and long disability to the civilized women as it is to the savage." Based on these observations Holbrook asserted, “parturition is likely to be painless in proportion as the mother is physically perfect and in a perfect condition of health.”

The principle means of achieving this, he thought, were exercise and sitz baths during pregnancy with special attention to the diet. “Civilized” pregnant women, he stated, should eat mostly fruit and avoid grains, such as wheat, from the temperate zones, for “in all those countries where tropical grains, rather than those of the temperate zones, are the food, and where vegetables and fruits predominate in the diet, as in the south of Europe, among the negroes of the Southern United States, among the Hindoos, and tropical nations generally, parturition is nearly

New System of Hygiene (London: S. Sonnenschein & Co.; New York, Stillman & Co., 1892); Otis Tufton Mason, Woman's Share in Primitive Culture (New York: D. Appleton, 1894). 56 painless.”56 Holbrook also recommended anesthetics in cases “where the pain is likely to do more harm to the nervous system than the anaesthetic could possibly do.”57

In 1882 John Dye, in another manual for achieving painless birth, asserted that “natural labor is never painful” and that “all pain, difficulty and danger are the consequences of violating natural laws.” As proof he offered the, by then, usual examples of painless birth among “slave women,” “American Indians,” and “the poorer classes,” theorizing that the only explanation for the difference between their birth experiences and those of civilization was “due to some physical condition of civilized woman which the uncivilized escape.” If civilized women could “banish disease, enforce hygiene and establish health,” he wrote, “labor (would) not be difficult.”58 To that end he suggested moderate exercise during pregnancy along with plenty of “pure air,” loose clothing, water baths and a mostly fruit diet—and even chloroform, if those methods didn’t sufficiently relieve pain.59

Significantly, Holbrook, Dye and most other contemporary “natural” childbirth writers stressed body-focused methods—diet, exercise, dress—to relieve pain and ease birth. Unlike later natural childbirth advocates, who, as we shall see, felt that the “overcivilized” mind got in the way of the physiology of birth, these early proponents of painless birth believed that physical deterioration of the body

56 Holbrook, Parturition without Pain: A Code of Directions for Escaping from the Primal Curse: 61. 57 Ibid., 91. 58 Dye, Painless Childbirth: 49, 52-53, 57. 59 Ibid., 70-90, 142-153. Most authors considered the use of drugs to achieve painlessness as natural because it was the outcome—a pain-free birth—that constituted natural birth. 57 contributed to difficulties in labor and delivery. Their emphasis, then, was on ameliorating poor health by combatting or avoiding the conditions of modern civilization that led to damaged bodies.

Early methods for painless, natural birth had their followers, but none of them caught the public’s attention like the Twilight Sleep Method in 1914. After the

McClure’s publication in June of Marguerite Tracy and Constance Leupp’s article on the subject, virtually every major woman’s magazine and nearly all of the major newspapers carried the story of this purported boon to womankind. 60 One enthusiastic supporter reported, “I’d much rather have a baby (using Twilight Sleep) than a bad cold.”61 Another stated that if she had another baby she “would have it in

Freiburg, if (she) had to walk all the way from California.“62 Emerging as it did in the midst of the Progressive Era focus on social reform, suffragist focus on the emancipation of women, and continuing worries about race suicide, the method met with keen interest from white middle-class women who hoped to both free women

60 For evidence of widespread coverage of Twilight Sleep see Henry Smith Williams, Twilight Sleep: A Simple Account of New Discoveries in Painless Childbirth (New York: Harper and Brothers, 1914); Sam Schmalhauser, "The Twilight Sleep for Women," International Socialist Review 1914; Hanna Rion Ver Beck, "The Painless Childbirth: Testimony of American Mothers Who Have Tried the Twilight Sleep," Ladies' Home Journal, September 1914; Mary Boyd and Marguerite Tracy, "More About Painless Childbirth," McClure's Magazine, October 1914; Clara G. Stillman, "Painless Childbirth," New York Call, July 12 1914; "Mothers Discuss 'Twilight Sleep'," New York Times, November 18 1914; Mary Boyd, "The Story of Dammerschlaf," Survey, November 7 1914; William Armstrong, "The Twilight Sleep at Freiburg," Woman's Home Companion, September 1914. 61 Ver Beck, "The Painless Childbirth: Testimony of American Mothers Who Have Tried the Twilight Sleep," 9. 62 Tracy and Leupp, “Painless Childbirth,” 38-39. 58 from the problem of pain in birth and encourage higher birth rates among their social class.63

To early-twentieth-century women who considered childbirth and its aftermath an unendurable ordeal of danger and “exquisite pain” and “anguish” the appeal of the technique lay in its promise of complete obliteration of childbirth suffering, and indeed, of the birth experience itself.64 Unlike methods that focused on physical means—diet, exercise and attire—to restore natural birth, Twilight

Sleep guaranteed a pain-free experience. For those worried about “nerves” already made too sensitive by “over-brainwork,” the ability of Twilight Sleep to turn off the

“overcivilized” neurasthenic mind so that the body could work unimpeded was a bonus. Named for its effect of producing a state of semi-consciousness in laboring women, Twilight Sleep involved an initial injection of morphine to deaden pain, along with another of scopolamine to produce “a sleep verging on consciousness,” a by-product of which was amnesia regarding the birth process. 65 Successive injections of scopolamine were given throughout labor, as necessary, to maintain a

63 For further discussion of the motivations of Twilight Sleep supporters see De la Pena, "Removing a Nail from the Lady's Foot: Twilight Sleep and the Struggle for "Natural" Birth," 102-11; Leavitt, Brought to Bed: Childbearing in America, 1750 to 1950: 130-33; Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960: 25; Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 55-58. 64 See A. Smith, Twilight Sleep in America : The Truth about Painless Childbirth (New York, NY: The Victor Pub. Co., 1915), 13-15.for a representative description of childbirth pain in "civilized" women 65 Professor Kronig, "Scopolamine-Morphine Narcosis In Labour," The British Medical Journal 2, no. 2490 (1908): 806. 59 condition of “Twilight Sleep” in which the patient was “awake and yet register(ed) no mental record of events.”66

Though women did experience pain, they awoke with no memory of their experience, often even unaware—and disbelieving—that they had given birth.

Tracy and Leupp describe the joy and relief that users of the method felt when they woke to realize that they had no memory of pain and difficulty: “When their pains began…they went to sleep…and woke happy and animated, and well in body and soul; and found, with incredulous delight, their babies, all dressed, lying before them.” Indeed, so marvelous and inconceivable was the complete absence of suffering that the experience seemed “’like a fairy tale.’”67

American physicians had actually first experimented with Twilight Sleep, or

“Dammerschlaf,” as it was known in Germany, the country of its origin, in 1907.

However, though some embraced the method, most had completely abandoned its use by 1909. Medical authorities complained that in a busy hospital the amount of medical attention, both from doctors and nurses, that the procedure necessitated, made its implementation impractical. Even more troubling though were dangerous side effects that included fetal asphyxia, hemorrhage, and prolonged labor. Though most women undergoing Twilight Sleep remained calm, the most common side effect, uncontrollable delirium, was both potentially dangerous to the mother and aggravating for the staff. One nurse recorded this relatively frequent type of patient

66 Williams, Twilight Sleep: A Simple Account of New Discoveries in Painless Childbirth: 21. 67 Tracy and Leupp, "Painless Childbirth," 38. 60 response: “So perverse and obstreperous! Kicked, writhed, scratched, and yelled like a caged animal. Took three nurses and two interns to manage her—and then some!”68 Some physicians developed cage-like beds to keep patients from falling and harming themselves and/or placed them in specially designed straight-jacket-type gowns while they labored.69 While proponents of Twilight Sleep insisted that these side effects would not occur if proper procedure and drug dosages were followed rigorously, most American doctors felt the risks outweighed the benefits and stopped using the method altogether by 1910. American women remained largely unaware of its existence. In 1913, however, after hearing a speech in Chicago by Dr.

Bernard Kronig, one of the principle developers of Dammerschlaf in Germany, an editor with McClure’s Magazine sent reporter Marguerite Tracy and mother-to-be

Mary Boyd to the Frauenklinik in Freiburg Germany to investigate. 70

The resulting article brought Twilight Sleep to the American public for the first time and set off an unprecedented campaign by white, middle-class women to make the “painless, natural” method available to them. Middle- and upper-class white women across the nation formed Twilight Sleep Societies and gave lectures to promote the method’s use in the United States. The leaders of the movement, many of whom were suffragists or active in other Progressive Era causes such as birth

68 Philadelphia Lying-In Charity, Patient Charts, vol. 43 (1908), March 30 entry quoted in Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 50. 69 Bertha Van Hoosen, Scopolamine-morphine anaesthesia. And A psychological study of "Twilight sleep" made by the Giessen method by Elisabeth Ross Shaw. (Chicago: The House of Manz, 1915), 88. Mothers often had no memory of this. For delivery they were moved to a delivery table and then back to a regular bed. 70 De La Pena, “Removing the Nail,” 79. 61 control and women’s and child labor reform, saw the battle for painless childbirth as a fight for women’s rights.71 Doctors initially responded heatedly against women’s demands, citing earlier evidence of dangerous side effects and charging the lay press with irresponsibly promoting a potentially hazardous technique about which it could have no authoritative knowledge.72 Eventually, however, many physicians bowed to patient demand and after studying the method in Germany brought

Dammerschlaf back to the United States.

Twilight Sleep, as a response to an historically specific conception of childbirth that classified suffering as part of a hierarchical process of civilization, relied on the language of neurasthenia and overcivilization, if not the actual terms, to highlight the problem of birth pain in the “modern” woman. According to Dr.

Kronig, the “modern woman…responds to the stimulus of severe pain more rapidly with nervous exhaustion and paralysis of the will” than does the “less developed type.” Indeed because their “sensitiveness…is much greater than that of those who earn their living by manual labor,” prolonged and difficult labor (and the concomitant use of forceps) in “mothers of the better class” had “increased to an alarming extent.” Twilight Sleep, Kronig believed, actually overcame these complications of civilization by “abolishing the suffering” and thus improving “the effectiveness of the birth pains, for the woman makes no apprehensive effort to hold

71 Leavitt, Brought to Bed: Childbearing in America, 1750 to 1950: 137; Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 55. 72 See for example, "McClure's Mistake," Journal of the American Medical Association LXII, no. 23 (1914); "Queries and Minor Notes," Journal of the American Medical Association 62(1914); Ralph Beach, "Twilight Sleep," American Medicine 21(1915). 62 them back.” The method provided an added benefit for the modern woman in that it

“conserved nervous energy” and thus prevented exhaustion and led to rapid recovery.73

As historian Carolyn de la Pena argues, many believed that this ability of

Twilight Sleep to obviate pain and thus facilitate birth, allowed civilized women to actually then experience the “normal” birth of primitive women.74 Indeed, in spite of the use of specialized medicines, the need for hospitalization and frequent reliance on restraints for laboring women (for this practice continued to be necessary even after the reintroduction of Dammerschlaf in the United States), many supporters of

Twilight Sleep enthusiastically promoted the “natural” aspect of the method.75 As we have seen, many Americans had by this point come to believe that suffering in childbirth was an abnormal consequence of civilized life. As physician A. Smith, a promoter of Twilight Sleep put it, “(t)he savage woman presents the normal obstetrical condition…We know that among primitive tribes, the American Indians, and uncivilized people, the woman in labor suffers practically no pain.”76 To negate the experience of pain then meant to “normalize” birth.

73 Tracy and Leupp, "Painless Childbirth," 43. 74 De la Pena, "Removing a Nail from the Lady's Foot: Twilight Sleep and the Struggle for "Natural" Birth." 75 There were a few supporters of Twilight Sleep that considered the method an artificial one. M. McDuffie writes, for example, that “Normal painless childbirth as brought about by fruit and veg diet, hot sitz baths, exercise and the use of such drugs as macrotys, michelle and cortex ulmi during pregnancy is the method par excellence” but that Twilight Sleep was a boon for those who did not have the wherewithal to live that lifestyle. See M. W. McDuffie, ""Painless Childbirth" from observations of "Twilight Sleep" or "Dammerschlaf"," The North American journal of homeopathy. 62(1914). And some supporters of painless birth for civilized women, who disavowed Twilight Sleep. See E. B. Lowry, Your Baby: A Guide for Young Mothers (Chicago: Forbes & Company, 1915). 76 Smith, Twilight Sleep in America : The Truth about Painless Childbirth: 9. Emphasis mine. 63 Medical authorities clearly understood this “normalization” of labor and delivery as a restoration of “natural” parturition. Dr. Bertha Van Hoosen, an ardent supporter who first used Twilight Sleep in 1904 and then continued to champion it well into the 1930s, posited that the method allowed mothers to “cooperate so that the baby could be born in a natural way.”77 Another physician, Woodbridge Hall

Birchmore, described his colleague’s reaction after watching a hyoscine (another name for scopolamine) augmented birth, “It was as if I had seen the natural action of a woman for the first time.” Birchmore himself believed that hyoscine enabled the

“restoration of the truly natural conditions” and noted that this effect had “almost as much importance as the unconsciousness from sleep.” 78 Together these doctors believed that Twilight Sleep did more than simply lessen pain and promote recovery—it actually restored “natural, normal” birth to civilized women.

In believing that “the women of primitive and barbaric tribes appear to suffer comparatively little in labor” and that it was “civilized women of the most highly developed nervous or intellectual type who suffer most,” 79 followers of

Dammerschlaf held similar beliefs concerning the class and racial nature of childbirth pain to others, like Dye and Holbrook, who attempted to recreate painless parturition through changes in diet or attire. However, and this is significant,

Twilight Sleep differed from other early attempts at “natural” painless birth in that it

77 Bertha Van Hoosen, Petticoat Surgeon (Chicago: Pellegrini & Cudahy, 1947), 275. 78 Woodbridge Hall Birchmore, "The Hyoscine Sleep in Obstetric Practice," Medical Record 71(1907): 59. 79 Henry Smith Williams, Twilight Sleep: A Simple Account of New Discoveries in Painless Childbirth (New York: Harper, 1914), 39. 64 posited that it was women’s “overcivilized,” over-sensitive minds—or, in the parlance of the day, their “nerves”—and not a strictly physical deterioration caused by civilization, that led to complications in civilized birth. Unlike other “painless” methods that located childbirth pain in the pampered, inactive urban lifestyles of middle- and upper-class-whites, Twilight Sleep drew specifically from the discourse of neurasthenia, with its emphasis on civilization’s demands on women’s nervous energy and the resulting excess of nervous sensitivity in modern women, to explain differences between civilized and primitive birth. Civilized or modern women failed at labor because of an increase in “mental occupations” that led, in turn, to a “too active mind,” “nervous exhaustion” and a subsequent extreme sensitivity to pain-- a sensitivity that in labor prevented women from bearing the discomforts of childbirth through to delivery.80 Charlotte Teller recounted how after admitting to her Dammerschlaf nurse her shame in her “extreme awareness of pain,” the nurse responded by asking if she thought “a race horse should be ashamed of its fine nerves. Those nerves convert into torture, sufferings which in a carthorse would seem slight. But they are what make the race horse.”81 It is Teller’s nerves, and not her body, which marked her as civilized or modern. And it is her “nerves,” if not for

Twilight Sleep, that made parturition a near impossibility.

It must be understood that “nerves” here refered to more than just the nerve fibers of the body. The term signified rather the heightened ability of the mind to

80 Kronig, "Scopolamine-Morphine Narcosis In Labour," 805-06. 81 Charlotte Teller, "The Neglected Psychology of Twilight Sleep," Good Housekeeping, July 1915, 23. 65 perceive stimulation to the nerve fibers. At issue then was civilized woman’s inability to “surrender” her mind in order to evade those heightened perceptions.

The following account from Kronig illustrates this point. In a tale that evokes the iconic “squaw” birth narrative, but in a European setting, he related how he once saw a gypsy woman drop behind her band to give birth, wash the baby, and then

“run at top speed” to catch up with her group. After inviting her to deliver her next child at his clinic, he came to the conclusion after watching this “nature-woman” that her chief advantage over the “more highly developed type lay not in being healthier and stronger” but in her ability to “surrender her consciousness and volition more completely to the great unconscious processes of birth.”82

Ultimately, then, Twilight Sleep proponents believed that it was an “excess of thought, not a deficiency in physique” that led to difficult childbirth for the modern woman.83 Even some who did not endorse the method for its pain-relieving attributes, valued it for its “psychologic effect" on “neurotic types,” indicating their belief in the important role for women’s minds in childbirth. 84 The real beauty of

Twilight Sleep in the minds of its supporters, however, was its ability to seemingly

“disconnect” the mind, to stop “excessive thought,” without impeding the physiological functions of birth. Earlier types of anesthesia, if they were to completely block pain, had had to be given in such large doses that the physiological

82 Ibid. 83 Ibid. 84 Barton Cooke Hirst, "Scopolamin-Morphin Aneshesia in Obstetrics-Discussion," Journal of the American Medical Association 65, no. 15 (1915): 1303. 66 process of birth markedly slowed or stopped. Dammerschlaf rendered the mind unable to perceive and react to pain, but the body was left to perform its natural functions unhampered by the nervous interference of civilization. Birchmore described how, in a majority of the cases of hyoscine use that he observed, the mothers, though unconscious, assumed physical positions that aided in delivery of the baby. Equally impressive to him was the “steady, slowly increasing, and tremendous force exerted by the abdominal muscles during the expulsive pains,” leading him to conclude that in “hyoscine sleep reflexes are greatly augmented.”85

Bertha Van Hoosen similarly stressed the ability of Twilight Sleep to prevent the civilized mind from interfering in the birth process: “The patient under scopolamine-morphine seems to make very little muscular effort” yet “gives birth…without instrumental assistance. (Y)ou begin to feel that much of the muscular effort exerted by the non-anesthetized patient was…positively wasted energy.”86 Twilight Sleep, she believed “solves the problem of child-bearing and rearing for the highly organized mothers of modern civilization” by “uncoupl(ing) the brain from the spinal cord” leaving the woman “a good animal” to bear her offspring.87 In another statement, she made the association between the “primitive” body and uncomplicated birth even more explicit: Twilight Sleep “renders the process of childbirth one of reflex action which resembles the delivery of primitive

85 Birchmore, "The Hyoscine Sleep in Obstetric Practice," 59. 86 Van Hoosen, Scopolamine-Morphine Anesthesia, 91. 87 Ibid., 101. 67 woman.”88 It is this conceptualization of natural birth—that of the necessity of freeing or disconnecting the physical body from the civilized mind in order to restore “natural,” “primitive” birth—that will underpin the ideology of natural childbirth in the decades to come.

Conclusion

The public furor over Twilight Sleep died within just over a year of its 1914 introduction when one of the method’s key champions, Mrs. Francis X. Carmody, died in childbirth while under the influence of scopolamine. Though her doctors and her husband insisted that her death from hemorrhage was not related to

Twilight Sleep, some physicians, and the public in general, questioned the safety of the treatment.89 Many doctors though continued to employ, with similar results, the drugs involved, if not the method itself, well into the twentieth century.

The legacy of Twilight Sleep, however, extends beyond its practical application for obliterating pain in childbirth. Twilight Sleep promoters popularized a particular notion of “natural” childbirth. Drawing on the long-standing dichotomy of civilized, agonized birth versus painless, primitive birth, they explicitly equated

“natural” birth with “primitive” birth, and more specifically, argued that modern or civilized women experienced difficult childbirth because their overcivilized minds

88 Bertha Van Hoosen, “The New Movement in Obstetrics,” Women’s Medical Journal, 25 (1915), 121 quoted in Loudon, Death in Childbirth : An International Study of Maternal Care and Maternal Mortality, 1800-1950: 347. See also Sandelowski, Pain, Pleasure and Childbirth, 8-10 for further discussion of Twilight Sleep and its reliance on a distinction between mind and body in childbirth pain. 89 "Doctors Disagree on Twlight Sleep," New York Times, August 24 1915, 7. 68 prevented their still primitive bodies from doing their natural work. Civilized women could experience natural, painless parturition by “turning off” their overcivilized minds and thus allowing their (primitive) bodies to work unimpeded.

While Twilight Sleep followers used drugs to achieve this goal and later proponents of natural birth sought to limit the use of drugs, the fundamental underpinning of

Twilight Sleep—the goal of restoring natural, primitive, painless childbirth by disconnecting the (over)civilized, modern mind from the physical function of labor—continued to shape and inform natural childbirth rhetoric and practice, as we shall see, well into the mid-twentieth century.

At the same time, ironically, the Twilight Sleep method helped to usher in the very type of birth—impersonal, “assembly-line” hospital birth dependent on anesthetizing drugs and heavy medical intervention—that later proponents of a different type of natural childbirth would oppose. Twilight Sleep introduced

Americans to the possibility of effective pain-relief during childbirth. Many

American women—and their doctors—felt the benefits of pain-relief and anesthesia outweighed the risks and pushed for their use during labor and delivery. The

Twilight Sleep method and resulting newer methods of obstetrical analgesia/anesthesia thus forced the move of childbirth from home to hospital where trained obstetricians could supervise the necessary pain-relieving drug regimens and attendant medical intervention. It is to these topics that we turn in the next chapter.

69 Chapter 2: Modernizing “Civilized” Childbirth: American Childbirth Practice and Rhetoric in the 1920s and 1930s

In 1936 The Nation made the following pronouncement: because the

“complex and nerve-racking life of civilization…has interfered with the automatic nature of the child-bearing process, the least civilization can do for the woman in childbirth is to find the means to alleviate the agony for which it is largely responsible.”1 The Nation made this observation in response to a heated medical and public debate, recently ignited by a physician’s assertion that consciousness at birth was necessary to prevent nervous disorders, over the use of anesthetics.2 The comment was an endorsement for pain-relief during birth. However, it also highlights America’s vexed thinking on childbirth during this era. Medical authorities and the general public in the 1930s were troubled, like their predecessors at the turn-of-the-century, about the negative effects of civilization on women and birth. They were also, paradoxically, optimistic at the same time about the potential benefits of civilization for childbirth.

Twenty years after the peak of the Twilight Sleep Movement which introduced Americans to the promise of drug-assisted, pain-free birth, American obstetrics in the 1930s was well on its way to developing into the modern medical specialty that it had become a decade later—one characterized by “assembly-line,” standardized hospital routines and drug-induced unconscious at birth. Yet in spite

1 Editorial, “From Genesis to Freud: Attack on Painless Childbirth,” Nation, June 3, 1936, 699. 2 I will further discuss this debate in Chapter 3. For a description of the controversy see "Childbirth: Nature v. Drugs," Time, May 25 1936. 70 of this emerging triumph for obstetrics, or perhaps because of it, the 1930s also saw the medical profession, and the nation in general, clearly anxious about the ways in which both doctors and laboring women managed childbirth. These anxieties arose, in part, from concern over the declining birthrate—the birth rate had been steadily decreasing since the turn of the century and reached a low point in 1935. These anxieties also stemmed from statistical findings in 1926 that ranked the United

States 19 out of 20 in the number of maternal deaths in “civilized” countries.3 They stemmed as well as from the release, in 1933, of an influential medical report on maternal mortality that indicated that two-thirds of maternal deaths were preventable, and that blamed these deaths, in large part, on the misapplication and overuse of forceps and pain-relieving drugs during birth—a misapplication and overuse blamed on poorly run hospitals, doctor negligence and inexperience, and patient demand for interventions.4 At the same time that Americans worried about the possible over-use of pain-relieving drugs, however, they also worried about the pain of childbirth itself. The 1920s, and especially the 1930s, saw an intense focus on determining the reasons for pain during labor and delivery, as well as on ways to relieve it.

Arguably, these anxious reactions—to the report findings and to pain in birth—resulted, in part, from the fact that ideas regarding childbirth continued to be bound up with ideas about America’s place in the “civilized” world; with the

3 Jacqueline H. Wolf, Deliver Me from Pain: Anesthesia and Birth in America (Baltimore: Johns Hopkins University Press, 2009), 75. 4 Margarete Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960 (Westport, CN: Greenwood Press, 1984), 42. 71 question of furthering the American “race;” and with worries about civilization’s ill effects on women’s health. Howard Haggard, doctor and medical popularizer, spoke for many when he wrote in 1929:

The position of woman in any civilization is an index of the advancement of that civilization; the position of woman is gauged best by the care given her at the birth of her child. Accordingly, the advances and regressions of civilization are nowhere seen more clearly than in the story of childbirth.5

Doctors and the general public alike worried that the higher maternal mortality rate in the United States threatened America’s standing overall in the ranks of civilized countries. These worries are reflected in the childbirth literature of the period. Medical authorities and social reformers continually exhorted women to fulfill their eugenic duty to the nation and the “race” by maintaining proper health during pregnancy and childbirth.

At the same time, many Americans during this period, in a vein similar to what we saw in the earlier decades of the twentieth century, asserted that the

“modern lifestyle,” or “civilization” itself, weakened bodies and created fearful, nervous minds, thus bringing undesirable consequences to bear upon childbirth— immoderate pain being one of them. “Primitive” or “natural” childbirth, on the other hand, was still usually painted as free of complications and less painful by contrast.

In this discourse, these “civilized” or “primitive” practices and experiences of childbearing continued to mark a woman’s place in a racialized hierarchy of civilization—with middle- and upper-class, native-born, “civilized” Americans at the

5 Howard Wilcox Haggard, Devils, Drugs, and Doctors: The Story of the Science of Healing from Medicine-Man to Doctor (New York and London: Harper & Brothers, 1929), 3. 72 top and non-white and ambiguously white (immigrant, poor, and rural) “primitive” women nearer the bottom—as well as marking America’s position as a civilized nation.

However, and this is significant, during this period a different, but related, narrative of childbirth emerged—that of “modern” birth. While women and their medical attendants continued to believe that civilization damaged birth, many came to believe that civilization also offered its own remedy in the form of medical technology and drugs. Proclaiming the victory of science over the “tortures of childbirth,” newspaper and magazine articles heralded the benefits of medical science and “streamlined birth.”6 Medicine could transform the agonized experience of “civilized” birth into birth that was painless and “modern,” marking those with access to modern childbirth as “modern” themselves. In an age steeped in the promise of science and medicine, obstetrical advances in medical intervention and pain management also revised America’s “story of childbirth” from one of decline into one chronicling “civilization’s advance.”

The new narrative of “modern” birth is highlighted by a new portrayal of the birth experiences of lower-class and African American women. Depression era concerns over poverty and malnutrition exacerbated older concerns over maternal mortality and led to increased attention to those that had higher rates of maternal death. Some medical authorities began to note that lower-class and African

6 For example, see Sara White, "Science Mercifully Blotting Out the Tortures of Childbirth," Boston Traveler, February 8 1938; J.P. McEvoy, "Our Streamlined Baby: New Method of Easy Childbirth," Reader's Digest, May 1938. 73 American women did, in fact, experience painful, difficult childbirth, not the easy birth of primitive women. These representations did not, however, feature birth made painless by modern medical intervention and thus they signaled the child bearers’ lack of modernity. They therefore fostered a new conceptualization of

African American and lower-class birth—one that is better characterized as outside of modernity rather than “primitive.”

After discussing the transition from home to “assembly-line,” drug-assisted hospital birth that occurred in the wake of the Twilight Sleep movement, as well as the medical and public reaction to maternal mortality rates in the 1920s and 1930s, this chapter will analyze the contemporary literature on childbirth, both medical and popular, in order to trace shifts in the rhetoric of primitivity, civilization and modernity in childbirth. The Twilight Sleep era of the 1910s inaugurated the push to restore “natural, primitive” birth in “civilized” women through the use of major pain-relieving methods during labor and delivery. In the mid-1940s, “natural childbirth” supporters reacted, as we shall see in Chapter 3, to the lack of control and awareness at birth that resulted from the widespread use of anesthesia, but nevertheless drew upon ideas of modern, civilized and primitive birth to define what “natural” meant. The transitional decades of the 1920s and 1930s, sandwiched between these two periods, are integral to our understanding of how and why natural childbirth rhetoric and practice emerged as it did in the mid- twentieth century.

74 Putting Labor on the Assembly Line

Though the Twilight Sleep movement itself waned after 1915, historians uniformly agree that the flurry of attention that the method received was integral to ushering in a widespread use of anesthesia and a concomitant use of medical instruments, especially forceps, during birth.7 Twilight Sleep also helped to push childbirth into the hospital. In the aftermath of publicity over the method, women who could afford it increasingly sought effective pain relief during labor and delivery—measures that could only be applied under the watchful eye of trained hospital personnel.

At the same time, childbirth advice manuals and popular magazine articles promoted the “modern” hospital which provided round-the clock nursing care for mother and baby in a clean, “attractive” and “homelike” environment. The hospital was more than, as one doctor put it, “a retreat for the parturient woman,” however.

It was also “designed for the purpose of making childbearing safer and less harrowing.”8 These conditions appealed to women who worried about the pain and danger of childbirth and who, as they moved to the city, were increasingly separated from friends and family and had no one near home to help them in the postpartum

7 See Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750 to 1950 (New York: Oxford University Press, 1986); Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960; Richard W. Wertz and Dorothy C. Wertz, Lying-In: A History of Childbirth in America (New Haven: Yale University Press, 1989); Wolf, Deliver Me from Pain: Anesthesia and Birth in America. 8 Palmer Findley, The Story of Childbirth (Garden City, N.Y.: Doubleday, Doran & Co., 1933), 348, 49, 60. 75 period.9 Thus during the 1920s and 1930s, the site for white, middle-class birth shifted dramatically from home to the hospital, formerly a location used only by the very wealthy (in private hospitals) or the very poor (who were forced to avail themselves of the free or low-cost services of doctors-in-training in urban “lying-in” hospitals, either because they could not afford an alternative or because no alternatives existed in their area). By 1940, 55 percent all births and 75 percent of urban births took place in the hospital, whereas just twenty years earlier birthing at home was the norm.10

The move to the hospital entailed a shift from the familiar environment and idiosyncratic rhythms of home to the institutional setting and routinized, “assembly- line” practices of medicalized birth. Hospital administrators and medical staff placed great importance on asepsis—the creation and maintenance of a sterile environment.11 Childbirth manuals and magazine articles promoting hospital birth often emphasized the “modern,” “germ-free” atmosphere of the delivery room and highlighted these attributes with descriptions or illustrations of gloved and masked medical staff and the latest medical instruments. (Fig. 2.1)

9 Leavitt, Brought to Bed: Childbearing in America, 1750 to 1950: 171; Wertz and Wertz, Lying-In: A History of Childbirth in America: 156. 10 ———, Lying-In: A History of Childbirth in America: 133; Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 83. 11 This is not to say that home-delivery services did not also aspire to and achieve asepsis. See, for example, the Chicago Maternity Center’s efforts in this regard in Paul De Kruif, "Why Should Mothers Die?," Ladies' Home Journal, April 1936. Also noteworthy is the fact that many hospitals were not successful in implementing asepsis. See "Maternal Mortality in New York City: A Study of All Puerperal Deaths, 1930-1932," (New York: New York Academy of Medicine Committee on Public Health, 1933). For a discussion of the general worry during this period about “germs” see Wertz and Wertz, Lying-In: A History of Childbirth in America: 155. 76

Figure 2.1 Source: Roy P. Finney, The Story of Motherhood (Liverright, 1937), 269.

Typically a woman’s progress though labor and delivery followed a standardized series of steps dictated by the hospital. The focus was on efficiency and speed. After a routine shave of the pelvic area and administration of an enema, the mother was given analgesics or anesthesia. Just before delivery, staff wheeled her to a delivery room where she was placed on a table. Attendants then splayed and bent her legs at the knee and strapped them high into stirrups. Her arms were strapped to the table. Doctors commonly performed an episiotomy just before birth and used 77 forceps to deliver the baby.12 Once born, nurses would remove the baby to a central nursery, a room that often reflected, in the arrangement of bassinets placed into rigid rows, the hospital emphasis on efficiency and mass production (Fig. 2.2), and bring it to the mother only at scheduled feeding times.

Figure 2.2 Source: Palmer Findley, The Story of Childbirth (Doubleday, Doran & Co., 1933).

Mothers were generally unaware of most of these steps, however, once they received their pain-relief medication. A 1938 Boston newspaper article described a hospital birth thus: “Two yellow capsules…(then) a jab in the arm, swiftly blot out scene, time, knowledge and feeling for the woman. When next she is aware…(an) amiable nurses chirps: ‘It’s all over. You’ve got your baby.’ With such streamlined

12 For descriptions of typical birth procedure during this period see Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 105, 06; Wertz and Wertz, Lying-In: A History of Childbirth in America: 165. 78 ease 1930s babies are born.”13 The lack of pain and “streamlined ease” that hospital birth promised proved a major motivation for women to seek “modern” hospital birth.

During this same period, America saw a growing emphasis on routine prenatal care, where before virtually none had existed. Born of Progressive Era concerns over infant and maternal mortality, between 1921, when Congress passed the Shepard-Towner Maternity and Infant Protection Act, and 1929, when the law was repealed, the federal government provided money for home nurses and clinics to dispense pre- and post-natal advice, especially to poor women, and thus encouraged millions of women to routinely seek medical care for themselves and their children.14 Both hospital births and routine prenatal care brought birth more fully under the purview of doctors and the medical establishment.

The Case for Anesthesia

Medical authorities and social reformers hoped that the new focus on prenatal care and a move to the hospital would make childbirth easier and safer. To the dismay of doctors, mothers, and health care administrators, however, these practices did not reduce maternal mortality. In fact, though the infant mortality rate had decreased significantly by this point, through the 1920s and into the early

1930s the maternal mortality rate was no lower than it had been in 1915. Just as

13 White, "Science Mercifully Blotting Out the Tortures of Childbirth." 14 Jacqueline H. Wolf, Deliver Me from Pain : Anesthesia and Birth in America (Baltimore: Johns Hopkins University Press, 2009), 111. 79 troubling, was the fact that the United States had one of the highest maternal mortality rates in the “civilized” world—a fact that threatened its status as an advanced, civilized nation.

In 1933, the New York Academy of Medicine released a report on maternal deaths in New York City between 1930 and 1932, a landmark study that sparked a national critique of hospital, instrument, and drug use during labor. The study found that over sixty percent of maternal deaths could have been prevented with better medical care. Septic hospital conditions, the over-use of anesthesia and the concomitant use of forceps were listed as the major causes of mortality. Almost all forms of anesthesia used during this time rendered the mother unable to push effectively during the second stage of labor, thus making the use of forceps necessary. Insufficient training and poor judgment on the part of doctors, along with mothers’ demand for pain relieving drugs, the study noted, contributed to these excesses.15 Public response to the report, which was carried in the popular press, was prolific. Doctors, mothers, and public health officials all weighed in on the debate over how best to combat these problems—with suggestions ranging from better education and board oversight for training for doctors, to increasing the number of professionally trained midwives,16 to eliminating the use of pain medication in labor. Ultimately, only the first suggestion—better education and board oversight for doctors—came to fruition.

