Last month, I looked at the mythology of traditional childbirth. This post examines history’s postpartum body in more detail. Admittedly, “history” is a broad term. Nonetheless, we can assume the childbirth repercussions for a sizable minority remained constant.
Notably, a fair number of books look at the history of childbirth, usually from a particular ideological viewpoint, but I couldn’t find any histories of the postpartum body. Once the baby is out, the stories end.
Well, that’s not entirely true. Our after birth bodies are much talked about and I found plenty of books on the postpartum body. But all the books are how-to guides. How to get it back. How to lose the mummy tummy. In other words, how to become a MILF. Some of the better guides include passing references to body image, but none of them provide a snapshot of women’s postnatal bodies throughout history. Somebody should write that book. Or, perhaps I’m the only person who would read it, which explains everything.
I’m not a full-time, professional researcher and couldn’t dig into the primary source material. Therefore, the information for this post is gleaned from Edward Shorter’s rather old book A History of Women’s Bodies.
Before the advent of germ theory and antibiotics, many women suffered from infections brought on by childbirth. Post-delivery sepsis was also called “puerperal fever” or “childbed fever” (103). Symptoms usually appeared 3 days after birth, sometimes more.
These symptoms often appeared suddenly. For example, in 1874 a Philadelphia doctor wrote, “There is nothing more sudden than the changes in the condition of these women. In the morning they are cheerful and smiling, and seem to be well, yet they are consumed by fever, pulse rapid, features pale and shrunken, and death is written upon their foreheads. They sink and die without a struggle” (104). I always thought the death scenes in Victorian novels were overwrought, but now I wonder if the Victorians simply had a closer relationship to postpartum death than we do.
Although most new mothers were able to escape puerperal fever, many more were infected with the more mild “weed” or “milk fever” (105). Doctors believed milk fever was the result of a mother’s milk coming in. They were mistaken. It was actually a uterine infection. This type of infection was nearly ubiquitous and considered normal. If the infection spread from the uterus to the bloodstream and then to other parts of the body, the stage was set for the more deadly puerperal fever.
These infections left their traces. The authors of an 1880s gynecology text remarked, “It is the rare exception to examine a multiparous female pelvis without finding some traces of a previous cellulitis or peritonitis” (109). Peritonitis was caused by bacteria that moved from the uterus and ovaries to the abdominal cavity. Cellulitis was an infection of the pelvic connective tissue. This means infected mothers could suffer from “abscesses, adhesions, or chronic tubal infections” (109).
Because infection was so common, postpartum women knew that even if they emerged from childbirth unscathed, the coming days, weeks, and years could leave them with permanent infectious reminders of their experience. They also knew they were powerless if an infection appeared. That’s terrifying.
Famously, Mary Wollstonecraft died in 1797 from a bacterial infection in her blood. It was caused by the incomplete expulsion of her placenta. Something to remember the next time you try a cleanse to purge “toxins” from your body. Real toxins cause acute damage and no smoothie is going to get rid of them.
This topic hits home. Read Is Your Vagina Falling Out and How Not to Freak Out About Pelvic Organ Prolapse if you have more technical questions. Today, tears to the perineum are not the norm, but they aren’t uncommon. I tore, as did many of my friends. Unsurprisingly, they were also common throughout history.
Unfortunately, at the turn of the twentieth century, the number of these tears increased as forceps came into fashion (271). Episiotomies also became routine, but the effect of that change is hard to quantify. Episiotomies might have prevented serious tears, but probably caused more harm than good, one reason they are not routinely done anymore. (I actually had one with my second child because he was huge and his shoulders got stuck. My youngish midwife said she had only done a handful. Oh, and my son was also the biggest baby she had ever delivered, so I was basically good training for her. I should note I tore less with an episiotomy than I did with my first kid’s “natural” tear. Go figure).
Edward Shorter makes the point that although the number of tears increased, the greatest negative consequences of these tears was likely pre–1900 when the tears were not commonly repaired. Let that sink in. A woman with the misfortune of suffering an un-repaired 4th degree tear (one that extends into the anus) would suffer from fecal incontinence for the rest of her life. Some skilled and trained midwives could repair these tears, but many traditional rural midwives could not. Even less serious tears, 3rd or 2nd degree, could cause prolapsing of the uterus. If a woman had practically no perineum, she wouldn’t even be able to wear a pessary to prop up the uterus (and even if she could wear a pessary, it was likely to aggravate and inflame internal tissues).
