Birth Story

Allow me one more post on this last day of Women's History Month about Anne Hutchinson, the midwife in the Massachusetts Bay Colony who was banished to Rhode Island for heresy.

The pregnancy Hutchinson had been carrying during her civil and ecclesiastical trials turned out to have been probably the first hydatidiform mole, or molar pregnancy, in New England, according to a 1959 article in the New England Journal of Medicine.

This freakish obstetrical event, which occurs in about 1 in 2,000 pregnancies in the United States today (it is 10 times more common in Asia), happens when a pregnancy goes awry and turns into a mass of tissue in the uterus. The mass might grow for several months, and lumps of tissue might eventually be "delivered." Such a "birth" event would likely be upsetting to anyone, but given the beliefs of the time, it carried a dark judgment on Hutchinson's state of grace.

She was safe in Rhode Island, but the event was sensational news. Imagine the response of her nemesis, Gov. John Winthop of the Massachusetts Bay Colony, when he heard that not only had Hutchinson attended Mary Dyer's "monstrous birth," but now had also delivered one of her own.

I can't stop wondering how Hutchinson felt about this. Although the austere religion practiced in the Massachusetts Bay Colony never allowed anyone to take salvation for granted, according to Calvinism, God's favorite people should be easy to spot: They prospered in this life as well as the next.

Hutchinson herself had had a comfortable life in England, and even in Massachusetts she was a member of the church, the wife of a prosperous textile manufacturer and the mistress of an elegant home right across the road from Gov. Winthrop's, according to Selma R. Williams in Divine Rebel: The Life of Anne Marbury Hutchinson.

Yet her life in America was one catastrophe after another. Hutchinson was a deeply religious woman. Did she feel God's presence so strongly that she was able to dismiss the evidence others saw of His disfavor? Or was she constitutionally unable to listen to people she judged unlikely conduits of the word of God? In any event, she spoke her mind, she stood for what she believed in, and she moved us all forward.

As the first woman doctor in the United States, Elizabeth Blackwell had the dubious honor of showing the way for women to qualify for and enter a profession in which, at the time, they were pointedly unwelcome.

Blackwell endured repeated rejections on her way into medical school, where she was shunned by the male students and shut out of clinical opportunities by the teachers. After she finished medical school, when no one would hire her, she founded her own hospital and made her own opportunities.

Elizabeth Blackwell

Blackwell was born in England; her father was a wealthy Quaker and sugar refiner whose business eventually fell on hard times. The large family moved to the United States when Elizabeth was 11 and settled in Cincinnati, Ohio.

Blackwell''s father died when she was a teenager and the family opened a small private school, where Elizabeth began teaching.

When she decided she wanted to be a doctor, she was turned away from 29 medical schools before being accepted by the Geneva Medical School in Geneva, N.Y. In spite of the hostility she encountered there, she graduated at the top of her class in 1849, with plans to become a surgeon.

Blackwell traveled to Paris to take a course in midwifery, where she contracted an infection that cost her the sight in one eye. That put an end to her hopes of becoming a surgeon. Back in the United States, Blackwell found she couldn't get work in a hospital, so she went into private practice.

In 1853, along with her sister Emily, and Marie Zakrzewska, two other early female doctors, Blackwell founded the New York Infirmary for Women and Children, now New York Downtown Hospital. During the Civil War, Blackwell trained nurses to treat soldiers injured on the battlefield.

The Blackwell sisters also founded the Women's Medical College of New York in 1869, but within a few years, Elizabeth went back to England. She was a professor of gynecology at the London School of Medicine for Women for the rest of her working life. Blackwell died at the age of 89, in 1910.

Women were thought to be more sensitive and spiritual than men in the mid-19th century, so people weren't completely surprised to discover that spirits nearly always chose women to serve as "mediums" to convey their messages to the world of the living.

The medium was the central figure in the Spiritualist faith. Women didn't choose to be mediums -- the spirits chose them -- and they often found themselves doing things they wouldn't have believed women could or should do.

Mediums not only channeled messages from the dead in small seances, but they also stood up in front of large groups and lectured. When they did so, they were in a trance. Nevertheless, some of these "trance speakers" became hugely successful on the lecture circuit, the historian Ann Braude writes in her book, Radical Spirits: Spiritualism and Women's Rights in Nineteenth-Century America.

