Lying-in Transition: The Modernization and Professionalization of Childbirth in Rural Alabama 1870-1910

This dissertation will analyze the underlying reasons childbirth became professionalized, which was due to the growing demands by women for safer birthing conditions. The demand evolved out of the complex relationship among social status, race and ethnicity, and regional locations, all made possible by the modernization and professionalization of tocology that became available during the latter part of the nineteenth and beginning of the twentieth-century. The history of childbirth is a critical topic because, as previously mentioned, the maternal mortality rate in the United States in the twenty-first-century is still incredibly high for a developed nation. Women deserve safer birthing conditions. Those who assist in ushering new life into the world are responsible for protecting both mother and infant. This work will primarily focus on the transformational period of the professionalization and modernization of childbirth; however, it is critical in some instances to extend the time frame to gain a better understanding of the matter at hand. Text Summary Chapter 1 briefly introduces the art of childbirth, discussing the evolving relationship between socioeconomic groups. Additionally, the reader is introduced to the examination region, rural Alabama: specifically, Hale, Greene, Dallas, Sumter, and Marengo Counties. The region was selected for its unique socioeconomic climate. In the nineteenth-century, the field of academic obstetrics was in its infancy. Midwives and physicians had a turbulent relationship as both thought the other was intrusive and careless. However, it is necessary for a woman to be accompanied by a birth attendant during delivery to help preserve the life of both mother and child—a point that both physician and midwife agree upon. The question becomes who is better at providing healthcare to both mother and infant while preserving the cultural climate that these women so desperately want. Who knows what is best for the parturient and why becomes a focal point for this dissertation with the ultimate goal of analyzing the overall thesis. This dissertation will argue that the reason for the professionalization of childbirth was due to the growing demand by women for safer birthing conditions that developed around the evolving relationship among social status, race and ethnicity, and regional location distinctions; reform was made possible by the modernization of medicine and the professionalization of tocology available during the nineteenth- and twentieth-centuries in America. Chapter 2 will examine the socioeconomic climate of rural Alabama, specifically in Hale, Greene, Dallas, Sumter, and Marengo Counties. These counties are five of the wealthier counties in Alabama during a period of extreme poverty. From 1870-1910, Alabama had a shifting diversity of ethnicity as it experienced a period of White Flight. This period was when more Whites left Alabama than entered or resided in it, providing open opportunities to the newly freed Black population. This chapter analyzes the trends in population shift as well as the financial stance of the region. Through census data, historians can better understand the class struggles in Alabama; however, the data is imperfect, presenting obstacles at every turn. Additionally, this chapter will analyze the vital statistics presented for Alabama from 1870 to 1910 to illustrate the maternal and infant mortality rates in the state, nation, and world. Chapter 3 analyzes the question “Why Are You the Way You Are?” to understand the growing tension among society, midwives, and physicians. To attempt to answer that question, the geo-occupational configuration of the population will illustrate the high rural population and the agricultural occupations of the state’s inhabitants. Alabama’s population was mostly rural farm workers of both genders. This chapter will further analyze the causes for women working in agriculture and why that was important to childbirth. Moreover, racial ideology will be examined in relation to quality birth attendants, education, and the societal pressure to ignore the Black population through the lens of the Disappearance Hypothesis. Lastly, as statisticians examine the vital statistics of the region reformers recognize the need for intervention because of the presented statistical analysis drawing parallels between race and death rates. The question becomes how? Chapter 4 discusses The Problematic Midwife. In a rural, poor, primarily Black population, women still needed quality birth attendants. Physicians were too expensive for the majority of parturients, so they leaned on the support of Granny midwives. The women did more than catch babies as they entered the world; thus, socially, they were accepted and respected, at least until physicians began to attack their lack of education. But who was to blame- the overworked, undereducated midwife who was doing the best that she could or the overpriced classically trained physician? The midwives were victims of societal making, damned if she did and damned if she didn\u27t. Chapter 5, Along Came a Doctor, examines the medical revolution the United States underwent during the latter part of the nineteenth-century through the twentieth-century. Medical schools were evolving, and with them, a new specialized physician was looking for a better society and an increase in social and financial status. The quest for the “almighty dollar,” as Washington Irving called it, may have altered many physicians\u27 regional path and moral compass. As medical advancements stimulated change for patients within hospitals, Blacks were excluded from such services due to Jim Crow Laws. The modernization of tocology was developed to provide physicians with the skills necessary to assist in delivery; however, ethical dilemmas arose from learning techniques. Men like Dr. J. Marion Sims and Josiah Nott utilized Black women in developing medical procedures, often with little pain management, which they justified through the assertion that Blacks experience less pain than Whites. Moreover, academia struggled with the ethical dilemma of practicing their skill on pregnant women. It takes creativity to overcome this challenge to educate blossoming physicians. In conclusion, the transitional period between home and medically sanctioned childbirth deserves additional research. While scholars claim that modernizing obstetrics made childbirth safer, I argue that the more accurate assertion is that it changed childbirth. Midwives who had limited resources provided for a community unselfishly in an attempt to fulfill a need. That selfless commitment was demonized and degraded because of their race or social status. Had the Granny midwife been a White wealthy male, he would have been hailed a hero for his efforts; however, the political, social, and economic makeup of rural Alabama generated the perfect conditions to allow hatred to grow