Tuesday, June 11, 2013

History of Male Partner Participation in the Birthing Process

This paper explores the history of men’s transition from the waiting room to the birthing room. This simple act has been mainly overlooked in both academic research and as a form of social discourse in general. The mere fact that it was hard to find source material which discusses the history and social impact of this transitional process demonstrates how this major subject continues to fly under the radar. The majority of the material I found was advice books for fathers-to-be, but little was found in regard to how these developments change male perceptions of themselves or how society views the changing face of masculinity.

Also view my short article on male birth control (the multi-orgasmic method) 
blogs on the Science of Sexuality in Sherlock (missed clues and Phenylethylamine)
and Where Love Resides in the Brain and the Related Hormones
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~The admittance of men into birthing chambers has shifted men’s roles both as parents and as partners. This development has enabled men to become more active and involved in the upbringing of their children as well as facilitating a more intimate bond with the mother of the child. My paper will only focus on the birthing process from a heterosexual standpoint (married and male-female partnered pair bonds) because it is within this context that these changes were first implemented. Queer parenting (gay, lesbian, transsexual, etc.) incorporates complex variables which were poorly researched at the dawn of the natural birthing movement. By focusing exclusively on heterosexual relationships, I wish to draw attention to the historical developments which first excluded men from the birth rooms, than direct focus to developments which facilitated men’s inclusion into birth rooms. Finally, I will examine how the changing role of fatherhood translates itself into a new definition of masculinity presented within the framework of the media within American society.

 Maternity Waiting Room” Norman Rockwell illustration, 1946

Historical Context: Midwifery
Midwifery was standard practice in America since the dawn of the colonial era. During most of documented western societies, traditional childbirth was exclusively considered “woman space,” in which no man, not even the father-to-be was allowed to enter. Only in extreme cases, such as when there were no other women present was a man called to participate. Only when the birth process did not proceed as anticipated, or when the child was stillborn were physicians summoned (Leavitt, p 22).

            There are however intriguing variations on the role of fathers during birthing which have been observed by anthropologists. The preeminent anthropologist Bronislsav Malinovski conducted a classic study on the Trobriand Islands in the Pacific Southwest in 1922. In his research he noted that the matriarchal society inhabiting these islands had no word for father. The role of the father would be to share the caretaking of his children, and to bathe and feed his baby. Harvey Graham, the author of “Eternal Eve: the History of Gynecology and Obstetrics” (published 1951), noted that a pregnant woman of the Caraya tribe within Brazilian interior would squat while holding onto a tree or outdoor post as her husband squats behind her and presses his hands on her contracting midriff. After labor is over, the husband then ties and bites off the umbilical cord (Sumner, p 2).

Hospitalized childbirth only became widespread in America during the early 20th century, thus replacing the traditional practice of home births which were administered by midwives. Starting in the 18th century, financially privileged women living in American cities began inviting physicians to tend to their labor and birth (ibid). Medical schools during that era were exclusively male; Elizabeth Blackwell was the first woman to be admitted into Geneva Medical College in 1847. It wasn’t until 1883 when Johns Hopkins became the first traditional medical institution to admit women as students of medicine. Yale University School of Medicine did not allow women to study medicine until 1969. This demonstrates that female doctors were few and far between during this time in history (The Evolution of Women as Physicians and Surgeons, p S27).

Birthing women continued to hold decision-making power over procedures and decisions because traditional female attendants, such as midwives and female family members, worked alongside the physicians. As new technologies came to the fore, such as forceps and anesthesia (primarily ether and chloroform), the power dynamic began to shift in favour of the doctors who were trained in the use of these advancements (Leavitt, p 25).

The Medicalization of Childbirth
Due to the increasing trend toward medicalization of childbirth, midwives were being nudged out of the position of attending births. The concern over high maternal and infant mortality as well as morbidity rates, prompted birth to move out of the comfortable and familiar setting of the home, and into the unfamiliar alien environment of hospitals. This was prompted in large part due to the increased awareness within the medical community of bacteriology and germ transmission. The concern over the risk of maternal mortality plaqued women who discovered they were pregnant. This “shadow of maternity” prompted women in ever-increasing numbers to seek medical expertise in the hopes of increasing their chances of surviving a pregnancy. Another factor in the move toward hospitalized birth was the fact that industrialization and urbanization of the population of America separated women from traditional kindred networks with other women. The women-centered “social childbirth” (as historians call it) started splitting apart as the population increased in mobility thus creating physical isolation from friends and family (ibid, p 27).

