Hospital Confinement: From the 19th Century to the 21st

Last summer I had a very different experience of childbirth than most women. I was not entirely sure what to expect when my husband drove me to the emergency room on the night of July 4, leaking amniotic fluid 10 weeks early. Rather than the straightforward checking of vitals and intermittent monitoring as labor gradually progresses that we had practiced for in birthing class only the week before, this premature labor was accompanied by frenetic activity by nurses and doctors who hooked up an IV, drew blood, attached monitors, and ordered tests and medications.

Perhaps the scariest thing wasn’t the speed of events but the worried and weighty looks exchanged by the physicians and nurses as they examined test results and monitored strips without saying a word. In my case, the obstetricians decided to try to stop my contractions since I could barely feel them and the amniotic leak was relatively slow.

I spent about eighteen hours half-conscious, feeling like my head and veins were on fire from the magnesium sulfate treatment given to slow the contractions and encourage the baby’s brain and lungs to develop. Once the magnesium sulfate was done, they gave me a course of muscle relaxants to stop the contractions and placed me on modified bed rest until I delivered. Most women who are prescribed bed rest are sent home, but since my water had broken, I had to remain in the hospital until my son was born.

Once my labor stopped, I was transferred to the antepartum ward, a section of the maternity ward where mothers usually spend only a few days. Most of the women on the floor were there for inductions, for monitoring after amniocentesis, or for treatment of preeclampsia. We were not encouraged to talk to one another, and except for a craft hour held every other week, we were all instructed to stay in our rooms to avoid spreading germs (a common fear in maternity wards in the early twentieth century as well).

Walking into the ICU in a maternity ward. (Dean/Flickr | CC BY-NC-ND 2.0)

The doctors wanted to keep me pregnant until I reached 34 weeks and then labor would be induced, as after that point the risk of infection is higher than the risks of prematurity. I was told to expect to go back into labor at any time; about 80% of women who have their water break early deliver their babies within a week of being admitted to the hospital.

That did not happen to me. I spent three and a half weeks sitting in a hospital room trying to finish teaching an online class and complete revisions on an article and a book review that were due later in the summer, all while struggling with the inevitable psychological impact of waiting and examining every twinge and contraction (all accompanied by the constant din of construction as the hospital was being renovated). Although I was only encouraged to stay in bed for the first few days, I was told it was better if I did not leave the room much and spent most of my time sitting down and resting.

Much of the emphasis on resting in my room was to accommodate frequent monitoring, as nurses constantly watched me for signs of infection or labor and my yet-unborn son for distress. Once or twice a day, the maternal-fetal medicine specialists I had been seeing for my entire pregnancy descended on my room with one to five medical students in tow, recited my medical history, asked me how I was feeling, and then discussed my case with the students.

I learned most of what I knew about changes in my condition or the doctors’ plan for the delivery of my son by eavesdropping on their conversations just outside my closed door. As I neared 34 weeks pregnant, plans for induction and delivery were made, but when the sizing ultrasound was done, it revealed that the drugs used to stop labor had damaged my son’s heart. I ended up having an emergency cesarean section. My son, who was only 4 lbs 5 oz at birth, spent several weeks in the NICU while his heart healed, he learned to eat, and he grew enough to keep his body temperature stable outside of an incubator. He is, thankfully, fine now.

NICU. (Schaaf/Flickr | CC BY-NC-ND 2.0)

It was during those three long weeks in the hospital that I began to wonder what women in the past had experienced during hospital confinement. As medicine was increasingly professionalized in the late nineteenth century, hospitals began opening maternity wards for complicated pregnancies and births, or for mothers whose homes were considered unsuitable, including women living in tenements or rooming houses.

Rural women and most African American women continued to give birth at home, attended by female relatives or midwives, well into the twentieth century. Doctors and many women thought that the hospital was a better location for childbirth because of the lack of privacy and the often filthy conditions of tenement buildings, and wealthier women sometimes chose to deliver at a hospital in order to have access to the most recent medical techniques.