15 "Maternal Mortality in New York City: A Study of All Puerperal Deaths, 1930-1932." Irvine Loudon notes that the maternal mortality rate was actually higher for hospital births. 16 The study found that midwife attended births had a significantly lower mortality rate. 80 Significantly, commentaries on maternal mortality during the 1920s and

1930s quite often equated healthy motherhood with a duty to race and nation. This rhetoric drew on then influential eugenic concerns with “racial progress”—a concept that associated the future of the white race with the advancement of civilization and posited that intelligent breeding, through forced sterilization of the

“unfit” and the promotion of childbearing among the “fit,” would produce a superior race of human beings. By the 1930s eugenicists had shifted from a focus on “today’s misfits” to a focus on the fitness of “tomorrow’s children,” America’s future citizenry.17 Bound up with the facts of maternal mortality were worries that the deaths of so many mothers threatened the very social fabric of America. Fewer healthy mothers meant fewer healthy children and, as one doctor put it, “healthy children (are) a national asset.”18 Authorities therefore exhorted Americans to insure the health and safety of mothers for “upon that depends our hope of a better and a stronger race.”19 The editor of Forum and Century, decrying the fact that the maternal mortality rate in the United States was higher than in “most other civilized countries,” summed up the views of many in saying that America needed a national campaign for “better motherhood,” one that called for better trained obstetricians and midwives and more maternity centers to aid mothers in “renewing the life of

17 For a discussion of American eugenics in the 1930s see Wendy Kline, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (Berkeley: University of California Press, 2001), 95-156. The 1930s saw both a dramatic increase in sterilization and the beginning of a focus on the “importance of motherhood and family to the future of the race.” Kline, p. 4. 18 Samuel Raynor Meaker, Mother and Unborn Child; A Little Book of Information and Advice for the Prospective Mother (Baltimore: The Williams and Wilkins Company, 1927), 4, 5. 19 Ibid. 81 the race.”20 If Americans could just effectively deal with the complications and pain of labor the rhetoric increasingly went, maternity would increase and the survival of the (white) race and nation would be assured.

Medical authorities, social reformers and mothers alike particularly focused on the pain of childbirth during this period. Doctors and social reformers were interested in the subject because many believed that pain in labor ultimately contributed to some of the complications associated with maternal death or that it dissuaded “fit” women from having babies. As the Reader’s Digest put it,

“Obstetricians…are practically united in agreeing that once this dread (of pain in labor) is removed…more children will be born in the white-collar professional groups, where at present the low birth rate is causing grave alarm.”21

Mothers focused on the pain of labor because of a culture of fear that surrounded birth. Women became increasingly vocal in the popular press about the childbirth pain they experienced, or feared they would experience. Popular childbirth manuals and magazine articles abounded with references to the experience of childbirth as one of “hours of agony…demoralizing terror…(and) depleting exhaustion.”22 Women’s interest in ways to eliminate that labor pain is

20 Henry Goddard Leach, "Better Mothers: Death Rate of Motherhood High in the United States," Forum and Century, May 1938, 258. 21 McEvoy, "Our Streamlined Baby: New Method of Easy Childbirth," 17. 22 Constance Todd, “Babies Without Pain,” Good Housekeeping, November 1937, 78. See also Inis W. Jones, "Childbirth with Less Pain and More Safety," Parents, February 1933; "From Genesis to Freud: Attack on Painless Childbirth," Nation, June 3 1936; White, "Science Mercifully Blotting Out the Tortures of Childbirth." 82 reflected in the numerous magazine and newspaper articles during this period that focused on pain-relief for childbirth.23

Indeed, in spite of the evidence in the 1933 New York Academy of Medicine report on maternal mortality linking death to the use of anesthesia, public interest in pain relief was so great, whether driven by eugenic concerns over racial progress or because of fear over the childbirth experience, that it spurred physicians to experiment with new pain-relieving methods, so much so that the period between

1920 and 1945 saw the development of most of the pain-relieving methods used in childbirth today.24 Parents magazine listed and described in 1940 a veritable arsenal of common techniques: 1) Twilight Sleep, “the oldest” and “still surprisingly common,” used a combination of morphine for pain relief and scopolamine to produce amnesia; 2) the Gwathmey method, which involved inserting ether-oil into the rectum and provided both pain relief and amnesia; 3) “pento-sco,” the use of pentobarbital sodium and scopolamine—a method which produced “deep sleep” for some patients, but which caused others to become “excited” to the point that they might fall out of bed or injure themselves; 4) a combination of ether and barbituric acid, which produced unconsciousness, and 5) paraldehyde, also an analgesic and

23 See, for example, Constance L. Todd, "Easier Motherhood," Ladies' Home Journal, March 1930; M. Beatrice Blankenship, "Enduring Miracle," Atlantic Monthly, October 1933; Jones, "Childbirth with Less Pain and More Safety."; Helena Huntington Smith, "Case for Anesthesia," Delineator, September 1934; "Relief of Pain in Childbirth," Hygeia, June 1936; Bruce Gould and Beatrice Blackmar Gould, "Medieval Thinking About Childbirth," Ladies' Home Journal, October 1936; White, "Science Mercifully Blotting Out the Tortures of Childbirth." 24 For a discussion of the public focus on labor pain and the resulting developments in obstetric anesthesia see Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 78. See also, Leavitt, Brought to Bed: Childbearing in America, 1750 to 1950: 175. 83 amnesiac.25 All of these methods either rendered the mother unconscious or caused her to forget the birth experience. Thus they ushered in a period lasting for over twenty years where, for the first time in history, a majority of women were either unawake at, or unaware of, the moment of birth.26

Civilization and the Pains and Perils of Childbirth

At the same time, and as part of the worry over the United States’ high maternal mortality rates and the resulting intense focus on labor pain, Americans concerned with childbirth sought to understand the reasons underlying “modern” women’s difficult labors. Many in the 1930s, much like their predecessors in the late nineteenth and early twentieth century, placed the blame squarely on “civilization.”

As the editor of the Journal of the American Medical Association put it,

“Civilization…increased the pain and perils of childbirth.”27 Dr. Joseph P. De Lee, seen by many as the father of modern obstetrics, stated in an address to the

American Medical Association in 1935 that “(a) large part of the pain in labor is…due to the changes, cultural changes, which are mostly mental…resulting from

25 Constance J. Foster, "New Techniques in Childbirth," Parents Magazine, May 1940, 41.An analgesic, also known as a pain-killer, relieves pain without producing unconsciousness; an amnesiac is a drug that produces amnesia, a state of forgetfulness. It is important to note that though a variety of pain relief methods existed, for the most part doctors, not women, chose which one would be used. 26 Not all women who experienced drug-assisted childbirth were unconscious or unaware during the entire labor. Jacquelyn Wolf argues that it was common for doctors to administer general anesthesia only during the last part of the second stage, just before the baby was born. They believed, because women tended to be most the most vocal then, that the actual birth was the most painful period. Ironically, then, women often experienced much of the pain of labor but missed the actual birth of the baby. See Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 5. 27 Editor, answer to “Queries and Minor Notes: Obstetrics in Rural Practice,” The Journal of the American Medical Association, 103 (November 17, 1934): 1557. 84 civilization.”28 Indeed, medical professionals in the 1920s and 1930s almost uniformly agreed that it was the conditions of civilization that made childbearing difficult for women.

Looking at several popular histories of medicine and obstetrics published by doctors in the 1920s and 1930s,29 we get a better sense of just how they conceived of civilization as the cause of this deterioration of childbirth. All saw modern childbirth as more difficult and painful than it had been in the distant past and all saw the cause in the presumed fact that, as medical popularizer Howard Haggard put it, “Civilization…imposed an increasing number of penalties on child-bearing.”30

Like his predecessors writing in the late-nineteenth and early twentieth centuries,

Haggard found that civilized women endured a “distortion of the bones of her pelvis by rickets,31 and the consequent difficulty or impossibility of natural birth,” which arose from consuming a “diet evolved by civilization” and a lack of exposure to the sunlight due to modern clothing and indoor living. Haggard also listed “that mongrelization characteristic of civilization…cross-breeding,” which supposedly

28 Joseph B. De Lee, “Obstetrics versus Midwifery,” The Journal of the American Medical Association, 103 (August 1935): 308. 29 Medical historian Bert Hansen notes that the 1920s through the 1940s saw an “unprecedented surge” in the publication of popular medical histories which indicates the popularity of the subject. See Bert Hansen, Picturing Medical Progress from Pasteur to Polio: A History of Mass Media Images and Popular Attitudes in America (New Brunswick, N.J.: Rutgers University Press, 2009). The books discussed here are part of that surge. Howard Haggard’s book, first printed in 1929, was especially popular and ran to eight editions. 30 Haggard, Devils, Drugs, and Doctors: The Story of the Science of Healing from Medicine-Man to Doctor: 8. 31 Rickets is a disease caused by Vitamin D and/or calcium deficiency that can result in bone deformity and contracted pelvises—a condition that can adversely affect labor. A Vitamin D deficiency may be caused by poor diet or lack of exposure to sunlight. Americans in the early twentieth century saw rickets as a disease of civilization because they thought “civilization” required more time indoors, working and living, and more clothing than “primitive” life did. Both of these aspects of civilized life reduced exposure to the sun. 85 created babies unsuited to the size of the mother’s pelvis, as a reason for difficult birth.32 Here he echoed the then common belief, dating back to the late nineteenth century, that within a particular “race” a baby’s head size matched the mother’s pelvic size. When people intermarried between races, the thinking went, a baby could inherit a head size that was too big for the mother to birth easily.33

Another medical historian, Palmer Findley, also blamed civilization for difficult birth. He noted that “among civilized peoples marriage is contracted without regard for race or differences in physical make-up, with the result that labour is made more difficult.”34 He cited, too, the problem of “the more cultured classes experiencing the debilitating consequences of dissipating habits and of fashionable modes of dress,” which “restrain the free action of the muscles” and

“tend to weaken the expelling powers of the mother.”35 In an example of the enduring cultural currency of the concept of neurasthenia, he lamented “the neurasthenic product of civilization” adding that “the nervous system of these women is unequal to the stress of labour.” In all, he asserted, “the modern woman pays the price for a life of luxury and ease and in this particular she is at a decided disadvantage with the stoical Indian.”36 In Findley’s examples the price modern women pay is physical debility and mental nervousness that make labor more difficult.

32 Ibid., 6-7. 33 The word “race” here indicates difference based on nationality or cultural origin. 34 Palmer Findley, The Story of Motherhood, (Garden City, N.Y; Doubleday, Doran & Co., 1939), 53. 35 Ibid, 53. 36 Ibid, 53-54. 86 In Into This Universe: The Story of Human Birth, Alan Guttmacher also asserted that childbirth is a more difficult and dangerous experience for women in

“modern society.” Along with citing the reasons given by Haggard and Findley, he discussed another popular explanation for the difficult births of civilized women— the fact that “Western civilization has eliminated the squatting position which girls and young women among the savages so constantly assumed in absence of furniture and toilets.” This impeded, he thought, the normal development of the pelvis.

However, he believed that the most important reason for difficult childbirth among modern women was their “mental attitude toward childbirth…the civilized woman views labour with a group of conscious and subconscious fear reactions.” Here

Guttmacher echoed supporters of Twilight Sleep who believed that the

“overcivilized” mind impeded birth.

Even Roy P. Finney, who, as we shall see, saw the story of civilization as one ultimately of success and triumph, admited in The Story of Motherhood that

“Despising hardship, work and pain, we have devoted centuries of thought and effort to the laudable task of finding out how to make life easy for us. So well have we succeeded that we have become softies.”37 This “soft” life, he thought, had made

“difficult and unnatural labors” more frequent. Partly, he wrote, due to a lack of exercise, resulting in weak muscles, a narrower pelvis, and less “elastic tissues.”38

37 Roy P. Finney, The Story of Motherhood (New York, Liverright, 1937), 3. 38 Ibid., 18. Though recent research supports the idea that exercise contributes to a more effective/easier labor, the point here is that Finney equates lack of exercise with modern civilization and contrasts it to the physically active lives of so-called primitive people. 87 The ease and convenience of civilized life, Finney believed, have brought physical degeneration to women.

Evidence suggests that the general public shared, or was at least aware of, similar beliefs regarding civilization’s effects on labor and delivery. A pregnancy and childbirth advice manual written in 1927 admonished that the “artificial conditions and the stress and strain of modern civilization” are likely to contribute to “various derangements and disorders” of childbirth.39 Popular magazine articles teem with similar references—an indication of the cultural currency of the topic. For example, a woman writing in the Atlantic Monthly on the “enduring miracle” of birth noted in

1933, “The complexities of civilization…gradually increased the rigors of childbirth until having a baby was for the mother almost as dangerous as going to war was for the father.”40 A 1934 Good Housekeeping article delineating the findings of the 1933

New York Academy of Medicine report stated that “from all authoritative sources…comes the imputation that (mothers) are getting too soft” and have an

“inability or unwillingness to bear pain.”41 In the opening article to an influential series on maternal mortality in the Ladies’ Home Journal, Paul De Kruif listed what he saw as the hallmarks of childbirth in America—“the terror of complicated childbirth, its bloodshed and cries of agony”—and wrote that the “grimmest of truths has become plain to anyone that childbearing, for most civilized women, has in

39 Samuel Raynor Meaker, Mother and Unborn Child (Baltimore: The Williams and Williams Company, 1927), 1. 40 Blankenship, "Enduring Miracle," 410. 41 G. Parkhurst, “Every Baby Needs a Mother,” Good Housekeeping, 98 (February 1934): 116. 88 the course of the ages become the opposite of natural, normal.”42 And in 1937 an article promoting the use of pain-relieving drugs during birth blamed civilization for their necessity: “The pain, the dread of pain, the exhaustion bred of pain and dread—for these civilization rather than nature are responsible.”43

Together these examples in the medical and popular press illustrate a widespread preoccupation with the pain and complications of labor. This literature also reveals a general agreement that these dysfunctions of “civilized” birth—birth characterized by pain, fear, exhaustion, and, in the words of the childbirth advice manual quoted above, “various derangements and disorders”—were caused by physical and mental debilities brought about by the anxieties and conditions

(urbanization, industrialization) of civilization.

“Labor Among Primitive Peoples”

Just as in earlier decades, the notion of painful, civilized birth was grounded in notions of what it was not—painless, uncomplicated primitive birth, or rather, birth as it was “naturally,” before it had been corrupted by civilization. The focus on the problems of civilized birth in the childbirth literature of the 1920s and 1930s was equaled by repeated contrasts to painless, uncomplicated “primitive” birth.

Usually presented as an ideal that had been lost, but sometimes used as an example of what was best left behind, writers employed the trope of primitive birth in a

42 Paul De Kruif, “Why Should Mothers Die?” Ladies Home Journal, 53 (March 1936): 8, emphasis his. 43 Constance L. Todd, "Babies Without Pain," Good Housekeeping, November 1937, 110. 89 variety of contexts, indicating its continued pervasiveness and cultural importance into the 1930s. Writers often also explicitly marked the class and/or racial identity—always non-white or lower class—of the women who gave birth easily and painlessly and who therefore must be primitive. Accordingly, their examples also implicitly defined who did experience civilized birth—the “white” middle and upper class.44

Popular magazine articles illustrate the persistence of the idea of easy primitive birth and Americans’ tendency to use it to highlight what civilized birth had become. Paul De Kruif, for example, in his series on maternal mortality in the

Ladies’ Home Journal, contrasted the difficult births of the “highly cultured civilized woman” to the easy births of Native American women. He employed the centuries- old story of the stoic and resilient Indian mother who lingers behind to give birth then runs to catch up with her tribe as an example of an “almost completely painless natural childbirth,” an experience that “civilized” women could achieve if they were free from fear.

44 Beginning in the 1920s Americans had begun to move towards an idea of race that unified whiteness under the term “Caucasian,” a term and concept that was most often contrasted, in binary fashion, to “Negro,” or “white” to “black.” However vestiges of the hierarchical scheme that positioned the “colored races” (African American, Native Americans, Latin American, Chinese and Japanese people) and multiple “white” races (that is peoples of European descent) along a continuum of civilization, with “Nordic” or “Anglo-Saxon” at the top, persisted into the mid-twentieth century. (See Matthew Frye Jacobson, Whiteness of a Different Color: European Immigrants and the Alchemy of Race (Cambridge, Mass.: Harvard University Press, 1998), 91-96.) Thomas Guglielmo argues that race during this period was structured in two ways—in terms of color (a social category, examples: “black race” and “white race”) and in terms of “race” meaning national or cultural group (examples: “Nordics” or southern Italians). (See Thomas A. Guglielmo, White on Arrival: Italians, Race, Color, and Power in Chicago, 1890-1945 (New York: Oxford University Press, 2003), 8-9.) My sources use racial terms in both of these senses. Here I use the term “white” to mean a social category of color, a unified whiteness.

90 We find another example of the contrast of the idea of easy, pain-free primitive birth to painful civilized birth in a letter to the editor of the American

Mercury. Written in response to an article by a mother who asserted that painful birth was a myth, the letter’s author, Ruth Lane, was angered by the claim that childbirth is not painful. She wrote that the fact that the author of the article did not experience pain during labor indicated that she must be of “Cherokee” descent. Lane seemed sure her audience will understand her reference when she sarcastically stated, “I’ll bet there’s a dash of Cherokee on (her) family-tree somewhere, for she

(the mother who experienced no pain during childbirth) reminds me of a squaw I once read about.” Lane then went on to describe this “squaw” and related the familiar tale, similar to De Kruif’s, of the Indian woman who, out on the trail with her tribe, stops to give birth alone, washes her baby in a creek and then catches up with her group as though there were “nothing to it.”45 Here Lane used the trope of primitive birth to validate her own experience of birth pain by implying that the mother who had a painless birth must somewhat primitive (a dash of Cherokee).

A Good Housekeeping article also illustrates the common reference to easy primitive birth. Admonishing fathers for being “careless and negligent” in the area of childbirth, and thus contributing to the needlessly high maternal mortality rate, the author listed the various types of husbands who unwittingly neglect their wives’ health and recounts their reasons for doing so. The author referenced the easy birth

45 Ruth H. Lane, "Letter to the Editor: Motherhood Is Not Bunk," American Mercury, Janurary 1939, 123-24. 91 of “primitive” women noting examples of “aboriginal women stopping by the roadside…delivering their offspring without assistance and resuming their way in stoic indifference.” There is one “type” of husband, she wrote, who having read about these “aboriginal women” believes that childbirth is “a normal healthy function,” and that therefore he does not need to be solicitous of his wife.46 The allusion to easy “aboriginal” birth was used to indicate what a husband should not assume about childbirth and his wife—that is, he should not assume that his wife, presumably a civilized woman, will experience birth as a “healthy normal function.”

The medical community commonly looked to easy, painless primitive birth to understand what birth had been—or to understand what it could be again.

Sometimes, for example, they looked to primitive birth to learn how restore civilized childbirth to a healthier state. Obstetrician Julius Jarcho explicitly took up this topic in his 1934 book, Postures and Practices During Labor Among Primitive Peoples, in which he hoped “to transmit to modern obstetricians…those (birth) postures and practices utilized to advantage by primitive peoples.”47 Jarcho related that after years of attending births in New York City among “almost all of the European and

Near Eastern racial and national groups, and a variety of social strata” he found that

“medical education fails to supply…certain instinctive or empirical knowledge that is possessed by ignorant classes, or by half-civilized or savage people.”48 In other

46 H. Welshimer, “Two Out of Three Can Be Saved,” Good Housekeeping, 102 (June 1936): 61. 47 Julius Jarcho, Postures & Practices during Labor among Primitive Peoples; Adaptions to Modern Obstetrics, with Chapters on Taboos & Superstitions & Postpartum Gymnastics (New York: P. B. Hoeber, Inc., 1934), ix. 48 Ibid., 1-2. 92 words, he, a medically trained doctor, did not possess the knowledge in childbirth that his “ignorant,” “half-civilized,” or “savage” clients did. He, the civilized, had to learn from the primitive.

Jarcho then went on to explain why “primitive” peoples generally birth more easily. Here, not surprisingly, we find echoes of the general thinking on why civilized birth is more difficult. Unlike civilized women, “primitive peoples” and

“savages,” we learn, “go about half naked; their bodies are constantly exposed to the…ultraviolet rays of the sun.” Rickets and osteomalacia and their resulting pelvic deformities were therefore unknown. Furthermore, “(t)heir tasks are menial in character” and so provide the “necessary gentle activity” for developing a health bony skeleton and musculature—“deformities of the pelvis do not appear.” Finally, and most important for Jarcho’s purpose (he promoted squatting as a labor posture for easing civilized birth), these women assumed various squatting positions when delivering, therefore enlarging the pelvic opening.49 A life free of the physical restraints of civilization, but steeped in physical activity, and the habit of

“instinctual” postures during birth, Jarcho argued, make labor and delivery easy in the primitive woman. He believed that if civilized women adopted more of these practices they, too, might have easy, less painful births.

Descriptions of primitive birth are important not only for what they tell us about perceptions of childbirth in the 1930s, however. Like their late-nineteenth-

49 Jarcho, 23, 32-33. See also Haggard and Findley for similar descriptions of the reasons why primitive birth was supposedly easier. 93 and early-twentieth-century versions, American portrayals of primitive birth continued to be important indicators and contributors to constructions of race. As such they reveal a continued association between “primitive” birth and non-white and women of the working- or lower-class.

That two of the doctors that we have been discussing—Findley and Jarcho— associated primitive birth with non-white or ambiguously white women is evident in their choice of groups for examples of primitive birth and how those examples are organized in their books. Each of the their books—Findley’s The Story of Childbirth and Jarcho’s Postures and Practices During Labor Among Primitive Peoples includes a section on “primitive” or “uncivilized” birth customs and taboos from around the world. Somewhat ethnographic in nature, these sections describe the birth practices of one national or cultural group after another—material that the authors glean from a number of shared medical sources, especially the influential nineteenth- century book by George J. Engelmann, Labor Among Primitive Peoples50. They give neither dates nor historical context.

Examples of primitive birth customs outside the United States came from indigenous peoples in Asia, Africa, Australia, and South and Central America and

“lower racial” groups in Europe, such as the “traditional” Italians, Greeks, Irish and

Polish. Within the United States, the authors looked to Native Americans, African

Americans, Mexican Americans and rural whites for their examples of primitive

50 George J. Engelmann, Labor Among Primitive Peoples (St. Louis: J.H. Chambers & Co., 1882). I discuss Engelmann and his work in Chapter One. 94 customs. We see this in Jarcho’s chapter on the “customs and taboos of primitive peoples” in which he included examples from, among others, the “Orientals,” the

“Persians,” the “Hungarian peasants,” the American “Indians,” “Half-breed Mexican” women and the “’granny’ midwives in the remote mountainous regions of

Kentucky.” He devoted almost an entire page to the “Southern Negroes” who “have a group of superstitions more or less all their own, brought with them from Africa” suggesting here a timeless and unchanging culture brought from outside the United

States, these “Negroes” are not civilized Americans.51 In all of these examples, the focus is on the customs and superstitions surrounding birth. Jarcho did not discuss whether or not these women had easy, painless “primitive” births, but that fact that he considered these groups of women to be primitive is made explicit by their inclusion his section on primitive customs and taboos.

Findley paraded past his readers the childbirth practices and beliefs of a similar selection of what he called “savage” peoples. He discussed the “Eskimo” woman who goes into the woods to dig a hole in the snow in which to deliver her baby. He quoted a doctor who knew of a Sioux woman “who left her hut in the dead of winter” to gather firewood. “While she was gone but for a short period of time, she not only accomplished her task but gave birth to a baby and carried it back safely together with the wood.” Findley also discussed the “Southern Negro,” whose

51 Jarcho, 4-13. 95 primitivity, though not specifically described, is marked by the fact that they are

“well-stocked with superstitions…many of which were imported from Africa.”52

Other writers explicitly linked easy birth and physical resilience—and therefore primitivity—with non-white women, as in the following example from

1938. A reviewer of Roy Finney’s The Story of Motherhood opened his article with an anecdote related by his doctor brother: Having “delivered (at home) a huge strapping negro…(the doctor) told her to stay in bed until he gave permission for her to get up.” Finding the mother up the next morning and doing household chores, the doctor indignantly reprimanded the woman. She responded by resting “her fists on her wide hips” and exclaiming, “Listen here, little w’ite (sic) Doctor…when you has had as many chilluns as I has had, you can come around and tell me what to do—but not ‘til then! Nossah!” The reviewer then went on to state, “Not all women, by any means, are as well-equipped and capable at their functions as this wench.”53

This woman’s strength and hardiness in childbirth was indicated in the author’s mind by the fact that she was up and doing chores the day after her baby was born—a point that recalls stories of Native American resiliency immediately after birth—and the reference to her wide hips implied superior childbearing capabilities. Thomason thus implicitly marked the “negro” woman as primitive because of the supposed ease of her birth.

52 Findley, 50, 52, 59. Elsewhere Findley associates superstition with primitive people, See Findley, p. 4, 7. 53 John W. Thomason, Jr., “The Conquest of Pain,” The American Mercury 43 (January 1938): 107. 96 The division between primitive versus civilized was not fully confined to race, however. Childbirth writers also marked the births of poor and working-class women as easier and therefore more primitive. Finney wrote that, “My own experience abundantly confirms the general impression among doctors that labor is easier and less likely to be complicated among the working class of women. Like their ancient forbears, they have smaller children and in general are hardier. As they, themselves, will assure you, they ‘can take it’.”54 Guttmacher wrote that, “The disregard of primitive women for the pain and suffering of childbirth and her rapid recuperation are reflected to a lesser degree by the less sophisticated members of our modern communities.” He noted that whereas ”private patients” remain in the hospital for two weeks after childbirth, are wheeled to the hospital exit in a wheelchair, and then stay in their own bedrooms for another week, “ward-patients”

(women who can’t afford private care) leave the hospital on their own two feet after nine days and within forty-eight hours have resumed their chores at home. Home delivery patients (generally women who were unable to afford any type of hospital care), he wrote, were usually up in less than nine days. Guttmacher’s remarks indicated that he believed women of the working-class, like “primitive women,” had more strength and stamina (rather than a more pressing need to get back to work), signaling a degree of primitivity not present in his “private ward” patients.

Together these examples of primitive birth illustrate the cultural pervasiveness of the concept and its use to highlight changes in civilized birth. The

54 Finney, 18-19. 97 examples also illustrate a widespread association between primitive birth and lower-class and non-white women. Middle-class and upper-class white women, it is clear, are the only ones who experienced civilized birth.

Civilized Childbirth Becomes Modern

That the literature of childbirth during the 1930s blamed civilization for difficult “civilized” birth is evident, as is the fact that many Americans contrasted civilized birth (associated with the white middle-class) with primitive birth

(associated with non-whites and the working-class). Also predominant, however, was the question of what to do about the pain and complications of civilized birth.

Though they thought that civilization caused painful, dangerous birth in civilized women, many argued that civilization—through its development and employment of modern medical science—could also remedy these debilities, transforming painful “civilized” birth into “modern” pain-free birth.55

Often the very same writers who described the negative effects of civilized life on women lauded the medical advances of civilization that made it possible not only to overcome those negative effects, but also to improve on the birth experience of primitive women. Medical historian Roy P. Finney, who, as we saw earlier, felt

55 Roland Marchand notes a similar narrative, what he calls the “parable of civilization redeemed,” in advertisements of the era. He describes advertisements that would lament the “deleterious by-products of civilization” and then offer their product as the remedy. “The point of the parable,” Marchand writes, “was that Civilization, which had brought down the curse of Nature upon itself, had proved still capable of discovering products that would enable Nature’s original and beneficent intentions to triumph…Civilization had become its own redeemer.” See Roland Marchand, Advertising the American Dream: Making Way for Modernity, 1920-1940 (Berkeley: University of California Press, 1985), 223-28. 98 that modern women experienced more difficult births due to the effects of civilization, illustrated this point when he noted that the “modern mother”—thanks to a “spotlessly clean delivery room, doctors and nurses garbed…in sterile white gowns and gloves…shiny boiled instruments and antiseptic solutions,” and oblivion due to “modern” anesthesia—is ultimately more fortunate than the “primitive” mother “(s)quatting on her bed of leaves” and “suffer(ing) in animal-like silence through the long hours of the night.” As a “modern girl” she took the “wonderful experience” of easy, painless birth “for granted.”56 Finney highlighted the benefits of medical science—the “modern” anesthesia, the “sterile” environment and

“antiseptic solutions.” This was what made “modern” birth better than primitive birth.

Palmer Findley, who also chronicled the degeneration of civilized birth, emphasized the fact that “modern science” helps women make up for their deficiencies: “Now thanks to modern science the woman who falls short of meeting the demands made upon her during labor can now be given such expert obstetrical assistance that there is little chance for any complication that cannot be successfully managed.”57

In some ways, this faith in medical science in the context of childbirth is not surprising. The consumer culture of the early twentieth century drove a quest for

56 Roy P. Finney, The Story of Motherhood (New York: Liverright, 1937), 6, 7, 12. Jacquelyn Wolf notes this as a reversal from late nineteenth century thinking about civilized birth, but does not discuss the fact that during the 1930s the childbirth literature is still rife with discussions of the ill- effects of civilization. See Wolf, p. 79. 57 Findley, 80-81. 99 “new” over “old,” and “modern” over “old-fashioned.” Americans discerned and appreciated convenience, as well as financial and health benefits, in the modernization of technology and modes of living. They thus often sought out the

“modern” products, programs and methods that promised these effects.58

The imprimatur of science and medicine had particular appeal. Americans during the first half of the twentieth century placed great faith in medical and scientific progress and enthusiastically greeted new medical discoveries and innovations.59 The cachet of the new and modern in science was reflected in advertising and articles in the popular press —ads in the Ladies’ Home Journal in the early 1930s, for example, promised that Old Dutch Cleaner “cleans with scientific efficiency…the modern quicker way” and that Squibb Dental Cream offered

“advantages that your own childhood never knew…For with each succeeding generation the science of human welfare makes a steady advance.”60 Science also held sway in mothering. Childrearing manuals through the late 1930s pushed

“scientific motherhood,” a practice of mothering that recommended putting children on strict schedules and withholding physical affection in order to develop a rational, rather than emotional, relationship between mother and child.61 The emphasis on

58 See Marchand, Advertising the American Dream: Making Way for Modernity, 1920-1940. 59 Bert Hansen argues that popular media images reveal an “overwhelming enthusiasm for medical progress” from the late 1880s to the late 1950s. See Hansen, Picturing Medical Progress from Pasteur to Polio: A History of Mass Media Images and Popular Attitudes in America: 10. 60 "Advertisement for Old Dutch Cleaner ", Parents, April 1932; "Advertisement for Squibb Dental Cream," Parents, November 1932. 61 Rebecca Jo Plant, Mom: The Transformation of Motherhood in Modern America (Chicago; London: The University of Chicago Press, 2010), 93. 100 the benefits of modern medical science in childbirth grew out the era’s enthusiasm for science in general.

Paradoxically, in spite of the acclaim for the new scientific approach to childbirth, however, part of the appeal of the new pain-relief methods was their ability to ensure “natural” birth. Like supporters of the initial push for Twilight

Sleep earlier in the century, some Americans in the 1920s and 1930s thought that use of pain-relieving drugs and/or occasioning unconsciousness—often done in ways similar, if not identical, to Twilight Sleep—during birth actually enabled the mother’s body to work more effectively. Once the mother’s mind was “turned off”

(whether because she was unconscious or because analgesics prevented her brain from receiving pain signals), the thinking went, her body was able to function in its natural (primitive) state. A 1937 magazine article, for example, noting that under analgesia a nerve “carries no message to the brain,” commented that “nature goes about her business unconcernedly” when pain-relieving drugs are used.62 Another magazine article reported that amnesia-producing drugs allowed the mother’s muscles “to go about their business.”63 One mother stated that she learned that “The drug administered (during birth)…relaxes the body so that the doctor and nature may work harmoniously.64 And another magazine articled noted, “Analgesia, by

62 Todd, "Babies Without Pain." 63 Foster, "New Techniques in Childbirth." 64 "I Had a Baby, Too: A Symposium," The Atlantic, June 1939, 767. 101 masking the pain, allows the patient to go on to a point where the baby can be born naturally.”65

In the eyes of mothers and doctors, this pain-free, “natural” birth was made possible because modern civilization provided its own antidote for the debilitating effect it had had on childbirth. Though civilization made childbirth more difficult and painful, the modern technologies of civilization, in theory, if not in practice— these technologies had been linked to maternal mortality after all—could alleviate a mother’s labor pain and forestall any complications. One proselytizer for anesthetics, Constance Todd, summed this up in Good Housekeeping in 1937. Though she states that “civilization” is responsible for the pain and fear of childbirth she is confident that “modern methods can transform normal (civilized) labor into an entirely endurable experience.”66 Modern medical science (drugs) not only effected the painlessness and ease of natural, primitive birth, but these medical techniques could improve upon the primitive experience by allowing for childbirth in clean comfortable hospital rooms staffed by nurses who relieved the mother of her maternal duties. As one women put it: “Remarkably life and modern science have simplified (labor)…science steps in and transforms what used to be an ordeal into an entirely endurable experience which, in many favorable cases, is quite literally a pleasant sleep and a happy awakening…looking back you may be able to say ‘I’d

65 Smith, "Case for Anesthesia," 52. 66 Todd, "Babies Without Pain," 78, 110. 102 much rather have a baby than a bad cold!’”67 Indeed, not only could modern medicine transform civilized birth into a pleasant, pain-free experience but according to some it had a moral obligation to do so, “With the mental and physical ordeal of childbirth increasing as civilization advances…(m)edical science is morally obligated to extend the fullest application of…analgesic therapy.”68

Ultimately the practice of using medical science to make “civilized” birth, that is agonized, dangerous birth, into “modern,” safe, pain-free birth proved that

America was a civilized nation. If, as Howard Haggard believed, the advances of civilization were seen most clearly in “the story of childbirth,” then the United

States, with its high use of medical interventions to relieve pain during parturition, might count itself as one of the more advanced nations. Constance Todd made the equation with the use of pain relief and America’s position as a civilized country explicit: “In America today, as in the rest of the civilized world, giving pain relief when babies are being born is no longer a debatable practice. It has come to stay.” In the “civilized world” women were unquestioningly given pain relief during childbirth. America, because it did the same, was part of the civilized word.

Indeed, according to some, America’s move to modern, pain-free birth indicated its status as an advanced civilization. As one writer put it, “Sure…we’ve got soft—Thank God! (A mother) is under no urge to get up and milk the cows tomorrow…she (does) not have (her) baby behind a bush on the Oregon Trail, like

67 Foster, "New Techniques in Childbirth," 41, 84. 68 C. O. McCormick, "Rectal Ether Analgesia in Obstetrics," The American Journal of Nursing 33, no. 5 (1933): 415. 103 that squaw they always tell you about…If you take a pretty good look at the Floor (in a hospital maternity ward), American civilization looks pretty good, better than you’ve been thinking lately. Better than any other civilization.”69

Primitive Birth or Not Modern?