This in no way addressed some of the prime causes of maternal/infant mortality/morbidity rates occurring in that time; such as (1) malnutrition due to conditions associated with poverty (inaccessibility to clean drinking water and healthy food) which was widespread during the era of the Industrial Revolution (Riis) and which continues to be an under-addressed issue in America to this day, 2) insufficient spacing between pregnancies which put a strain on the female body (Steinem) (Mayo Clinic website). The main reason why birth control and contraception was inaccessible during that era was because of the Comstock Laws of 1873 which prohibited the distribution of birth control devices as well as informational pamphlets via the postal system (even doctors and nurses served jail time for violating this law) (D’Emilio, p 147). Prenatal care was poorly understood, and preconception care as a form of preventive medicine only came into frame within the medical community in the late 20th century (Sussman, p 3).

The medicalization of childbirth started reaching its peak approximately 1935 and continued until 1985, when most births in America took place within the highly sterilized hospital environment. By 1938, half of the pregnant women in America delivered in hospitals under the care of physicians and obstetric specialists, which was at that time a newly developed field (Leavitt, p 8).  The percentage had gone up to 99% of white deliveries conducted in hospitals by the mid-1960s, with nonwhite births in hospitals at about 85%. During the 1940s women at a hospital stay between 7 and 14 days postpartum; 1960s it dropped to 4 - 5 days. In the 1980s the stay averaged out to 2 – 3 days (Leavitt, p 8).

As hospitalized birth became the norm, fathers were relegated to the strictly enforced confines of the “Waiting Room” also known as the “Stork Room” or “Husband’s Room.”  Pregnancy was no longer perceived as a natural process: it increasingly started being viewed as pathological with an emphasis on “curing the condition” (a mentality which sadly persists to this day especially in terms of women’s health in relation to men and work status) (ibid, 50).

 Labour rooms were separate from delivery rooms; the former is where women were placed on a hospital bed and left alone for hours until they had properly dilated, the latter was a sterile environment, where they were treated impersonally by the medical staff. Expectant mothers were immediately separated from expectant fathers the moment they walked into the hospital. “The cruelest part of [hospital] childbirth was being alone among strangers” wrote a woman about her experience (ibid. 34). Urban hospitals were the worst; resembling factory assembly lines in order to accommodate the high-volume of pregnant women and doctors working schedule of interest labour. Nurses would check into labor rooms periodically just the
 status of dilation (ibid. 37).

During the 1930s and 40s women were forced to take anesthesia whether they wanted to or not. A common anesthetic cocktail was scolomine and morphine, which induced a sense of dizziness which often lead to women accidentally hitting their heads against the railings of the hospital bed. The conditions worsened when medical staff strapped women down to the bed and the stirrups, and introduced “protective headgear” to prevent injuries. One woman said, “In the delivery room, they put a mask over my face, though I insisted I didn’t need it. I tried to take it off, but my hands were tied. Everything that was wonderful was blotted out” (ibid, p 99). 

Twilight sleep

Throughout these procedures men were forbidden to enter into either the labour room or the delivery room. They stayed in the waiting rooms for hours with no news on the condition of either wife or pregnancy, these was basically holding spaces for men the male was considered the least important character in the process. The architecture of hospitals was designed to keep expectant mother and father segregated; his only axis would be to a public corridor and the elevator. The Wesley Hospital in Chicago had a sign on the waiting room door stating “Patients are not allowed in Stork Club – for ‘waiting fathers only.’” Some hospitals throughout the country were not so strict and allowed men into the delivery room for brief periods of time. This was, however, more common amongst rural communities with smaller patient volume (ibid. 57).

Some hospitals kept “Fathers’ Books” in the waiting rooms which men used to jot down their thoughts, concerns, and feelings. These blank journals provided solace to anxiety-ridden men; they could read what other men have written about their experiences and insights. Many of these books have been destroyed by the hospitals that kept them. The few surviving copies offer a treasure-trove of insight into what men thought and felt during their stays in the hospital. This recorded history was a form of male bonding and it also helped pave the way for change (ibid 67).

Men expressed a wide spectrum of emotions and concerns in the “Fathers’ Books.” Some men were philosophical about the transition into parenthood; one man wrote this during the middle of the Cold War, “In times like these when plans for wholesale destruction are being formulated even one small step in the other direction seems worthwhile.” Men face gender stereotyping in the media about how hapless and helpless they were in waiting rooms. A man who had returned from World War II expressed his frustration at how “This man gazing through a glass window at his-day-old son - irritation, annoyance and frustration keeping him silent - this is the man who crashed through barriers of steel in a blazing tank” (ibid. 79). A new generation of men, ready for change, was coming to the fore. Both men and women galvanized their strength to push for better birthing conditions and inclusion of the men.

