Mums the Word, with Marissa Diggs and Judy Durkin
[Judy] Picture a birthing scene in just about any medical or family drama. The mother is pushing, gritting her teeth as doctors and nurses swarm around her yelling. She’s on her back, her legs are up in stirrups—And this depiction of birth is common. It's normal, but why is this normal?
[Judy] Hi, I’m Judy Durkin.
[Marissa] And I’m Marissa Diggs, and we’re two juniors at Harvard University studying the history of science with a focus in the history of maternal health.
[Judy] And welcome to Mums the Word, a podcast that looks into the silencing and decentering of the mother and her body in the history of maternal healthcare.
[Marissa] Judy and I first ran into each other when we both enrolled in a history of medical technologies course at Harvard, and our eyes were opened to the complex role that technology has come to play in our modern healthcare system.
[Judy] That, for me, was where my concept of technology completely changed. I had always thought of technologies as being positive interventions that radically improved the way that medicine was practiced, I think a lot of people kind of had this idea, but the definition of technology was broadened for us in that class. We began to see the ways in which certain technologies had become intertwined with natural processes, such as childbirth, and have created irreparable damages.
[Marissa] While technology can be healing, it can also hurt and almost create problems of its own, and then oftentimes, we turn back to technology as a solution to those problems that technology created in the first place. So, you can see how we’re getting into this loop of problems and technology, and it's inescapable, almost.
[Judy] It’s like technology is needed to solve the problem that technology created.
[Marissa] Exactly.
[Judy] In many ways technology has made us, perhaps, lose sight of the original intentions of medicine, which is to heal people, not to understand them as diseases. So, technology has both progressed medicine and created a formidable barrier between the patient and their doctor.
[Marissa] That’s exactly right, and one statistic that just was mindboggling to me is that the United States ranks first in healthcare spending per capita, and we spent over $173 billion on medical devices and diagnostic technologies in the year 2016 alone, but even despite all of this spending on technologies and new procedures, we came in last place in a comparison of healthcare system performance among eleven industrialized nations.
[Judy] So this input is not matching the output.
[Marissa] Not at all.
[Judy] And when we think about healthcare equality, we have to acknowledge that not all patients will have an equitable experience, right. The healthcare system is a tangled web on inequitable structures, and yet, physicians strive for standardized practices even when each patient is a complex entity that may not be able to fit into these medically created boxes.
[Marissa] So, thinking about this “normal depiction of birth,” how did we get to what we call normal, and thinking about this long history of birth and pregnancy, at what point should we start.
[Judy] I mean, there’s probably a lot of different ways to kind of start the story we want to tell with this, but I’m going to tell a story, it’s a bit weird, but have you ever thought about why women give birth on their backs?
[Marissa] I guess, I hadn’t really considered it, but I’m ready for this story.
[Judy] So, in Europe, up until around the year 1550, midwives were the only attendants at births. Before this time, women gave birth in upright positions, in bed on their sides, but this all changed in the mid-17th century with the reign of King Louis the 14th of France.
[Marissa] That’s the King that built the Palace of Versailles, right?
[Judy] Yeah, that’s right. He was famous for quite a few things, it seems. According to Dr. Lauren Dundes, and many other scholars, this King enjoyed watching women give birth, and was incredibly frustrated by the obscured view of birth when women used a birthing stool. He began advocating for a reclined position, which would allow for a better view of the birth for an onlooker. Yikes. He insisted on male attendants at the births, and because of his power, he was able to popularize this new birthing position that looks a lot like the contemporary reclined position for births that we see today in delivery rooms across the United States and on shows, like ‘Grey’s Anatomy.’
[Marissa] Geez—When I thought of changed birthing positions, this is not the story that would’ve come to mind. So, it seems like this shift was not really necessary and not based on a problem, it was just done out of a man’s desire about how women should be when they’re giving birth, which is really creepy, but still, that’s the gold standard today.
[Judy] Yeah, this position proved, I guess, in a way to have iatrogenic results, right. It kind of created its own problems, because giving birth on your back you remove kind of the benefit of gravity as an aid, and so more procedures kind of built up around the position, solidifying it in maternal healthcare for centuries to come.
[Marissa] Yeah, and this strange, but really important example gets at what we’re hoping to accomplish in this series, which is demonstrating how technologies have been introduced in odd ways and sometimes to cure problems and sometimes not, and how, you know, what result that has had on women’s healthcare. So, throughout this series, Judy and I will be looking at five important technologies in the history of maternal healthcare, all of which are still present today.
[Judy] Yeah, in some form, they’ve, you know, all served to alter women or their experience of pregnancy in a very drastic way, and we kind of see this intervention with King Louis as a major shift in the ownership of pregnancy away from the mother and into the hands of medical professionals.
[Marissa] And we’re hoping to show how pregnancy has been transformed over the past few centuries from this natural process, very centered around the woman who is giving birth, to this pathological issue that’s in need of intervention by medical professionals. And natural childbirth, as we know it, so vaginal delivery, no epidural, and even some home births, frankly, are still very much a modernized and pathologized version of pregnancy, and really drastically different from the natural birth of the past. So, if you’re hoping to hear more, please, please join us over the next five episodes as we explore more technologies in the history of maternal healthcare.
[Judy] So Marissa, what are we going to talk about in the next episode?
[Marissa] Yeah, so in the next episode, we interviewed an incredibly, incredibly amazing professor at Harvard who we both really, really admire, Professor Evelyn Hammons, about the history of Jay Marion Simms and his procedures on enslaved women that ultimately brought forth the vaginal speculum, which is our next technology.
[Judy] We look forward to having you come join us for the next episode and throughout the rest of the series.
[Marissa] This has been Judy and Marissa, and we’ll see you in the next one!