The poor would suffer the most from vaginal trauma because they had limited access to better trained midwives and were often compelled to resume laborious work immediately after childbirth. This was especially true for slaves in the antebellum South (273).
Although precise statistics are not possible, prolapse’s ubiquity was well known. For example, out of 20 laboring women in an early 20th century Silesian village, five had prolapse (273). Some researchers even believe classical authors mistook the uterus as a wandering animal because they had observed prolapsed uteruses. Ultimately, for most of human history severe vaginal trauma plagued many women for the rest of their lives.
Prolapse is still fairly common and, in fact, becoming more common as women live longer. However, fistulas are unheard of in present day developed countries because they were virtually eliminated in the U.S and Europe in the late 19th century and early 20th century with the advent of c-sections and surgical repair. Unfortunately, they are still prevalent in the undeveloped world where medical care during childbirth is unavailable (Something to consider when anyone claims medicalizing childbirth was anti-feminist).
A fistula is literally a hole that develops in the tissue separating the rectum from the vagina, or, more commonly, the bladder from the vagina. Urine continuously runs through this hole (or feces in a rectovaginal fistula). Constant incontinence causes ostracism and repulsion. Tragic is the only appropriate word to explain the life of a woman with a fistula.
Usually a fistula results from prolonged labor that causes the infant’s head to jam in the vagina, but historically, it could also result from a perforation via forceps or embryotomy (actually pulling out a dead infant with a hook in the head, or even a live infant before c-sections were routine) (268).
Fistulas still occur today and the Fistula Foundation notes that “more than 75% of women with obstetric fistula have endured labor that lasted three or more days.” The Fistula Foundation also says the root cause of fistula is grinding poverty and the low status of women and girls in sub-saharan African and parts of Asia. I’m not connected with them, but of course admire their foundation, so if you would like to donate to The Fistula Foundation and help these women get surgery, you can follow this link.
Although c-sections have been around since recorded history, they are not part of the postpartum body historical record. This is for a simple reason. Most c-section bodies didn’t stick around. Early c-sections were last resorts performed not to save a mother but to save the baby. Therefore, they were basically done on corpses.
Even when c-sections moved to the hospitals in the early 19th century, most women died because the doctors didn’t stitch the uterus back together. C-sections didn’t become a relatively safe procedure until modern antibiotics were invented and surgical techniques advanced, sometime after the first few decades of the twentieth century. It’s always surprising to learn that a surgery performed so frequently today was not a viable option even 150 years ago. C-sections are controversial. The rate is almost certainly too high in places, but personally, I will forever be grateful that modern medicine allowed me a beautiful third baby born through this operation.
The history of the postpartum body is incomplete. The mothers who suffered the most severe consequences of childbirth were often those least likely to leave a record. This included slaves, the working poor, and the illiterate; in other words, the backbones of society.
My great-grandmother was a first generation immigrant from Russia and raised 11 children, including my grandmother, on a North Dakota farm. Sometimes I wonder if she herself was left with childbirth’s legacy. I’ll never know. All I know is I am grateful to live with my imperfect postpartum body in the 21st century. Injuries that would have left me dead or maimed for life have become manageable thanks to medical advances. I think about this when I run across another Pinterest post promising to give me six pack abs or see a mom on Facebook selling a pyramid scheme diet shake. Concern about the bikini appearance of our postpartum bodies is normal. But it is a historical anomaly. We should remember that.
- Edward Shorter, A History of Women’s Bodies, New York: Basic Books Inc., 1982. ↩
- Some debate surrounds whether hospitals or midwives were more prone to causing infections in women during the late 19th /early 20th century. Published statistics show hospitals as 6x more likely to infect during this time period, and I’m inclined to believe hospitals were more septic than homes were. However, Edward Shorter finds flaws with these statistics and believes hospitals and midwives were equally likely to prompt an infection. He says the hospital reports include many abortion infections in their numbers. He says abortion victims fudge the numbers because they were much more likely to die. He also says many other infections that were not attributed to childbirth, especially outside the hospital, were likely misreported because of ignorance about the exact mechanisms for infection. In other words, the numbers are hard to read (131). Either way, infection was a problem no matter how a woman gave birth. And it’s something most present day mothers don’t even consider. ↩