  Change was in the Air
An early advocate for reform was the English physician Grantly Dick-Read, upon visiting the New York Maternity Center in 1947, felt that link the pain was brought on by tension and fear. His book “Childbirth without Fear” advocated relaxation methods such as positive visualization and deep breathing; this method became known as “natural childbirth” despite the fact that he was not opposed to using medication to alleviate pain. This method became increasingly popular during the 1950s because of his emphasis on the women’s role in life as child bearer, thus wishing to make that role in a more positive experience for the woman (ibid. 100). The Dick-Read method also emphasized education on nutrition is a form of prenatal care as well as breath-holding the second stage of labour (Sumner, p 122).

An article entitled “The Case for Natural Childbirth” appeared in “Cosmopolitan” (July 1953) in which the author, Jack Pollock, articulated what many men had been thinking at that time; “In too many hospitals, mother and father are separated at the elevator door. She goes to the labor room and he to the waiting room. Though he wants to be with his wife - and she needs him as never before - his role is treated like a joke. One hospital even has a sign: ‘Babies should be shown as infrequently as possible to fathers as it is a waste of nursing time’” (Ibid. 80). That was the first of many articles crying out for change: “Ladies Home Journal,” “Women’s Home Companion,” and “Life” soon followed suit. “Redbook” published an article called “how to get better maternity care” in July 1962 in which a woman was quoted as saying, “It was both ridiculous control to keep my frantic husband pacing up and down the dead his room hour after hour while I was lying miserably alone only a few yards away” (Leavitt, p 81). The Bradley method advises good posture as well as genital and pelvic floor muscle awareness pubococcygeus exercises to facilitate the birth process) (Sumner, p 123).

These magazines had the demographic of a white middle-class readership, and that is within that demographic where the changes slowly started taking shape. Some couples started to talk to their doctors and hospitals in advance regarding labor and delivery procedures. Most doctors during the 1950s and 60s insisted that men stay in their place and not interrupt labor and delivery (ibid. 84).

Hospitals were segregated by race and class until the mid-1960s. This fact facilitated the transition of men from the waiting room to the birthing room because of the three p: place, privilege, and power. Private hospitals had earliest access to flexible birthing practices and the modern facilities had a floor plan which combined labor/delivery rooms thus making active participation of fathers/partners possible.  Privilege played an important role since rural hospitals had higher flexibility with smaller numbers of patients, whereas urban hospitals had more of a conveyor belt approach to labour and delivery. Hospitals with larger wards, often hospitals and less economically privileged communities, did not permit men to see their wives at all, whereas privileged hospitals had private and semi private rooms slowly allowed men started trickling in. Change was a long and arduous process because, first of all, the architecture of the hospitals had to change: hallways were widened, waiting areas were designed to be more family inclusive (for men and other family members, who previously were excluded from the spaces) (ibid. 83).

Although a small number of hospitals in New York City started teaching “classes for expectant fathers” as early as the 1930s, very few men attend them. These classes started to pick up momentum after natural birth movement started in 1947.  The focus of these classes was to train men in assisting the expectant mother in breathing exercises, administering massages, recognizing signs of oncoming labour, as well as educating men on postpartum tasks such as changing diapers and mixing formulas (ibid 129).

 In 1965, American obstetrician, Robert Bradley, wrote “Husband-Coached Childbirth” in which he encouraged prenatal education for both expectant parents with a special emphasis on the importance of the man being active labour “coach.” At first men were reluctant to take these classes had to be nudged into it by their wives. One such fellow was Hal Higdon, who wrote about his experience in “Dad Had It!” in the June 1960 issue of “Parents Magazine.” He mentioned how he had reservations about going to the expectant father class, but because he had taken his classes he was allowed to stay with his wife in the labour room but not allowed to enter the delivery room (ibid. 143). Most hospitals required that men take prenatal classes before accompanying their wives into the labour room. As time progressed and more men attended prenatal classes, the barriers keeping men from the delivery room started to come down. Some doctors became more receptive to the presence of men who had received prenatal education. In 1965, Dr George Schaefer wrote his fellow physicians, “a properly trained expectant father can be an ally to the doctor… He can be given advice guidance not only for the benefit of his wife and himself but also to make the physician’s task easier” (ibid. 145).