Strikingly, even as Americans continued to associated primitive birth with non-white and lower-class women, as “modern” hospital birth gained ascendancy and worries over maternal mortality shifted attention to high childbirth-death rates among African Americans, contradictions to the association of easy, primitive birth with African American birth began to emerge. These new representations depicted pain and complications during labor and delivery and death in childbirth and belied the notion that black women gave birth painlessly and with ease.

Social reformers turning their attention to alleviating the high mortality rate in the 1920s and 1930s could not ignore the fact that African American women died at a rate at least half again as high as that of white women. As we saw in Chapter

One, evidence in the nineteenth century of African American disease during childbirth might be discounted as an anomaly, but by the 1920s Progressive Era interest in health reform and regulation and a national vital statistics registration system that made it possible to more easily track infant and maternal death made

69 Bernard DeVoto, "Maternity Floor," Harper's Magazine, April 1940, 559. 104 African American maternal mortality an area of focus.70 At the same time those seeking to explain why the United States maternal mortality rate was so high began blame African American rates of mortality as the cause. In 1927 Helena H. Smith noted, for example, that “(t)he American problem (of maternal mortality) is complicated by the Negroes, among whom a very high obstetric death rate prevails.”71 This acknowledgement of high rates of childbirth death among black women contradicted the notion that they were inclined to birth without complications.72

Looking at the 1930s other evidence also points to a new representation of

African American birth. Given the high level of Depression era focus then on issues of poverty and malnutrition, it is not surprising that this new representation highlights these conditions in African American mothers’ childbearing experiences.

In a direct refutation of the prevailing beliefs regarding modern (white) women’s and African American women’s physical condition, a 1933 Hygeia article noted that

70 For an example of nineteenth-century evidence of African American disease in pregnancy and its treatment as an anomaly, see Joseph T. Johnson, "Apparent Peculiarities of Parturition in the Negro Race, with Remarks on Race Pelves in General," American Journal of Obstetrics and Diseases of Women and Children 5(1875). See also Laura Briggs’ discussion of this instance in Laura Briggs, "The Race of Hysteria: 'Overcivilization' and the 'Savage' Woman in the Late Nineteenth-Century Obstetrics and Gynecology," American Quarterly 52, no. 2 (2000). For maternal mortality rates see Anne S. Lee, "Maternal Mortality in the United States," Phylon 38, no. 3 (1977). For examples of the recognition of high African American maternal mortality see Aldine R. Bird, "Progress of Obstetric Knowledge in America," Hygeia, May 1933; Elizabeth C. Tandy, "Infant and Maternal Mortality Among Negroes," The Journal of Negro Education 6, no. 3 (1937). 71 Helena Huntington Smith, "Death at Birth: Our High Maternal Mortality," Outlook and Independent, November 13 1929. See also C. Leon Wilson, "Prenatal Care," Journal of the National Medical Association 20, no. 4 (1927): 101. 72 My point here is not that there was no reason for concern over what was clearly a grave problem in African American women’s health. Rather I argue that the recognition of maternal mortality and complication during childbirth indicates a shift away from conceiving of African American birth as easy, painless primitive birth. 105 prominent obstetrician and former dean of the Johns Hopkins University School of

Medicine John W. Williams believed that “the modern young woman is better physically and makes a better physical mother than her own mother did a generation ago.” Williams stated that, “the modern woman…is just about in her prime, physically.” Conversely, it is the “Negress” that Williams singled out as lacking: “Quite contrary to belief, the Negress has the odds stacked heavily against her in competing with white girls in childbirth.” Conflating class issues with race, he argued that “in the big cities…the Negress is imperfectly nourished, with a development of rickets. 73 Her condition at the time of confinement too frequently is such that normal delivery is impossible.” Williams added that even with quality medical care at delivery “the white girl has almost a two to one advantage over the

Negress” and that “It is undernourishment and lack of understanding as to proper self care that causes Negresses to suffer more than white women do.”74

This about turn in rhetoric is striking and is signaled by William’s use of the phrase “quite contrary to belief” to introduce his thoughts on African American childbirth. Though he clearly conceived of black women as not modern, in that he contrasted them to “modern” women, they do not experience the easy births of primitive women—instead they find “normal delivery” almost always “impossible.”

73 As early as 1911 Williams noted the prevalence of rickets among African American women. His analysis of women in Baltimore showed that 33.2 percent of African American women had contracted pelvises due to rickets versus 7.7 percent of all white women. See Carolyn Leonard Carson, And the Results Showed Promise ... Physicians, Childbirth, and Southern Black Migrant Women, 1916-1930: Pittsburgh as a Case Study., ed. Judith Walzer Leavitt, Women and Health in America: Historical Readings (Madison, WI: University of Wisconsin Press, 1999), 351. 74 Bird, "Progress of Obstetric Knowledge in America," 438-39. 106 Black women, Williams stated, not modern (civilized) white women, are the ones that suffer in childbirth. Here the “modern” or “white” woman (the terms are used interchangeably) was in her physical prime, the “Negress” clearly was not.

The idea that the “Negress” is not modern is not a new one. As we have seen, non-whites had long been associated with the primitive and thus outside of the realm of civilization and modernity. What is new here, though, is the fact that the non-modern body is enfeebled, weak and abnormal in the context of childbirth. One might argue, in fact, that this is not actually “primitive” birth, but rather a new conceptualization of non-white birth—birth that is not modern but that has been corrupted by civilization (she has rickets, commonly believed to be a disease of civilization). This experience of birth cannot be modern because the mother, due to her poverty, has no access to the medical interventions that would remedy civilization’s ill effects. In this telling we get the sense that African Americans have been hurt by their contact with modern civilization. No longer seen as true

“primitives” who birth with ease, they are not quite modern either.

Paul De Kruif painted a similar, albeit more sensationalistic, picture of dysfunctional African American birth in a four part series titled “”Why Should

Mothers Die?” In the series, which ran in the Ladies’ Home Journal in 1936, De Kruif sought to alert his readers to the fact that the “needlessly high” maternal mortality rate in the United States is largely preventable and due to the

107 “shameful…widespread failure to use…science against pain and death.”75 To prove his point, he chronicled the work of the Chicago Maternity Center (CMC) which provided low-cost physician-led birth services, mostly in the patients’ homes, to the

“forlornest, poorest of America’s poverty stricken people.”76 Despite the fact that the

CMC “works amid wretchedness incomparably worse than average,” he noted, the

Center has only lost one mother in 4, 180 deliveries—a rate far lower than the national average. Ostensibly a story about the mortality rate for all women, De Kruif used the complicated, “wretched” births of African American women to illustrate the triumph of science over dysfunction—and therefore revealed yet more instances of the new representation of African American birth.

The following description of a delivery overseen by the CMC is typical of De

Kruif’s depictions of poverty and danger in childbirth. A “Negro” woman in her last weeks of pregnancy began to hemorrhage at home—this after slight bleeding previously for which she had been treated in the hospital and then sent home. The attending physician sent her back to the hospital, the bleeding again stopped, and for the next two days the “able doctors of the hospital” tried to induce the baby, but to no avail. At this point, the patient, a “dark lady—primitive and temperamental— hauled off and hit the nurse who tried to hold her down,” bit the doctor “who tried to reason with her and restrain her,” and fled the hospital for home “with her old coat over nightdress and without shoes.” Once home—a “dirty tenement” apartment

75 Paul De Kruif, "Why Should Mothers Die?," Ladies' Home Journal, March 1936, 8. 76 Ibid., 108. 108 with a “dirty kitchen,” a “bed with (a) tattered coverlet,” and “only two chairs in all”—her labor started and she began bleeding once more, so she sent again for help from the CMC. “There was every reason why our doctors…should have washed their hands of… (this) thoroughly ungrateful woman,” De Kruif wrote. “Her conduct at the hospital was scandalous…and anyway, who was this unmarried mother from the toughest Negro district of our city?” The doctors heeded the woman’s call, however, and though her baby died, were able to save the young mother’s life.77

De Kruif’s description here is telling in that it portrays the “dark” mother as primitive—both directly in the actual use of the term “primitive,” and also in the way that he highlighted her “temperamental” behavior (often associated with the

“uncivilized”) which he read as “ungrateful” and “scandalous” rather than as the possible reaction of someone who is probably frightened and in pain in unfamiliar circumstances. His descriptions of her environment as dirty, unkempt and deficient in furnishings further mark her lack of civility and middle-class respectability, as does the fact that she was unmarried and in the “toughest Negro district.” Yet, as indicated by the episodes of preterm hemorrhaging and the eventual death of her baby, she does not have the easy birth, free of medical complications, that many commonly associated with her race and class. This narrative reveals a shift to conceptualizing lower-class African American birth as arduous and dangerous to the mother.

77 ———, "Why Should Mothers Die?," 111. 109 Overall De Kruif was sympathetic to the plight of the women he described and acknowledged poverty as the basis for complications during their labors. Yet, as the example above indicates, his tone was patronizing, if not offensive. Still “Other,” this woman needed to have civilization, in the form of modern medical science, brought to her. In short, she needed “civilizing.” Though modern medical intervention saved her life, however, hers was no “modern” birth. Skin color, environment and behavior marked her as primitive, but her inability to bear a child with no pain or complications marked her as “un-modern.” Her birth required correction, not emulation.

While commentators during this era also portray “modern” women as deficient in childbearing capabilities, those women were able to overcome their deficits through the use of modern medical technologies, to which they had access to. Significantly, mothers who could afford hospital birth could take “modern” birth for granted. The new “modern” birth, with its attendant reliance on modern medical technology, inscribed modernity upon the mothers who experienced it, but those had limited access to the new technologies remained primitive—or, in a new representation, outside of modernity. The African American women whose birth experiences are described above suffer the disabilities of civilization on childbirth, but they do not have the means to correct it. No longer portrayed as primitive, their births are not modern either.

110 Conclusion

While the dichotomy of civilized and primitive childbirth persisted in the

1930s and remained linked with ideas of race and class, another dichotomy emerged—that of “modern” childbirth versus birth excluded from modernity—as

Americans came to feel that modern medical science had the power to remedy the ill-effects of civilization on labor and delivery. Modern birth, that is birth made easy and pain-free with anesthetics and modern medical care, was similar to civilized birth in that it was closely associated with the white, middle- and upper-class—the group most likely to have access to modern medical resources and technology. Yet modern birth also represented an improvement over civilized birth—it signified, one might say, the modernization of civilized birth—and marked the women who experienced it as modern themselves. Increasingly, as painless, medicalized birth became more available to women in the United States, the inability to experience an uncomplicated, painless labor became less associated with a woman’s level of civilization or primitivity and more associated with a woman’s lack of modernity—a condition associated with lower-class and racialized groups of women, the very types of women previously thought to have easy and pain-free deliveries.

Ultimately, as we shall see in the next chapter, these understandings of the effects of civilization and modernity on childbearing helped to shape the rhetoric and practice of “natural” childbirth in the 1940s through the 1960s in ways both similar to and different from that envisioned by participants in the Twilight Sleep

Movement. Supporters of Twilight Sleep had sought to restore natural, primitive,

111 painless childbirth by disconnecting the (over)civilized mind from the physical function of labor thru the use of medical science and in the form of pain-relieving and amnesiac drugs. Supporters of natural childbirth as it emerged in the postwar period also sought to restore natural, primitive childbirth by disconnecting the civilized mind from the body with the aid of medical science—but with limited, or no use of, drugs. As women increasingly sought—and found—safe, painless hospital birth in the 1940s, the emphasis on the benefits of modern medical science for childbirth endured. However, many came to see the drug-induced loss of control and unconsciousness at birth and the impersonal approach of medical staff as dehumanizing. They sought to recreate the easy “primitive” birth not through the use of pain-relieving drugs, but rather through a “modern, scientific” method that relied on relaxation exercises to disconnect the mind and the physical emulation of primitive women (through exercises to mimic physical labor and squatting during parturition) to restore the primitive body. In a fundamental and significant shift natural childbirth advocates began to see drugs as unnecessary at best and at worst as “unnatural.”

112 Chapter 3- Taking Labor Off the Assembly Line: Grantly Dick-Read and Natural Childbirth

In 1939, The Atlantic, in an indication of an emerging trend in childbirth that would mushroom in the postwar period, published an article on pain-free but conscious birth. In a direct attack on the “new techniques” of modern, unconscious drug-assisted childbirth that we explored in Chapter 2, Lenore Friedrich bemoaned having allowed hospital procedure and anesthesia to make her “into a sterilized package, babbling and unaware” during the births of her first three children.

Convinced by her experience with farm animal births that labor need not be painful, she determined to undergo the “experience of reality…(the) clarity of sensation and the continuity of consciousness” for the delivery of her fourth child. Unable to find a

“well-trained” doctor in the American Northeast who would agree to forgo the use of anesthesia, Friedrich joined her husband on a professional trip to Switzerland where a clinic there facilitated her conscious birth. Afterwards Friedrich described the delivery as relatively pain-free and the “most exhilarating” experience she had ever had—she felt, she said, as if she “could move mountains.”1 In the decades to come thousands more women, striving for what would become known as a “natural” childbirth, sought to have just such a conscious, painless experience.

1 LenoreP. Friedrich, "I Had A Baby," The Atlantic, April 1939, 462, 64. 113 Friedrich's and others’ reaction to unconscious, drug-mediated

“streamlined”2 childbirth and their consequent search for conscious, pain-free birth was born of general mid-twentieth century anxieties about the role of science and technology in modern life. Though many women sought and appreciated the oblivion to pain and fear that medical science (in the form of anesthetics) brought, some began to feel that the “streamlined” procedure of unconscious birth served to dehumanize and to mechanize the process of labor and delivery, as well as to rob the mother of the supposedly psychologically important and personally fulfilling experience of witnessing the birth of her baby. They sought instead a solution that would allow them to be awake and aware throughout.

Grantly Dick-Read, the so-called “Father” of natural childbirth, provided one such solution. Like those in the first third of the century, Dick-Read was concerned with ways that the “civilized” or “modern”3 mind interacted with the “natural” physical process of childbirth—and he looked to “primitive” birth as the model for natural birth. However, unlike Twilight Sleep supporters of the 1910s and those in the 1930s who promoted drug-assisted childbirth as the means to allowing the body to labor naturally, unimpeded by the mind, Dick-Read believed, instead, that it was necessary to eschew drugs and instead re-educate the mind and use relaxation

2 “Streamlined” birth was a term common in popular sources of the time. See for example, J.P. McEvoy, "Our Streamlined Baby: New Method of Easy Childbirth," Reader's Digest, May 1938. 3 As I noted in the introduction, Americans during this period tended to use the terms “civilized” and “modern” interchangeably. While “civilized” connoted a level of advancement along a continuum of social evolution and “modern” a level of advancement along a continuum of scientific and technological advancement, the two conditions were seen to go hand in hand. Both terms were contrasted with “primitive,” a term that implies a lack of both social and technological advancement. 114 techniques to disconnect it during labor and delivery to ensure a pain-free natural childbirth. His stress was on enabling mothers to remain awake and aware so that they could focus on the experience of birth. Though both supporters of drug-assisted childbirth and Dick-Read saw a disconnection of the civilized mind from the primitive body as the key to natural birth, Dick-Read, significantly, believed that drugs and the resulting lack of sensation and consciousness prevented a birth from being natural.

This chapter analyzes the reaction to “streamlined” childbirth and then focuses on the written work of Grantly Dick-Read, pioneer of the most influential natural childbirth method in America during the postwar period. I analyze his conception of the relationship between (civilized) mind and (primitive) body—both a legacy from early-twentieth-century ideas on “overcivilization” and a reflection of newer theories of psychosomatic medicine. I argue that Dick-Read looked to the example of primitive birth as an antidote to the dehumanized process of streamlined birth. As a by-product of this view, his reliance on the notion of easy, primitive birth and his equation of primitive with non-white and lower-class women worked to inscribe notions of class and race onto ideas of modernity, as well as to romanticize the birth experiences of people of color and obscure the reality of substandard childbirth conditions for the majority of them in the United States. At the same time, Dick-Read’s rhetoric reinforced a particular construction of postwar modern American womanhood—as exclusively white, middle-class, deferential to male authority and bound to motherhood.

115 “Streamlined” or “Natural”?

A survey of the popular and medical literature on childbirth from the 1940s to the mid-1960s indicates that concern over “civilized” women’s mental and physical “softness” and the seemingly related inability to easily bear children, along with a fascination with the supposed painlessness and ease of “primitive” birth continued well into the mid-twentieth century. In 1942, for example, columnist J.D.

Ratliff of the Science Digest noted that, “Primitive woman had little difficulty bearing children” but “the softening influence of modern civilization (has) changed all this.”4

Similarly obstetrician Addie Schwittay stated in 1950, “Childbirth is normal and easier among primitive women and animals.”5 However, though the supposedly painless, “primitive” childbirth experience remained a standard for many by which to judge successful labor and delivery,6 by the end of the 1930s, both mothers and medical professionals had begun to disagree over how women could best replicate the painless birth experience of primitive childbearers—through medically- managed, unconscious birth or through “natural,” conscious birth.

4 J.D. Ratcliff, "Towards Easier Childbirth," Science Digest, November 1942, 23. 5 I. E. Soehren, "Today's New Mother Is No Invalid; Early Ambulation," Hygeia, January 1950, 36; For other examples see Bernard DeVoto, "Maternity Floor," Harper's Magazine, April 1940; J. Andrews, "Taking the Fear Out of Childbirth," Parents Magazine, May 1943; Aiken Welch, "The Boon of Natural Childbirth," Coronet, June 1945; Alan Guttmacher, "Odd Facts About Human Birth," Science Digest, August 1947; Grantly Dick-Read, "Jungle Childbirth and Motherhood," Parents Magazine, July 1955; Sloan Wilson, "American Way of Birth," Harper's Magazine, July 1964. It is important to note that not everyone believed that primitive birth was easier or less painful. In 1950 the American Journal of OrthoPsychiatry published a scholarly article refuting painless birth among primitive women—an article that nevertheless, in its focus on addressing the issue, illustrates the cultural prevalence of the concept. Lawrence and Vera M. Ferguson Freedman, "The Question of 'Painless Childbirth' in Primtive Cultures," The American Journal of OrthoPsychiatry 20, no. 2 (1950). 6 Another important standard of successful childbirth was, of course, the health of mother and newborn during and after delivery. 116 As we saw in Chapter 2, the 1930s saw an unprecedented rise in the number of hospital births and use of drugs during childbirth. By 1940 55% of all births took place in the hospital and 75% of urban births took place there. These numbers continued to rise precipitously so that by 1950 88% of all births were hospital births. By the early 1940s the majority of obstetric and family practice doctors employed a variety of anesthetic and analgesic methods. Though some used the caudal block, which significantly reduced or even eliminated pain in the pelvic region, but allowed mothers to remain conscious during most of the birth process,7 the vast majority of physicians used methods during this period that rendered the mother unconscious or unaware during delivery. As we saw in Chapter 2, mothers and doctors who favored medically managed births and the use of pain-relieving drugs—and the vast majority of them did8—stressed the modern, scientific qualities of such deliveries. As one mother noted in 1940, “having a baby is much worse in anticipation than realization now that science has been hooked up to the stork.”9

Many cited ease, painlessness, and convenience as the primary benefits of using such a method.

Streamlining childbirth also benefited physicians. Frustrated with the unpredictability of labor and seeking efficiency, doctors had long sought ways to

7 The caudal block was similar to an epidural in that it provided local anesthesia in the pelvic region. Even with the caudal though, mothers were routinely given gas at the moment of birth and generally were delivered with forceps and thus did not actively push the baby out. 8 See Jacqueline H. Wolf, Deliver Me from Pain: Anesthesia and Birth in America (Baltimore: Johns Hopkins University Press, 2009), 108-10. 9 Constance J. Foster, "New Techniques in Childbirth," Parents Magazine, May 1940, 84.Emphasis mine. 117 regulate, shorten and schedule labors. The beginning of the post-war baby boom coincided with the shift from home to hospital birth and the emergence of the new pain-relief methods described above, providing a particular need for “convenient” or “streamlined” childbirth as doctors and hospitals struggled to keep up with demand.10

Streamlined childbirth may have been efficient, but its procedures necessitated hurried, routine and impersonal interactions between mothers and hospital staff. The heavy reliance on anesthesia also ensured that many mothers were mentally absent at the births of their children. In an example of just how pervasive the practices of streamlined birth were—and how removed these methods had caused the mother to become from childbirth—a 1949 advertisement for Johnson’s Baby Lotion proclaimed, “Someone would like to meet you, Mother!”

Showing a uniformed nurse wheeling a newborn in a cart through a hospital room doorway the copy reads, “Dreamily you listen to the comings and goings in the hospital corridor. And then your door opens. A smiling nurse bundles in a tiny cart…Your baby…As the evidence convinces you (that) you really are a mother, you vow you’ll be the best ever.”11 Unconscious birth was by then so much a part of the popular mind that advertisers apparently believed that readers would find nothing strange in a bemused new mother being introduced to her baby for the “first” time by the hospital staff and needing to “convince” herself that the baby was hers.

10 See Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 118-19. 11 "Advertisement for Johnson's Baby Lotion," Ladies' Home Journal, May 1949, 8. 118 Another photograph, in Life magazine, illustrates the absence of the mother during birth even more graphically. Published as a public health announcement of sorts, the article consists of a series of screenshots from a public film on the subject of “motherhood, pregnancy and maternal care.” Interestingly, the film/article features a young mother (played by an actress) and shows her in nearly every shot—talking to her husband, visiting the doctor, being weighed—but when it comes to images of the actual birth all the viewer sees is a woman’s draped pelvic area, legs spread so wide that the figure does not look human, and uncovered only enough to show the baby emerging from the mother’s body. (Fig. 3.1) In spite of the human focus in earlier pictures in the article, here the mother is treated as and depicted as a machine.12

Figure 3.1 Source: “The Birth of a Baby,” Life, April 11 1938, 35.

Increasingly, hints surfaced indicating that not everyone found drugged childbirth satisfactory. In 1941, Cedric Belfrage described watching his wife

12 "The Birth of a Baby," Life, April 11 1938. 119 undergo childbirth in a California clinic a few years earlier. Though not directly critical of the method used, he described the way the “dope” robbed his wife of self control and handed her over to the “mercy of this terrible and irresistible power of nature.” He continued, “there was nothing of her but the breathing. She was as if laid aside while something a million times more potent visited the room, passing on its eternal way, and took control.”13 He spoke with an almost horrified awe of the

“power of nature,” but his language indicates unease with the drugs’ effects on his wife—the drugs allowed nature to take over, making his wife’s body machine-like as

“she” was “laid aside.” His reaction to his wife’s childbirth is an indication of the way many women themselves would interpret their own medicated (unconscious or partially-conscious) childbirth experiences in the following decades.

Women who protested streamlined birth all stressed their desire to remain conscious and do without drugs. Some disliked earlier experiences with anesthesia in childbirth. One mother, who sought consciousness in childbirth after unpleasant previous deliveries, expressed dread over the thought of having to endure a similar experience, “I wanted this third baby, but I dreaded childbirth and …what I dreaded most was the thought of the anesthetic.”14 Another mother more specifically described the terrible loss of control that she suffered with the birth of her first child:

I experienced the sensation which has always seemed worse to me than any pain—of struggling for consciousness, going down into blackness, coming up

13 Cedric Belfrage, They All Hold Swords (New York: Modern Age Books, 1941), 271, 72. 14 "I Had My Third Child without Anesthetic," Parents Magazine, January 1948. 120 only to know that something big and dreadful is happening, to feel fear, to hear oneself moaning…then to go way under, and to recover hours later, clean and dizzy, and be told that one is alright and a boy has been born.15

Others protested the impersonal, assembly-line nature of routine hospital births. “I hated the impersonal efficiency of the big hospital where the 17 mothers being delivered that night were just numbers,” one mother wrote.16 Another stated,

“Childbirth should be more than the routine delivery of a live statistic.”17 These women and others like them sought an alternative method of childbirth.

Physicians also spoke out against drugged hospital births, indicating a conflict within the medical profession itself.. As early as 1933 some, such as the editor of the Journal of the American Medical Association, Morris Fishbein, argued that childbirth was a “normal physiological function” that was well served at home.

The demand for hospital birth, he thought, was due to “an expansion of human desires and wants” in the wake of modern labor-saving and leisure-enhancing devices in everyday life and resulted in unnecessarily high medical costs.18 Others worried specifically about the deleterious effects of depriving babies and mothers of the ability to engage their instincts. Arguing that it was time to “take baby off of the assembly line,” pediatrician Harry Bakwin wrote that hospital isolation (babies during this period were routinely removed from their mothers at birth, placed in a nursery with other newborns, and only brought to the mother for feeding) and a

15 Friedrich, "I Had A Baby," 462. 16 M. Longwell, "Your Truly Blessed Event," Farm Journal (Eastern Edition), May 1959, 93. 17 Ibid. 18 Morris Fishbein, "The Costs of High Obstetrical Care," American Mercury, September 1933, 62, 63. 121 focus on scheduled bottle-feeding robbed a baby of pleasure in the first moments of its life by forcing it to rub “his face against a stiff, starched uniform” instead of his mother’s warm skin.19

Like proponents of unconscious, drug-assisted birth, seekers of conscious birth generally agreed that modern civilization had taken a toll on what they believed was a “natural” process in the primitive state. Indeed their rhetoric is quite similar in describing the discomfort that most “civilized” women underwent when giving birth in comparison to “primitive” mothers.20 The difference was that promoters of natural childbirth didn’t see drugged childbirth, especially unconscious childbirth, as the means to restoring natural, primitive painless birth.

Most felt that performing relaxation exercises that disengaged rather than “turned off” the mind during labor and delivery resulted in a “truer” experience of childbirth because it allowed the mother consciousness at delivery. By the 1940s many had come to believe that training for childbirth—often through pregnancy exercises designed to physically emulate primitive women’s work in the field and during labor—was also key to achieving natural birth. In the eyes of these people, the civilized mind, and to a lesser degree, the civilized condition of modern-convenience laden, easy living, were still the culprits in painful birth in modern women. Using drugs, however, to restore primitive birth was not the answer, because they robbed a woman of the conscious experience of childbirth.

19 Harry Bakwin, "Take Your Baby Off the Assembly Line," Woman's Home Companion, January 1946, 18. 20 See for example "I Had My Third Child without Anesthetic."; Charlotte Shapiro, "Fear Makes Childbirth Harder," Your Life, February 1949. 122 In the appeals and admonitions to forsake the assembly line of birth, one hears traces of Americans’ more generalized anxiety during the interwar and postwar periods about the dehumanizing or “softening” aspects of mechanized modern life. Faced with the effects of world war and an increasing reliance on mechanical and technological devices, Americans, as one writer put it, lived “in an age of tension” exacerbated by “artificial restrictions upon the natural physical and emotional outlets.”21 As another stated, the reason for the “unrest and imbalance currently unsettling the world” was that “civilization…(was) too civilized.”

Civilization, he wrote, had thoroughly destroyed “the ancient natural bonds” with

“our earth” by “hermetically sealing” people in their homes and saddling them with an “unprecedented variety of …gadgetty appurtenances,” even delegating the “whole superintendence of births to hired hospitalers, that we may hear no scream and smell no blood.”22 This understanding of civilization is different from the talk of civilization that we encountered in Chapter 2. Here, the writer condemned civilization over all. Rather than seeing promise in “modern” birth he denounced it as too removed from the human functions of sound and smell. Childbirth in this manner was for him dehumanized.

Anxiety over the stresses and dehumanization inherent in civilization and modernity pervaded all facets of American life, but is especially noticeable, not only in the area of childbearing as we have seen, but in the areas of physical and mental

21 George K. Makechine, "Camping Round the Calendar," Hygeia, December 1949, 839. 22 Alan Devoe, "Down to Earth: The Overcivilized," American Mercury, October 1938, 222, 24. 123 health in general. A 1949 article promoting the therapeutic benefits of nature through a year-round camping program for young women, for example, noted that

“vigorous activity in our time has been curtailed by our 'push-button' society” leading people to “rust.”23 Another writer bemoaned the effects of the “stresses of modern civilization” on women and their subsequent choice not to breastfeed their babies.24 In another 1949 article, titled “Is Your Wife Too Civilized,” the author, betraying anxiety about the changing role of women, goes so far as to blame the ills of modernity—high blood pressure, ulcers, neuroses and mental illness—not on civilization as a whole, but on the “too civilized” or modern woman—“the emancipated woman of the roaring twenties (who) didn’t stay home with her children and love and mother them’” but instead subjected them to bottles, feeding schedules and early toilet training, the assembly-line approach to parenting. A return to “primitive mothering,” he wrote, might just restore “emotional peace” to

Americans.25 Here the author called into question the modern processes of scheduling and “assembly-line” practice associated with scientific motherhood. In his mind civilization damaged human life, but held no promise in fixing it.

Together these discussions—of streamlined birth and of modern life, in general—reveal concerns about the dehumanizing effects of modern systems and institutions that emphasized rationality and efficiency over personal, emotional

23 Makechine, "Camping Round the Calendar." 24 C. W. Wyckoff, "Childbirth and the First Days of Life," Hygeia, March 1944, 189. 25 W. Adams, "Is Your Wife Too Civilized?," Better Homes and Gardens, November 1949, 46, 197. 124 experience. In the area of childbirth, at least, women who voiced these concerns found an alternative in the natural childbirth method of Grantly Dick-Read.

Grantly Dick-Read and Natural Childbirth

Between 1944 and 1967 Americans saw the publication of well over fifty popular magazine articles, numerous medical journal discussions and several best- selling books on the topic of natural childbirth. British obstetrician Grantly Dick-

Read26 is credited with sparking this interest. (Fig. 3.2) Dick-Read, by all accounts a persuasive, if not overbearing, man published his first book, Natural Childbirth, in

1933 in England and by 1936 word of his method had filtered over to the United

States. Dr. Paul de Kruif wrote admiringly of the book in a series on maternal mortality for the Ladies’ Home Journal and Joseph B. DeLee, preeminent obstetrician of the early twentieth century, cited it favorably in his 1938 edition of Principles and

Practice of Obstetrics.27 In 1944 Dick-Read published his seminal work, Childbirth

Without Fear, in the United States—a book that was eventually published in over seven languages, went to six editions, and is still in print today. Soon newspapers and magazines began to feature women’s experiences with the Read method—in fact virtually every article on natural childbirth in the 1940s and 1950s references

26 Dick-Read did not legally hyphenate his name until 1958, one year before he died. Therefore, anything written before then refers to him as Grantly Dick Read. I have left those references unchanged, but refer to him myself and cite his written work using the hyphenated version of his name, Dick-Read. His method of natural childbirth was known as the Read Method and I refer to it as such. 27 Paul De Kruif, "Why Should Mothers Die?," Ladies' Home Journal, March 1936; Joseph B. De Lee, The Principles and Practice of Obstetrics., 7th ed. (Philadelphia: W. B. Saunders Co., 1938). 125 Dick-Read. In 1947 the Maternity Center Association of New York City invited him on what proved to be a popular lecture tour of the United States to promote his method. In the late 1940s Yale medical professors Herbert Thoms and Frederich

Goodrich undertook a study on the experiences of 1100 mothers undergoing natural childbirth using the Read principles. Even the Pope weighed in on the Read method, stating in a 1956 encyclical that “Grantly Dick Read has perfected a theory and technique which…(is) undoubtedly valid.”28 Until the early 1960s then, when other

“natural” methods began to gain prominence, Grantly Dick-Read was nearly synonymous with natural childbirth. As such he, perhaps more than any one else, helped to shape the rhetoric surrounding natural childbirth in America in the 1940s and 1950s.

Figure 3.2 Source “Dr. Grantly Dick-Read” http//www.pollingerltd.com/estates/grantly_dick_read.htm.

Essentially, Dick-Read believed that childbirth was an inherently pain-free process. In Childbirth Without Fear, Dick-Read described “the seed which would eventually alter the course of (his) life”—the pivotal moment in his career when he

28 Pope Pius XII, "On Painless Childbirth," Catholic Mind 1956. 126 first realized that childbirth did not have to be painful. In London he had attended a woman, in a “hovel,” the interior of which was a “disgrace to any civilized country,” who for the first time in his experience refused (“kindly yet firmly”) the chloroform he proffered. When he asked later why she had done so, she replied, “’It didn’t hurt.

It wasn’t meant to, was it, doctor?’”29 Later, during his service in WWI, he witnessed additional women (in these cases, “peasants”) “having their babies in the most natural and apparently painless manner.” He concluded then, after these encounters with women of the working class, that it was “faith in the normal and natural outcome of childbirth” that allowed for painlessness. “Civilization and culture,” he thought, “(had) brought influences to bear upon the minds of women which…introduced fear…This fear (had) given rise to …muscle tension…which close(s) the womb and prevent(s) the child from being driven out…(F)ear, pain, and tension are the three evils…introduced (by) civilization” in childbirth.30

Grantly Dick-Read sought, above all else, to “re-establish childbirth in the civilized races as a painless procedure.”31 Like so many of his contemporaries (and many before him) he believed that “primitive” birth experiences held the answer to painless birth: “Parturition amongst the primitive races still persists today as a relatively painless procedure…(In) our utilization of culture…the most essential of natural functions, (has been) made…an agony and a nightmare.”32 Key to his

29 Grantly Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth (New York,: Harper & Brothers, 1944), 1-2. 30 Ibid., 5-6. 31 Grantly Dick-Read, Natural Childbirth (London: W. Heinemann, 1933), 17. Emphasis mine. 32 Ibid. 127 theorization was his belief that the physical process of birth was no different in civilized women than in primitive. Though “cultured” women often became physically weak because they were “diverted from (their) normal routine by those who advertise care, rest (and) diets,” modern women who remained active during pregnancy could be expected to be “muscularly strong and physiologically efficient” much as primitive women, who continued their regular work—“in the harvest field, on trek, in the rubber plantation”—during pregnancy and “live(d) a full and natural existence.”33 In body strength and efficiency, at least, modern women could equate with primitive women.

Physical similarities notwithstanding, however, Dick-Read believed that civilized women unquestionably experienced more pain during childbearing than those in the “primitive state.” The issue was not body, but mind. “Culture has essentially arisen of the mind in contradiction of the body,” he thought.34 In Dick-

Read’s view, the main difference between civilized and primitive women, in childbirth and in all respects, was ”the development of the mental functions.”