Despite the depiction of hospitals as clean, infection and puerperal fever were increasingly common in physician-assisted births due to injury and infection caused by instruments like forceps. As more women delivered their babies under the care of doctors, interventions increased and so did complications from those interventions. Childbirth may have been routine, but it was also very dangerous, and many women and infants died.1

Navajo maternity ward. (Flickr)

Hospital bed rest for complicated pregnancies used to be a relatively common practice, but has become less so as the cost of hospitalization has risen and treatments for premature labor and preeclampsia have improved. The majority of women now spend only a few days in the hospital after the birth of their children, but historically women spent longer periods before and after delivery in the hospital. As more hospitals opened maternity wards around the turn of the century, large teaching hospitals used destitute women as well as women with complicated pregnancies as teaching cases.2

The use of ergot to stimulate contractions, forceps to ease delivery, and sutures to repair damage could cause as many problems as they prevented, particularly before the discovery of penicillin in 1928.3 These methods were refined on the bodies of impoverished and minority women and then offered as pain-relieving options to the wealthier women who labored in private hospitals.

As the number of women delivering in hospitals rose, new policies controlled the process of labor and delivery and the patients themselves. Concerns about infection as well as the limits of staffing and delivery rooms meant hospitals began to control women’s movement about the hospital while they were confined. Laboring women, particularly those with complicated pregnancies, were often not told what was happening to their bodies or to their babies, and interventions were for the convenience of hospital staff and doctors rather than medical necessity. Women were kept uninformed and dependent on hospital staff to ensure their compliance with hospital policy.4

Southmead Hospital maternity ward with Christmas decorations (Townsend/Flickr | CC BY-SA 2.0)

Like in the nineteenth and early twentieth centuries, working class and minority women today are much more likely to have pregnancy complications that result in premature birth or hospital bed rest. Because complicated deliveries and premature births require specialized medical care for both mother and child, most women facing these issues are transferred to large teaching hospitals that are served by medical schools where specialists teach. This means the experience of being on the antepartum ward today is in many ways similar to confinement in early maternity wards: women there are used as teaching cases for medical students, and their pregnancies and births are controlled in a way that is not the norm for middle-class women with typical pregnancies.

The emphasis on compliance to hospital regulations and doctors’ orders to rest, as well as the side-effects of many of the treatments used to slow or halt labor, means that women on hospital bed rest are often not told the full risks of their treatments or they are only informed of the outcome of test results and scans after the doctors have already determined the best course of action.

Although modern medical regulations require that doctors obtain consent before proceeding with a course of treatment, vestiges of the hospital models developed in the early twentieth century to ensure docile compliance to hospital routine remain. One of the most vivid memories I have from my month in the hospital was when immediately after being told the news about my son’s heart problem and the need for a c-section the next day, which they did when my spouse was not present, a resident crouched down in front of the chair I was sitting in and asked not if I was okay, but if I would consent to the c-section by repeatedly asking, “Are you okay with this?” As my own experience illustrates, women who endure premature labor are placed in a system which prioritizes hospital procedure over patient agency. Although the policies are intended to keep women calm and compliant with doctors’ wishes, the legacy of early hospital labors leaves women on the antepartum floor subject to the same risks of increased postpartum depression, complications from bedrest and psychological trauma that women faced in the early twentieth century.

Notes

  1. Richard W. Wertz and Dorothy C. Wertz, Lying-in: A History of Childbirth in America (New Haven: Yale University Press, 1989), 135–36; Judith Walzer Leavitt, Brought to Bed: Childbirth in America, 1750-1950 (New York: Oxford University Press, 1988), 149. Return to text.
  2. Leavitt, 83–85. Return to text.
  3. Leavitt, 149. Return to text.
  4. Wertz and Wertz, Lying-in: A History of Childbirth in America, 167–68. Return to text.

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