To close the loop on our discussion of the role Spiritualism played in preparing American women for a public role in American life, women had been making inroads in some religions, but had not served a primary role before Spiritualism, Braude writes. And religion went a long way toward setting the tone in 19th century life.

Spiritualism began to take shape in 1848, the very year, and in the very same area, the Finger Lakes region of New York State -- the so-called "Burned Over District" -- that gave birth to the organized women's rights movement.

"Dissident Quakers" were at the center of both of these radical movements, and considerable overlap ensued. Quaker women already enjoyed more freedom and prestige than women in other religions, but women who were or would become Spiritualists were so aggressive in pushing for a central role for women that they put off even some of their fellow feminists, Braude writes.

None of the women who put together the Seneca Falls Convention believed a woman should preside over such an assembly, for example. So James Mott, Lucretia Mott's husband, was pressed into service as president of the meeting that established the women's rights movement.

However, when the group met again in Rochester two weeks later, a faction of the women, most of whom later became Spiritualists -- notably Amy Post, Rhoda DeGarmo and Sarah Fish -- insisted that a woman should preside. Mott and Elizabeth Cady Stanton "stoutly opposed" the motion as "a most hazardous experiment." They wanted James to head this gathering as well.

The meeting was a contentious one, but in the end, Abigail Bush, a Presbyterian who would become a lifelong Spiritualist, was elected president. The world did not come to an end, and the idea of women as leaders took one step forward.

Thanks to my friend, the historian Rima Lunin Schultz, for putting together a list of books for me about how Americans' ideas about women took shape in the 19th century.

As Women's History Month winds down, you might want to visit Birth Activist's  "Women's History Blog Carnival" about "women who have led the way in birth."

The rate of births that ended in Caesarean-sections climbed by 53% in the years between 1996 to 2007, when they stood at 32%, the highest rate ever reported in the United States, the National Center for Health Statistics reported on Tuesday.

The rate is higher than those most other industrialized countries are experiencing, according to the report from the NCHS , which is an arm of the Centers for Disease Control, based in Atlanta, Ga. The cost of a C-section is almost double that of a vaginal delivery, the report notes.

C-sections were up for all groups across the board in the 11 years that were the major focus of the study, in terms of age, race, location, and how far along women were in their pregnancies.

About 1.4 million women gave birth by Ceasarean in 2007. In 2006, Caesarean delivery was the surgical procedure most often performed in American hospitals.

Here are the major findings of the report:

The U.S. C-section rate, 21 percent in 1996, was 32 percent in 2007, an increase of 53 percent. The steepest rise occurred between 2000 and 2007.

C-section rates went up by 50 percent or more in 34 states. In six states -- Colorado, Connecticut, Florida, Nevada, Rhode Island, and Washington -- the rate increased by more than 70 percent.

The rate rose for women of all age groups, with women under 25 having greatest rate of increase, 57 percent.

All racial and ethnic groups experienced increases. Black women had the highest C-section rate in 2007, 34 percent. Native American women had the lowest rate, 28 percent.

Caesarean rates increased for deliveries of infants of all gestational ages. C-sections for pre-term babies (less than 34 weeks gestational age) increased 36 percent; the rates for late pre-term babies (34 to 36 weeks) and term and post-term babies (37+ weeks) went up nearly 50 percent.

Early and late pre-term babies were more likely to be delivered by Caesarean section than were babies born at 37+ weeks.

The report cited possible reasons for the increases in Caesarean sections, in addition to medical indications for the surgery, as "maternal demographic characteristics," like advanced maternal age, fears of malpractice suits among physicians, doctors' preferences, and maternal preferences.

Elizabeth Blackwell was the first female doctor in the United States, but it’s her sister, Anna, I would like to consider today. Anna Blackwell was a Spiritualist; that is, she believed it was possible to communicate with the dead.

She wasn’t alone. Many prominent families, especially in the Northeast, contributed passionate believers to this native American religion. Harriet Beecher Stowe, author of Uncle Tom’s Cabin, had two siblings who were Spiritualists.