Indeed, he defined as primitive those women “whose mental development has not attained a state of civilization.”35 In modern women the “habits and customs” of civilization had surrounded “primitive simplicity with a tangle of complicated mental influences,” including “intensification of emotions.”36 Furthermore, Dick-

33 Ibid., 23. 34 Ibid., 25. 35 Ibid., 22. 36 Ibid., 26. 128 Read felt that “the speed of modern life, the grim struggle for survival and the close competitive relationships of men demand an expenditure of nervous energy out of all proportion to its physical sublimation” leading to “anxieties and doubts in the minds of the vast majority.”37 In addition, from the “beginning of civilization,” childbirth had been portrayed as a event that entailed “peril and agony,” painting childbirth as something that could only be feared.38

This conception of childbirth as horrific, coupled with civilization’s

“intensification of emotions” and “anxieties and doubts,” imposed new

“neuromuscular activities” upon the function of childbirth, which caused pain. In short, fear caused tension, which caused uterine muscles to tighten and contract in unnaturally painful patterns—painful muscular patterns that primitive women avoided because they had no fear.

In framing childbirth in the dichotomous tropes of (natural) “primitive” and

(damaged) “civilized,” Dick-Read was using class-associated and racialized constructs reminiscent of early-twentieth-century thinking on “overcivilization.” As we saw in Chapter One, Twilight Sleep proponents drew on the discourse of overcivilization to shape a conception of birth that relied on “turning-off” the

“overcivilized” mind with drugs to allow the “natural” functioning of the body in a primitive state. Though his method was different, Dick-Read, too, saw the mind, or more specifically, the civilized or “highly-cultured” mind, as the principle

37 Grantly Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth, Revised and Enlarged (New York: Harper & Brothers, 1953), 45-46. 38 Dick-Read, Natural Childbirth: 21. 129 obstruction to the natural, painless labor that primitive women enjoyed and he, too, sought ways to “turn off” or override this psychological impediment.

However, Dick-Read’s thinking was also part of a newer way of conceptualizing the relationship between the mind and body. Beginning in the

1930s doctors and psychiatrists began to shift away from a focus too narrowly centered on the body to one that attempted to understand the role that the mind played in health and wellness. By the mid-1940s doctors involved with this

“psychosomatic” approach had convincing medical evidence of a mind-body link and could demonstrate how emotions could cause physiological changes in the body.

Dick-Read’s understanding of the “fear-tension-pain syndrome” both drew from and bolstered psychosomatic theories concerning the role that fear played in pain.39 In particular he cited Ivan Pavlov’s work on conditioned reflexes and used it to theorize that civilized women, because they were accosted on all sides with tales of agonized, horrible birth, had been conditioned to feel fear and pain during labor.40

Dick-Read’s conceptualization of a mind-body link between pain and childbirth led him to focus on disengaging the mind to eliminate pain. “When the conscious, reasoning inhibiting brain is put out of action,” he wrote, it allowed for

39 For an overview of the development of psychosomatic medicine see Margarete Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960 (Westport, CN: Greenwood Press, 1984), 56-57. For a discussion of the physiologic concepts that supported Dick-Read’s ideas on fear and pain see Donald Caton, What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present (New Haven: Yale University Press, 1999), 180. 40 Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth: 42, 43. 130 “the instinctive expulsive activities unimpaired by reason or discretion.”41 His solution for disengaging the mind was different from that of Twilight Sleep proponents and others who advocated medicated childbirth, however. They, depending on the method, relied on drugs to either make the mother unconscious or to prevent the brain’s perception of pain. Dick-Read, on the other hand, believed that drugs were unnecessary and unnatural. He argued that “the best and safest anesthetic is an educated and controlled mind.”42 In his words, a “carefully introduced mental process” would “maintain the normal perception of natural stimuli” so that pain would never occur.43 This “mental process” consisted of

“mental adjustment” combined with physical relaxation. The Read method, which became popular in the United States in the 1940s, involved childbirth education classes to 1) provide the facts of childbirth and thus eradicate fear based on ignorance; 2) instruct women “in the phenomena of labor so that they may interpret its varying sensations correctly” and “assist the natural forces and not resist them;”

3) teach women how to prepare themselves for birth so that they can “relax when tension will cause resistance and pain;” have “control of respiration;” and be physically fit enough “to persist in the expulsive effort of labor.”44 The Read method also insisted that a sympathetic and supportive medical attendant be at the mother’s side throughout labor and delivery. Relaxation, Dick-Read and his followers argued,

41 Ibid., 119. 42 Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth, Revised and Enlarged: 154. 43 Ibid., 153. 44 Ibid., 227-28. 131 along with encouragement from the birth attendant, eliminated pain and resistance to contractions during labor and proper physical positioning allowed women to work with contractions during delivery. This method and not one based on drug- induced unconsciousness, Dick-Read asserted, was the foundation for a pain-free and natural birth.

Dick-Read asserted that childbirth without drugs was best because he believed that women should be both awake and aware of the physical sensations, which did not include pain, of birth during labor and delivery. Awareness at birth strengthened the mother-child relationship, he thought. The “first scream” of a woman’s baby, Dick-Read wrote, “vitalizes mother love, and the maternal sense awakens to protect, comfort and care for the child.”45 The implication here was that if a woman did not hear her baby’s first cry her “maternal sense” would not awaken.

Simply being conscious at the birth was not enough, however. Even women who were awake at birth, but had spinal anesthesia, could not know the “joy of spontaneous delivery of their child.” Birth under this circumstance was “a painless, sensationless birth without emotional rectitude” and provided no “sense of personal achievement.”46 Those who managed childbirth with no drugs, however, were rewarded with a “sense of exaltation and incomparable happiness” at the moment of birth which provided for a positive relationship between mother and child.47

45 Ibid., 55. 46 Ibid., 152. 47 Ibid., 13. 132 This thinking on the importance of the birth experience for the mother was in keeping with psychoanalytic theories of the time that insisted that consciousness and awareness at birth was key to a mother’s mental health and personal fulfillment. In 1936 Dr. Gertrude Neilson’s statements on this topic indicated a growing concern with the issue. “Childbearing is so essential an experience for a woman,” Neilson argued, “that the thwarting of its normal course…may cause great damage to her personality. If she (is)…in delivery in an unconscious state…in some cases (she) will pay for this escape from reality by nervous disorders.” 48 By 1945 influential psychoanalyst Helene Deutsch stressed a theory that would dominate the obstetric and psychoanalytic literature for the next two decades: “Childbirth is the greatest and most gratifying experience of woman, perhaps of human beings.”49

Dick-Read’s emphasis on consciousness and awareness ensured that a woman could fully realize this experience.

Dick-Read’s writing also reveals his discomfort with interpretations of birth that treated a woman’s body as a machine. He derided the fact that women who turned to the medical literature to learn more about childbirth would find nothing more than an emphasis on uterine contractions and how they gave rise to pain, particularly because “the impression we get is that the woman concerned…becomes a machine, without either consciousness or volition…We never read of the thoughts

48 "Childbirth: Nature v. Drugs," Time, May 25 1936, 34. 49 Helene Deutsch, The Psychology of Women, New York: Grune and Stratton, 1945 quoted in Herbert Thoms and Robert H. Wyatt, "A Natural Childbirth Program," American Journal of Public Health 40(1950): 790. For an overview of Deutsch’s psychoanalytic influence on obstetrics see Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960: 58-59. 133 of the woman” during labor.50 What he sought instead was for obstetrics to focus on the “emotional factors in the reproductive functions of women” so that it would see them as “human beings with minds as well as bodies.”51

For all that Dick-Read rejected some aspects of modern drug-assisted birth, however, he nevertheless revealed an appreciation for, and indeed, a reliance on medical and scientific theory. He did not seek, in other words, to establish a theory that overturned the basic premises of modern medical science. We see this in his emphasis on the modern aspects of his method and his stress on the scientific underpinnings of his theory as well as in his construction of a self-consciously

“modern” program of birth. Dick-Read made of point of stating, for example, that his early training was in biology, physiology, and neurology and he stressed his own

“scientific” approach, noting that he “arrived at conclusions from observations of phenomena” and evaluated those conclusions in the “light of modern scientific discovery.”52 As we have seen, he attributed, in part, his understanding of the “fear- tension-pain” syndrome to the work of Pavlov. He also clearly saw natural childbirth theory as adding to the canon of thinking in obstetrics rather than undermining it,

50 Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth, Revised and Enlarged: 69. 51 Ibid., ix, 226. Emphasis his. 52 Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth: viii. Dick-Read, Natural Childbirth: 16. Douglas Caton argues that Dick-Read’s scientific knowledge regarding the effects of the mind on pain in childbirth was limited and that “he preferred to rely more on common sense and clinical experience than on the experiments and opinions of experts.” See Caton, What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present: 179. I am not arguing here that Dick-Read himself had a high level of scientific expertise, but rather that the emphasis that he placed on his training in science and on the scientific basis of natural childbirth indicates that to some extent he valued scientific and medical expertise. 134 stating that the theory and practice of natural childbirth took the “science of obstetrics” to “a new and higher plane.”53

Not only did he believe that modern science was necessary to the study of painless birth, however, he also believed that ”natural childbirth (itself) must be a science.”54 This thinking was manifested in his conception of the level of skill needed for an attendant at a natural birth. In a comment that highlights the postwar context of his thinking, Dick-Read stated that “The work of readjusting the minds of

(civilized) women occupied in the primitive function of childbirth,” he stated,

“requires as much skill, precision and foresight…as the countermeasures against bombs from airplanes, gas attacks…mines, submarines and all the innovations of modern warfare demand from those whose business it is to know such things.”55

Attendants at natural childbirth, in other words, must possess the level of expertise of those involved in the science of weapon development and military warfare. His desire to make natural childbirth into a science is also reflected in the fact that he formulated a specific program of physical and relaxation exercises, a program that neither arose organically nor “naturally” from an individual, but instead had to be taught by, or acquired from reading, an “authority” on the subject. Overall, in its reliance on scientific theory and in its emphasis on “system” and “expert,” Dick-

Read’s method was a modern method. In this he was not unlike those, who we saw

53 Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth, Revised and Enlarged: 5. 54 Grantly Dick-Read, "Childbirth Without Fear and Without Pain; Condensation," Ladies' Home Journal, June 1957, 150. 55 Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth, Revised and Enlarged: 43. 135 in Chapter 2, who used what they saw as a beneficial modern innovation—pain- relieving drugs—to correct the pain-inducing effects of civilization. In Dick-Read’s mind, his method of natural childbirth also represented a modern approach to remedy these same damaging effects.

Childbirth Safari: Finding Experience and Defining Modernity Through

Parturition

At the heart of Dick-Read’s theory was the idea that “civilized” or “modern” women could restore “natural” pain-free birth in themselves if they could learn to birth the way “primitive” women did. In this way civilized women, too, could have a pain-free, joyful experience of birth. “Birth is natural,” Dick-Read stated, “yet because the civilized way of life has taken the power of naturalness from us…it has to be relearned and rediscovered.”56 Relearning “natural” childbirth, he thought, meant learning from “uncivilized” women. So, in 1953 Dick-Read embarked on a journey through Uganda, Kenya and the countries that are now known as the

Democratic Republic of Congo, Zimbabwe, and Botswana to observe the childbirth practices of, as he put it, “the Africans least influenced by Europeans.”57 He sought

“the minds of those who carried on the torch of custom that had not altered with the ages.”58

56 Dick-Read, "Childbirth Without Fear and Without Pain; Condensation," 150. 57 Dick-Read, "Jungle Childbirth and Motherhood," 42. Prior to this trip, from 1948 until 1953, Dick-Read lived and practiced obstetrics in Johannesburg, South Africa. He returned to England in 1954 at the conclusion of his childbirth safari. 58 Grantly Dick-Read, No Time for Fear (New York: Harper, 1955), 222. 136 In undertaking this childbirth safari and a search for untouched “African” women, Dick-Read hoped to validate his belief that pain and fear during childbirth were the products of civilization. As he chronicled in his 1955 book, No Time for

Fear, as well as in an article penned that same year for Parents magazine titled

“Jungle Childbirth and Motherhood,” this trip confirmed for him that his theories were correct:

Their customs do not allow the acts and interferences which account for over sixty percent of maternal morbidity in the white man’s countries…between ninety-four and ninety-eight percent in different tribes have normal natural births and no more convalescence than a few hours rest…We make the pain that, through the mind, the African prevents…Bwalya Kalunda, how wise you are, how close to reality you live!”59

The majority of “African” women, Dick-Read noted here, were able to prevent pain and have “normal, natural” births because they lived “close to reality” and were unencumbered by the customs of the “white man.”60 Just as important as the lack of dysfunction and pain in “African” childbirth, Dick-Read also found that the “African woman…starts her labor with no fear…It is a moment of rejoicing for her and her friends.”61 “Africans,” their minds untouched by white civilization, were seemingly able to achieve a joyful experience of birth.

As we have seen, this equation of natural with the untouched primitive—and the fascination with this construct— had much in common with the discourse of

59 Ibid., 222-23. 60 In spite of the fact that Dick-Read himself notes that “habits and customs varied considerably…in different places” he generalizes across a broad range of cultural groups in his assessment of “African” childbirth. He sees similarity in a “large number of tribes who were least associated with Europeans.” See Dick-Read, "Jungle Childbirth and Motherhood," 44. 61 Ibid., 84. 137 overcivilization that was so influential for Twilight Sleep proponents and other seekers of natural birth in their search for painless, primitive birth in the early twentieth century. Earlier ideas equating the natural with the primitive took on new life in the mid-twentieth-century. Americans in the postwar period, increasingly concerned in the wake of World War II with issues of conformity and alienation, searched for ways to give their lives personal meaning. For many the primitive represented a lost human authenticity that seemed missing from the streamlined, impersonality of modern life.62 In particular, as we have seen, Dick-Read and others who reacted against drug-assisted childbirth focused on the dehumanizing, mechanistic aspects of “assembly-line” birth. When Dick-Read looked to the primitive to “relearn” and “rediscover” the “power of naturalness” he not only sought to rectify the harm that modern civilization had done to childbirth in making it painful, he also hoped to make childbirth a meaningful, personal, more human experience. “Civilized” women who achieved natural birth not only avoided pain but also, like primitive women, realized joy and personal fulfillment during labor and delivery. This experience of birth offered an antidote to the dehumanizing aspects of streamlined birth.

Dick-Read’s writing, however, did more than simply encourage emulation of the “primitive” in order to improve the modern experience of birth. His insistence that “primitive” childbirth differed from “civilized” childbirth and his explicit

62 For a discussion on primitive authenticity and Cold War “anxieties (that were) focused on a perceived lack of personal identity” see Philip Joseph Deloria, Playing Indian, Yale Historical Publications. (New Haven: Yale University Press, 1998), 129-33. 138 equation of primitive with non-whites helped to mark those who needed to

“relearn” natural childbirth as white and modern. Another look at his childbirth safari narratives demonstrates this implicit mapping of modernity onto whiteness.

In his forward to No Time to Fear Dick-Read set out his intention to uncover the

“hidden mysteries of the interior of Africa,” mysteries possessed in the “minds and bodies of millions of black people.”63 The opening editorial text in “Jungle Childbirth and Motherhood” highlighted the remoteness of Dick-Read’s subjects of study from modern civilization, describing his journey “among little known tribes” in the

“hidden depths of the jungle“ so as to “bring back…(the) moving revelation of the natural miracle of childbirth and motherhood.“64 The article itself, as well the book

No Time for Fear, in a manner reminiscent of National Geographic photo spreads of the period, featured photographs of bare-breasted or scantily-clad women breastfeeding or posing with their children strapped to their bodies.65 These images reinforced, through the depiction of non-Western standards of dress and physical customs, an image of these women as primitive and non-modern, while at the same time further inscribing difference by subjecting their bodies to the prurient gaze of

American readers—it would not have been acceptable in the context of postwar

American culture for white middle-class women’s bodies to be displayed this way.

(Fig. 3.3)

63 Dick-Read, No Time for Fear: xi. 64 Dick-Read, "Jungle Childbirth and Motherhood." 65 For a discussion of images of women in National Geographic during this period, and the narrative work they do marking race and primitivity, see Catherine Lutz and Jane Lou Collins, Reading National Geographic (Chicago: University of Chicago Press, 1993), 166-78. 139

Figure 3.3 Source: “Jungle Childbirth and Motherhood,” Parents, July 1955, 43.

In recounting his childbirth safari, Dick-Read was careful to take the position of twentieth-century scientific observer, stating that his “observations were of simple facts to present to scientists…for their consideration.”66 However, in many ways his text differed little from that of travel writers and explorers from the fifteenth century, perpetuating the gendered tropes of a hierarchical and racialized concept of civilization that were by that point centuries old: “The men in the villages are astonishingly lazy”, he wrote of the various people he saw on his trip, “and it is

66 Dick-Read, No Time for Fear: 221. 140 the women who do the work…the manual labor as well as motherhood.”67 This remark recalls similar descriptions of the overworked “squaw” drudge employed by earlier writers. Just as those descriptions worked to differentiate Europeans, who considered manual labor performed by women to be a mark of savagery, from so- called uncivilized “dark races,” Dick-Read’s similar assessment of reproduction and gendered work in various parts of Africa in the 1950s worked to perpetuate a racialized conception of civilization, modernity and difference through a focus on women’s (productive and reproductive) labor. In this discourse, a woman’s manual work as well as her easy, painless birth—always associated with women of color and/or the working class—marked her as primitive and outside the realm of modernity. Implicit in this equation was the notion that women who had lost the ability to birth easily, that is, modern women, were always white and middle- or upper-class. To be modern, in other words, was to be white.

In addition to racializing modernity, Dick-Read’s equation of painless primitive birth with women of color in sub-Saharan Africa also romanticized their birth experiences and obscured the pain and the health complications that many undoubtedly endured in a region where maternal mortality rates remained high compared to Western rates.68 Furthermore, and most important to the discussion of

67 Ibid., 143.italics his 68 Sociologist Sheryl Nestel makes a similar point about the use of the “trope of the primitive” by birth reformers in the 1980s and 1990s. She argues that their use of this trope encouraged the notion that childbirth in “traditional” cultures was a “safe and fulfilling experience” when in reality a depressing state of maternal health existed in the regions—Asia, Africa, South America—associated with “traditional” peoples. See Sheryl A. Nestel, ""Other" Mothers: Race and Representation in Natural Childbirth Discourse" (M.A. Thesis, University of Toronto, 1994), 38. 141 childbirth in the United States, his focus on the idealized birthing practices of black women in the countries of Africa and his contrast to the problems of white

“civilized” women, coupled with a complete absence of discussion of women of color in Europe and the United States, shifted attention away from the reality of substandard maternal and infant health care for the majority of non-whites in

America. Almost half the population of American black women either had limited choices over where and how their labors would proceed or they chose not to place themselves at the mercy of a white-dominated medical system they had good reason to distrust.69 Their births may have been “natural” in that they received no pain relieving drugs, but not in the sense that Dick Read meant it. In 1950 92.8 percent of births to white mothers took place in the hospital, whereas only 57.9 percent of births to black mothers took place there. As we saw in Chapter 2 and will discuss again in the Chapter 4, African American women did indeed experience pain during childbirth, but the majority of them had limited access to basic health care during pregnancy and childbirth, let alone to either pharmaceutical pain relief or training in

“natural” childbirth.

Dick-Read and the Domestic Ideal

In addition to fostering particular ideas regarding race and modernity through his reliance on and promotion of the trope of painless primitive birth, Dick-

69 See Susan Lynn Smith, Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America, 1890-1950 (Philadelphia: University of Pennsylvania Press, 1995), 120. 142 Read’s writings also contributed to a particular conception of modern American womanhood—one that aligned with the maternally-centered, heteronormative tenets of the postwar domestic ideal in which women’s fulfillment arose from motherhood. Unlike proponents of drug-assisted childbirth, who focused on obliterating the primitive function of childbearing from women’s minds, Dick-Read believed that childbirth itself was a beautiful, noble process—that it was meant to be a woman’s crowning glory and as such should be experienced consciously.

Hearing her baby’s first cry produced in the mother, he wrote, an “ecstasy mere man seems quite unable to comprehend.”70 He also exalted motherhood, describing it as a “holy estate,” and in “healthy-minded women … the realization of their highest ambition, the fulfillment of their instinctive urge, and the ultimate perfection of their bodily functions.”71 In Dick-Read’s mind, evidently, a woman who did not agree was not “healthy-minded” and one who chose not to bear children could not be

“fulfilled.”

A woman had to do more, however, than undertake the functions of parturition and believe in the glory of childbirth and motherhood to fit Dick-Read’s ideal. She must also possess “guts,” “stoicism,” and the willingness to bend her will to the authority of her husband and her doctor. Dick-Read believed that “many girls try to hide…their true characteristics,” but that a woman’s true nature was often revealed through her actions during and just after childbirth—he even went so far

70 Dick-Read, Childbirth Without Fear: The Principles and Practice of Natural Childbirth: 95. 71 Ibid., 3. 143 as to evaluate labor pain based on his expectations for proper womanly behavior.72

The following evaluation of a woman in labor is revealing. Dick-Read described a woman who, during her two and a half hour labor, yelled wildly throughout, but pushed him away when he, having “appreciated the rapid dilation (of her cervix)” and thus the “violence of her labor,” offered her an anesthetic. He wrote that he

“had been quite honestly sorry” for her until just fifteen minutes after the birth when “sitting up in bed smoking a cigarette and dabbing her cheeks with powder,” she “brightly” told him that the birth was an “absurd little affair.” Rather than consider the woman a successful participant in natural childbirth—after all she made it through labor and delivery without using pain-relief medication and apparently make a quick recovery afterwards, Dick-Read decided that she must have been merely trying to “alarm her husband” with a display of affected pain.73

Clearly this woman did not meet Dick-Read’s expectations for womanly behavior— not only did she yell instead of quietly “relaxing” through her contractions, but she

(by rudely pushing him) refused his proffered assistance (and therefore rejected his male/medical authority).

Probably worst of all, in Dick-Read’s mind, was her diminishment of the

“glorious” act of childbirth into an “absurd little affair.” He concluded this description with the comment that most birth pain is subjective—a comment in keeping with his theory that the pain of childbirth was mostly in the mind, but that

72 Dick-Read, Natural Childbirth: 28-29. 73 Ibid., 35. 144 nevertheless delegitimized this woman’s painful birth experience. Dick-Read also believed, however, that in some cases “pain is indeed real”—as evidenced when “a stout-hearted girl makes a big, brave effort, but is beaten (by labor)…She is relatively quiet and still, in marked contrast to the bawling, leaping, actively demonstrative” cases. These “brave” women, appropriately behaved as they were, earned Dick-Read’s “deep…pity” and inspired him “to help, to relieve and to comfort.”74

Even if a woman succeeded in the Read method, overcame her fear and delivered her child joyfully and consciously, however, she could not take full credit for the success—for a woman’s forbearance and stamina during childbirth were only as good as her male moral support at home and in hospital. After witnessing

“the most beautiful natural labor” he had ever seen Dick-Read wrote, “I felt that I had succeeded—until her husband (who had not been present during labor or delivery) came in, then I knew that the success (of his wife’s birth) was his.”75

Indeed, woman’s very nature apparently prevented her from being independent enough to achieve conscious childbirth on her own, forcing her to seek out the highest male authority. In relating the experience of another woman, Dick-Read noted that as labor intensified, “She wanted the doctor, not the husband. Someone upon whose knowledge she could lean, and upon whose personality she could

74 Ibid., 35-36. 75 Ibid., 32. 145 exercise the women’s prerogative of dependence.”76 The doctor, in fact, “must be the protector, the defender—he must realize that in him absolute and complete confidence is being placed…(the mother) demands a knight, a valiant protector from all harm.”77 Dick-Read’s natural childbirth mother evidenced satisfaction in motherhood and deference to and dependence on male authority. She was, in this construction there—to construct his vision of the modern, civilized woman.

Paradoxically, however, Dick-Read elevated different traits in working-class women, even as he reinforced class-based ideas of gender difference. The woman whose life has “entailed hardship and struggle for survival,” Dick-Read wrote approvingly, has “learned to be dependent upon herself…by her own efforts, to overcome” life difficulties. “The attitude of the poor,” he stated, “explains the difference (the ease and lack of pain) in the large majority of their labors.”78 For women of this type, Dick-Read applauded independence rather than the dependence he vaunts in middle- and upper-class women. This distinction, though, in its stress on the implicitly primitive characteristics of hard-working self-sufficiency and ease in parturition, marked working-class women as not entirely part of the modern, civilized world.

76 Ibid., 59. 77 Ibid. Anecdotal and clinical evidence supports the notion that women who receive continuous psychological support throughout labor and delivery benefit from faster, easier labors. My point here is that Dick-Read sees that support as necessarily coming from an authority figure rather than an equal. 78 Ibid., 44. 146 Conclusion

As “streamlined” childbirth became the norm, many women became concerned with the alienating and dehumanizing effects of the routinized, assembly- line aspects of drug-assisted hospital birth. Grantly Dick-Read’s method of natural childbirth addressed these concerns. He and his followers argued that natural, painless birth was best achieved consciously through the “modern” and “scientific” application of relaxation exercises and minimal to no use of anesthetics. This approach to birth, with its focus on the personal experience of labor and delivery, provided a more human-centered alternative for those who wanted to be awake and aware when they delivered their babies.

Dick-Read’s method of natural childbirth did more than offer an alternative to streamlined birth, however. The rhetoric surrounding it, with its reliance on the racialized and class-associated trope of painless, primitive birth and its equation of primitive birth with non-whites worked to mark those who had need to use the

Read method as white and modern. Natural childbirth rhetoric also masked the realities of substandard childbirth care and higher rates of infant and maternal mortality for the majority of people of color in the United States. In addition, Dick-

Read’s rhetoric, because of its emphasis on submissive feminine behavior and satisfaction in motherhood as women’s only goal helped to shape and reinforce a particular construction of modern womanhood—one that aligned with postwar notions of the domestic ideal.

147 As important as Dick-Read was in shaping the rhetoric of natural childbirth, however, his interpretation was not the only one. As the next two chapters will show, Americans reacted to and interacted with the theory and practice of natural childbirth in a variety of ways—ways that reflected complex conceptions of primitivity, modernity and femininity in relation to natural birth.

148 Chapter 4: “Having a Baby the New Way: Natural Childbirth, Modernity and the Domestic Ideal”

In 1954, in a Coronet magazine article titled “Natural Childbirth,” Maggie

Baker told readers that she “wanted to be awake when (her) baby was born” so that she would not miss “that wonderful experience of creation and motherhood that can’t be equaled any other time in a woman’s life.”1 Despite the fact that “everybody” told her she “was foolish” and that “even (her) doctor ridiculed the idea,” she was

“determined to have (her) baby” without anesthetics. This she had told her doctor

“almost defiantly.”2 The young, white, college-educated wife then spent her pregnancy practicing “a series of instructions and exercises” so as to “learn how to bring certain muscles into play: when to relax, when to tighten, how to breathe.” Her goal was to “reduce pain-producing fear and tension” so that she could be “an active participant in the birth of (her) baby.”3 This method, Baker stressed, had “nothing whatever in common with the crude and unscientific child-bearing techniques of years ago,” but instead used “all the skills of modern medicine.” When it came time for the birth, Baker’s husband, who had read several natural childbirth books, joined her in the labor room where he was a “tremendous comfort” to her. During the second stage of labor, pushing the baby out, Baker “started working with each

1 Maggie Baker, "Natural Childbirth: A Picture Story," Coronet, May 1954, 45, 50. 2 Ibid., 45, 46. 3 Ibid., 48. 149 contraction” and “didn’t need anyone to tell (her) when to push and when to relax.”

When she finally delivered her baby she “never felt so satisfied in (her) life.”4

This article, typical of many, highlights the key aspects of representations of natural childbirth in the mainstream popular press between 1944 and 1967. Baker’s emphasis on the scientific basis of the Read method and its reliance on the “skills of modern medicine,” for example, illustrates the ongoing characterization of natural childbirth as a distinctly modern medical enterprise.

In spite of the facts that natural childbirth theorists, as we have seen, generally looked to the so-called primitive woman for examples of effective birthing practice, and that natural childbirth arose, in part, as a reaction to, and rejection of, the so-called modern, assembly-line characteristics of medically-managed anesthetized childbirth, supporters of natural childbirth in the postwar period neither cast the method as a return to primitive methods of childbirth nor as a “back to nature” endeavor. Rather, as we shall see, followers routinely touted the method as one that relied on “science” and “the best modern medical practice.”5

Furthermore, the natural childbirth method itself, in its reliance on a training program of “instructions and exercises” represented a rational, systemized, modern—in the eyes of participants—approach to labor and delivery.6

4 Ibid., 50, 51. 5 Milton J. E. Senn, "Let's Be Sensible About Natural Childbirth," Woman's Home Companion, May 1953, 30. 6 Previous scholarship on natural childbirth has tended to see the method as one that embraced nature as a benign process or even as an antidote to modern medical technologies. See Rebecca Jo Plant, Mom: The Transformation of Motherhood in Modern America (Chicago; London: The University of Chicago Press, 2010), ; Mary Thomas, Post-war Mothers: Childbirth Letters to Grantly 150 Baker’s article, in its description of her motivations and experience, also illustrated another common representation in natural childbirth articles—that of the confident young, white middle-class mother who seeks—and finds—fulfillment in the experience of childbirth. Representations of natural childbirth, like the method that they chronicle, emerged in the midst of the postwar “domestic revival”—a period characterized by intense focus on the Cold War family, early and enduring marriage, high births rates, and an emphasis on the importance for women of finding fulfillment in their often subservient roles as wives and mothers. This emphasis was embodied in the “domestic ideal,” a construct of this dominant discourse of domesticity that situated women (white, middle class) within the context of home and family. On the one hand, Baker was portrayed as the epitome of the domestic ideal in her adherence to social expectations for satisfaction in marriage, childbirth and motherhood—her husband is at her side, she has “never felt so satisfied in her life”; on the other hand, however, she challenged

(successfully) male medical authority by demanding a nonstandard method of childbirth in which she was a conscious and active participant, one who “works” with the contractions.

This chapter focuses on these representations of natural childbirth in the mainstream popular print media during the 1940s through 1960s, and contrasts them with those of births using different methods, in order to understand the role

Dick-Read, 1946-1956 (Rochester, NY: University of Rochester Press, 1997), 23, 51; and Richard W. Wertz and Dorothy C. Wertz, Lying-In: A History of Childbirth in America (New Haven: Yale University Press, 1989), 178. 151 that representations of natural childbirth played in shaping and expressing ideas of postwar modernity and femininity. The fact that popular magazines and other print media in the postwar period enjoyed an extensive readership in the mid-century ensured the widespread dissemination of their content. Both editors and advertisers, ever focused on increasing circulation figures and profits and responding to a variety of cultural forces—including changing definitions of race, class and gender, the economic environment, family structures, and changes in science and technology—shaped and selected content in response to what they saw as audience interest. Thus the content of the popular print media may be viewed, in part, as a reflection of the perceived desires and expectations of consumers. But pictorial and textual content, in their very selectivity, also worked to reinforce and shape cultural expectations. When we read natural childbirth articles in this context we understand that, as part of the content of the popular media, they too played a role in reflecting and shaping cultural expectations—and thus are useful as “cultural artifacts.” 7 I argue that experiences and representations of childbirth marked a woman’s “modernity,” or lack thereof—just as at the turn-of-the-century they had marked her “primitivity” or “civility”—and concomitantly marked her race, class, and gender identity as well.

7 Nancy A. Walker, Shaping Our Mothers' World : American Women's Magazines, Studies in Popular Culture (Jackson: University Press of Mississippi, 2000), x-xi. Walker argues that "magazines' interactions with other facets of American culture…makes them revealing as cultural artifacts" and that "when magazines' contents are examined in the context of the historical processes in which they participated, they emerge as dynamic elements of American popular culture, responding to and interacting with events and ideologies that had wide cultural currency." 152 In particular the alliance of natural childbirth with modern medical science defined it as a modern method and its users as modern themselves—a designation that not only connoted technological advancement but individual agency within this context. Because representations of natural childbirth in the mainstream press focused exclusively on white, middle-class women, they help to define “modern” womanhood as white and middle-class. By contrast, as we shall see, the sole image of non-white, lower-class birth that also surfaced in the popular press during the postwar period showed a mother birthing in impoverished surroundings, suffering during labor, and lacking the agency to change the situation—conditions antithetical to ideals of modern progress—highlighting her perceived deviance from the postwar white, middle-class ideals of modern womanhood. This image was quite different from the still common “primitive” representation lower-class, non-white birth, but it still posed these women as outside of modernity.

Natural childbirth articles in the 1940s through 1960s do more than construct ideals of modern femininity, however. They also offer a more complex version of the “domestic ideal” than previous childbirth scholars, who align with

Betty Freidan’s well known critique of women’s magazines and their supposed promotion of the hegemonic “feminine mystique,” have recognized. Scholarship on natural childbirth in the postwar period has tended to focus on the ways that portrayals of natural childbirth mothers in this period aligned with cultural expectations for women to conform to middle-class ideals of feminine domesticity,

153 thus encouraging women to find contentment in family and home and to adhere to cultural standards of proper feminine behavior.8

I argue, however, that this assessment only tells part of the story. True, at first glance natural childbirth articles, in their focus on motherhood and a particular ideal of feminine behavior, do seem to emphasize adherence to Friedan’s “feminine mystique.” However, featuring, as they did, women determined to achieve active, conscious participation in childbirth—at a time when many articles on anesthetized childbirth leave the mother out of the picture both literally and figuratively— popular magazine articles on natural childbirth challenge the notion of a universal submissive femininity and provide evidence of a complex, at times contradictory, ideology of domesticity.9 They also anticipate later feminist concerns with paternalistic medical authority and women’s control of their bodies.

As we have seen in previous chapters, experiences of childbirth—and representations of those experiences—historically worked to shape ideas of race, class, and gender and to mark a woman’s relationship to and position within the dominant social, economic and political culture. Representations of postwar natural childbirth illustrate the ways that experiences of childbirth, through their adherence

8 See, for example, Margarete Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960 (Westport, CN: Greenwood Press, 1984), 114. 9 In this respect they support the contention, a corrective to Friedan’s notion of a hegemonic “feminine mystique,” that postwar domestic ideology was complex, varied, and, at times, contradictory. See Joanne J. Meyerowitz, Not June Cleaver: Women and Gender in Postwar America, 1945-1960 (Phliadelphia, PA: Temple University Press, 1994); for discussion of a "multivocal concept" of "domestic" in women's magazines between 1940 to 1960 see Walker, Shaping Our Mothers' World : American Women's Magazines: vii-ix. For a discussion of the “contradictory expectations” for women portrayed in the postwar media see Susan J. Douglas, Where the Girls Are: Growing Up Female with the Mass Media, 1st ed. (New York: Times Books, 1994), 14-15. 154 (or lack of) to ideals of modernity and femininity, continue to do this work into the mid-twentieth century.

Natural Childbirth in the Popular Media

In order to understand the significance of images of natural childbirth in the postwar popular media, we must first understand just how pervasive they were. As we saw in Chapter Three, popular magazines picked up on glimmers of dissatisfaction with unconscious and routinized “assembly-line” birth as early as the

1930s. In 1939, for example, The Atlantic published Leonore Fredrich’s “I Had a

Baby,” in which she described her discomfort and unhappiness with being

“oblivious” or “groggy” during delivery and missing the births of first three children and then her subsequent satisfaction with the drug-free and painless delivery of her fourth.

