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Let's Talk about the History of Postpartum Care in the U.S.

October 9, 2023
Image Credit: Büşranur Aydın

From past to present, birth has been commonly represented as a beautiful and routine event. While many deliveries go as planned, no birth is a walk in the park. In fact, depending on the method of birth, delivery is considered a major surgery. Now, after any other major surgery, patients will take days, sometimes weeks, to rest and recover. However, with birth, proper rest and relaxation has become almost impossible and unattainable in the United States --though research shows that proper care for a mother and her child in the hours, days, and weeks post birth can have great benefits to their overall health.

The 2012 show Call the Midwife has rekindled itself as a popular series on streaming services. Adapted from the memoirs of Jennifer Worth, we are taken back to the 1950s at Nonnatus House, where an unexpected group of Londoners reside. Nuns and midwives work together to provide the best care for mothers in Poplar before, during, and after birth. We are taken through time in its historical realm, but the actions themselves seem almost fictional. The postpartum care that is common today is ages behind what is pictured in Call the Midwife. Giving birth in a hospital with a doctor and nurse is much more common today than utilizing a midwife–but why have the amount and intention with postpartum care changed?

Similar to the transition of delivery from home to hospital, postpartum care was originally provided by midwives or other family members in the home of the mother. It wasn’t until the end of the 1800s and the early 1900s that hospital-based postpartum care emerged. Parallel to the emergence of postpartum care in hospitals was the expansion of urban areas that resulted in kin living further from one another. Now, hospitals were the main location for birth and postpartum care for all mothers, not just those who couldn’t afford midwives. This increase in responsibility for hospitals resulted in a shift from caring for a handful of women, to maintaining and controlling the birth and delivery experience of the majority of American women.

Around 1920, obstetrician De Lee advocated for the use of forceps to deliver both the baby and the placenta as physicians believed spontaneous birth to be dangerous for the safety of the baby and mother. This use of forceps and the recovery required post-delivery resulted in postpartum care that was interchangeable with that of any other surgery. The introduction of twilight sleep into mainstream childbearing practices continued the need for postpartum care in hospitals.

From the end of the nineteenth century until the beginning of World War I and II, the majority of postpartum care happened in the hospital. Women were often told to stay in bed for up to two weeks after giving birth. However, mothers were separated from other loved ones, had limited visiting hours, and minimal, restricted time with their new baby. For better or for worse, the onset of war changed many things in American life, including postpartum care. Crowding, economic turmoil, and lack of staff all led to inhibiting a lengthy postpartum care stay. The 14 day recovery was shortened to 3-5 days. This shortened time frame was questioned, as well as the restricted time mothers had with their babies. As a result, and with push from childbirth movements, rooming-in programs and mother-infant units were implemented in hospitals; mothers now had more choices of how they wanted to experience their postpartum days. Furthermore, the implementation of this care that was more family-centered helped to broaden postpartum care by incorporating education on motherhood and family relationships.

Consequently, even with these new rooming-in and mother-infant units, mothers began to side with a shortened hospital stay postpartum as they questioned the need as long as their delivery went well and they wished to spend more time with loved ones without any constraints. With the combination of hospitals and mothers urging a shorter stay, the average length for a hospital stay post birth dropped to two days in the mid 1990s. Still, questions remain regarding the optimal time that a mother and her infant should spend in postnatal care.

In her book Postnatal Care, Sheena Byrom highlights a quote from UK Audit Commission, 1997: “There is some uncertainty about what postnatal care is aiming to achieve – whether it is solely to prevent and treat immediate health problems in the mother and the baby or whether it is aiming to enhance the overall experience, giving mothers time to recover and get to know her baby…perhaps because of this uncertainty there is considerable variation in the nature of postnatal care” (p.49). Particularly, the economic and social constraints of the hospital urge them to follow suit with what is feasible and necessary for the times. However, this can lead to care that is centered on the institutions rather than the mother and child. In Call the Midwife, we see a different story, where care from the midwives is catered towards each mother and child.  

Two methods of postpartum care–the hospital and the midwife–stand at either end of the spectrum. The type of postpartum care a mother receives is entirely up to her. However, the practices that are in place for women post-birth should not focus on the caretakers or the institutions, but consider the needs of mothers and infants at the forefront.

In this history of postpartum care in hospitals, what makes itself clear is that hospitals have a lot to deal with–in many realms, within birth and beyond. While having a postpartum center where women are fully cared for may not be feasible in a hospital setting, there should be places women can go to for the postpartum care, rest and relaxation that they want and need.

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