Human reproduction is simultaneously unchanged and radically different over time and across cultures. This paradox has preoccupied me for over a year as I carried and gave birth to my first child one year ago today, and as I watched my sister follow the same path soon after. Throughout my pregnancy, delivery, and now early motherhood, I’ve found myself thinking often long-dead women and pondering how vastly different our experiences of the same condition must be.

Pregnancy and birth generate intense  feelings. Most parents experience joy, hope, and fear. As a historian, I regularly identify with the women I encounter in the archive. The empathy born of our shared biological and emotional experiences generated two additional emotions that most new parents may not: gratitude, on the one hand, and anger on the other.

For women today, modern medical science offers myriad insights into a process largely secret from our eighteenth, nineteenth, and even many twentieth-century counterparts. We hear heartbeats, see the developing fetus, and if we choose, discover the sex and confirm the presence or absence of many developmental conditions. Yet in large part, we have little more control today than centuries ago. Due dates are illusory—roughly 5% of women actually deliver on theirs. I was dismayed to learn in birthing-preparation class that there are no reliable indicators of when labor will begin or how long it will last.[1] At least women in earlier generations may have had fewer illusions that they could affect the course of their delivery.

I also had occasion to marvel at the endurance of women, past and present, who perform(ed) physically demanding labor while pregnant. How would my friends afflicted by hyperemesis gravidarum—severe nausea and vomiting due to pregnancy sometimes requiring hospitalization for fluids and prescription medications—manage the agricultural and domestic labor expected of most women in the eighteenth and nineteenth centuries, or long hours of repetitive factory work? As my bulk swelled and locomotion became more challenging, I pondered the women whose primary mode of transportation was on foot, or the luckier ones who had the luxury of jolting along in coaches and carriages. I thought of, among others, Ann Morris Vanderhorst, who in the summer of 1829, well advanced in her pregnancy, spent at least three weeks traveling by carriage to her mother’s home in New York—with two toddlers in tow. I also marveled at the resilience of the enslaved women she left behind, taking for granted that they would toil up until their delivery and resume their work shortly thereafter.

The setting of labor and delivery in the United States today would be barely recognizable to early American women. American women today typically complete their labor in hospitals, surrounded by a few select friends and family and rotating cast of strangers. Early American women remained at home, with female neighbors and relatives as “welcome companions” who sought to cheer and comfort the laboring woman—sometimes with mulled wine or other spirits. Between contractions, I rather envied earlier women’s opportunities to support and be supported by other women in their “travail.” At least they had some idea of what they were in for! By the mid-nineteenth century man-midwives and physicians had largely eclipsed midwives and birth was an increasingly private affair.[2]

Yet I would be reluctant to trade sterile conditions, fetal monitoring, and the availability of surgical intervention. I know it was just a matter of luck that I did not experience complications, as many friends and acquaintances did. I am enormously thankful surgical help was available to the friend with preeclampsia; with an obstructed delivery; with a labor that stalled after over thirty hours and who hemorrhaged extensively after her surgery, requiring multiple transfusions. Still, I am conscious that many obstetric advances were achieved at enormous cost to vulnerable women on whom male surgeons experimented under exploitative conditions.[3]

Many early American women prepared themselves emotionally and spiritually for the possibility they could die as a result of childbirth. While childbirth was not as hazardous in the past as many modern people assume, it was the main cause of death of women of childbearing age. Estimates vary by time and place, but historians generally find that between one in eight and one in twelve women died as a result of childbirth in early British North America.[4] Cognizant of the risk, many well-to-do women committed their last wishes to paper as they neared the end of their pregnancies.[5] In 1826, in anticipation of her “approaching confinement,” Georgina Amory Lowell wrote a letter to her “beloved husband” John. “If it should it please the Almighty . . . that the birth of a child should be the occasion of my death,” she wanted to express her deep love for her husband and her sadness that she would not be able to help raise the child. She entreated John to bring the child up in the fear of God, with specific concerns depending on the child’s sex. If a son, she requested that John “sometimes speak to him of his mother . . . let me not be to him as if I had never been.” “[I]f I should leave you a daughter,” she continued, “my only request is that my daughter may not be brought up at a boarding-school.”[6]

Some women died of hemorrhage or of convulsions, likely as a result of conditions like preeclampsia. These are currently two of the causes of maternal mortality in the United States (thanks, NPR and Pro Publica, for that joint investigation of maternal mortality late in my pregnancy). Statistically, however, the far greater risk before germ theory was infection, like the one that caused the slow death of Nancy Barraud Cocke in 1816. Three months after the birth of her sixth child, accepting she would never recover, Nancy spent her thirty-second birthday saying her goodbyes. Saying “she could not as well commemorate this day as by bestowing her blessing upon the pledges of our love. The infant [Sally] and our younger children [Charles and Ann, ages two and five] were carried to her and received her last embrace.” Two days later, her husband and best friend held her hands as she died.[7]

The majority of women who survived their frequent encounters with childbirth had to brace themselves for the likelihood that they would lose at least one child before the age of five. Georgina Amory appears to have lost the child she anticipated in 1826, because almost exactly one year later she gave birth to the first of two daughters. She died in 1830, leaving John with a one-year-old and a three-year-old. Even more tragically, John lost the youngest the following year and his other daughter the year after that, before dying himself in 1836. Out of the hundreds of families whose letters and diaries I’ve read, in only a handful did all the children outlive their parents.