Today perhaps most people view Spiritualism as a hoax, but in the mid-19th century, when electricity was beginning to be harnessed and people realized there were things about their world they couldn’t see and didn’t understand, Spiritualism attracted a huge number of followers.

Spiritualism sprang to life in a small town near Rochester, N.Y., in 1848 after two sisters, Kate and Margaret Fox, 12 and 14 years old, claimed that the raps that only occurred in their presence were urgent messages from a dead man they said was buried in the basement of their house.

Margaret and Kate Fox with their sister Leah (left to right)

When the sisters moved into Rochester, they were taken up by an enthralled community of progressive people ready to move away from the grim outlook of traditional religions, and traumatized by the virtually universal untimely loss of children and other loved ones.

“The hunger for communion with the dead gave Spiritualism its content, transforming what may have been a teenage prank into a new religion,” writes Ann Braude, author of Radical Spirits: Spiritualism and Women’s Rights in Nineteenth Century America.

Many of these people discovered that they, too, could communicate with the dead. Virtually all these mediums were women, and even young girls. Spiritualism was not a particularly organized religion, but it did pick up a guiding philosophy from the Quakers, abolitionists and feminists who swelled its ranks.

One of the most important tenets of Spiritualism was gender equality. ”Not all feminists were Spiritualists, but all Spiritualists advocated women’s rights,” Braude writes.

Documentation is scarce, but membership estimates range from a few hundred thousand to 11 million at a time when the United States population was 25 million, Braude reports.

What does Spiritualism have to do with the birth story? According to Braude’s book, this colorful native American religion played a major role in preparing women to occupy a role on the center stage of American life.

We’re going to explore that connection this week.

Virginia Apgar MD devised the simple observational test that bears her name after watching doctors swiftly give up on struggling newborn babies, leaving them to die, Atul Gawande writes in his book, Better. At the time, a few years after World War II, one in 30 births in the United States ended in the infant’s death.

Dr. Virginia Apgar

The Apgar score, introduced in 1953, is a 10-point scale for assessing how a newborn baby is doing — first with the birth process, and then with adjusting to the world. It is given in hospitals one minute after birth, and again at five minutes. A robust baby might garner 10 points, but a baby with an Apgar score of four or less draws serious concern and, likely, vigorous intervention.

Dr. Apgar’s scoring system transformed delivery, Gawande writes. “Even if only because doctors are competitive, it drove them to want to produce better scores—and therefore better outcomes—for the newborns they delivered,” he writes.

The daughter of a Westfield, N.J., insurance executive, Dr. Apgar graduated from Mount Holyoke College in 1929, and began medical school at Columbia University’s College of Physicians and Surgeons, where eight of her classmates were women and 81 were men. She began a surgical residency but, in the depths of the Great Depression, decided it might be difficult, especially as a woman, to make a living as a surgeon.

Dr. Apgar enrolled first in a course for nurse-anesthetists and then in Dr. Ralph Waters’ seminal residency program in anesthesiology at the University of Wisconsin in Madison, followed by a stint with Emery Rovenstine at Bellevue Hospital in New York — strong training for the day.

She founded the anesthesiology program at Columbia’s College of Physicians and Surgeons. However, when the program became a department, Dr. Apgar was passed over for the job as chairman, in favor of a man. She did become a full professor, though — in itself an accomplishment at the time — and was a pioneer in obstetrical anesthesiology.

Dr. Apgar saw a number of birth defects during the thousands of births she attended, and in 1958 she went back to school in public health at Johns Hopkins’ medical school in Baltimore. In 1959, Dr. Apgar joined the March of Dimes in its campaign to eliminate birth defects.

Dr. Apgar never married. Her entire life, she was famous for intelligence, energy, empathy and a great sense of humor. She was still working on behalf of the most vulnerable babies when she died in 1974, at the age of 65, of liver failure.

Gawande’s chapter about Dr. Apgar, “The Score,” also ran in the New Yorker.

The Chicago River, ready for the parade

From Chicago on St. Patrick's Day, here is our famous green river, dyed last Saturday for the big downtown parade, captured by my friend Bill Linden.