In 1970, Fernand Lamaze published “Painless Childbirth” which focused on shallow chest breathing techniques in order to get the uterus space needs to do its work, as well as encouraging abdominal massage, which could be administered by the father-to-be. Lamaze proposed childbirth without pain whereas Dick-Read’s emphasis was on childbirth without fear (ibid. 142).

 The natural birth movement moved toward family-friendly architecture in hospital design. Obstetrician Dr. Sumner, founder of the first hospital birth center in America (located at Manchester Memorial Hospital Connecticut) spoke of the old method birthing treated mothers in an impersonal manner as they were transferred “from early labour room, to advanced labour room, to delivery room, to recovery room, to postpartum room” (Sumner, p ix). The first birthing room at the hospital was opened in 1969. The birthing chairs were modified beds modeled after designs used in Europe (ibid. 26). The subsequent rooms had indirect lighting and as time progressed they were less like operating rooms and more like hotel rooms: containing a rocking chair, desk, window with curtains, and prints on the wall. These rooms still contained medical equipment which took up less than a third of the space in the room (ibid. 22). The birth center is still in operation; it had changed its name to the Family Birthing Center at Manchester Memorial Hospital (Family Birthing Center).

Societal Changes Regarding Fatherhood
Alongside second wave feminism there was a push for increased male connection to both wife and children. This began to replace the male cronyism which had became pervasive during the mid-20th century in white middle-class suburban America. In 1972 Pres. Nixon created a permanent national observance of Father’s Day (third Sunday of June), thus bringing attention to the new role of father as an active participant in the modern family (Leavitt, p xi). The concept of Father’s Day was first proposed in 1909 by Sonora Louise Brooks after she heard a sermon proposing the idea of Mother’s Day. She thought of her father, William Jackson Smart, who raised six children as a widower (New York Times).

Father’s Day has turned into a profitable holiday for businesses. Hallmark has estimated that 67 million cards were sold in 1972 and 85 million cards were sold in 1987. The themes of these cards also changed over time: in the 1970s images of dogs, trains and baseball dominated, whereas in 1987 the messages became more sentimental “you were never too busy taking care of business to make time for me” (ibid.). The Hallmark website has Father’s Day cards has messages such as “There was a dad who had a daughter. Swung her, chased her, caught her” (inside: “Loved her, praised her, taught her. Oh what happiness he brought her”). This alludes to the type of rough-housing that characterizes father-child play. Stereotypes still prevail (fishing, camping, and guitars) but the current zeitgeist also mentions a father’s love for his son “Son, this wish comes with plenty of love (inside: No brilliant advice, no handy tips to share, just admiration for all you do, and love for all you are” (Hallmark). This would have never happened in “Leave it to Beaver”!

In 1973 a bill was proposed in the House of Representatives to allow the biological father to attend his child’s birth if the mother permits. This bill never passed the committee (Leavitt, p 248).

 Bill Cosby published a well-known book simply titled “Fatherhood” in 1987 in which he discussed his own experiences with fatherhood and gave advice to other men. “Fathers Magazine” entered into circulation to accommodate estimated 80% of American fathers who were present delivery room (Leavitt, p. 300).

The United States census estimates that there were 154,000 stay-at-home dads in 2010. These men with children under the age of 15 stayed out of the labor market for at least one year so they could care for their family as the wife worked outside of the house. Collectively, these fathers care for 287,000 children (US Census).

Images of Father-Child and Male-Baby Bonding

With the shift of male parental roles came a shift in how masculinity was portrayed by the media and in photography. Societal images of fatherhood and masculinity changed over time. The image of the midcentury “father reading his newspaper and being disengaged from his kids” is a thing of the past. My dad would not have been caught dead being seen changing diapers or pushing a stroller. Now when I go to the playground, I often see men playing, interacting, and otherwise engaging with their children. That’s not saying that all men engage with their children, but the trend is evident to see. Today it is commonplace to see men carrying their babies around in Baby Bjorns; 20 years ago that would’ve been unfathomable.
A good indicator of how the image of masculinity has changed over time in society can be seen through the lens of how prominent men are portrayed in photographs. Due to the demands of fame with the Beatles, Lennon didn't spend much time with his son, Julian, from his first marriage. Therefore, he took five years off from his music career in order to be a stay-at-home dad with his son Sean. He was avant-garde in another way by changing his middle name, Winston, to the last name his wife thus legally becoming John Ono Lennon (Fawcett, p 74). Yoko Ono was in third trimester pregnancy when she was admitted into the hospital for various bleeding. John Lennon stayed with her in the hospital sleeping in an adjacent bed. When a member of Parliament stated that John was invading the hospital’s privacy by doing so, the Ministry of health himself defended him by stating that it was normal procedure for Queen Charlotte’s Hospital to “allow prospective father to attend confinement and be present at delivery, unless asked to leave by a doctor” (ibid. 40). Ono later suffered a miscarriage and when the spare bed was needed for another patient he slept on the floor in a sleeping bag (ibid. 41). Here is his all too brief fatherhood told in pictures.