Following World War II American interest in natural childbirth increased substantially. As we will discuss in detail in Chapter 5, this interest stemmed from a variety of factors and motivations, but seems primarily to have emerged at this point for three main interrelated reasons: 1) Beginning in the late 1930s maternal mortality rates in the United States dropped precipitously, due primarily to the widespread use of sulfa drugs, which prevented deaths from puerperal fever, and new techniques in blood transfusion, which prevented deaths from hemorrhaging.

This unprecedented lessening of danger allowed women to focus on the experience

155 of birth, rather than the safety of birth;10 2) The postwar period saw a significant increase in the birth rate and an intense focus on the American family; 3) By 1945, the majority of births, for the first time, took place in the hospital under routinized care systems that relied heavily on pain-relieving drugs which often rendered the mother unconscious. Many women found these practices dehumanizing and alienating.

Grantly Dick-Read’s Childbirth Without Fear, in offering an alternative to dehumanized unconscious birth and in promising to help women to achieve a joyful birth experience, struck a chord for many—which was reflected in the popular media. Women’s magazines became increasingly peppered with titles such as “The

Needless Fear of Childbirth,” “Motherhood Without Misery” or “The Boon of Natural

Childbirth.”11 In 1947, the Maternity Center Association of New York City (MCA), an influential childbirth education and resource group, brought Dick-Read to the

United States for a lecture tour and initiated, in their own words, a “strategic” media blitz, holding press conferences about the tour and sending Dick-Read’s book and other descriptive material about his method to syndicated women’s and health columnists and other journalists nationwide, resulting in coverage “as far apart as

Boston…San Francisco…Montgomery, Alabama…Portland, Oregon…Chicago, Illinois”

10 See Sandelowski Sandelowski, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960. 11 Herman N. Bundesen, "The Needless Fear of Childbirth," Ladies' Home Journal, November 1944; Aiken Welch, "The Boon of Natural Childbirth," Coronet, June 1945; Lawrence Galton, "Motherhood Without Misery," Collier's, November 16 1946. 156 and New York City.12 Along with publications in other popular periodicals, Reader’s

Digest, with an “international circulation of over 2,500,000 monthly”, ran a condensed version of Childbirth Without Fear and True Story Magazine, circulation

2,000,000 (“reader audience of young women and adolescent girls”), ran an article featuring the Read Method.13 Dick-Read noted that by 1947 “over thirty million people (worldwide) had read of (his method), or a synopsis of it, or the books published on this subject.”14

The method continued to garner similar press attention for the next two decades. Between 1945 and 1966 in fact, at least one, and often many, of the major popular magazines included at least one story on natural childbirth each year.15 The list of publications included not only popular women’s magazines like Ladies’ Home

Journal, Woman’s Home Companion and Good Housekeeping; but also general interest publications such as Time, Newsweek, Look, Life, Reader’s Digest; special

12 Unknown author, typewritten paper titled “Public Opinion,” 2-3, n.d., box 26, folder 18, “Grantly Dick-Read Clippings 1946-1948 for Scrapbook,” Maternity Center Association Records (hereafter cited as MCA), Archives & Special Collections, Columbia University, Augustus C. Long Health Sciences Library, 2-3. The Maternity Center Association, originally formed in the 1910s out of a Progressive intent to improve maternal and infant mortality rates in NYC, had shifted by 1945 to focus efforts on improving the experience of childbirth. Their promotion of Dick-Read, along with their subsequent sponsorship of a natural childbirth study at Yale, did much to further the cause of natural childbirth during this period. See the Historical Note in the Finding Aid for the MCA Records at http://vesta.cumc.columbia.edu/library/archives/findingaids/maternity.html. 13 Ibid. The circulation figures are the MCA’s. 14 Grantly Dick-Read to name withheld, 11/02/51, box 47, “PP/GDR/D.113,” Personal Papers: Grantly Dick-Read Collection, Archives and Manuscripts, Wellcome Library for the History and Understanding of Medicine, London, England. According to the terms of the Wellcome Library privacy protection policy I have withheld all names and other identifying information other than Dick-Read’s. 15 This seems to have been the case only for the “mainstream” periodicals aimed at a white, middle-class audience. A survey of the African American popular press (Ebony, and Jet) during this period turns up no articles on the subject of natural childbirth. I discuss this in more detail later in this chapter. 157 interest magazines such as the Farm Journal and Kiplinger Magazine: The Changing

Times (a personal finance magazine); and even, one year (1949), “the magazine for men,” Esquire.16 Throughout the 1950s together these magazines ran on average five articles a year on the subject and into the mid-1960s carried roughly three a year. In addition, the New York Times and LA Times and smaller newspapers nationwide ran syndicated health columns that discussed natural childbirth and frequently reported human-interest stories featuring women who had chosen the method. They also often reported on numerous medical studies and journal findings into natural childbirth.17

16 See for example Welch, "The Boon of Natural Childbirth."; Galton, "Motherhood Without Misery."; Beatrice E. Tucker, "What Price Painless Childbirth?," Ladies' Home Journal, June 1948; Dale Clark, "A Man's Crusade for Easy Childbirth," Esquire, October 1949; Amy Selwyn, "I Watched My Baby Born," Pageant, January 1949; B. Coats, "Most Glorious Experience, Natural Childbirth," Reader's Digest, May 1950 1950; "Childbirth Free From Fear," Changing Times: The Kiplinger Magazine, April 1951; Jack Harrison Pollack, "The Case for Natural Childbirth," Cosmopolitan, July 1953; "Natural or Unnatural?," Time, January 19, 1953 1953; Senn, "Let's Be Sensible About Natural Childbirth."; Jean Libman Block, "It's Great to Have a Baby in Flint, Michigan!," Redbook, November 1954; "Natural Childbirth…This Mother of Nine Delivers Her Own Babies," Look, November 13 1956; Julie Harris, "I Was Afraid to Have a Baby," McCalls, December 1956; Natalie Gittelson, "The Case Against Natural Childbirth," Harper's Bazaar, February 1961; M. Furlong, "Unnatural Childbirth," Mademoiselle, March 1962; Sloan Wilson, "American Way of Birth," Harper's Magazine, July 1964; "Natural-Or Unnatural?," Newsweek, March 15 1965; Maude Longwell, "The Happiest Way to Have a Baby," Farm Journal, May 1966. 17 For example, William Brady, "Here's to Health," Los Angeles Times, May 24 1951; Myrtle Meyer Eldred, "Natural Childbirth Gives Meaning to God's Plan," The Milwaukee Sentinel, January 10 1951; "Wider Trial Urged for Childbirth," New York Times, April 22 1952; Myrtle Meyer Eldred, "Natural Childbirth Very Rewarding," The Pittsburg Press, March 22 1953; Frances L. Ilg and Louise Bates Ames, "Natural Childbirth Theory Incorporates Common Sense," St. Petersburg Times, September 28 1953; Dr. William Brady, "For Natural Childbirth," The Milwaukee Sentinel, October 28 1955; "Natural Birth Advocate Has Her 8th Child," Owosso Argus-Press, May 20 1955; Mary Lou Culbertson, "Mrs. Carter Expects Ninth Child and Book on Natural Childbirth," Daytona Beach Sunday News Journal, May 20 1956; Frank G. Slaughter, "To Ease The Pangs," New York Times, October 6 1957; Joseph Molner, "Proper Excercise Makes Birth Easier," Eugene Register Guard, June 10 1963; "Letter to Ann Landers," The Daily Union Democrat, September 16 1964; "Letter to Dr. Joseph Molner," The Sumter Daily item, April 13 1964. 158 The volume of responses from readers indicates that these articles reached a large audience. Hazel Corbin, director of the Maternity Center Association (MCA), reported, for example, that after the publication of a symposium on natural childbirth in Parents’ magazine in 1950 letters from interested women “almost snowed (the MCA) under for a few days.…One day (they) had five hundred letters!”18 The MCA noted a similar upsurge in correspondence regarding natural childbirth after Grantly Dick-Read published an article in the Ladies’ Home Journal in

1957, reporting the “tremendous effect of Read’s article…upon the number of letters received during the months immediately following its publication.”19 Dick-Read’s own correspondence also reflects this upsurge—in the two months immediately following the publication of his Ladies’ Home Journal he received an average of nineteen letters each month, whereas he received an average of five letters per month during the rest of that year.20 In 1962 the editorial assistant to McCall’s reported that the magazine had received “an unusually large response” to an article that it had published criticizing the method.21 In short, in the decades following

18 Hazel Corbin to Clare S. Littledale, editor of Parents’ Magazine, July 18, 1950, box 60 “Parents’ Magazine,” folder 6, “1948-1971,” MCA. 19 “Analysis of Contents of ‘Parents’ File, MCA, ” June 9, 1958, box 45, folder 5 “Survey of Inquiries, Re: Natural Childbirth & Maternity, 1956-1957,” MCA. 20 Boxes 47-48, 54, Personal Papers: Grantly Dick-Read Collection, Archives and Manuscripts, Wellcome Library for the History and Understanding of Medicine, London, England. These figures do not include letters that were dated 1957 but included no month. 21 Elizabeth Weston to Hazel Corbin, June 22, 1962, Box 45, folder 15 “Response to McCall’s article, June 1962,” MCA. See Waldo L. Fielding and Lois Benjamin, "The Medical Case Against Natural Childbirth," McCall's, June 1962. 159 World War II natural childbirth featured prominently in the media and was the subject of, as one reporter put it, “much popular discussion.”22

“Something New in Childbirth:” Making Natural Childbirth Modern

One of the most salient features of the numerous magazine and newspaper articles on natural childbirth is their frequent reference to the method as offering the “latest” in scientific and medical advances. Whereas later birth reform proponents, participants in the larger consumer-driven medical reform movement that emerged in the late 1960s, highlighted the differences between natural childbirth and modern medical practice in general (which they saw as the root of problems in childbirth), postwar advocates of natural childbirth challenged specific aspects of modern childbirth practice (unconsciousness at birth, impersonal,

“assembly-line” treatment by hospital personnel), but overall stressed the ways in which the method not only benefited from modern medicine, but was, in fact, a product of it.23

Natural childbirth often emerges in these accounts as a method only possible given the current state of scientific advancement. For example, “Modern Trek to

22 Slaughter, "To Ease The Pangs." 23 The first half of the twentieth century through to the mid-1960s saw an enormous public fascination with and appreciation of advances in medical science, fueled, in part, by extensive media coverage of medical breakthroughs. (See Bert Hansen, Picturing Medical Progress from Pasteur to Polio: A History of Mass Media Images and Popular Attitudes in America (New Brunswick, N.J.: Rutgers University Press, 2009); See also David J. Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making (New York, NY: BasicBooks, 1991). It is therefore not surprising that natural childbirth supporters during this period lauded the scientific and medical advancement of the method, nor that associations between natural childbirth and medical progress feature so prominently in the media. 160 Nature,” a 1949 article in the Washington Post, stated that the “’return’ to natural childbirth is really an advance along the lines of psychosomatic medicine” and that it

“requires time, money and other resources of civilization to provide ‘natural’ childbirth.”24 A 1953 edition of Today’s Health reported that the Read method was “a far cry from the unscientific methods practiced by many midwives. It is, instead, a somewhat elaborate procedure.”25 Here midwife-assisted childbirth, similar to the

Read program in its limited, or non, use of pain-relieving drugs, was not “scientific” because it did not use an “elaborate procedure”—a characteristic that differentiated it from the natural childbirth method.26

Articles also frequently characterized the method as “something new” and contrasted it to the “old” methods of drug-assisted birth. In 1948, for instance,

Collier’s magazine, in an article titled “Having Your Baby the New Way,” featured the results of a medical investigation of “the most interesting group of mothers in… the medical world today.”27 These women were “most interesting” not because, as one might expect given the recent development of multiple types of pain relief for birth, they used any of the relatively new types of anesthesia then available to birthing

24 Malvina Lindsay, "Modern Trek to Nature," Washington Post, January 27 1949, 10. Italics mine. 25 E. M. Stoney, "Let's Be Reasonable About Natural Childbirth," Today's Health, February 1953. Today’s Health was a magazine for “lay-persons” published and edited by the American Medical Association with the aim of emphasizing the “personal need for a family doctor and the community’s need to suppress medical fraud and quackery.” In 1954 it had a circulation of 340,000. "New Record for Today's Health," Journal of the American Medical Association 156, no. 3 (1954). 26 I will discuss this differentiation in more detail later in the chapter. 27 Gretta Palmer, "Having Your Baby the New Way," Collier's, November 13 1948, 26. 161 women.28 Rather, the medical world found these women fascinating precisely because they limited or did not use any of the new anesthetic interventions.

Surprisingly, natural childbirth or the “natural way,” was actually the “new way” to have a baby. “New,” we learn, because of its basis on Grantly Dick-Read’s medical

“theory and “new” in its use of the “Read-method technique.”29 Here the recent, seemingly modern practice of anesthetized birth had become old.

The contrast of “new” natural childbirth with the “old” methods of drug- assisted birth was also articulated almost two decades later by Dr. Robert Bradley, pioneer of the Husband Coached Method of Childbirth. He noted in a magazine interview, “There are two ways to have babies—the scientific, modern way, and the old way. The older way is by medicated, anesthetized delivery…The modern way is one by which…the mother (is) educated and trained.”30 He went on to mention a third way of giving birth by cautioning the reader not to “confuse today’s scientific, prepared childbirth with ancient, primitive untrained childbirth.”31 In Bradley’s telling, natural childbirth was modern, drug-assisted childbirth was old, and

“primitive untrained childbirth” was ancient.

28 Just a little over a decade earlier Time magazine reported that two-thirds of American births occurred without “any form of pain relief for the mother.” "Childbirth: Nature v. Drugs," Time, May 25 1936, 36. As birth moved from home to the hospital (in 1940 55% of all births occurred in the hospital, but by 1950 that number had increased to 88%) the number of drug-assisted births increased accordingly, but still would have been a relatively new phenomenon for most women. 29 Palmer, "Having Your Baby the New Way," 26. See also Elizabeth Austin Lindsay, "The Old Way is New: Natural Childbirth Plus Rooming-In," Vassar Alumnae Magazine, December 1948; J. F. Webster, "Something New in Childbirth," Parents', December 1949. 30 Longwell, "The Happiest Way to Have a Baby," 82. I will discuss Bradley’s method of childbirth in more detail in Chapter 5. 31 Ibid., 85, 107. It seems likely that the highlighting of the modern scientific and medical aspects of natural childbirth at this point also had to do with defensiveness in the wake of criticism of the method. I will address this in Chapter 5. 162 In addition to overtly drawing attention to the “modern,” “new,” and

“scientific” attributes of natural childbirth, magazine and newspaper articles also often implicitly referenced, either visually or in the article text, aspects of the method—the hospital setting and staff, for example—that readers likely interpreted as medical or scientific in practice. Illustrations of asepsis (the creation of a sterile environment, a key component of twentieth-century modern medicine) occurred frequently, such as in this image of a new mother, a successful participant in natural childbirth, wearing a surgical mask. (Fig. 4.1)32

Figure 4.1 Source: “Having Your Baby the New Way,” Collier’s, November 13 1948, 27. The opening shot of a 1950 Life magazine photo-essay illustrates the common depiction of medical asepsis and natural childbirth even more vividly. The story begins with a half-page photograph of mother Jean Barnes joyously receiving her baby minutes after birth. Barnes is attended by a nurse who is attired in a

32 Palmer, "Having Your Baby the New Way," 27. 163 surgical cap and a mask that hangs to her chest. A caption noted that Barnes herself has her “hands covered by a sterile sheet” as she holds her baby.33 The image, seemingly at odds with the title of the article, ”Natural Childbirth” (which is emblazoned below the photograph), illustrates the degree to which ideas of

“natural” coexisted with ideas of modern medicine and science within the context of natural childbirth.34 (Fig. 4.2)

Figure 4.2 Source: “Natural Childbirth: Young Mother Has Her Baby with No Fear, Little Pain," Life, January 30 1950, 71.

33 "Natural Childbirth: Young Mother has Her Baby with No Fear, Little Pain," Life, January 30 1950, 71. 34 Italics mine. For a description of a new natural childbirth mother holding her "minutes- old child through an antiseptic sheet" see also "Childbirth Free From Fear," 40; for additional images featuring natural childbirth in sterile, hospital settings see Palmer, "Having Your Baby the New Way."; Baker, "Natural Childbirth: A Picture Story."; Block, "It's Great to Have a Baby in Flint, Michigan!." 164

The Life photo-essay on Jean Barnes also features another common, albeit implicit, association between natural childbirth and modernity—the association between the labor of birth and the labor of the assembly-line through the use of images that evoke the mechanization, repetition, and standardization of mass production. Captioned “Mother for Labor,” a photograph captures Barnes, on hands and knees in her childbirth training class, performing “pelvic rocking” (an exercise designed to help prepare the body for birth) along with a line of several other women in similar pose.35 (Fig. 4.3)

Figure 4.3 Source: “Natural Childbirth: Young Mother Has Her Baby with No Fear, Little Pain," Life, January 30 1950, 73.

A Parents magazine article of the same year provides a comparable example of assembly-line imagery—it features several photographs of groups of women

35 "Natural Childbirth: Young Mother has Her Baby with No Fear, Little Pain," 73. Emphasis mine. 165 simultaneously practicing identical prepared childbirth exercises, their bodies machine-like in their uniformity and repetitive movement.36 (Fig. 4.4)

Figure 4.4 Source: “Natural Childbirth: Young Mother Has Her Baby with No Fear, Little Pain," Life, January 30 1950, 73.

In another example of the use of mechanical metaphors in relation to natural childbirth a New York Times Magazine article noted that a woman related, “My husband keeps kidding me about wanting to have a baby in this new way…He calls it the ‘drive-it-yourself’ system”37—a phrase then commonly used by rental car businesses. This was a modern method in the couple’s mind, a sophisticated process

36 "We Had Our Babies without Fear: Natural Childbirth; Symposium," Parents, June 1950, 38, 39. 37 Dorothy Barclay, "Natural Childbirth: A Progress Report," New York Times Magazine, January 29 1950. 166 analogous to driving a car.38 Critics, too, gave the natural childbirth method machine-like qualities. In 1953, for example, Dr. Hilde Bruch cautioned against falling for the “sensational publicity” that sold natural childbirth “as if were a new gadget on the road to manufactured happiness.”39

These associations between the labor of birth, the labor of factories and the work of machines are drawn out even further in a 1954 Redbook article titled, “It's

Great to Have a Baby in Flint, Michigan!” The birthplace of General Motors, the city of Flint was at that time at the height of its manufacturing prosperity and, according to the article, was “one of the safest and most pleasant places in the world to have a baby.” In addition to associating modernity and natural childbirth in ways we have already seen, the article text made the association between the labor of assembly- line car production and the labor of birth explicit with the subheading “A city famous for turning out sleek automobiles has discovered the secret to producing healthier babies, happier mothers.” The opening photograph shows a new mother and baby being wheeled from a medically-equipped hospital delivery room by a masked nurse, explicitly illustrating their access to a modern medical natural childbirth; and a father implicitly referenced the modern, medically advanced aspects of childbirth in Flint when he noted that the town where his wife had given birth previously was like the “dark ages.” The article then goes on to detail aspects of the Clara Elizabeth Fund for Maternal Health, a “family-life program for the whole

38 Another important aspect of the phrase “Drive-it-yourself-system” is the fact that it acknowledges the importance of the woman’s controlling role in childbirth. Chapter Five analyzes this aspect of postwar natural childbirth more thoroughly. 39 Ilg and Ames, "Natural Childbirth Theory Incorporates Common Sense," 8. 167 community” that enabled, in part, “nearly 100% of…mothers to leave the delivery room wide-awake and holding their own babies.”40 The Clara Elizabeth program, we learn, offered a variety of services and classes for expectant parents and young families—including prenatal and delivery care, training in natural childbirth, maternity wing hospital tours, a Men’s Forum for fathers (indicating the common practice for men to participate in natural childbirth), classes on infant care and child development, and a cooperative nursery school. All of this was done on a standardized, mass scale, illustrating the degree to which natural childbirth, and associated programs, operated along its own “assembly-line,” the previous year, for example, over 1200 women had completed the Training for Childbirth class in groups numbering over fifty students at a time.41

Natural Childbirth and the Domestic Ideal

In addition to defining natural childbirth as a distinctly modern project, popular press articles also served to shape ideas about the women who did and did not use the method. Indeed, one of the most striking features of articles on the subject is their consistent representation of natural childbirth mothers. They were always white and always middle class. The articles also frequently situated natural childbirth mothers in a domestic environment and highlighted their roles as housewives—through mention of housework and the discussion of the benefit of

40 Block, "It's Great to Have a Baby in Flint, Michigan!," 50. 41 Ibid., 93. 168 some types of housework in preparing the body for childbirth—and as mothers. The articles also highlighted husbands’ involvement during pregnancy and labor, noting their attendance at childbirth classes, their interest in learning about pregnancy and birth, and, most important, their presence during delivery. 42 Thus they fostered the notion that natural childbirth contributed to marital harmony, a key component of the postwar emphasis on family and domesticity. A 1957 article in the Ladies’ Home

Journal, in fact, made this connection explicit by quoting Grantly Dick-Read: “I have never seen anything…more likely to establish the emotional security of married life than that look which is exchanged between husband and wife when each has just seen their baby born.”43 Natural childbirth articles thus, in these respects, portrayed a particular version of postwar femininity—white, heterosexual, companionately married and domestically inclined—that reinforced and contributed to the dominant postwar ideology of the “domestic ideal.”

The 1950 Life magazine article discussed earlier, the cover story for the

January issue, is typical. The cover photo featured new mother Jean Barnes, wearing lipstick, her hair tidy in the short, permed style of the times, sitting up in bed and holding her new baby. The photo essay inside the magazine includes a series of

42 Well into the 1970s it was very rare for fathers to attend the births of their children. Indeed most hospitals had explicit regulations banning them from the delivery room on the grounds that they would be a distraction to the medical staff or even for the reason that seeing their wives during childbirth might negatively effect “marital relations” or sexual intimacy. The emphasis in natural childbirth on the importance of the father at birth, and the consequent demand from parents that the father be included, helped to change these regulations. For a history of this transition see Judith Walzer Leavitt, Make Room for Daddy: The Journey from Waiting Room to Birthing Room (Chapel Hill: University of North Carolina Press, 2009). 43 Grantly Dick-Read, "Childbirth Without Fear and Without Pain; Condensation," Ladies' Home Journal, June 1957, 72. 169 pictures of Barnes in various stages of pregnancy and labor: practicing her prenatal exercises, including one in which she squats while cleaning a wall, captioned

“Squatting is basically the same position as that realized on the delivery table. It also permits housework without bending over;” (Fig. 4.5) attending a birth class with her husband; chatting with the medical staff and playing cards with her husband in early labor; and then, under the sub-title, “Mother Is Conscious All

Through Delivery,” (which highlights the degree to which consciousness was unusual at the time) several close-up shots of her as face as during and just after delivery.44

Figure 4.5 Source: “Natural Childbirth: Young Mother has Her Baby with No Fear, Little Pain, Life, January 30 1950, 73.

44 "Natural Childbirth: Young Mother has Her Baby with No Fear, Little Pain." 170 The article text notes that Jean Barnes, a middle-class, white woman— described simply as “25 years old and the wife of a South Norwalk, Conn. (sic) life insurance salesman”—went into “the delivery room cheerful, unafraid, and excited” and described her natural childbirth experience as “unlike anything else (she had) ever known…and better—better even than graduating from high school and college.”45 The article also stresses the fact that her natural childbirth program, at the Yale New Haven clinic, “brought in that usually forgotten man, the father,” including him in childbirth classes and allowing him to remain at Barnes’ side throughout labor until the time of delivery. One caption describing a photo of

Barnes’ husband at her bedside reads: “Mrs. Barnes awakens and, reassured to find her husband still there, reaches up to take his hand. He remained at his wife’s side for 18 hours.”46 Overall, the article presents a woman who fully represents the postwar domestic feminine ideal—a young, attractive, white, heterosexual, companionately married, middle-class housewife, who faces birth cheerfully and finds it more fulfilling than graduating from college.

Other natural childbirth articles of the period also highlight mothers’ adherence to dominant cultural expectations of femininity. A mother commented in

Parents magazine that after the successful natural childbirth of her second child her husband “remarked in amazement that I looked ‘wonderful’—my lipstick was still

45 Ibid. 46 Ibid. 171 on and my hair wasn’t even mussed.”47 Similarly, a reporter for the Woman’s Home

Companion, commenting on the “amazing new approach to obstetrics,” noted that he

“found it hard to believe that the young woman (he) was looking at had had a child within the hour. Every hair was in place. Powder and lipstick were on just so. Her eyes were shining.”48 He also drew a connection between prenatal exercises and positions utilized during housework (and, at the same time, alluded to the belief that working class women gave birth with less effort and pain): a childbirth preparation

“exercise,” he stated, “throws new light on a remark you have often heard: ‘I can’t understand why I had such trouble in labor. Our charwoman gave birth to her baby just like that!—and was up in a day or so working.’ The exercise is, simply, scrubbing the floor.”49

The emphasis on marital harmony and natural childbirth is especially evident in a 1960 Ladies’ Home Journal article. Published a decade after the Life article on Jean Barnes came out, the Ladies’ Home Journal piece featured Patty

Nissen’s experience of a conscious, prepared natural (doctor-assisted) home birth.50

The setting was different from Barnes’ hospital birth, but the representation was the same. The article, part of the magazine’s monthly series “How America Lives,” and

47 Webster, "Something New in Childbirth," 77. 48 Morton Sontheimer, "Miracle in the Delivery Room; Yale Method of Natural Childbirth," Woman's Home Companion, December 1948, 4. See also Jacqueline H. Wolf, Deliver Me from Pain: Anesthesia and Birth in America (Baltimore: Johns Hopkins University Press, 2009), 161. for discussion of the importance of appearance and countenance of women in natural childbirth articles. 49 Sontheimer, "Miracle in the Delivery Room; Yale Method of Natural Childbirth," 164. Italics his. 50 Joan Younger, "Our Baby Was Born at Home; Patricia Nissen's Third Child," Ladies' Home Journal, January 1960. 172 more about how the family conducted itself during the birth than an introduction to natural childbirth itself, nevertheless shares similarities with earlier natural childbirth pieces. Nissen, who had two previous children in the hospital, the last one by natural childbirth and an “unforgettable and joyful memory,” chose home birth so that her husband could be with her during labor and delivery. Just as in the Life magazine article on Jean Barnes in 1950, the story includes pictures of Nissen’s husband, Gene, at her side throughout labor. Here, however, the emphasis is greater—there are four pictures of the two of them—and the poses and captions more intimate: “5:10p.m.—What would I ever do without you?” (Patty says to Gene in between contractions); “6:30p.m.—You’re wonderful, Patty” (Gene tells her as she relaxes through a contraction). The last photo reads: “7:41 p.m.—‘It’s a miracle,’ says Patty, “I love you.” (as she and Gene reach out to kiss each other just after the birth.)51 (Fig. 4.6)

51 Ibid., 112-13. 173

Figure 4.6 Source: Joan Younger, "Our Baby Was Born at Home; Patricia Nissen's Third Child," Ladies' Home Journal, January 1960, 113.

Nissen, we learn, is a housewife and mother, married to a PhD student and part-time Lutheran minister. She filled her days with housework, childcare and, even during labor, cooked dinner and “washed not only the dishes but two picture windows in the hope of speeding up the birth process.”52 She was a model of self- control: “The contractions are coming closer together now…but she has not cried out; only the heaving of her body and the noise of her breathing reveal the pressure the baby is applying.”53 And while the article includes no photos of a masked nurse or sterile hospital room to indicate the mother’s position within modern postwar medical and consumer culture, the fact that a doctor attended Nissen’s birth gives her experience medical legitimacy. This along with descriptions of the Nissens’

52 Ibid. 53 Ibid., 116. 174 “shining-new one-floor four-bedroom house,” the fact that the family owns two cars and that they have “acquired all the major laborsaving appliances” both place the family squarely within the modern, middle-class ideal and help to shape it. 54

Significantly, even when a natural childbirth mother deviated somewhat from the domestic ideal, the popular press shaped her story to fit the terms of postwar domestic femininity. In the mid-1950s Florida woman Patricia Carter received national attention, including coverage in Look magazine, for her unusual manner of childbirth—delivering her baby at home alone, with no attendant, medical or otherwise, present. Her method, as described in an article published in newspapers across the nation, was one that she used for seven of her nine children, and involved drinking “a few whiskey highballs,” going into “a bedroom alone to relax and wait” and then, when the time came, delivering her baby herself.55 The articles note further that after each baby was born she tied the umbilical cord, bathed the child, showed the newborn to its siblings and father and then made

“breakfast or whatever meal (was) due” and did her “other daily household chores as usual” so that “the organs…immediately (went) back into place.”56

54 Ibid., 111, 14. 55 Mary Lou Culbertson, "Woman Has Delivered 5 of Her Own Babies," Daytona Beach Morning Journal, March 30 1955, 1. See also "Woman Takes Snort, Has Baby, Resumes Her Work," The Dispatch, May 19 1955; "Mother of 7 Again Plans to Deliver Baby Herself," Los Angeles Times, March 31 1955; "Natural Birth Advocate Has Her 8th Child."; "Mother Halts Housework One Hour to Have Baby," Pittsburgh Post-Gazette, May 19 1955; "Has Baby, Continues Housework," Tri-City Herald, May 20 1955; "Natural Childbirth…This Mother of Nine Delivers Her Own Babies."; "Mother Delivers Own Infant for 7th Time," The Miami Daily News, August 21 1956. 56 Culbertson, "Woman Has Delivered 5 of Her Own Babies." 175 Newspaper headlines for Carter’s story indicate that the fact that she was up and doing housework immediately after a birth was just as fascinating and noteworthy as the fact that she delivered her baby by herself (after drinking alcohol). In 1955, after a local reporter, Mary Culbertson, heralded the upcoming unassisted birth of Carter’s eighth child, newspapers across the United States picked up the story, proclaiming: “Mother Halts Housework One Hour to Have Baby,” “Has

Baby, Continues Housework,” and “Mother Takes Snort, Has Baby, Resumes Her

Work.”57 These headlines and the corresponding articles on Carter and her method emphasized her role as housewife. They also highlighted her feminine appearance.

Various articles noted: “Mrs. Carter, a slender, attractive, gay, and charming woman, does most of the housework for her husband and seven children;”58 and “Mrs. Carter was ‘absolutely beautiful’ and calm as she tied the umbilical cord and washed and dressed her newborn…’When I left her home she was dusting a piano, the baby asleep in its crib;’”59 and “’It’s the way nature intended babies to be born, and it’s a wonderful experience, said the trim, attractive housewife, who is in her early 40s."60

A photograph shows her five minutes before birth dressed in a floral sundress and draped, somewhat seductively, on her couch, “serenely waiting” for the birth of her child. (Fig. 4.7)

57 "Mother Halts Housework One Hour to Have Baby."; "Has Baby, Continues Housework."; "Woman Takes Snort, Has Baby, Resumes Her Work." 58 Culbertson, "Woman Has Delivered 5 of Her Own Babies," 1. 59 "Has Baby, Continues Housework," 16. 60 "Mother Delivers Own Infant for 7th Time," 12A. 176

Figure 4.7 Source: Mary Lou Culbertson, “Mrs. Carter Expects Ninth Child and Book on Natural Childbirth,” Daytona News Journal, May 20 1956

At first glance, Patricia Carter is not the typical heroine of a natural childbirth story. No young mother, she was in her forties and near the end of her childbearing years. Nor did she share a companionate pregnancy and birth with her husband— they did not share natural childbirth materials or attend childbirth preparation classes together. Indeed, for her the moment of birth is one of absolute independence. Yet the stress in the media on housework and Carter’s role as housewife, along with the emphasis on her adherence to norms of attractiveness, signals her position within white middle-class culture even though her actions during childbirth are so far from the norm. Interestingly, a mistruth served as the basis for the focus on housework. Carter herself, in her self-published book on her method, noted that she was embarrassed by the stress on what she said was a misrepresentation of her post-birth activities: “It really made me feel stupid when people all over the country sent me clippings entitled ‘dusts, has baby, dusts on’ and

177 the like…I wasn’t dusting the piano…I was rubbing away a melted lollipop so there wouldn’t be a trail of Florida ants all over... I’m usually capable of doing something more entertaining than dusting furniture when I have a new baby to hold.”61 That a reporter chose to interpret and highlight Carter’s actions as housework, and the fact that those actions became the subject of such attention, indicates the cultural resonance of the domestic ideal.62

The subjects of natural childbirth articles may have varied in their choice of birth attendant or in setting for delivery, but every article had this in common—the focus was always wholly on the mother, her satisfactory experience of birth, and her primary role as mother and housewife. These depictions helped to shape dominant conceptions of a domestic femininity. However, representations of natural childbirth also complicate the image of submissiveness that is associated with the domestic ideal: they put women at the center of the picture, so to speak, and illustrated the achievement of a principle goal of the women who sought natural childbirth—to be included as active participants in childbirth.

The significance of these representations of female agency and assertiveness is demonstrated when we consider the climate of paternalism that dominated obstetrics. Americans during the postwar period held medical authority in general

61 Patricia Cloyd Carter, Come Gently, Sweet Lucina (1957), 74. 62 Carter’s disdainful comments about dusting, however, indicate the degree to which individuals might choose to adhere to that ideal. She was emphatic in her book about her rejection of housework as necessary to her role as mother. She did, however, stress the importance of feminine appearance. She made a point, for example, of always wearing attractive dresses, especially during childbirth—as seen in Figure 4.7 above. 178 in high regard, but the nature of obstetrical care made women particularly reliant on their doctors. By the 1940s routine prenatal care was common, as were lengthy postpartum stays in the hospital, and they provided ample opportunity for doctors—who as men and as physicians, tended to feel protective of their female patients—to extend their authority. Such was the extent of obstetrical paternalism that doctors, to avoid “worrying” the mother, often would consult only with the father, if they consulted with any besides the staff, if a complication arose during pregnancy or delivery. 63 As one woman put it, “The doctor was in command…the doctor was God.”64

Representations of natural childbirth reveal, in text and photos, women who challenged male medical authority and social conventions surrounding childbirth.