Despite the virtual inevitability of such loss, parents struggled to accept their afflictions as divine will.[8] Hopped up on postpartum hormones, staring at a tiny being with a mixture of wonder and terror, I found myself fervently thankful that the American infant mortality rate in 2016 was about 0.6 percent, as compared to fifteen to twenty-five percent for free women in the late eighteenth century.[9] The hard-wired worry that nags modern new mothers must pale in comparison to the fears that plagued mothers in prior centuries.[10]

The empathy I felt for the privileged women I encountered in the archive was, and is, tempered by sympathy for the less-privileged mothers often elided in the archive. I identified with the physical and emotional experiences they described; I found myself angry, though not surprised, that well-off women failed to extend that empathy to women of lesser means. Wealthy white women dismissed pregnant servants, denying them of the wages they relied upon. Slaveholding women thought nothing of demanding that enslaved new mothers return to work within days while they themselves recuperated for weeks. This callousness surely contributed to enslaved infants’ higher mortality—up to fifty percent in the brutal labor conditions of the Caribbean. Enslaved women’s bodies might be further commoditized as wet nurses, compounding slaveholders’ exploitation of their reproductive abilities.[11] As Sasha Turner argues, the archive “obscures” and much previous scholarship “obfuscates” the suffering of enslaved mothers.[12] Who has access to quality pre- and post-natal care still reflects engrained inequalities on the basis of race and wealth; the African-American infant mortality rate in 2015 more than double that of whites.[13]

The early twenty-first century is witnessing a gradual shift in accepted best practices that harken back to older ways of giving birth and caring for infants. A small but growing minority of women is questioning why uncomplicated births and deliveries are treated as pathological.[14] My obstetrical practice incorporates midwives because their patients experience better outcomes with fewer interventions, in part because they employed a less rigid and time-bound approach. Doulas, as birth coaches or postpartum assistance, assume some of the functions assumed by friends, relatives, and neighbors. And social media has allowed new parents to overcome some of the isolation of caring for a newborn by seeking support and exchanging information that the local community previously provided.

As the circumstances surrounding birth continue to evolve, I wonder how much the shared experiences of pregnancy and birth will continue to transcend time. To what extent will historians of the future see themselves in this moment?

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[1] I was given this figure by in my birth class—this article provides a more detailed analysis: Mona Chabali, “Why Are Due Dates Usually So Wrong?”, New York Magazine, 3 March 2016, http://nymag.com/scienceofus/2016/03/why-are-due-dates-usually-so-wrong.html (accessed 30 June 2017). For a in-depth analysis of pregnancy statistics, see Emily Oster, Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong—and What You Really Need to Know (New York: Penguin Books, 2014).

[2] Catherine M. Scholten, “‘On the Importance of the Obstetrick Art’: Changing Customs of Childbirth in America, 1760 to 1825,” The William and Mary Quarterly, Vol. 34, No. 3 (Jul., 1977),426-445, quotation on 433.

[3] Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology (University of Georgia Press, 2017).

[4] Sources and methodologies for precise calculations vary. See Richard W. Wertz and Dorothy C. Wertz, Lying-in: A History of Childbirth in America (Yale University Press, 1989), 19-24; Deborah Kuhn McGregor, From Midwives to Medicine: The Birth of American Gynecology (Rutgers University Press, 1998), 37-38.

[5] Caitlin E. Haynes, “‘To Trust it to Another’s Hands—Another’s Love’: Deathbed Directives and Last Wishes of Elite Women in the Antebellum South,” The Southern Quarterly 53:1 (FALL 2015), 121-136.

[6] Georgina Amory Lowell to John Lowell, 7 May 1826, John Lowell Papers, Box 2, Massachusetts Historical Society.

[7] John Hartwell Cocke describes his wife’s illness and death in his Journal, November 26, 1816–January 1, 1817, and Nancy’s friend described his reaction to her husband in a letter: Polly Cabell to Joseph Cabell, December 29, 1816, both from the Cocke Family Papers, 1725-1931, Accession 640, etc., Special Collections Department, University of Virginia Library.

[8] See Lucia McMahon, ““So Truly Afflicting and Distressing to Me His Sorrowing Mother”: Expressions of Maternal Grief in Eighteenth-Century Philadelphia,” Journal of the Early Republic 32, no. 1 (2012): 27-60.

[9] “Infant Mortality,” Centers for Diseases Control and Prevention, https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm (accessed July 21, 2018); Susan E. Klepp, Revolutionary Conceptions: Women, Fertility, and Family Limitation in America, 1760-1820 (Chapel Hill: University of North Carolina Press, 2009), 292-293

[10] Adrienne Lafrance, “What Happens to a Woman’s Brain When She Becomes a Mother,” The Atlantic, 8 January 2015, https://www.theatlantic.com/health/archive/2015/01/what-happens-to-a-womans-brain-when-she-becomes-a-mother/384179/ (accessed July 20, 2018); Pam Belluck, “Pregnancy Changes the Brain in Ways That May Help Mothering,” The New York Times, 19 December 2016, https://www.nytimes.com/2016/12/19/health/pregnancy-brain-change.html (accessed July 20, 2018).

[11] Stephanie Jones-Rogers, “‘[S]he could … spare one ample breast for the profit of her owner’: white mothers and enslaved wet nurses’ invisible labor in American slave markets,” Slavery & Abolition, 38:2, 337-355

[12] Sasha Turner, “The nameless and the forgotten: maternal grief, sacred protection, and the archive of slavery,” Slavery & Abolition (2017), 38:2, 232-250,

[13] “Infant Mortality”; Cara Heuser and Chavi Eve Karkowsky, “Why Is U.S. Maternal Mortality So High?” Slate, 23 May 2017, http://www.slate.com/articles/health_and_science/medical_examiner/2017/05/medical_error_isn_t_to_blame_for_our_high_maternal_mortality_rate.html

[14] See, for example, Jennifer Block, Pushed: The Painful Truth About Childbirth and Modern Maternity Care (New York: De Capo Press, 2007).