The current most searched actor on IMDb is Benedict Cumberbatch (IMDb). This photo of him holding a baby is popular amongst fans of his on both Twitter and Tumblr. This baby is not his child, it is the child of a friend of his, but it is intriguing to note how viral this picture has become. What is of particular interest is that this photo represents part of his fan designed “image.” People can now personally select which images they wish to see instead of simply being presented images which promotional industries have traditionally spoon-feed the public. Social media bypasses not only the mainstream press and the “image making” machine of the film and music industries, but it also has the potential to sidestep such pseudo-journalism as the yellow press.

President as Husband and Father: Change over Time
Let us look at the re-election photograph of President Obama hugging his wife. This image has been retweeted over 802,000 times and favourited over 300,000 times on Nov 12, 2012, thus shattering the twitter record for most tweeted picture (Barack Obama Official Twitter site). This contrasts sharply with the traditional male head-of-the-household role of Theodore Roosevelt. This photo of President Roosevelt and his wife, Edith, was taken during his term in office in 1903 (History Channel website). During the 1960s John F. Kennedy was one of the first presidents to be more expressive in his photographs with his wife, Jacqueline, and his children (Time magazine).

I shall close with the work of the prominent photographer, Carrie Sandoval, who is best known for her photographs of newborn babies, has done a series of both black and white, as well as colour photographs of men with their newborn babies. What is unprecedented about these pictures is that they are sentimental in nature with topless fathers bonding with their children with skin on skin contact. A quarter of a century ago this may have been deemed inappropriate, but now because of the natural birth movement fostering skin-on-skin between parents and the baby immediately after birth, these type father-child bonding photos have become mainstream (Baby as Art website).
Also view my short article on male birth control (the multi-orgasmic method) 
Barack Obama Official Twitter site. 2 June 2013. <https://twitter.com/BarackObama/status/266031293945503744>

Burrow, Gerard N., MD, Burgess, Nora L., MD, “The Annals of Thoracic Surgery.” The Evolution of Women as Physicians and Surgeons, 2001;71:S27-S29 <http://ats.ctsnetjournals.org/cgi/content/full/71/2_suppl/S27>

D’Emilio, John, Freedman, Estelle, B., “Intimate Matters: A History of Sexuality in America,” Harper and Row publishers, New York, 1989

Family Birthing Center at Manchester Memorial Hospital website, 25 May 2013.

Fawcett, Anthony, “John Lennon: One Day at a Time” Grove Press, New York, 1976.

Leavitt, Judith Waltzer, “Make Room for Daddy: the Journey from Waiting Room to Birthing Room,” the University of North Carolina press, Chapel Hill, 2009

Mayo Clinic website, 22 May 2013. < http://www.mayoclinic.com/health/family-planning/MY01691>

Ogle, Amy, MS, RD; Mazullo, Lisa, MD, “Before Your Pregnancy: A 90-day Guide for Couples on How to Prepare for a Healthy Conception” (2nd edition), Ballantine books, 2011

Riis, Jacob. How the Other Half Lives: Studies Among the Tenements of New York. The Authentic History Center. 10 May, 2013 <http://www.authentichistory.com/1898-1913/2-progressivism/2-riis/introduction.html>

The Selling of Father’s Day: A New Image is Emphasized, New York Times online. 14 June 1986. 30 May 2013. < http://www.nytimes.com/1986/06/14/business/the-selling-of-father-s-day.html>

Steinem, Gloria. “Margaret Sanger: Her Crusade to Legalize Birth Control Spurred the Movement for Women’s Liberation.” Time 13 April 1998. 20 May 2013. <http://www.time.com/time/magazine/article/0,9171,988152,00.html>

Sumner, Philip E., MD, Phillips, Celeste R., RN, MS, “Shared Childbirth: A Guide to Family Birth Centers,” Mosby Press, St. Louis, MO, 1982

Sussman, John R., M.D., Levitt, B. Blake, “Before You Conceive: the Complete Pre-Pregnancy Guide,” Bantam Books, 1989

United States Census website. 2 June 2013. <http://www.census.gov/newsroom/releases/pdf/cb11ff-11_father.pdf>

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