Maggie Baker, we may recall from the example at the beginning of this chapter,

“almost defiantly” told her doctor that she was “determined” to have her baby by the method of her choice. Her description of her actions during labor—she worked with contractions and did not need anyone to tell her when to push—further illustrate her active, assertive behavior. Another woman recalled grabbing her knees every time she felt a contraction and “leaning on the bed with (her) whole weight” until it passed, stating proudly, “I was helping my baby to be born!”65

Natural childbirth articles showcased women who discarded a submissive role in the face of paternalistic medical authority. Indeed, the very images the

63 Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 110-12. 64 Quoted in ibid., 111. 65 Selwyn, "I Watched My Baby Born," 8. 179 articles used highlight the independence and active participation of these women in childbirth: the focus on their faces and expressions highlight their experiences as awake and aware autonomous individuals and the images of their active participation in birth signal their agency within the male medical world. (Figs. 4.8 and 4.9) The captions for Figure 4.8 emphasize this active representation. They note that “the veins” stand out on Barne’s neck “as she strains” and that she “takes a deep chest breath” and holds it as “she bears down.”

Figure 4.8 Source: “Natural Childbirth,” Life, January 30 1950, 74.

180

Figure 4.9 Source: “Painless Childbirth,” Life, May 1 1956, 74.

A 1950 Pageant photo-essay featuring anesthetized birth, part of an article on the “miracle of reproduction,” illustrates the relative absence of the mother in drugged deliveries and underlines, by contrast, the degree to which natural childbirth articles portray women in an assertive, independent light. Whereas the focus is on the mother from the very beginning in natural childbirth articles—they almost invariably began with a photo of a smiling mother with her new baby—the photo spread in the Pageant opens with a full page picture of the mother being led away from the camera, down a hospital hallway by a uniformed nurse. We see only their backs.66 Two small pictures, the only ones showing the mother’s face, follow on the next page, one showing her grimacing in pain prior to the administration of the anesthetic; the other, lying on her side with belly exposed while the doctor listens to the baby’s heartbeat. The opposite page features an extra large picture of the mother from the chest down, presumably unconscious, lying strapped to the

66 Francis Reiss, "A Child is Born," Pageant, May 1950, 15. 181 delivery table, legs spread and in stirrups. Her body is exposed from the belly down and three masked and gowned medical attendants hover near and between her legs.67 (Fig. 4.10)

Figure 4.10 Source: Francis Reiss, “A Child is Born,” Pageant, May 1950, 15.

67 Ibid., 16-17. 182 In the next few pictures the focus is on the baby as it is delivered. The text reads,” As the woman lies oblivious under her anesthetic, her child is brought forth into the world.” The final photograph, two full pages in size, shows the still unconscious mother, unattended now that the birth is over, her body slack and lifeless-seeming, head lolling away from the camera, arm hanging limply off the delivery table, pubic area uncovered and legs still splayed and in stirrups from the birth. A lone nurse holds the baby up for the camera in the background.68 (Fig.

4.11)

Figure 4.11 Source: Francis Reiss, “A Child is Born,” Pageant, May 1950, 16-17.

68 Ibid., 22-23. 183 This mother was not present at the birth of her child—not during the delivery and not in the photographs of the event. Even the title of the article, “A

Child Is Born,” underscores the passive role the mother played.

Another article featuring anesthetized childbirth, published in 1956 in

Woman’s Home Companion, is not quite so stark. Here we do see several images of the conscious mother, though only after her baby is born. However, in effect this representation of childbirth is similar to that of the Pageant photo essay. The only picture of her taken during labor shows her unconscious, lipstick unsmudged, hands pinned above her head by a medical attendant (Fig 4.12). The caption reads, “My doctor says I came to from time to time, but I don’t remember my labor and delivery.” 69 This mother, too, the image and caption illustrate, has ceded authority over her birth to her doctor. She, too, was absent when her baby is born. Together these images of anesthetized birth, when contrasted with those of natural childbirth, highlight the degree to which portrayals of natural childbirth, (in their focus on women who chose to challenge male medically authority) complicate the notion of a quiescent feminine domesticity.

69 D. Schaffer and M.S. Welch, "We Have Our Baby," Woman's Home Companion, June 1954, 54-55. 184

Figure 4.12 Source: Schaffer and Welch, “We Have Our Baby,” Woman’s Home Companion, June 1954, 55.

Unmodern Birth

Media representations of natural childbirth might reveal an alternative, more autonomous, femininity to the one commonly portrayed in articles on drug-assisted childbirth, but the representations of both held two key aspects in common: all of the mothers, drug-assisted or not, gave birth in a modern medical setting and all of the mothers are white and middle-class. The representations therefore, in general,

185 identify these women, through their experience of modern birth, as modern themselves. Moreover, the representations racialize “modern” as white.

This point is made more clear when we consider the women that the mainstream press generally did not depict—the many who, whether by choice or circumstance, gave birth outside the hospital.70 These women, at least in terms of birth experience, did not meet the criteria for modern. At the same time that news of the “new” method of limited intervention in childbirth—that is, natural childbirth— spread through the United States, a different, but similar, method of non- medicalized childbirth predominated in rural and urban working-class areas. Most women in these communities had limited access to medical care and generally had their babies at home under the care of a lay or professional midwife.71 Significantly, though childbirth under these conditions precluded the use of anesthesia, other than the occasional whiff of gas, and mothers were almost certainly awake at the time of birth, this type of birth (midwife-assisted home birth) was never classified as “natural” in the sense that promoters of the natural childbirth method meant it and thus it was not seen as a modern method of birth.

The reasons why midwife-assisted home birth lacked the designation of

“natural childbirth” were two fold. First, in spite of some shared characteristics, use of the natural childbirth method in the United States in the postwar period did not

70 In 1950 12% of births took place outside the hospital. See Leavitt, p. 171. 71 Neal Devitt, "The Transition from Home to Hospital Birth in the United States, 1930- 1960," Birth and the Family Journal 4(1977). 186 generally involve midwives.72 As we have seen, advocates of natural childbirth in the

1940s through 1960s aligned themselves with what they saw as the “latest” in modern medical practice. Though female midwives had been the primary birth attendant for most women through the nineteenth-century, women who could afford it increasingly sought physicians who had been formally trained and who thus had the skill to use forceps and anesthesia. By 1900 doctors attended 50% of all births, including home births. By the 1950s, when the vast majority of births took place in the hospital under physician supervision, midwives typically only attended populations that either could not afford hospital care and/or those who lived in rural areas with limited access to hospitals.

Americans generally perceived untrained and unregulated lay midwives as ignorant, superstitious and uneducated and professionally-trained and regulated nurse-midwives, part of the growing government movement to train and professionalize midwives for deployment in medically underserved communities, as

“scientifically” trained but suitable only for public health programs for the poor.73 In neither case did midwives have the status of doctors. Midwives thus did not usually classify as “modern” in the minds of the white middle-class and therefore did not

72 The major exception here was the Maternity Center Association of New York City (MCA). A pioneer in low-cost public maternity care, in midwifery training, and in the use and promotion of Dick-Read’s method of natural childbirth, the MCA frequently led midwife-assisted homebirths using the natural childbirth method. Indeed, as I will discuss later, MCA records provide one of the few sources on use of natural childbirth training by lower-class and non-white mothers. 73 For the rise of the nurse-midwifery profession see Laura Elizabeth Ettinger, Nurse- Midwifery: The Birth of a New American Profession (Columbus: Ohio State University Press, 2006). For a discussion of perceptions of lay midwives see Gertrude Jacinta Fraser, African American Midwifery in the South: Dialogues of Birth, Race, and Memory (Cambridge, Mass.: Harvard University Press, 1998), 90-93; Susan Lynn Smith, Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America, 1890-1950 (Philadelphia: University of Pennsylvania Press, 1995), 119. 187 qualify for them as appropriate medical attendants. Because midwife-assisted homebirth generally lacked medically scientific legitimacy, natural childbirth proponents distanced themselves from that form of birth. Second, and most important, most women who were delivered by midwives at home were probably unfamiliar with the natural childbirth method and the childbirth preparation training that was a defining aspect of the natural childbirth program. Natural childbirth was not simply childbirth without drugs, but a systemized program based on explicit “scientific” principles. Certainly not modern drug-assisted childbirth, midwife-assisted childbirth, in lacking these medical and scientific attributes, was not modern, natural childbirth either.

When we compare the previous natural childbirth articles with a 1951 Life magazine photo essay featuring a midwife-assisted homebirth—the only mainstream print article during this period (1944-1967) to feature a non-white, non-middle-class childbirth—some important associations between childbirth experience and practice and ideas of race, femininity and modernity become clear.

The article, titled “Nurse Midwife: Maude Callen Eases Pain of Birth, Life and Death,” detailed the duties of midwife Callen, including her delivery of a baby, in rural South

Carolina. We see images of her not only delivering a baby, but also teaching classes to student midwives, holding a clinic and dispensing basic medical care and vaccinations to all, and transporting those with more serious illnesses to (white) doctor-supervised hospital care. In focusing on Callen, a trained and registered nurse with a great deal of prestige and authority in the community where she

188 works, the article made the unusual move (unusual, at least in the mainstream white press) of featuring not only a woman of color but one who commanded respect as a competent medical professional. Here, at a time when many white middle-class women strove to insert their own authority into the birth process, was a woman who was a medical authority herself.

But Callen was not the only woman in the article. The mother, Alice Cooper, whom Callen attended at birth was also featured prominently. If we look at Cooper’s experience, and Callen in relation to her, we find an emphasis on a lack of agency for

African American women and a portrayal of their distance from modernity. True,

Callen was represented as a medical professional—but her authority and medical training was second to that of the white male doctor to whom she must transfer her critical cases. She did not have the level of modern medical training that he did. To a white middle-class audience accustomed to seeing midwifery as a “second best” alternative for those who not afford doctor-supervised hospital care, Maude Callen’s presence a the birth signaled the lower-class status of the mother and her limited access to modern medical care.74 Also, the article’s depiction of childbirth, in stark contrast to the articles on natural childbirth that highlighted the modernity and the autonomous domestic femininity of their subjects, revealed a world far from modern and a young mother far from the image of the domestic ideal.

74 The African American middle class also generally associated midwives with a lower class status. See Linda Janet Holmes, African American Midwives in the South, ed. Pamela Eakins, The American Way of Birth (Philadelphia: Temple University Press, 1986), 287. Holmes argues that middle-income “southern blacks sometimes abandoned the midwife because hospital birth symbolized social and economic status.” 189 The article began with Cooper, an African American teenaged-mother in labor, no husband at her side, as she waited “forlornly” at the window for the midwife—in a home that decidedly lacked middle-class amenities. (Fig. 4.13)

Figure 4.13 Source: W. Eugene Smith, “Nurse Midwife,” Life, December 3 1951.

The area that she lived in, we learn, was so remote and poor that it had no paved roads or electricity, and so far outside the norm of modern civilization that as recently as the 1920s midwife Callen “found people that did not know the use of

190 forks and spoons.”75 An image shows Callen picking her way across logs because the road was too muddy to pass in a car. (Fig. 4.14)

Figure 4.14 Source: W. Eugene Smith, “Nurse Midwife,” Life, December 3 1951.

Images of the birth itself began with a shot of Cooper lying on a bed in a home lit by gas lamp. (Fig. 4.15) The only evidence that a medical event was underway was the presence of Callen, uniformed with stethoscope, but not gloved or masked, and a covered enamel bowl set on newspapers on a nearby table—the few signs of modern sterility. There was no indication or mention of a husband.

75 "Nurse Midwife: Maude Callen Eases Pain of Birth, Life and Death," Life, December 3 1951, 145. 191 Whether or not Cooper was actually married (we are not told), this depiction of childbirth placed it outside the norm of white middle-class domesticity and respectability. Also striking is the fact that in this portrayal the birthing mother had no agency. She was described and depicted as forlorn, frightened, sick, disheveled, nervous, waiting for help, in misery and writhing in pain—a helpless victim of painful childbirth, rather than the confident, competent embracers of pain-free childbirth that we saw in the natural childbirth articles. Cooper clearly received no training in natural childbirth, but neither did she receive pharmacological relief from pain. Hers was not a modern natural birth.

Figure 4.15 Source: W. Eugene Smith, “Nurse Midwife,” Life, December 3 1951.

192 The fact that the Life article emphasized Cooper’s lack of agency and her distance from modernity is highlighted by an article on a similar topic just a few years earlier in Ebony magazine. In “Babies By Special Delivery,” the subject was the work of the Chicago Maternity Center (CMC), a clinic that performed physician- attended homebirths for women who could not afford hospital care. The focus in the article was on a home delivery and the mother, like Cooper, was young, African

American and poor. However, though the author described a “rickety, dingy…smelly slum flat,” the article in general portrayed the mother in positive terms that demonstrated her access to medical care—she was shown attending the clinic for a prenatal visit; and that indicated her domestic respectability—she was married and her husband was shown with her during the birth and afterward in a family shot with the new baby. 76 Overall the story was one of medical progress—the CMC had an exceedingly low maternal mortality rate for African American compared to national average—and of maternal satisfaction.

By contrast, in the absence of modern medical legitimacy, in the absence of middle-class and medical amenities, and in the absence of adherence to the domestic ideal and in her experience of uncontrollable pain, Cooper’s labor was portrayed as outside of modernity, similarly to what we saw in the representations of African American birth in the 1930s. In this representation her birth was not of the painless, “primitive” type that natural childbirth promoters such as Grantly

Dick-Read favored for modern women to emulate. Rather it was an experience that

76 "Babies By Special Delivery," Ebony, January 1948, 11. 193 the modern woman should and, just as important, could avoid. In this narrative of birth it was only modern women who were able to birth easily and painlessly without drugs—a new discourse of painless childbirth was emerging.77 Significantly, though Cooper’s birth was not that of a “primitive” woman, the birth experience of this lower-class, woman-of-color was still antithetical to those of modern (white, middle-class) women—and it therefore marked her as unmodern.

Paradoxically, the overall impression of difference between the two types of birth experience is heightened by images in this article that are remarkably similar to those in the natural childbirth articles. For example, the article on Cooper interpreted her grimace of labor as one of universal suffering: “As hard labor begins the face of Alice Cooper seems to sum up all the suffering of every woman who has ever borne a child.” (Fig. 4.16)

77 See Dolores Flamiano, "Heroes of Hell Hole Swamp: Photographs of South Carolina Midwives by Hansel Mieth and W. Eugene Smith," Southern Cultures 17(2011). for an alternative discussion of the Callen photo essay. Flamiano argues that “Nurse-Midwife,” a piece that became one of the most famous of Life’s photo-essays, actually represents one of the first nuanced visual portrayals of African Americans in the mainstream press in that it has at its center a respectable, power wielding African American woman and it touches on issues of racism as the root of poor health and medical services in this African American community. I do not disagree with this analysis in general—but a comparison of the representation of childbirth here to the dominant images of childbirth in the popular press reveals startling differences in portrayals of agency and modernity in terms of race and class. 194

Figure 4.16 Source: W. Eugene Smith, “Nurse Midwife,” Life, December 3 1951.

In contrast, a similar image of Jean Barnes (of the hospitalized natural childbirth) was interpreted as one of hard work—the article text stated that despite the grimace in this image “at no time during the delivery…was she in severe pain.”

The contrast is clear—Cooper was a victim of suffering, whereas Barnes had the agency to overcome her suffering through “hard work.” (Fig. 4.17)

195

Figure 4.17 Source: “Natural Childbirth,” Life, January 30, 1950.

Another similar image shows Cooper’s joy when seeing her new baby (Figure

4.18). Here, the similarity to a comparable one of Barnes (Fig. 4.19), in revealing a commonality between women, erases the power differential that existed between white and black Americans.. The similarity of these photos also brings into sharp focus the near absolute absence of lower-class and people of color (mothers and attendants) in popular articles on what was, in many ways, a shared experience for women—childbirth. Though not surprising, perhaps, in an era when images of white, middle-class people dominated the mainstream media regardless of the subject, this erasure of color, class and history obscured the substandard realities of

196 birthing conditions for the many American women who had limited access to adequate medical care.78

Figure 4.18 Source: “Nurse Midwife,” Life, December 3 1951.

78 See Chapter 3 for statistics. 197

Figure 4.19 Source: “Natural Childbirth,” Life, January 30, 1950.

At the same time, the absence of images of women of color undergoing natural, or any type of, childbirth, along with the fact that the only portrayal of non- white birth in the mainstream media during this period represented the mother as a helpless and unmodern ignored the fact that women outside the white middle-class did exercise agency and make choices about how and where they gave birth. Some, for example, did undergo training and delivery in natural childbirth and also chose to birth at home. The Maternity Center Association of New York City (MCA), arguably one of the most influential and prominent promoters of the natural childbirth method in the United States, conducted a large portion of its work among the urban working-class. Since its inception in the 1910s, the MCA, seeking to improve infant and maternal mortality rates, held classes on health and baby care 198 and provided free prenatal and childbirth services, including home and hospital delivery. In the 1940s they expanded their mission to include the promotion of a satisfactory birth experience for the mother and family and adopted the Read method as a means towards achieving this goal. By 1949 they offered natural childbirth training to all of their clinic patients.79 Though their records indicate that some of the attendees of their classes were physician-referred patients who planned hospital births, the MCA primarily served women who sought home delivery for cultural and/or financial reasons—and for whom, as one nurse-midwife put it,

“natural labor (was) a foregone conclusion, a natural event that (was) to take place in their homes, among their relatives in their secure environment.”80

Their records chronicle a multiracial population, which the MCA classified as

“Negro,” “Puerto Rican” and “White,” the latter making up only a small percentage of patients. They note that “incidence of language difficulty is high,” indicating that many were from immigrant backgrounds, and that “the educational background of the majority of the mothers is limited to grade school graduation,” a probable indication of a working class background.81 Two clinical studies reveal that the MCA offered all of these patients natural childbirth training: many of them accepted the training at the time of labor and delivery and many of them also attended the

79 Hentschel, Helen, “A Report of Group Instruction and an Appraisal of Natural Labors of 211 Mothers Delivered at Maternity Association Clinic from February 1, 1949 to January 30, 1950,” March 15, 1950, Box 93 “Natural Childbirth,” folder 9, “Class Papers 1948, 1949,” MCA. 80 Ibid. 81 Ibid. 199 Center’s natural childbirth classes prior to childbirth.82 Notes taken on each participant’s labor paint an alternative picture of home birth and birth for lower- class and women of color than that portrayed in the Life essay on midwife Maude

Callen—many of the women in the study actively made decisions regarding the place and method used during birth (sometimes rejecting proffered natural childbirth training), they often underwent birth in a controlled and confident manner, and their family relationships aligned with the norms of the domestic ideal.83 An African American woman, deemed successful in natural childbirth, for example, reportedly “appeared controlled and relaxed” throughout labor and thought the natural childbirth classes were so “wonderful” that she was planning on telling “all her friends” about them. Another African American woman expressly chose to give birth at home rather than in the hospital (MCA patients could be transferred to the hospital, if they wished.). Other entries note cooperative and attentive “Negro” and “Puerto Rican” husbands, as in this example: “Husband

82 Ibid. See also Katherine Kendall, “A Study of Natural Childbirth,” October 3, 1949, Box 93 “Natural Childbirth,” folder 9, “Class Papers 1948, 1949,” MCA. 83 This is not to say that women who had limited access to adequate medical care were necessarily able to make the same choices about their births, nor that they were necessarily able to experience birth in a positive way. Clearly differences in material conditions could have a great impact on a mother’s subjective and physical experience of birth. There were probably very real differences between the birth experiences of the women with the MCA and of Alice Cooper, the young black mother in the Life article. My point is that the lack of positive representations of non-white and lower-class birth in general, coupled with a representation that highlighted the distance of women of color from modern advances in childbirth served to reinforce a dominant ideology that racialized “modern” as white and middle class. 200 interested and cooperative. Showed kindness and attention to (wife) during delivery.” 84

Evidence also indicates that some middle-class black women chose alternatives to drug-assisted birth. Though a survey of Ebony turned up no articles on the natural childbirth method, the April 1959 issue included a report on “Painless

Childbirth by Hypnosis.”85 The article’s portrayal of the mother, Myrtice Ballard, is quite similar to portrayals of natural childbirth mothers. For example, Ballard, a middle-class African American women, expressed similar motives for choosing her method—she felt as though she had missed something during her first childbirth, when “traditional drugs had put her to sleep,” and she wanted to be “aware of what was going on” for her second.86 The article includes various images of her in the hospital, including several in which she is attend by a doctor, also an African

American.87 The text describes her as “calm” and able to undergo labor and delivery with little pain. This is an example of “modern” African American birth that was absent from the mainstream press.

The white popular press did not report on any of these more positive experiences of non-white birth. In fact, the only article in the mainstream media to feature African American birth, the one carried by Life, portrayed a helpless, forlorn

84 Katherine Kendall, “A Study of Natural Childbirth,” 1949, unpublished class paper, box 93, folder 9 “Class Papers 1947, 1949,” MCA. 85 The white popular press also reported on birth and hypnosis during this period. See, for example, E. Breecher and R. Breecher, "Childbirth Under Hypnosis," Reader's Digest, August 1957; G. Bush and J. Juhl, "I Had This Baby Under Hypnosis," Better Homes and Gardens, November 1959; "Hypnosis in Childbirth," Parents Magazine, October 1960. 86 "Painless Childbirth by Hypnosis," Ebony, April 1959, 89. 87 Unfortunately the images were of too poor quality to include here. 201 mother giving birth in a setting that was far from medically advanced. In this way representations of childbirth helped to shape a dominant ideology that classed and racialized “modern” as white and middle-class.

Conclusion

Depictions of “natural” childbirth in the white-oriented press reinforced the mainstream postwar construction of domestic femininity by portraying exclusively white middle-class women, always married and with husband present, and content with motherhood and life in the home. At the same time, the natural childbirth participants featured in the popular media went against the cultural grain to demand a “modern” and “scientific” painless method of childbirth that allowed them to actively experience the births of their babies--thus illustrating their own legitimacy as “modern” participants in American social and economic culture; and complicating the image of feminine deference associated with the domestic ideal.

The portrayal of lower-class and non-white birth, on the other hand—the only one that exists in the mainstream media—depicts a woman in agonized childbirth, without the aide of a husband, laboring in squalor and pain with little medical intervention and no choice or control over how she gave birth. Though the latter representation challenged the still pervasive notion of easy, painless “primitive” birth in low-income and women of color by acknowledging the pain and danger that they often experienced, it nevertheless depicts this woman as a victim with little agency and as deviant from the postwar white, middle-class domestic ideal.

202 Together representations of childbirth in the postwar period illustrate the degree to which experiences and practices of labor and delivery marked a woman’s modernity—or lack thereof—and concomitantly shaped ideas of race, class, and femininity in the context of natural childbirth into the mid-century.

203 Chapter 5: “The Most Controversial Issue in Modern Medicine”: Responses to Natural Childbirth

In 1955 a mother wrote to Grantly Dick-Read about the “impersonal, detached” way of birth that she said was typical in the city where she lived:

You enter the hospital…a nurse is summoned who briskly whisks you off…without a chance to properly depart from your husband…regardless of how much you need this comforting presence at this time. The unfamiliar cold surroundings are closing in on you, and the contractions are becoming more severe—You are ushered into a small room with two beds. One is occupied. Your fear increases. The patient in the other bed is an expectant mother like yourself—only you wouldn’t recognize her as such. Side-boards are on her bed…and she is tossing and moaning in a drugged state. No one is near to assist her. You wonder fearfully if that is to be your fate in a short time, as indeed it is.1

This mother went on to relate that she did not remember anything of the rest of her experience other than that the delivery was a “ghastly, nightmarish ordeal.”

Pregnant with her third child, this women wrote that she “cringed at the thought” of

“reliving another unnatural birth.” She asked Dick-Read if he knew of any doctor or hospital in her area that used the Read method.2 In writing the letter this woman did not merely describe an experience of birth, but rather articulated a sharp critique of the prevailing standards of hospital care in her region and sought resources for avoiding another birth in that system. She was one of many women in the postwar period who felt unhappy with what they perceived as inhumane care and a lack of

1 Name Withheld letter to Grantly Dick-Read (hereafter GDR), Michigan, 6/25/55, box 46, “PP/GDR/D.104,” Personal Papers: Grantly Dick-Read Collection, Archives and Manuscripts, Wellcome Library for the History and Understanding of Medicine, London, England (hereafter cited as Wellcome). According to the terms of the Wellcome Library privacy protection policy I have withheld all names and other identifying information. 2 Ibid. 204 control during labor and delivery and who sought to find another way to give birth.

These women, in a groundswell of interest in natural childbirth, wrote letters, talked with friends, formed childbirth education groups, and pushed for their doctors to support them in birth method of their choice.

Their attempt to achieve natural childbirth was far from easy however.

Though their actions, and, as we saw in Chapter Four, popular media attention illustrate a significant widespread and sustained interest in the method, the number of women who wanted natural childbirth were a minority of the general population.

They faced opposition on all sides—from other women who supported drug- assisted childbirth, from doctors who resisted the new method and from many in the influential psychoanalytic community. So contentious was the subject of natural childbirth in the postwar period, in fact, that in 1963 one of the leading Yale proponents of the method, Dr. Milton J. Senn, characterized it as “the most controversial issue in modern medicine.”3

This controversy indicates that natural childbirth struck a nerve for many

Americans. The issue was about more than how a woman should give birth, however. In a sense, what was at stake was how best to define what constituted modern womanhood. As we have seen, natural childbirth was deeply tied to complicated, sometimes contradictory, notions of femininity and modernity and allowed for a variety of interpretations. Both critics and supporters of the method

3 M.J.E. Senn, "Storm over Childbirth: The Most Controversial Issue in Modern Medicine," McCalls, February 1963, 130. 205 drew from this discourse to characterize, in different ways, natural childbirth and the women who chose the method in relation to the dominant ideal of maternity and feminine domesticity.

The controversy surrounding natural childbirth also had to do with control.

Though by no means an overtly political response to medical control over women’s bodies, as it later would be, natural childbirth nevertheless represented a challenge to many doctors who had become used to delivering the babies of “absent,” unconscious women. Natural childbirth mothers in the postwar period insisted on childbirth on their own terms and inserted their conscious selves into the previously sacrosanct delivery room, thus potentially threatening male medical authority.

While Chapter Three focused on Grantly Dick-Read’s theory of natural childbirth, and Chapter Four looked at media representations of natural childbirth, this chapter focuses on the voices and actions of the participants in the natural childbirth debate—some doctors, but mostly the women who did or did not choose the method. After tracing the ways that interest in natural childbirth emerged and the role that women played in spreading word of the program, I analyze responses to the method from the mid-1940s to the mid- 1960s in order to better understand what natural childbirth meant to both its supporters and detractors.4 I find these

4 My periodization begins with the publication of Grantly Dick-Read’s seminal natural childbirth book in 1944 and ends with the emergence of the first overtly feminist discussions of natural childbirth in 1968 and 1969. Though significant changes in women’s political and social culture had begun occurring by the early 1960s, those changes are not reflected in my sources until later. 206 responses in books and magazine articles written about natural childbirth by the general public and by doctors, letters to the editor, and over seven hundred letters written to Dick-Read and to the Maternity Center Association of New York City

(MCA) and the Boston Association of Childbirth Educators (BACE), both organizations that promoted natural childbirth.

Key to my analysis were women’s letters to Dick-Read.5 Not only did they serve as an important source of information for doctor/patient interactions and women’s individual actions during childbirth, the letters also revealed how women interacted with the popular media and with Dick-Read’s writing. 6 Many of the women who wrote to Dick-Read mentioned that they had been introduced to his ideas in the pages of Collier’s, Readers’ Digest, Ladies’ Home Journal, and other

5 Women’s letters to the BACE were also important, but represent a different type of communication than that with Dick-Read. The women who wrote to the BACE had all participated in BACE childbirth preparation courses and the letters were written as part of post-birth, end of class assessment of their success with the method. This necessarily limited the content of the letters and therefore did not facilitate the range of responses that Dick-Read received. Also, these women were trained in natural childbirth and generally went to doctors known to the BACE to be supportive of the method. Their childbirth experiences were generally positive. 6 As we saw in Chapter Four, there is evidence from urban clinics that offered natural childbirth classes that women from a variety of race and class backgrounds learned about and used the method. However, this seems to have been limited to only those cities that offered such programs (New York City and New Haven, CT). See Katherine Kendall, “A Study of Natural Childbirth,” October 3, 1949, Box 93 “Natural Childbirth,” folder 9, “Class Papers 1948, 1949,” MCA; Lawrence Z. Freedman, Fredrick E. Redlich, Leonard D. Eron, and Edith B. Jackson, "Training for Childbirth; Remembrance of Labor," Psychosomatic Medicine: Journal of Behavioral Medicine 14, no. 6 (1952); Cathleen Schurr, Naturally Yours (1953), 49. In most cases it is difficult to tell definitively the class and race backgrounds of writers to Grantly Dick-Read and the Boston Association of Childbirth Educators (BACE). However, many women mention being college graduates or being married to graduate students or professionals—education levels and occupations consistent with the middle- class. Linda Holmes argues that black middle-class women eschewed alternative birth methods because “hospital birth symbolized social and economic status.” See Linda Janet Holmes, African American Midwives in the South, ed. Pamela Eakins, The American Way of Birth (Philadelphia: Temple University Press, 1986), 287. This evidence, along with the fact that a survey of Ebony turned up no articles on natural childbirth, indicates that natural childbirth seems to have been mostly of interest to white, middle-class women, especially outside of large urban areas. 207 magazines.7 The letters illustrate how women received, interacted with and shaped both Dick-Read’s theory and media representations of natural childbirth. The letters also represent and illustrate part of a groundswell of interest in the Read method and the ways that women shared information about this method by talking with other women. They demonstrate that women articulated their concerns regarding childbirth beyond the home and doctor’s office.

These letters generally fell into two narrative types. One, those which thanked Dick-Read for offering a childbirth method that had allowed the writer to be conscious and participate in the birth of her baby or that asked for more information on how to achieve such a birth. Two, those that described a previous bad experience with drug-assisted childbirth, antagonistic interactions with medical staff, and/or an inability to find a doctor that supported the Read method. Both types reveal women’s desire to be present and active during labor and delivery and to have some control over the process. The later group also illustrates women’s critical articulation of the problems with conventional childbirth. Far from passive receptors of prevailing medical thought on birth procedures, the women who wrote these letters showed a willingness to step into contested terrain and, though not always successful, a desire to chart their own path to the type of birth they wanted—actions that represent individual agency, but that then became part of a

7 The following letters are representative examples: Name withheld, letter to GDR, 04/14/1957, Colorado, box 48, “PP/GDR/D.133;” Name Withheld, 9/18/1947, California, box 46, “PP/GDR/D.102;” Name Withheld, letter to GDR, 06/13/1957, Ohio, box 48, “PP/GDR/D.124,” Wellcome. 208 collective response as women shared what they learned with friends and in the media.

I argue that in spite of the controversy over natural childbirth, in spite of critical interpretations of the method that labeled, as we shall see, those who used it as “primitive,” “neurotic” or “unfeminine,” women persisted in choosing the method and in doing so constructed a version of modern femininity that expressed agency and critical engagement in the medical arena and allowed for some control within the birth process. While women did seek pleasure and gratification in childbirth and motherhood, they often openly defied the medical dictates and social conventions of the postwar years in order to achieve the childbirth experience they wanted. At the same time, they sought to actively participate in and be present at the births of their babies. Their words and actions thus reveal a more complicated enactment of modern white middle-class femininity than that of Dick-Read’s and others’ deferential, quiescent feminine ideal.

Natural Childbirth Through the 1960s: An Overview

Within an overall context of lower maternal mortality rates, which allowed women to focus on things other than the danger of childbirth, and a pronatalist culture that emphasized the worth of childbirth and motherhood, natural childbirth emerged in the postwar period in direct response to what women perceived as the alienating, even inhumane, experience of unconscious and routinized “assembly- line” birth. Glimmers of dissatisfaction began to surface, in fact, at just the same time

209 that drug-assisted hospital births were becoming routine. Into the 1950s and beyond, dissatisfied women described drugged births as nightmares of fear, pain and impersonal attention.8 One mother, for example, wrote to Grantly Dick-Read stating that the birth of her third baby, in a “larger hospital,” was a “nightmare…the whole attitude was one of routine boredom” on the part of the medical attendants.9

Another stated that during the birth of her first baby she had been “full of terror and tension, drugged to such an extent that I cannot now describe the events at all except to say that the whole thing was a nightmare.”10

A pair of articles published in the Ladies’ Home Journal in 1958 provides evidence that outrage at experiences such as these were widespread. Titled “Journal

Mothers Report on Cruelty in Maternity Wards” these two articles, the first published in May and the second in December, published mothers’ responses to a

November 1957 letter to the editor. In it a registered nurse had accused doctors of

“sadism in the delivery room,” writing that despite great strides made in maternal health care, hospital staff routinely strapped down mothers-to-be for hours “with cuffs around (their) arms and legs, steel clamps over (their) shoulders and chests…

(and) knees pulled far apart.” Some doctors still say, she noted, ‘Tie them down so

8 As discussed in Chapter 2, physicians drew from a wide variety of anesthetic and analgesic medications, often used in combination, some of which blocked pain, some of which were amnesiacs and were supposed to cause mothers to forget their pain, and some of which rendered unconsciousness. Frequently the drugs worked imperfectly and mothers felt pain and or remembered their experiences. 9 Letter to Grantly Dick-Read, New York, 1/16/51, box 47, “PP/GDR/D.114,” Wellcome. 10 Letter to Grantly Dick-Read, New Jersey, 3/4/47, box 47, “PP/GDR/D.112,” Wellcome. 210 they won’t give us any trouble.’” The Ladies’ Home Journal wondered, “Would other readers care to report?”11

Reader response was enormous. “Few full-length articles,” the editors wrote in the May follow up to their query, had “elicited such a flood of letters” as the “brief plea” from the nurse.12 Though many women wrote to defend doctors and hospitals and to describe their positive experiences with childbirth, the majority confirmed the nurse’s charges and added some of their own, complaining of indifferent or callous treatment: “far too many hospitals, far too many doctors and far too many nurses (treat mothers) as unimportant cogs in the machinery of the mass production of infants” and “Women are herded like sheep through an obstetrical assembly-line.”13 Others lamented being left completely alone for much of their labors. Around ninety percent of the mothers pleaded “Let us have our husbands with us.”14 Over half of the respondents reported that their deliveries had been artificially slowed for the convenience of the doctor through such means as tying their legs together, sitting on their knees, or the ample administration of ether.15

Experiences such as these motivated women to seek a method that would allow for a more personal experience of birth, one that would allow for consciousness during the delivery and for less fear and pain and more control. The

11 "Sadism in Delivery Rooms?," Ladies' Home Journal, November 1957, 4. 12 Gladys D. Shultz, "Journal Mothers Report on Cruelty in Maternity Wards, Part I," Ladies' Home Journal, May 1958, 45. 13 Gladys D. Shultz, "Journal Mothers Report on Cruelty in Maternity Wards, Part II," Ladies' Home Journal, December 1958, 59; Shultz, "Journal Mothers Report on Cruelty in Maternity Wards, Part I," 153, 45. 14 Shultz, "Journal Mothers Report on Cruelty in Maternity Wards, Part II," 155. 15 Shultz, "Journal Mothers Report on Cruelty in Maternity Wards, Part I," 153. 211 theory and method of Grantly Dick-Read’s Childbirth Without Fear promised to allow women the experience they sought. It is possible that nothing would have come of individual women’s desire for alternative birth, however, without the groundswell of actions and responses of other women who shared their feelings of unhappiness with conventional birth methods, as well as their knowledge of the natural childbirth method.