What does this have to do with the birth story? Well, nothing, but we of Irish descent just get the one day to celebrate, you know? Or, counting parade day and the festivities on the South Side on Sunday, three days, tops.

And Ireland does have the lowest maternal mortality rate in the world at last tally, with just one mother dying per 100,000 births in 2005.

That certainly is something to celebrate, and to remark upon.

Happy St. Patrick's Day!

Mary Breckinridge, a daughter of a prominent Kentucky family that included John C. Breckinridge, James Buchanan’s vice president, suffered the loss of both her children before they reached the age of 5. Instead of allowing these tragedies to ruin her life, she channeled her energy into a passionate campaign to improve the health of the children of Appalachia.

Mary Breckinridge at work

To Breckinridge, a healthy child required a safe birth, a living mother and a healthy family. Making childbirth safe was a primary goal when, in 1925, she founded the Frontier Nursing Service in Leslie County, Ky. The previous year, Breckinridge, 43 and already a nurse, had traveled to England to learn midwifery because she could find no adequate course in the United States. She continued to send FNS nurses to England until the outbreak of World War II.

The FNS deployed the first nurse-midwives to practice in the United States. Breckinridge had encountered nurse-midwives in Europe, and thought that the model was well suited not only for delivering babies but also for providing prenatal care and for assessing and helping to plan for the health needs of the whole family and, indeed, the whole community.

FNS nurses traveled by horseback to attend home births; high-risk patients went to the FNS hospital in Hyden, Ky. Clinics in the community served an average of 250 families. The FNS maternal mortality rate for its first 30 years was about one quarter of the rate for the United States as a whole.

Breckinridge died in 1965. The Frontier Nursing Service, based in Wendover, Ky., is still active, as its midwifery school, which was added in 1939.

Only one American midwife of the Revolutionary War era left a diary that has been recovered, Martha Ballard of Hallowell, Maine. It is a fairly basic document. Some entries are just a few words. Still, between 1785 and 1812, a time of incredible change in New England, Martha tended her diary regularly.

A Midwife's Tale

In 1990, the historian Laurel Thatcher Ulrich used her own considerable knowledge of the period to connect the dots in Ballard's diary. The result was A Midwife's Tale, which won the Pulitzer Prize and other awards. It is a terrific book, and it was made into a film for PBS's "American Experience."

One of the best things about A Midwife's Tale is the fact that Ulrich has given us a fully fleshed-out picture of Martha Ballard, and has at the same time retained her distinctive voice. Ballard was a religious, hard-working wife and mother who trained her daughters and other young women to assist her, understood the medicinal uses of the plants she grew in her kitchen garden, and in her prime delivered two-thirds of the children in Hallowell.

The town had more than one doctor, but in 816 births over the course of 27 years, Martha called a doctor in to help her with a birth just twice. In all those years, Martha saw 19 babies and five mothers die just before, during or just after birth.

While childbirth rested on a community of women when Ballard began her career, one of the tensions of the book comes out of the inroads male doctors were already making into midwifery by the time Martha died in 1812.

Mary Wollstonecraft, the earliest feminist writer in English, died in childbirth in London in 1797. At a time when women were bound to the home and dependent on the men in their lives, Wollstonecraft was a professional writer who had already had one child out of wedlock, and had only recently married her lover, the writer William Godwin.

Mary Wollstonecraft

The birth began with a midwife of Mary’s choosing, but when the placenta would not come out, a male physician was called in and removed it surgically.  Wollstonecraft died 11 days later, at the age of 38, of puerperal fever, a wound infection.

At the beginning of the 19th century, women found their public voice.  Wollstonecraft didn’t have an easy life, but the speed with which others followed in her footsteps reflects seismic changes.  Jane Austen’s first novel, Sense and Sensibilty, was published in 1811; born in 1775, Austen was a well educated woman.

Mary Wollstonecraft not only supported herself with her writing, but she started women on the path to speaking for themselves. On the day she died, Godwin wrote, “There does not exist her equal in the world.”

The daughter Wollstonecraft bore that day grew up to marry the poet Percy Bysshe Shelley, and to write a seminal Gothic novel, Frankenstein, as Mary Shelley.