Though it is difficult to find reliable statistics on the number of women who actually attempted the Read method, there is evidence that many sought more information about his program and enthusiastically spread news of it by word of mouth and by writing about the topic—and that they pushed their doctors to allow them to try it. As one journalist put it (in 1950), Dick-Read’s book “touched off a controversy” that inspired discussions “at medical meetings—and over back fences.”16 Women described hearing about the Read method from others who had become so enthusiastic about it that they zealously “urge(d) it on their friends.”17

“I’ve turned into a missionary,” wrote a mother who felt that natural childbirth was the “happiest experience in (her) life.”18 Some women learned of natural childbirth in college where it was “the big topic of social-club conversation among girls.”19

Others described networks of friends who spread the word: “small islands of natural

16 Dorothy Barclay, "Natural Childbirth: A Progress Report," New York Times Magazine, January 29 1950, 148. 17 Name Withheld, letter to GDR, n.d., 1950, Maryland, box 46, “PP/GDR/D.101.” See also Name withheld, letter to GDR, 02/10/1959, North Carolina, box 48, “PP/GDR/D.128” and Letter to GDR, n.d., Utah, box 47, “PP/GDR/D.114,” Wellcome as representative examples. 18 Letter to GDR, 07/02/1946, box 46, “PP/GDR/D.109,” Wellcome. 19 Maggie Baker, "Natural Childbirth: A Picture Story," Coronet, May 1954, 46. 212 childbirth users are springing up. These girls will spread the news until many more

American women can experience the wonderful time I…have had.”20

The continuing proliferation of magazine and newspaper articles and books on natural childbirth during this period reflects sustained interest in the topic and also served as a principle source for dissemination of the Read method. As women learned of natural childbirth they often wrote to magazine editors, to the Maternity

Center Association (MCA) or even to Dick-Read himself, for more information or simply to thank promoters of the method for introducing a way to birth without fear and pain.21 A number of these mothers felt so inspired that they sought, themselves, to proselytize to much larger audiences—at least three of Dick-Read’s correspondents went on to write books promoting natural childbirth, others wrote magazine articles of their own, one founded a magazine, Child-Family Digest, that was committed, in part, to promoting natural childbirth and at least one founded and led an influential childbirth education group in Boston.

As women’s interest in the Read method grew, a grassroots effort to achieve natural childbirth emerged. Women began to ask their doctors for support. A

Virginia doctor noted, “Women are reading your book and articles by others based on your work. They are coming to their doctors and compelling them to get interested in natural childbirth. That is precisely how my interest was aroused.”22

20 Name withheld, letter to GDR, Connecticut, 03/21/53, box 46, “PP/GDR/D100,” Wellcome. 21 Grantly Dick-Read received over five hundred letters from American women between 1944 and his death in 1959. Women wrote from all over the United States, with only Montana, Idaho, Nevada, Wyoming, North Dakota, South Dakota, and West Virginia not represented. 22 Name withheld, letter to GDR, 9/16/49, Virginia, box 53, “PP/GDR/D.197,” Wellcome. 213 Dr. Frederick Goodrich reported a similar occurrence. He first practiced the Read method when a young woman already in labor, who herself had read of the method in a magazine, asked him, a young resident at the Yale-New Clinic, to assist her.

Goodrich was so impressed with the results that he and Thoms invited Dick-Read to speak to doctors in New Haven. The local papers reported on the talk and “within a few months over 20…women had come to the hospital asking for a drugless delivery.”23 Eventually he and Dr. Herbert Thoms, with the support of the Maternity

Center Association of New York (MCA), undertook a three-year clinical study of eleven hundred women using the Read method in the Grace-New Haven Community

Hospital. Reports on the New Haven program and, in some cases, the results of the study—that 948 of the 1,010 mothers who delivered without operative intervention were fully conscious at the births of their babies and that many of those women were “thrilled and delighted”—made it into newspapers and magazines across the country, and became the subject of two books by Thoms.24 A California woman noted then that the Read method received “a tremendous amount of publicity…particularly in regard to the New Haven Clinic.”25 A year later, in 1951,

23 Gretta Palmer, "Having Your Baby the New Way," Collier's, November 13 1948, 61. 24 Barclay, "Natural Childbirth: A Progress Report," 34; See also "Training Program Eases Pain in Childbirth," Indiana Evening Gazette, October 28 1948; "Painless Childbirth at Yale," Newsweek, November 7 1949; J. F. Webster, "Something New in Childbirth," Parents', December 1949; William Brady, "Here's to Health," Los Angeles Times, May 24 1951; "Natural Childbirth: Young Mother has Her Baby with No Fear, Little Pain," Life, January 30 1950; Herbert Thoms, Training for Childbirth: A Program of Natural Childbirth with Rooming-In (New York: McGraw-Hill, 1950); Herbert Thoms, Understanding Natural Childbirth: A Book for the Expectant Mother (New York: McGraw-Hill, 1950). 25 Name withheld, California, 1/29/1950, box 46, “PP/GDR/D100,” Wellcome. 214 Hazel Corbin, director of the MCA, wrote to Thoms that “Natural childbirth (was) spreading like wildfire.”26

The growth of natural childbirth organizations indicates the extent to which women pushed for natural childbirth. Beginning in 1950, with the formation of the

Milwaukee Natural Childbirth Association—a group that sought to “interest prospective parents, doctors, (and) nurses” in natural childbirth and to “promote the establishment of training programs”—women across the country also formed grassroots childbirth education associations. These groups actively disseminated information on the Read method by training mothers in natural childbirth and by meeting to “pool ideas, discuss mutual problems, and bring in speakers.”27 The San

Francisco League for Childbirth and Parent Education, for example, played Dick-

Read’s recording “Natural Childbirth” and reported a large attendance, including many from out of town and a large number of student nurses.28 The La Leche

League—a grassroots organization formed in Franklin Park, Illinois in 1956 which emphasized the importance of breastfeeding, but also had interest in natural childbirth—invited Dick-Read himself to speak and “had to turn away hundreds

26 Corbin to Thoms, box 30, folder 2 “Yale, 1947-1961,” MCA. 27 “Easier Childbirth,” Natural Childbirth Association of Milwaukee, n.d., box 93, folder 8 “Natural Childbirth: Articles, Curriculum Materials, 1940s-1950s,” MCA; “100 Launch ‘Natural Birth’ Group Here; Honor Teacher,” J.A. Wadovick, Cleveland Plain Dealer, July 19, 1951, box 77, folder 4 “Parenting Classes and Natural Childbirth: Clippings, 1949-1951,” MCA. In 1961 these groups and other natural childbirth associations came together under the umbrella organization, The International Childbirth Education Association. 28 Mrs. Gale R. Blosser to Hazel Corbin, n.d., box 26, folder 17 “Grantly Dick-Read, Correspondence 1954-1958,” MCA. 215 after admitting 1250 people from three states” to his lecture.29 By the mid-1950s several similar childbirth associations had formed across the United States and in

1955, and again in 1958, representatives from several of the groups met at the

Maternity Center Association in New York City to discuss common problems and goals.30 In 1960, in a move that revealed a growing effort to educate women and institute birth reform on a large scale, these groups and others came together to form the International Childbirth Education Association (ICEA), an organization that rapidly increased in membership and influence through the 1960s and beyond.

In the late 1950s and early 1960s two other methods of natural childbirth emerged in the United States—methods that would eventually out-rival the Read method and that even in their early popularity illustrate a continuing enthusiasm for natural birth. In 1959, with the publication of Thank You, Dr. Lamaze, young wife and mother Marjorie Karmel introduced American women to psychoprophylaxsis, or as it was known in the United States, the Lamaze method.31 Although initially

29 La Leche League Newsletter, Vol.1, No. 1, May-June, 1958, box 64, “PP/GDR/F11,” Wellcome. 30 See the minutes from both conferences in box 93, “Natural Childbirth,” folder 8, “Articles, curriculum materials, 1940s--1950s,” MCA. The conference minutes list representatives of groups from Seattle, WA; Cleveland, OH; Boston, MA; Jamaica, NY; Columbus, OH; San Jose, CA; Jersey City, NJ; Milwaukee, WI; Washington, D.C.; Dayton, OH; Princeton, NJ; Tulsa, OK; and Jackson, MS. See also Patricia Murphy, "Expectant Mothers Organize for Natural Childbirth," American Journal of Nursing 56(1956). Development of childbirth education groups seems to have been uneven. Even in the late 1960s a certified childbirth educator found that Tucson, Arizona and Tampa, Florida lacked childbirth education classes “even though the spread of Lamaze was taking place in many (other) areas of the country.” See Lorraine Kushner, "The Journey of an Early Lamaze Childbirth Educator," Journal of Perinatal Education 14, no. 1 (2005). 23. 31 Ferdinand Lamaze and childbirth educators that taught his method stressed that it was not to be mistaken for natural childbirth (Natural Childbirth), which they argued, was specific to Dick-Read. However, I use the term “natural childbirth” to mean any method that emphasized the education of mothers and stressed relaxation rather than drugs to alleviate childbirth pain because, as magazine and newspaper articles and letters from mothers reveal, this was generally how the 216 resistant to natural childbirth, Karmel had been won over after reading Dick-Read’s

Childbirth Without Fear at the suggestion of a friend. Though an American she was living in France during her first pregnancy and Ferdinand Lamaze, an obstetrician who had been championing psychoprophylaxsis was the only doctor she could find who was amenable to assisting her with achieving conscious birth without fear and pain. Psychoprophylaxsis, a Soviet-developed method of Pavlovian conditioning to prevent pain during childbirth, was quite similar to the Read method in that it sought to banish fear, and thus pain, by educating pregnant women on the development of the fetus and the physical processes of childbirth and training them for childbirth by teaching breathing, relaxation and muscle exercises to aid in labor and delivery. However, whereas Read emphasized maternal fulfillment and relied on anecdotal evidence to support his theory, Lamaze and his followers used the language of Pavlovian theory and technique, giving the Lamaze method an imprimatur of scientific authority that the Read method seemed to lack.32 In

Karmel’s words, “I have tremendous respect for Dr. Read and his accomplishments…but…I couldn’t go along with (Dick-Read’s) rhapsodic and various methods were popularly know, even by women who had specifically trained in the Lamaze method. See the letters of the BACE collection. 32 See Paula A. Michaels, "Comrades in the Labor Room: The Lamaze Method of Childbirth Preparation and France's Cold War Home Front, 1951-1957," The American Historical Review 115, no. 4 (2010): 1039-40. As we saw in Chapter Three, Dick-Read also based his method, in part, on Pavlovian theory and saw his method as grounded in science. However, though he noted this in his book Childbirth Without Fear, he did not stress it when discussing his method in general. Dick-Read was competitive with Lamaze, as well as with the original Russian developer (I. Z. Vel’vovskii) of the method upon which the Lamaze method was based, and charged them with not only usurping his theory, but also with attempting to extend communism: “people like the Russians,” Dick-Read wrote, “have seized it (natural childbirth), knowing they can get a internal influence by utilizing this method.” Grantly Dick-Read to name withheld, 3/12/59, box 48, “PP/GDR/D.128,” Wellcome. See Michaels, "Comrades in the Labor Room,” 1049. 217 mystical view of childbirth…The (Lamaze method) replaces this emotional force with a whole series of physical and mental techniques based on conditioned-reflex and pain theories.”33 Numerous women shared Karmel’s reaction.

Overwhelmed with the popular response to her book, Karmel was relieved when Elizabeth Bing, an obstetrical nurse who had promoted the Read method and trained mothers in natural childbirth in the 1950s, contacted her about learning the

Lamaze method. “You’re the person I need,” she told Bing, “because since my book has been out I’ve been overwhelmed with demands from women asking where they can learn the method. You’re going to teach it!”34 In 1960 Karmel and Bing began teaching classes in psychoprophylaxsis in New York City. That same year they and several obstetricians formed the American Society for Psychoprophylaxsis in

Obstetrics and “so the whole movement grew, and soon it wasn’t just a group in

New York City, but there were groups in Los Angeles and then all over the country.”35

The 1960s also saw the emergence, on the national stage, of the Bradley, or

Husband-Coached, Method of Childbirth. By the time, however, that Robert Bradley, a Denver-based obstetrician, published Husband Coached Childbirth in 1965 he had been practicing what he called family-centered natural childbirth for nearly fifteen years. Bradley, like Dick-Read and Lamaze, believed that education regarding

33 Marjorie Karmel, Thank You, Dr. Lamaze: A Mother's Experiences in Painless Childbirth (1959), 26. 34 Karmel to Bing, quoted in Elaine Zwellling, "The History of Lamaze Continues: An Interview with Elisabeth Bing," Journal of Perinatal Education 9, no. 1 (2000): 18. 35 Ibid., 19. See also Margot Edwards and Mary Waldorf, Reclaiming Birth: History and Heroines of American Childbirth Reform (Trumansburg, N.Y.: Crossing Press, 1984), 33-39 and 48-54. 218 pregnancy and labor, along with relaxation and breathing techniques, allowed a women to experience conscious delivery without fear and thus without pain.

Though Dick-Read and Lamaze, as well as followers of their methods, encouraged fathers’ attendance at childbirth, Bradley took it a step farther and actively argued for “the deliberate inclusion of the father in the delivery room as an essential member of the birth team.”36

The postwar period was characterized by a high level of interest in natural childbirth—an interest manifested not only in the widespread media coverage that we discussed in Chapter Four, but by the widespread discussion of the topic among women, in the fact that women pushed for their doctors to adopt the method, in the growth of childbirth education organizations across the nation and in the emergence of new methods of natural childbirth. The widespread discussions that started in the late 1940s “at medical meetings—and over back fences” continued into the 1960s, leading one medical opponent of the method to worriedly note in

1962, “everyone is talking about (natural childbirth).”37

Resistance to Natural Childbirth

While it may have been, in the postwar years, that everyone was talking about natural childbirth, the fact was that medical and cultural resistance to the method was pervasive. Indeed this was precisely what kept the conversation going.

36 Robert A Bradley, "Fathers' Presence in Delivery Rooms," Psychosomatics 3(1962): 479. 37 Waldo L. Fielding and Lois Benjamin, The Childbirth Challenge: Commonsense Versus "Natural" Methods (New York: Viking Press, 1962), vii. 219 Part of this resistance came from women who preferred, and the vast majority of them did, drug-assisted childbirth.38 Various doctor correspondents to Dick-Read noted this preference. One from Chicago relayed in 1948, “There is tremendous demand for not only painless childbirth but amnesia for the event.”39 In Boston in

1948 a nurse noted, “here a great deal of medication is used, and the mothers love it because they don't feel a thing from the time they come in until after the baby is born; it is a complete blackout.”40 Two years later the situation was much the same,

“Most women I talked to said plainly, that they wanted to be asleep when their baby was born and they didn't see any reason why they should be awake. Giving birth to a child constituted no particular sensation and the best thing was, to be asleep and to get over with it as soon as possible. This is the general attitude."41 In 1957 a

Virginia doctor who had been supportive of natural childbirth wrote to Dick-Read that he had to revert back to drug-assisted methods so that he would not loose his practice. “I was employing your theories with such of my patients who expressed a preference for it. The results were quite nice. However, rumors were widely and persistently circulated that I compelled all of my patients to go through labor

38 During the postwar period natural childbirth in the United States often involved administration of tranquilizers in first stage labor and light gas during delivery. For some women, even the use of spinal anesthesia equated with their idea of a natural birth if they actively helped to push the baby out and were conscious during delivery. By drug-assisted childbirth I mean use of a level of drugs that either rendered a woman unconscious or unable to remember her labor and delivery or the use of spinal anesthesia with a “high forceps” or “midforceps” delivery—meaning the baby was extracted from the mother before its head reached the lower birth canal. 39 Name withheld to Grantly Dick-Read, Illinois, 2/12/48, box 53, “PP/GDR/D.198,” Wellcome. 40 Name withheld to Grantly Dick-Read, Massachusetts, 8/9/48, box 46, “PP/GDR/D.106,” Wellcome. 41 Name withheld to Grantly Dick-Read, Massachusetts, 4/22/50, box 54, “PP/GDR/D.205,” Wellcome. 220 without any relief whatsoever. As a result, (I) lost a large share of my practice" and had "to conform more or less to the prevailing obstetrical standards in this community.”42

As these comments and the data suggest, most women felt that pain-relief during birth was essential. Some were so indignant at the suggestion of an unmedicated birth without pain that they wrote critical letters to Dick-Read, some scathing in their accusations about his misguided, or even callous, assessment of the potential for no pain in childbirth. A Pennsylvania mother of seven, for example, criticized Dick-Read for his lack of respect for women. She insisted that childbirth was painful and called Dick-Read a “a very good comedian” going on to state, “I have always thought men were the stupid ones. Do you really believe that women are less intelligent than men?...Is it because they believe that there is no pain in childbirth?”43 Not only did this writer challenge Dick-Read’s intelligence and his beliefs on the existence of childbirth pain, but she implied that women who “believe there is no pain” were also unintelligent.

Several of Dick-Read’s correspondents wrote that friends reacted in disbelief when they mentioned wanting natural childbirth, saying things like, “Just tell the doctor to knock you clear out from the first” or describing natural childbirth as “old- fashioned” or “primitive.”44 A woman wrote to the Boston Association of Childbirth

42 See Name withheld, letter to GDR, 8/30/57, box 54, “PP/GDR/D.206.” 43 Name withheld, letter to GDR, Pennsylvania, n.d., 1958, box 48, “PP/GDR/D.129,” GDR. 44 Names withheld to Grantly Dick-Read, Iowa, 2/24/57, box 48, “PP/GDR/D.128”and Ohio, 12/10/53, box 46, “PP/GDR/D.104,” Wellcome. 221 Educators (BACE) that “other women looked at me like I was freak because I’d wanted to have my baby that way (through natural childbirth).”45 Others also mention being challenged or ridiculed by friends. Kathleen Schurr, for example, wrote that her friends, when they learned that she had signed up for natural childbirth classes, “slyly insinuated that there might be something strange about” her.46 A Louisiana mother wrote to Dick-Read that the skepticism of her friends was the “biggest battlefront” in her quest for natural childbirth.47 Many women spoke of their friends stressing the agony of childbirth and urging them to forgo the natural method in favor of painless oblivion.48

For women who chose drug-assisted childbirth, natural childbirth did not fit with their understandings of modern femininity. They wanted to avail themselves of the full arsenal of modern anesthesia. Women who did not do so were suspect in their eyes—“strange,” lacking in intelligence, “old-fashioned,” or even “primitive.”

Doctor Resistance

Many, if not most, women interested in the natural childbirth had difficulty finding a doctor or a program that practiced it. A Californian woman noted in 1947,

45 Redacted to Justine Kelliher, n.d., probably 1967, box 8, “Class Questions and Letters, 1956-1970, 5 of 5,” Boston Association for Childbirth Education Records, 1934-1993; MC 515, Schlesinger Library, Radcliffe Institute, Harvard University (hereafter BACE). The Boston Association of Childbirth Educators (BACE) is a prominent childbirth organization that developed in the early 1950s. Their archive, housed at the Schlesinger Library, contains hundreds of class questionnaires, surveys, and student letters from 1948-1978. I looked at materials through 1969. 46 Schurr, Naturally Yours: 43. 47 Name withheld, Monroe, Louisiana, 03/05/57, box 47, “PP/GDR/D.119.” 48 See letter to GDR, Iowa, 02/24/1957, box 48, “PP/GDR/D.128” and letter to GDR, Ohio, 12/10/1953, box 46, “PP/GDR/D.104,” Wellcome as examples. 222 for example, that in spite of the fact that at a recent American Association of

University Women meeting “almost half had heard of (Dick-Read), while almost a third had read (his) book,” she couldn’t find a doctor who knew the Read method.49

Several years later numerous women were still writing to Dick-Read asking for help in finding a doctor to attend them. In 1955 a mother from Detroit wrote that the

“only drawback” to having her “baby delivered the natural way” was her “inability to find a doctor who goes along with (Dick-Read’s) method.”50

Women not only had difficulty finding a medical attendant, but often faced great medical opposition, even antagonism. Some doctors and nurses who opposed natural childbirth claimed “the time that physicians and nurses must devote to it” was inconvenient or impractical in the context of the era’s busy medical practices and hospitals.51 Some physicians, though acknowledging that no risk-free method of analgesic or anesthetic pain relief existed, worried that natural childbirth, too, was dangerous. Dr. Waldo Fielding wrote a book challenging the method, a portion of which McCall’s magazine published in 1962. “Natural childbirth’s basic principle— that of non-interference by the doctor—carries with it,” he argued, “definite dangers to both mother and child…in the usual confinement (where labor is slow and deliberate)…non-interference is a positive decision to let the destructive side of

49 Name withheld, California, 12/29/1947, box 46, “PP/GDR/D100,” Wellcome. 50 Name withheld, Michigan, 06/25/1955, box 46, “PP/GDR/D.104,” GDR. Doctor acceptance of natural childbirth seems to have been more common in some areas than others. One writer to Dick-Read noted, for example, that according to her sister in Atlanta the Read method was unusual in the South, but “around here (New York state) your ideas are heartily received.” See Name withheld, New York, 02/08/58, box 48, “PP/GDR/D.131,” GDR. 51 Barclay, "Natural Childbirth: A Progress Report," 148. 223 nature take its course.”52 This “non-interference,” he believed could lead to weakened or even torn pelvic muscles and perhaps incontinence and uterine prolapse in later life. He warned that widespread adoption of the practice of natural childbirth would even lead to a “small but definite increase in infant mortality,” presumably because followers of the method abstained from using forceps to aid delivery thus preventing the baby from being born in a timely manner.53

Many physicians expressed their misgivings about natural childbirth in terms that revealed how much notions of childbirth continued to be tied up with ideas of primitivity, modernity and civilization. A doctor in New York, for example, told a woman “that it would be impossible for a civilized woman to have natural birth…because of the highly developed nervous system of the modern woman.”54

Another mother wrote that she had “tried to talk natural childbirth” with her doctor, but he told her that “childbirth is not a natural thing and was so painful that (she) wouldn’t be able to stand it.”55 In stating that birth was not natural, the doctor

52 Fielding and Benjamin, The Childbirth Challenge: Commonsense Versus "Natural" Methods: 40. 53 Ibid., 39-40. Fielding and Benjamin published excerpts from this book in McCall’s the same year. See Waldo L. Fielding and Lois Benjamin, "The Medical Case Against Natural Childbirth," McCall's, June 1962. Though they seem to have had little evidence for their claims, reader response to the piece was, according to the assistant editor of McCall’s, “unusually large,” including in equal numbers both letters denouncing natural childbirth as an unworkable method and letters angrily disavowing Fielding and Benjamin’s portrayal of the natural approach. Robert Bradley, developer of the Bradley method, wrote to the Maternity Center Association (MCA) director, Hazel Corbin, that he was “deluged by indignant Natural Childbirth parents” over the “silly” article. See Robert Bradley to Hazel Corbin, July 10, 1962, box 45, folder 15, “Response to McCall’s Article, June 1962,” MCA. For discussion of Fielding and Benjamin’s lack of evidence see various letters to and from Hazel Corbin, box 45, folder 15, “Response to McCall’s Article, June 1962,” MCA. For discussion of reader response to the article see Elizabeth Weston to Hazel Corbin, June 22, 1962, ibid. For examples of letters see "Pats and Pans: Letters from Readers; Natural Childbirth," McCall's, August 1962. 54 Name withheld, letter to GDR, New York, 03/31/47, box 47 “PP/GDR/D.116,” Wellcome. 55 Name withheld, Massachusetts, 12/03/1957, box 48 “PP/GDR/D.123,” Wellcome. 224 probably meant that it was not natural for a woman such as the patient—a woman of modern civilization.

Others argued that natural childbirth represented a return to primitive childbirth. “To many,” one doctor wrote, “natural childbirth means the primitive practice of medicine.”56 Another expressed his equation of natural childbirth with primitivity in more explicitly racial terms, “I know of no intelligent reason that american (sic) obstetrics, which has established a sound record for safe deliveries, should revert to antiquated practices used by African and Oriental races on the basis that this is a fearless approach."57 Doctors such as these felt that their methods of obstetrical delivery were the modern methods and thus best suited for use on the modern woman.

The issue of control in the delivery room was also key. Some doctors feared that forgoing drugs might cause their patients to lose control. One mother related to

Dick-Read that her doctor told her that “everyone is given caudals,” but an exception could be made in her case if she did not get too loud and disturb patients.58 Most medical staff, however, seem to have been more worried about challenges to their own control of the medical arena. To those used to uncontested authority, allowing a conscious patient into the delivery room, especially one who had a specific plan for how she wanted to conduct birth, represented an encroachment into the medical

56 Name withheld, 6/24/57, box 54, “PP/GDR/D.208,” Wellcome. 57 Name withheld, New York, 4/8/58, box 54, “PP/GDR/D.210,” Wellcome. 58 Letter to Grantly Dick-Read, Texas, 11/19/57, “PP/GDR/D.129,” Wellcome. A caudal is similar to an epidural. 225 domain. Many doctors and nurses went beyond verbal criticism of natural childbirth and forced drugs and medical interventions on mothers who sought to do without.

Numerous women wrote of being given anesthesia against their will. One described how her doctor and hospital told her that they "had rules which couldn't be broken," then gave her anesthesia, despite her objections, from which she didn’t awaken until after her baby was born.59 Another parturient complained about being given gas against her wishes while in labor with her second child. The nurses held her legs together and lay across them while her hands were strapped down. She struggled in anger, blacked out, then awoke to a "swimming unconsciousness."60 One mother relayed a particularly striking example of medical paternalism. Even though her doctor had agreed beforehand not to administer anesthesia, during labor he and a nurse “forcibly” administered “Demerol, scopolamine, and later ether” and she did not “regain consciousness for 12 hours.” The doctor later “answered (her) protests by explaining bitterly that (her) request had been the result of a ‘pregnancy hallucination’: that men were too intelligent to let women suffer because of their

‘notions.’”61

Not only doctors took umbrage at the challenge to standard practice. Many mothers sensed resentment from the nursing staff and some even described

59 Letter to GDR, Florida, 05/26/1958, box 48, “PP/GDR/D.127,” Wellcome. 60 Name withheld, Florida, box 47, 11/26/54, “PP/GDR/D.118,” Wellcome. “Rooming-in” was the term given to the practice of allowing the newborn to stay in the same room as the mother instead of in a nursery. Rooming-in, very unusual during this period, was often associated with natural childbirth. 61 Letter to Grantly Dick-Read, Illinois, 2/26/1949, box 46, “PP/GDR/D.109,” Wellcome. Emphasis hers. 226 mistreatment that they believed stemmed from their choice of method: A nurse in

Colorado refused a mother’s request to change her blood soaked sheet, for example, saying, “Just because you had that natural childbirth thing doesn’t mean you can a have new sheet!”62

Together the oppositional reactions of medical staff indicate a high level of unease over the ways that natural childbirth stood to impact their own standard delivery procedures. In defining natural childbirth as primitive, they defined, by contrast, their own methods as modern. In their minds the modern woman was not one who benefitted from “primitive” methods, but rather from their own. These oppositional reactions also make it clear that doctors often felt that natural childbirth mothers overstepped the bounds proper submissive femininity—a move that they would not tolerate.

Psychoanalytic Criticism

Women who sought natural childbirth faced additional resistance from the psychoanalytic community. Here, too, at issue was a woman’s proper femininity—or lack thereof. American women during this period faced a great deal of psychoanalytic scrutiny over the choices they made in maternity. Not only did they live in a pronatalist culture that linked children and family with personal happiness, they also endured the admonitions of psychoanalytic experts and obstetricians that stressed that childbearing and motherhood “represented the culmination of a

62 Letter to GDR, Colorado, 04/14/1957, box 48, “PP/GDR/D.133,” Wellcome. 227 woman’s psychosexual development.”63 Part of this thinking was the notion that pregnant women were especially vulnerable to anxiety and neurosis and that the experience of childbirth could ultimately have profoundly damaging effects on the psyche if not conducted properly. Critics of natural childbirth worried that the method put women who “failed” (that is, women who felt pain or asked for drugs) at emotional risk. 64

In an example of just how closely practices of childbirth were tied to notions of femininity an article titled, “How to Know When You’re Really Feminine,” reported that psychiatrists and other specialists listed women’s belief that it was

“definitely more feminine to deliver one’s child without the aid of drugs” as one of the “most widespread and emotionally damaging convictions women (held)…about what is …feminine” because if a woman failed to have a drugless delivery she would believe she had failed as a woman.65

However, psychologists, psychoanalysts, and other “experts” just as often characterized women who chose natural childbirth as victims of their own neuroses.

Deriding the “current wave of what can only be called blind veneration for drugless deliveries,” a journalist in 1961 quoted a common psychoanalytic theory concerning natural childbirth:

63 Senn, "Storm over Childbirth: The Most Controversial Issue in Modern Medicine," 40. For a discussion of the pronatalist climate of the postwar period see Elaine Tyler May, Homeward Bound: American Families in the Cold War Era (New York: Basic Books, 1988), 121. 64 See, for example, Fielding and Benjamin, "The Medical Case Against Natural Childbirth." 65 Leonard Wallace Robinson, "How to Know When You're Really Feminine," Good Housekeeping, June 1960. 228 Masculinity with its assumed prerogatives is coveted…by many women…For such a woman, having a baby promises to complete her drive to power. She has always hungered for authority and domination…it is the fairly aggressive, masculine oriented, nonconservative woman who is most apt to elect natural childbirth.66

Natural childbirth might not only cause neuroses but also marked the woman who chose it as neurotic.

Dr. Waldo Fielding echoed these assertions in his article, “The Medical Case

Against Natural Childbirth.” He argued that women with damaged or disturbed personalities are the ones most “likely to be the most enthusiastic volunteers for natural methods.” Some psychiatrists thought, he noted, that this type of woman sought natural childbirth to prove their femininity, others argued “that it is power or psychic masculinity that they are after.” Fielding went on to state that psychiatrists also suggested that ”a woman who insists that her husband watch (the birth) may be unconsciously punishing him for making her suffer.67

Mothers’ reports indicate that they encountered charges of neurosis on a personal basis. One woman wrote that after ether was forced on her despite her refusal during her first delivery, she did not resist anesthesia during the births of her next two babies; however, she had always felt she “didn't know full joy of childbirth” as a result. When she relayed her desire to have a natural birth to her

66 Natalie Gittelson, "The Case Against Natural Childbirth," Harper's Bazaar, February 1961, 136, 79. 67 Fielding and Benjamin, "The Medical Case Against Natural Childbirth," 185; See also E. M. Stoney, "Let's Be Reasonable About Natural Childbirth," Today's Health, February 1953. 229 psychiatrist she was told she was a “masochist.”68 Another mother wrote that doctors in the United States believe “if you seriously desire a (natural) delivery and rooming-in…you're hysterical.”69 One woman received some childbirth manuals from her doctor, one of which stated "a woman was a neurotic if she believed and practiced what you (Dick-Read) said."70

Like obstetricians’ dismissal of requests for drug-free birth, worries over psychic damage from failure in natural childbirth stemmed from the intensely paternalistic medical climate in the postwar period. This thinking infantilized women and made it difficult for them to achieve the birth experience they desired.

On the other hand, charges of neurosis or a need for power reveal anxieties about the element of control that natural childbirth might afford a women—both during birth and in her challenge to (male) medical authority in general. In either case, psychoanalytic critics of natural childbirth characterized mothers who chose the method as deviants from the norms of proper modern femininity.

The Natural Childbirth Ideal

While critics of natural childbirth clearly perceived a threat from the method to dominant ideals of modern femininity, the rhetoric of supporters of the method often upheld those very ideals. In an example of just how malleable notions of natural childbirth were, supporters of natural childbirth argued, for instance, that

68 Name withheld to Grantly Dick-Read, Washington, D.C., 10/29/47, box 46, “PP/GDR/D.106,” Wellcome. 69Name withheld to Grantly Dick-Read, Florida, 11/26/54, box 47, “PP/GDR/D.118,” Wellcome. 70 Name withheld to Grantly Dick-Read, South Carolina, box 48, “PP/GDR/D.127,” Wellcome. 230 use of the method would enhance a woman’s femininity by allowing her to experience the crowning moment of her womanhood—childbirth. As we have seen some doctors and psychoanalysts argued that it was unconsciousness at birth that posed the most risk to a woman’s mind, that a woman must undergo conscious birth or risk “damage(ing) her personality” because of her “escape from reality” during the essential experience of childbirth.71 Dick-Read himself believed that unless a woman was conscious at birth she could not properly bond with her baby.

Mothers who chose natural childbirth also shared similar beliefs on the psychological benefits of the method. Helen Wessel argued in the early 1960s that it was doubtful that a woman could experience a “fully mature response” to sex until after she had “successfully completed the whole sexual cycle of intercourse, a healthy pregnancy, a happy natural birth experience, and successful, pleasurable nursing of her child.”72

Another mother showed her belief in the psychological relationship between natural childbirth and femininity. A supporter of natural childbirth, this woman wrote to Dick-Read that her psychiatrist had discovered that her “neurotic difficulties were similar to those of most modern women.” She had formerly had a

“desire to compete in the world on a masculine basis” and, as a result, resented

“being a woman.” “Like so many modern women,” she wrote, “I felt unconsciously that everything feminine was inferior and demeaning—a feeling I suspect most

71 "Childbirth: Nature v. Drugs," Time, May 25 1936. 72 Helen Wessel, Natural Childbirth and the Christian Family (New York: Harper and Row, 1963), 22-23. 231 ardent feminists share." Now, having gone through psychoanalysis, she had come to embrace all aspects of womanhood, including natural childbirth. Other women, she wrote, who were “outraged” at the idea that childbirth should not be painful must be

“neurotic” and unhappy in their femininity. “Before natural childbirth can ever be an accepted thing, women are going to have to learn that there is happiness in being a woman, and that being a wife and mother is not a sacrifice but is the ideally satisfactory life.”73 Curiously, this woman used almost the same language to describe “modern” women’s “neurotic difficulties”—the desire to compete on a masculine basis, the rejection of femininity—as did those who described the neurotic natural childbirth mother. Here, however, this natural childbirth mother proved that she had resolved her neurosis through her desire for natural childbirth.

This emphasis on maternity as the pinnacle of female achievement aligned neatly with mainstream postwar white, middle-class ideals of proper femininity.

Promoters of the method encouraged adherence to this ideal in other ways as well.

Elizabeth Bing, for example, a prominent Lamaze advocate, emphasized the dominant role of the doctor, and implied the need for women to behave with decorum during childbirth. In an early version of her psychoprophylaxsis (Lamaze) training manual she stressed that childbirth educators should encourage a woman to take her “doctor’s word as final…On no account should she be led to believe that she knows more about the subject than he does…She is responsible for controlling

73 Name withheld, letter to GDR, California, 06/24/1948, box 46, “PP/GDR/D102, GDR. 232 herself and her behavior.”74 The Bradley Method, too, with its emphasis on husband- coaching, implicitly reinforced male authority at the bedside. As Bradley himself put it, “We do not deliver babies, we train husbands how to teach their wives to give birth to babies.”75 The husbands, not their wives, were in the position of authority here.

Other natural childbirth practitioners, like Dick-Read, glorified the importance of childbirth and motherhood for women. Herbert Thoms, pioneer of the natural childbirth program at Yale’s New Haven Clinic, when writing of the

“important psychological reactions” that conscious birth afforded under his method, quoted psychoanalyst Helene Deutsch’s pronouncement: “’childbirth is the greatest and most gratifying experience of woman.’”76 A nurse’s article on the Natural

Childbirth Association of Milwaukee also alluded to Deutsch’s statement, asserting that conscious delivery assured that women would not be cheated out of “one of the biggest moments in their lives.”77

Some women advocates of natural childbirth also embraced the idea that motherhood was the ultimate calling. One mother wrote that she was “old-

74 Elisabeth D. Bing, Marjorie Karmel, and Alfred Tanz, A Practical Training Course for the Psychoprophylactic Method of Childbirth (Lamaze Technique) (New York1961), 7; Bing's emphasis changed over time. In 1969 she was quoted as saying, "I try to give (women) a little backbone" when speaking to their doctor. See Jane O'Reilly, "Bearing in Mind," New York Magazine, April 7 1969, 63. 75 Bradley, "Fathers' Presence in Delivery Rooms," 475. 76 Herbert Thoms and Robert H. Wyatt, "A Natural Childbirth Program," American Journal of Public Health 40(1950): 790; See also Herbert Thoms and B. Bliven, "Challenge to American Obstetrics," Ladies' Home Journal, April 1960, 81. 77 Murphy, "Expectant Mothers Organize for Natural Childbirth," 1298. 233 fashioned enough to believe (childbirth) is woman's greatest triumph.”78 Others saw natural childbirth as a method that would strengthen society by establishing a stronger bond between mother and infant. A New York mother noted that she wanted to help Dick-Read in “endeavoring to do away with (the) mechanization of a natural process” because the damaging “psychological influence upon the children born” to unconscious mothers is “a major factor” in the possible inability to maintain “a balanced mental and physical make-up of the future generation.”79

Apparently babies born to unconscious mothers were likely to suffer an unbalanced

“mental and physical make-up” that had repercussions for the whole of society.

Some, situating natural childbirth within Christian teachings, argued that the method should be a fundamental aspect of the Christian family, emphasizing that the father’s participation in the birth followed from his role as head of the family, the “one who leads, supports, sustains,” and that a mother’s consciousness at delivery allowed her to be “as joyous as Mary” at the birth of Christ. Their “happy and satisfying” experience laid the foundations for a strong family, which was in turn the “foundation of peace.”80 In this thinking, the mother was subordinate to her husband in childbirth. He was the one who “leads.”

These natural childbirth supporters clearly stressed deference to male

(medical) authority and a focus on home, family and motherhood. In this, their

78 Name withheld, letter to GDR, Texas, 08/12/1949, box 46, “PP/GDR/D103,” GDR. 79 Name withheld, letter to GDR, New York, 04/11/1950, box 46, “PP/GDR/D99,” Wellcome. 80 Aileen Hogan, “Natural Childbirth,” pamphlet, 1950, box 35, folder 2 “Hogan, Aileen: Natural Childbirth, 1950,” MCA. 234 notion of modern femininity mirrored that of critics of the method. Women and doctors on both sides of the debate advanced this ideal of womanhood, with childbirth as the pinnacle. The difference was that natural childbirth advocates believed that the method would help develop that ideal rather than undermine it, as the critics thought.

Natural childbirth rhetoric, however, like the representations of natural childbirth that we saw in Chapter Four, embraced multiple understandings of femininity—it contained more than a simple exaltation of motherhood and focus on deference to male authority. Promoters of natural childbirth often spoke of, indeed, encouraged, the active role that natural childbirth allowed women and contrasted it with the passivity that came with anesthetized birth. MCA literature, for example, approvingly attributed women’s (and men’s) interest in natural childbirth to the

“deep desire” to “participate actively” in the births of their babies.81 The director of the MCA, Hazel Corbin, went further and explicitly placed women on an equal footing with members of the medical community. In a 1951 essay titled “What is

Natural Childbirth?” Corbin defined the method as one that exemplified “team work at its best…The mother, father, nurse and doctor work together with mutual respect and confidence…It is a maturing, satisfying experience for all four.”82 In this meaning of medical team women worked together with their doctors as equals.

81 Hazel Corbin, “What is Natural Childbirth,” manuscript revision, n.d., box 31, folder 4 “What is Natural Childbirth? Article, undated,” 25, MCA. 82 Hazel Corbin, “What is Natural Childbirth?” ibid, 1. 235 Corbin also encouraged women to use their power as consumers to band together and demand change. When a mother wrote complaining about childbirth care in her small town (doctors routinely delayed delivery by having nurses administer frequent doses of ether and tie up or sit on patients’ legs), Corbin advised, “If there are many women in your community who feel as you do, and if there are only a few doctors there, it would seem to me that if the women got together…they could put up a united front” and ask doctors to comply with their wishes. She added, “(A)s the famous advertising slogan reminds us every week, ‘You must never underestimate the power of a woman.’”83 And while Herbert Thoms did see motherhood as a woman’s “great fulfillment in life,” he also encouraged women to “demand the kind of childbirth experience that will give her joy.”84

The words and actions of natural childbirth mothers complicate the simple equation of natural childbirth with the postwar ideal of feminine deference and domesticity even further. Evidence indicates that mothers who chose the Read method did not take in his rhetoric of maternity and womanhood uncritically. For example, Otis Kidwell Burger, who, in 1951, published An Interesting Condition:

Diary of a Pregnant Woman, found Dick-Read’s “attitude towards women and the joys of women pretty insufferable.” She nevertheless decided that his book “was a help.” 85 One woman went further and challenged the very underpinnings of Dick-

83 Hazel Corbin to Mrs. Donald Buffington, April 26, 1951, box 60, “Parents’ Magazine, folder 6, “1948-1961,” MCA. Corbin is probably referring to the slogan of The Ladies’ Home Journal. 84 Murphy, "Expectant Mothers Organize for Natural Childbirth," 1301. Emphasis mine. 85 Abigail Lewis, An Interesting Condition: The Diary of a Pregnant Woman (Garden City, N. Y.: Doubleday, 1950), 141. Abigail Lewis is Burger’s pen name. 236 Read’s ideology—that motherhood could—and should—be a woman’s crowning achievement. This mother of three believed that Dick-Read had good intentions to alter “the stone age treatment of twentieth-century maternity patients” but she questioned his view of women. She wrote in 1949 that a “sensitive person of either sex does not like to feel that they are regarded only as a breeding animal, and, stripping aside such sentiments as the beauty of motherhood, the nation’s need, the future of the race, my husband’s attitude and yours breaks down to the statement that ‘breeding is the one and only duty of woman’…Women are people, too, and as much entitled to careers apart from the biological function nature has assigned them as men.”86 Such clearly articulated feminist responses to Dick-Read were rare, but this letter illustrates that at least some rejected his equation of feminine fulfillment with motherhood.

Other women who wrote to Dick-Read, most even, chose natural birth because they did feel that the experience of childbirth represented a fulfillment of sorts, but this does not mean that they also accepted the quiescent submissiveness that Dick-Read and some other promoters of natural childbirth seemed to encourage. In general, women described their experiences of natural birth in glowing terms of satisfaction and reward. They wrote, for example, that “it was one of the happiest moments in my life” or “the most incomparably wonderful

86 Name withheld, letter to GDR, Plainfield, New Jersey, 11/01/49, box 46, PP/GDR/D99,” Wellcome. 237 experience of my life” or “the most marvelous experience I have ever had.”87 Quite often these “marvelous” and “wonderful” experiences were defined by the fact that they had been conscious, active participants in the births of their babies. 88 Women referred to the “reward of 'doing it yourself'” and the satisfaction of doing the

“whole job together” with the baby and the gratification of “knowing what was going on.”89 They spoke of being proud and of experiencing “a tremendous feeling of accomplishment.”90 Some echoed the comments of this woman who appreciated being recognized as “an intelligent woman who knew how she wanted to have her baby and also knew what she was talking about.”91 Clearly, for some women at least, natural childbirth was an empowering experience.92

87 Name withheld, letters to GDR, Nebraska, 6/24/49, box 46, “PP/GDR/D.110” and North Carolina, 8/5/53, box 46, “PP/GDR/D.107,” Wellcome; and Redacted to J. Kelliher, September 3, 1959, box 8, “Class Questions and Letters, 1956-1970, 5 of 5,” BACE. 88 Interestingly, as long they helped to push during second stage labor and/or were conscious at birth, the majority of BACE respondents felt that had had a successful natural childbirth even if they accepted tranquilizers, gas or spinal anesthesia—indicating the degree to which being a conscious, active participant defined natural childbirth. For example, an informal survey of 100 questionnaires reveals that only 20 women had no drugs whatsoever. The drugs ranged from barbiturates and opioids; to ether, trilene and nitrous oxide gas; to spinals, caudals and pudendals. Of the remaining 80 women who did have drugs only 8 did not consider their births to be natural births (though some who had drugs did not specify.) Nine of those who received drugs specified that they did not like the drugs’ effects, reporting that they made it hard to focus, for example. Some of those women also felt like failures for not going through the whole process drug-free. See questionnaires in folders 8.7-8.9, 9.5, 9.10 and 10.4. 89 Name withheld, letters to Grantly Dick-Read, Michigan, 8/19/57, box 48, “PP/GDR/D.128” and New Jersey, 11/3/53, box 47 “PP/GDR/D.112,” Wellcome; and Redacted to J. Kelliher, May 3, probably 1961, box 8, “Class Questions and Letters, 1956-1970, 5 of 5,” BACE. 90 For examples of feeling proud see Redacted to J. Kelliher, February 19, 1961 and May 31, 1962, box 8, “Class Questions and Letters, 1956-1970, 4 of 5,” BACE. “Tremendous” quote is in Amy Selwyn, "I Watched My Baby Born," Pageant, January 1949, 9. 91 Letter to Grantly Dick-Read, 4/2/55, box 46, “PP/GDR/D.109,” Wellcome. 92 Not everyone felt empowered through natural childbirth. A significant minority reported feeling ashamed or guilty if they felt pain, did not perform the training correctly or asked for pain- relief. Both critics and supporters of natural childbirth reported this as a concern. See, for example, Goodrich to Grantly Dick-Read, 12/3/47, box 53, “PP/GDR/D.200,” Wellcome and Fielding and Benjamin, The Childbirth Challenge: Commonsense Versus "Natural" Methods. See also Rebecca Plant’s 238 Women who wrote to Dick-Read also more overtly linked natural childbirth to empowerment. A California mother sent Dick-Read a description of two cases of natural childbirth stating “although I am not particularly impressed with a theory about the existence of the mother 'instinct', I do think that 'natural childbirth' is important for physiological and psychological reasons.” She went on to say that by undergoing natural childbirth women “would gain enormous self-confidence. This factor cannot be minimized because the limitations placed on women in our society make it difficult enough for them to maintain even a normal degree of self- confidence.”93 The confidence gained through natural childbirth could help make up for social limitations on women as a whole.

Another woman, an aspiring author hoping to spread word of the benefits of

Dick-Read’s method, explicitly labeled choice in childbirth as an inalienable right of women, “I sincerely hope that I will no longer have to fight for woman’s inalienable right to have her baby in the manner that she wishes and not in the manner that some doctor, some hospital or some anesthetist desires. Just because each one or all three of the former have the work down to a clockwork like routine and do not wish to deviate from the normal…is not a sufficient…reason to reject Dr. Read’s teachings.”94 Hazel Corbin, director of the Maternity Center Association, quoted a testimonial from a mother using similar language, ““women have the right to know argument that some of the BACE correspondents seemed to have felt a sense of accomplishment only in relation to their doctor’s approval or because they felt that they “measured up to an ideal of ‘natural’ womanhood.” Rebecca Jo Plant, Mom: The Transformation of Motherhood in Modern America (Chicago; London: The University of Chicago Press, 2010), 141. 93 Letter to Grantly Dick-Read, California, 1/30/51, box 46, “PP/GDR/D.108,” Wellcome. 94 Name withheld, book manuscript sent to GDR, box 46, “PP/GDR/D.100,” Wellcome. 239 that there is a body of medical opinion which feels that (natural childbirth) is safer for the baby…They have a right to know that natural labor often comes along with considerably more speed…a quicker convalescence…(and a) strong psychological union…between mother and baby.”95 In using the language of “rights” these women made an assertive claim to birth in the manner they chose.

The childbirth education associations we discussed earlier, formed out of women’s frustrations with being unable to find natural childbirth resources or because they had difficulty achieving the childbirth experience they wanted, illustrate early group efforts at empowering women in the arena of birth. Justine

Kelliher, one of the principle founders of the Boston Association of Childbirth

Education (BACE), for example, had had difficulty finding a Boston area doctor that would consent to following natural childbirth methods for her first child: “(T)he situation is now becoming desperate,” she wrote to Dick-Read. “I am two months pregnant and have spoken to quite a few doctors about the type of delivery I want.

They tell me I am crazy… (and) flatly refuse to deliver me without anesthesia.”96 A trained obstetrical nurse, Kelliher eventually found someone amenable to delivering her child with minimal use of drugs. She went on to form the BACE with other women who had had “much the same difficulty in their search for help.” Though far from revolutionary (the group required students to have permission from their doctor in order to attend a class), BACE sought to educate and empower women to

95 No name, letter to Hazel Corbin, quoted in “What is Natural Childbirth,” manuscript revision, n.d., box 31, folder 4 “What is Natural Childbirth? Article, undated,” MCA. 96 Justine Kelliher to GDR, Massachusetts, August 9, 1948, box 46, “PP/GDR/106,” MCA. 240 make informed choices about childbirth and to mentally and physically prepare them “for a birth in which (they were)…consenting participant(s).”97 The Natural

Childbirth Association of Milwaukee also used the language of agency, stating in a brochure that natural childbirth enabled a woman to “GIVE birth to her baby consciously…instead of ‘being delivered’ unconsciously.”98

As we saw earlier, women often faced great obstacles in achieving natural birth. In spite of sometimes fierce opposition from doctors, nurses, and friends the striking fact is that many women persisted in achieving the experience they sought.

Perhaps the strongest attestment to women’s agency in relation to birth is the way in which they behaved in the delivery room in their efforts to remain conscious.

While some women felt futile in the face of medical authority—“how can one person fight an institution as regimented as a hospital?”99—many women displayed a willingness to fight to achieve natural childbirth, though they did not always succeed. “I tried to fight the anesthetic,” wrote one mother to Dick-Read, “but what can you do strapped to a table?”100 Another woman wrote that in an attempt at

“natural childbirth” for her first child, she “crouched in one corner of a labor room”

97 Justine Kelliher, “Natural Childbirth in Boston,” typed manuscript of article that appeared in The Grail, March 1956, 1.1, “BACE History, 1956-1965, n.d.,” BACE. Emphasis mine. It is also possible to view the insistence on permission from the doctor as a means to ensure that the BACE would not be held liable by doctors or mothers if disagreement over procedure occurred during delivery. It may also have helped to ensure that mothers chose a doctor likely to support their childbirth choice. Most mothers reported having fairly cooperative doctors and nurses, though a few did mention having to “fight” to have the experience they wanted. 98 “Easier Childbirth,” Natural Childbirth Association of Milwaukee, n.d., box 93, folder 8 “Natural Childbirth: Articles, Curriculum Materials, 1940s-1950s,” MCA, emphasis and quotation marks theirs. 99 Name withheld to GDR, Florida, 7/7/55, box 47“PP/GDR/D.112,” Wellcome. 100Name withheld to GDR, Massachusetts, 12/3/1957 ,“PP/GDR/D.123,” Wellcome. 241 in order to avoid being drugged. In spite of this effort, medical staff forced a

“hypodermic needle” on her.101

Others were more successful. Actress Julie Harris described the despair she felt when she was wheeled into the delivery room leaving her husband, who had been a helpful partner to her during first stage labor, behind. “They were wheeling me into bright white light, lifting me onto another table, strapping my legs down in long white leggings, clamping my feet and hands in stirrups…And then the doctor tried to clamp an ether mask on my face. I was terrified, then angry. They were going to make me miss the climax. I wanted to be there when my baby was born. I fought so that when they took the mask off I was still conscious.”102 One of Dick-

Read’s correspondents also noted that she had to “fight off” ether and that her efforts had resulted in a “wonderful” experience.103 Another correspondent refused to allow the doctor to give her a shot of “something or other,” unless he promised not to give her an episiotomy. She was glad that she had been so “fractious” because with all the “time consumed arguing about cutting” the point for “bearing down began” and she was able to deliver her baby consciously.104 Robert Bradley, in discussing the “trend towards patients demanding and getting conscious, natural, spontaneous deliveries,” noted an alternative way that mothers subverted hospital protocol in order to have the childbirth experience of their choice: “Laboring

101 Letter to GDR, Illinois, n.d., 1951?, box 46, “PP/GDR/D.106,” Wellcome. 102 Julie Harris, "I Was Afraid to Have a Baby," McCalls, December 1956, 74. See also letters to GDR, 03/14/57, Colorado, box 48, "PP/GDR/D.123" and New York, o6/24/47, box 46, "PP/GDR/D.110," Wellcome. 103 Letter to GDR, Washington, 5/18/1948, box 46, “PP/GDR/D.110,” Wellcome. 104 Letter to Grantly Dick-Read, 11/07/1951, box 47, “PP/GDR/D.114,” Wellcome. 242 mothers have taken unnecessary risks by delaying the trip to the hospital until delivery is imminent, in order to be with their husbands.”105

These women in their actions and their words displayed a determination to conduct birth on their own terms. By insisting on being present and active at the births of their babies, they defied medical conventions, inserted themselves into the delivery room and in many cases succeeded in gaining some measure of control over how they gave birth. In thus challenging the norms of the domestic ideal within the context of the medical arena, they sowed the seeds for the more overtly political birth reform movement that later emerged.

Conclusion

The widespread controversy over natural childbirth reveals a variety of interpretations of the method’s relationship to modern femininity. Critics of the method frequently characterized it as a primitive approach to childbirth that disregarded the pain and the neuroses that modern women experienced; represented a loss of the gains that modern medicine had made; and threatened, in its insistence on consciousness at delivery, to undermine male medical authority.

Supporters of the method, on the other hand, offered it as a solution to the childbirth pain of modern women and claimed it resolved or prevented damage to the feminine psyche. At the same time, natural childbirth rhetoric, in stressing the importance of motherhood and deference to men, in many ways upheld the very

105 Bradley, "Fathers' Presence in Delivery Rooms," 474. Emphasis mine. 243 ideals that critics sought to keep intact. The women who used, or sought to use, the method, however, reveal a more complicated construction of modern femininity than the deferential mother ideal. While most of them did conceive of childbirth as a potentially fulfilling endeavor, they displayed a willingness, even determination, to challenge medical authority, and to go against the advice and admonitions of friends and society as a whole, to ensure a conscious birth experience on their own terms.

In doing so they constructed a version of modernity femininity that included agency, critical and articulate thought, and, in some cases, even empowerment.

244 Conclusion

As natural childbirth moved into the 1970s and 1980s—the period during which interest in the method peaked—it did so with a distinct shift in rhetoric, tone, and, in some cases, practice. Many followers of the method took on the language and the consciousness of second wave feminism, which gave them the means and the space to more powerfully articulate their desire to undergo birth on their own terms. By the late 1960s, for example, some had come to perceive natural childbirth as part of, as Lamaze instructor Elizabeth Bing put it, “the liberation of women.”1

Those who championed natural childbirth began to more concertedly and more overtly challenge the medical system and assert women’s right to their choice of birth method—in some cases forming groups to facilitate direct confrontation with oppositional doctors and even burning offensive obstetrical texts.2 General interest in natural childbirth spiked. Membership in childbirth education associations and birth reform organizations grew substantially. By 1968, for example, the

International Childbirth Education Association (ICEA) had sixteen hundred members and by 1972 that number had grown to over three thousand.3 Whereas once the Read method had been synonymous with natural childbirth, the Lamaze method came to predominate because women felt that it provided for a more active

1 Elizabeth Bing, quoted in Jane O'Reilly, "Bearing in Mind," New York Magazine, April 7 1969, 63. 2 For a detailed discussion of the more militant aspects of birth reform see Jacqueline H. Wolf, Deliver Me from Pain: Anesthesia and Birth in America (Baltimore: Johns Hopkins University Press, 2009), 146-49. 3 "International Childbirth Education Association: History," http://www.icea.org/content/history. 245 experience of birth.4 In 1975 the New York Times reported that in the city of Detroit

“at least 50 percent” of women delivered with Lamaze.5

Not all women were satisfied with natural childbirth in the hospital, however. Over the next two decades, though they made up a small percentage of overall births, women increasingly chose to circumvent medical authority altogether and give birth at home with a midwife—a departure from earlier proponents of natural childbirth who had rejected midwives because of perceptions of their inadequate medical expertise. Many also, in contrast to postwar mothers who had embraced the medical and scientific basis of natural childbirth, emphasized the “natural” aspect of the method, stressing the avoidance of drugs and medical intervention in birth as part of an overall attempt to live more “naturally,” a lifestyle that included eating health food and using “natural” remedies.

Yet, in spite of this shift in rhetoric and practice, natural childbirth in the

1970s and 1980s shared similarities with, if not direct ties to, postwar interest in the method. For many, efforts towards birth reform had begun with their experiences with natural childbirth and their resistance to the medical community years earlier. In her 1969 self-professed “polemic” against the “destructive” aspects of contemporary American childbirth practices, Lester Hazell, birth reform activist

4 It is worth pointing out here that some historians argue that Lamaze came to predominate because hospitals were particularly amenable to method. Jacqueline Wolf notes that unlike proponents of the Read or Bradley method, Lamaze instructors were less rigid about allowing pain- relief during labor and delivery and they often stressed “the potential benefits of …medical protocols and cooperation with doctors.” Thus the method lent itself better to conventional hospital procedure. See Wolf, Deliver Me from Pain: Anesthesia and Birth in America: 167. 5 Richard Flaste, "American Childbirth Practices: Time of Change," New York Times, November 7 1975. 246 and later president of the ICEA, argued “Birth is something which must be done by the mother and not something which is done to her.”6 The road that led her to this declaration of empowerment began in the mid-1950s with the birth of her first child, an unpleasant, frightening, alienating experience that led her to the work of

Grantly Dick-Read, two successful natural childbirths (the last one at home) and to the teaching of childbirth education to other women into the 1980s.

Others had less direct experience with postwar natural childbirth, but echoed similar concerns regarding control of birth in the 1970s, albeit in more militant terms. In 1973, mother Joan Haggerty wrote an article in the newly emerged Ms.

Magazine. In it she railed against medical authority writing, “Even the terminology is wrong. The doctor is said to ‘deliver’ the baby. Damn it, the woman delivers the baby. The doctor receives it.” She then related her recent experience with natural birth gone awry. Nurses tied her legs into stirrups and tied her wrists “to the table in leather thongs” while she “struggled” against them and “demanded” that they stop— to no avail. “The staff did everything possible,” she wrote, “to undermine my control.” Haggerty then called on women to “pool (their) energies and revolutionize the system.”7 Her individual reaction to oppression in childbirth was similar to that of women that fought off medical staff and anesthesia during the postwar period.

The difference was in the fact that she had the venue and the feminist consciousness to call for a “revolution.”

6 Lester Dessez Hazell, Commonsense Childbirth (New York,: Putnam, 1969), xxi. Emphasis hers. 7 Joan Haggerty, "Childbirth Made Difficult," Ms., January 1973, 16, 17. 247 In addition to addressing similar concerns and stemming from similar motivations to those in the postwar years, natural childbirth in the 1970s and 1980s continued to be bound up with understandings of modern versus primitive birth that equated “modern” with being part of, or having access to, medical science and technology and “primitive” with a lack thereof in both of those cases. Detractors of the method, for example, persisted in denigrating its disavowal of pain-relieving drugs as a “disgrace to modern obstetrics” or as the “propaganda of primitive principles.”8 In addition, the trope of painless, primitive birth as a contrast to medicalized birth endured in popular culture. One woman speculated that she might undergo natural childbirth with the same ease as those who “dig a hole in the sand, give birth, and then run to catch up with the tribe.”9 Childbirth educators in particular depended upon the association of natural birth with racialized notions of primitive birth and used examples from “traditional” culture to illustrate the benefits of the method. Nora Ephron, for example, in 1978 described her Lamaze instructor’s reference to the “30 African babies” that she saw born under a method associated with natural childbirth and the “enormous differences between them and their American counterparts” in terms of muscle control.10 In the 1980s two

Brazilian doctors published an article titled “Birth and Rooming-In: Lessons Learned from the Forest Indians of Brazil” which highlighted the benefits of squatting to give

8 Flaste, "American Childbirth Practices: Time of Change."; Doris J. Warren, "Letters to the Editor: Having a Baby After 35," New York Times, December 31 1978. 9 O'Reilly, "Bearing in Mind," 63. 10 Nora Ephron, "Having a Baby After 35," New York Times, November 26 1978, 29. 248 birth as the “Indians” did.11 Their film on the same topic, “Birth in the Squatting

Position,” depicted several indigenous women giving birth and became a staple in childbirth reform circles—indicating the degree to which racialized notions of

“natural” birth continued to resonate.12

The rhetoric and practice of natural childbirth in the 1970s and 1980s reveals the legacy of natural childbirth in the postwar period. Some followers of the method translated the desire for control in birth into the language and tactics of the women’s movement in order to deliver their babies on their own terms, while others constructed primitive birth as a model to which to aspire. These women drew from and, in some cases, transformed the rhetoric and practice of natural childbirth in the postwar years. In doing so, they demonstrated the ways that experience and interpretation of childbirth marked multiple, sometimes contradictory, understandings of femininity and modernity—just as they had for the thousands of women who, in mid-twentieth-century America, had their babies the

“natural” way.

11 Moyses Paciornik and Claudio Paciornik, "Birth and Rooming-In: Lessons Learned from the Forest Indians of Brazil," Birth 10, no. 2 (1983). 12 See Sheryl A. Nestel, ""Other" Mothers: Race and Representation in Natural Childbirth Discourse" (M.A. Thesis, University of Toronto, 1994). Nestel provides an excellent analysis of the article and movie as well as other uses of the trope of primitive birth within the childbirth reform movement during the 1970s through the 1990s. Significantly, even today a Google search for the movie brings up hundreds of positive reviews and movie clips posted by current supporters of natural childbirth. 249 Bibliography

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Books: Abrahamson, David. Magazine-Made America: The Cultural Transformation of the Postwar Periodical. Hampton Press Communication Series. Cresskill, N.J.: Hampton Press, 1996. Bederman, Gail. Manliness & Civilization: A Cultural History of Gender and Race in the United States, 1880-1917. Chicago: University of Chicago Press, 1995. Brown, Kathleen M. Good Wives, Nasty Wenches, and Anxious Patriarchs: Gender, Race, and Power in Colonial Virginia. Chapel Hill: Published for the Institute of Early American History and Culture by the University of North Carolina Press, 1996. Buhle, Mari Jo. Feminism and Its Discontents: A Century of Struggle with Psychoanalysis. Cambridge, Mass.: Harvard University Press, 1998. Carson, Carolyn Leonard. And the Results Showed Promise...Physicians, Childbirth, and Southern Black Migrant Women, 1916-1930: Pittsburgh as a Case Study.. Women and Health in America: Historical Readings. edited by Judith Walzer Leavitt Madison, WI: University of Wisconsin Press, 1999. Caton, Donald. What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present. New Haven: Yale University Press, 1999. Carter, Julian B. The Heart of Whiteness: Normal Sexuality and Race in America, 1880- 1940. Durham: Duke University Press, 2007. Davis-Floyd, Robbie E. Birth as an American Rite of Passage Second Edition, with a New Preface. 2nd ed. Berkeley: University of California Press, 2004. Deloria, Philip Joseph. Playing Indian. Yale Historical Publications. New Haven: Yale University Press, 1998. Douglas, Susan J. Where the Girls Are: Growing up Female with the Mass Media. 1st ed. New York: Times Books, 1994. Edwards, Margot, and Mary Waldorf. Reclaiming Birth: History and Heroines of American Childbirth Reform. Trumansburg, N.Y.: Crossing Press, 1984. Ehrenreich, Barbara, and Deirdre English. For Her Own Good: Two Centuries of the Experts' Advice to Women. 2nd Anchor Books ed. New York: Anchor Books, 2005. ———. Witches, Midwives, & Nurses. Contemporary Classics. 2nd ed. New York: The Feminist Press at CUNY, 2010.

255 Ettinger, Laura Elizabeth. Nurse-Midwifery: The Birth of a New American Profession. Columbus: Ohio State University Press, 2006. Fraser, Gertrude Jacinta. African American Midwifery in the South: Dialogues of Birth, Race, and Memory. Cambridge, Mass.: Harvard University Press, 1998. Guglielmo, Thomas A. White on Arrival: Italians, Race, Color, and Power in Chicago, 1890-1945. New York: Oxford University Press, 2003. Hansen, Bert. Picturing Medical Progress from Pasteur to Polio: A History of Mass Media Images and Popular Attitudes in America. New Brunswick, N.J.: Rutgers University Press, 2009. Hawkins, Stephanie L. American Iconographic: National Geographic, Global Culture, and the Visual Imagination. Cultural Frames, Framing Culture. Charlottesville: University of Virginia Press, 2010. Holmes, Linda Janet. African American Midwives in the South. The American Way of Birth. edited by Pamela Eakins Philadelphia: Temple University Press, 1986. Jacobson, Matthew Frye. Whiteness of a Different Color: European Immigrants and the Alchemy of Race. Cambridge, Mass.: Harvard University Press, 1998. Jones, Jacqueline. Labor of Love, Labor of Sorrow : Black Women, Work, and the Family, from Slavery to the Present. New York: Perseus Books Group, 2009. Kline, Wendy. Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom. Berkeley: University of California Press, 2001. ———. Bodies of Knowledge: Sexuality, Reproduction, and Women's Health in the Second Wave. Chicago: University of Chicago Press, 2010. Lears, T. J. Jackson. No Place of Grace: Antimodernism and the Transformation of American Culture 1880-1920. New York: Patheon, 1981. Leavitt, Judith Walzer. Brought to Bed: Childbearing in America, 1750 to 1950. New York: Oxford University Press, 1986. ———. Make Room for Daddy: The Journey from Waiting Room to Birthing Room. Chapel Hill: University of North Carolina Press, 2009. Litoff, Judy Barrett. American Midwives, 1860 to the Present. Westport, CT; Greenwood Press, 1978. Loudon, Irvine. Death in Childbirth : An International Study of Maternal Care and Maternal Mortality, 1800-1950. Oxford: Oxford University Press, 1992. Lutz, Catherine, and Jane Lou Collins. Reading National Geographic. Chicago: University of Chicago Press, 1993. Marchand, Roland. Advertising the American Dream: Making Way for Modernity, 1920-1940. Berkeley: University of California Press, 1985. Matthews, Sandra, and Laura Wexler. Pregnant Pictures. New York: Routledge, 2000. May, Elaine Tyler. Homeward Bound: American Families in the Cold War Era. New York: Basic Books, 1988. Meyerowitz, Joanne J. Not June Cleaver: Women and Gender in Postwar America, 1945-1960. Phliadelphia, PA: Temple University Press, 1994.

256 Morgan, Jennifer L. Laboring Women : Reproduction and Gender in New World Slavery. Early American Studies. Philadelphia: University of Pennsylvania Press, 2004. Newman, Louise Michele. White Women's Rights: The Racial Origins of Feminism in the United States. New York: Oxford University Press, 1999. Plant, Rebecca Jo. Mom: The Transformation of Motherhood in Modern America. Chicago; London: The University of Chicago Press, 2010. Rosen, Ruth. The World Split Open: How the Modern Women's Movement Changed America. New York: Penguin Books, 2000. Rossinow, Douglas C. The Politics of Authenticity: Liberalism, Christianity, and the New Left in America. New York: Columbia University Press, 1998. Rothman, David J. Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making. New York, NY: BasicBooks, 1991. Russett, Cynthia Eagle. Sexual Science : The Victorian Construction of Womanhood. Cambridge, Mass.: Harvard University Press, 1989. Sandelowski, Margarete. Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914-1960. Westport, CN: Greenwood Press, 1984. Schwartz, Marie Jenkins. Birthing a Slave: Motherhood and Medicine in the Antebellum South. Cambridge, Mass.: Harvard University Press, 2006. Shah, Nayan. Contagious Divides: Epidemics and Race in San Francisco's Chinatown. Berkeley, University of California Press, 2001. Smith, Susan Lynn. Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America, 1890-1950. Philadelphia: University of Pennsylvania Press, 1995. Starr, Paul. The Social Transformation of American Medicine. New York: Basic Books, 1982. Stern, Alexandra. Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America. Berkeley: University of California Press, 2005. Thomas, Mary. Post-War Mothers: Childbirth Letters to Grantly Dick-Read, 1946-1956. Rochester, NY: University of Rochester Press, 1997. Torgovnick, Marianna. Gone Primitive: Savage Intellects, Modern Lives. Chicago: University of Chicago Press, 1990. Ulrich, Laurel. A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785- 1812. 1st ed. New York: Knopf : Distributed by Random House, 1990. Walker, Nancy A. Women's Magazines 1940-1960: Gender Roles and the Popular Press. Boston, MA: Bedford/St. Martin's, 1998. ———. Shaping Our Mothers' World : American Women's Magazines. Studies in Popular Culture. Jackson: University Press of Mississippi, 2000. Wertz, Richard W., and Dorothy C. Wertz. Lying-In: A History of Childbirth in America. New Haven: Yale University Press, 1989. Wolf, Jacqueline H. Deliver Me from Pain: Anesthesia and Birth in America. Baltimore: Johns Hopkins University Press, 2009.

257 Unpublished Material

De la Pena, Carolyn Thomas. "Removing a Nail from the Lady's Foot: Twilight Sleep and the Struggle for "Natural" Birth." M.A. Thesis University of Texas at Austin, 1996. Nestel, Sheryl A. ""Other" Mothers: Race and Representation in Natural Childbirth Discourse." M.A. Thesis, University of Toronto, 1994.

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