Coming across these photos I took in the late 80's, I nodded, totally remembering every minute of my time in the Frankfurt Army Regional Medical Center (FARMC -no longer in existence). I'd gone to a few births before moving to Frankfurt, but once I was there, I had a steady stream of women invite me to their births. I've said, for years, that I was a doula long before there was the word doula, but I came across Sarah's birth plan that we'd worked on (1986) and on the top is the word "doula" with a ? next to it. I was as surprised as anyone! I called myself a Birth Assistant back then. Oh, probably Labor Assistant -until someone asked me if I was a Union Organizer; then I changed it to birth.
So, here are some of the photos with short thoughts or stories that go with them. Ask questions. I hope you enjoy the history lesson.
I lived really close to FARMC and some of the women lived far in the outlying areas. Instead of hanging out in early labor at the hospital (where, if they were full, the women would be shipped out to a German hospital), they'd come to my house. I fed them, put them in the tub and tucked them into bed to nap. We also walked a lot. My kids got very used to seeing women in labor and were understanding enough, even though they were all under 5, to stay out of the mamas' way so they could labor without screaming kids.
Above is one client in labor with a previous client helping her as well. I smile looking at these, how hard I worked (and how successful I was!) in keeping women out of bed while they labored... both in my home and in the hospital.
The CNMs at FARMC were wonderful. They gave me chux pads to keep at home for the laboring women. Most of the moms who came to my house were my own clients, but I got a few calls from the nurses asking me to take someone in who lived 100km out. I gladly took anyone in.
This mama, not having fun in labor, is wrapped in a family heirloom. I love this photo.
You know how hard it can be to keep women out of bed nowadays in the hospital? It was just as difficult then, too. But, as long as I hung out with the women, they were permitted off the monitor for a couple of hours at a time. (There wasn't the 20-minutes-out-of-every-hour thing there is now.) I walked all over that huge hospital with those women! This is in the waiting room right inside the hospital doors of the old OB area.
During this time period, women labored in one room, delivered in another, recovered in another and then were in still another for the postpartum hospital period. When I first started at FARMC, women labored two to a room with a curtain separating the women. It seems astounding now to imagine two women in the same room, but we didn't even bat an eye about it. I remember one birth in particular when my client was zooming through her labor and the woman on the other side of the curtain had been laboring for over 24 hours... and was signing papers to have a cesarean. That poor woman cried with every contraction -hers and my client's. I was so glad when she was finally wheeled out, but the empty bed was quickly filled with another mom in early labor. She was scared to death hearing my woman in transition. Nothing like doula-ing for two women, explaining and comforting the stranger while supporting and breathing with my own client.
There was no such thing as an epidural for labor back then. I've heard some women say in their area it was, but it wasn't in Florida, Frankfurt or San Diego when I was in those areas in the late 80's. Because there was no epidural, women coped. It was hard and they worked with all of their beings, but they did it... all without being numb from the waist down. I never heard anyone ever say they wished they could be numb. The most anyone got was Demerol.
Oh, but there were paracervical and pudendal blocks. Both of these are considered localized anesthesia, the paracervical done during labor and the pudendal either in anticipation of an episiotomy or immediately after the birth to repair the episiotomy. I haven't seen either method used in at least 15 years.
When women didn't want to walk around, I'd drag a chair in and plop them in it. Anywhere but the bed. It's kind of amusing now, thinking how focused I was on keeping women out of the bed. To me, The Bed represented malpresentation, stagnation and a lot more pain.
A side note. We rarely saw posterior babies back in these old days. It was very rare that a mom had one and I cannot remember one woman having a cesarean for a persistent posterior baby. I wasn't attended births for a five-year period in the mid-90's and when I came back, it seemed every other woman had a posterior baby. The cesarean rate skyrocketed in that time, too, and I heard of so many women having one for the posterior kidlet that just couldn't turn. For awhile, I was baffled and then another midwife explained that in those five years, recliners in living rooms became commonplace and everyone started driving SUVs. It made perfect sense that as a woman leaned back in her comfy chair, the heavy part of the baby's head was going to swirl around to the back of the pelvis. Our bodies are meant to be upright and/or forward... picture gardening, cooking on the ground, walking to the river to get water... all activities we've done for eons. And suddenly, within a five-year period, the sedentary life consumed pregnant women.
She's still out of the bed. And leaning forward.
These women all had running IVs... hep(arin) locks weren't really an option unless you were a nurse or doc having a baby. (Today, they are saline locks instead of hep locks.)
This mom is pushing in the Delivery Room on her labor bed. Once the baby is crowning, she will scoot over to the delivery table.
This is the same mom on the delivery table after the birth. The CNM is in the gold scrubs. A Labor and Delivery Room back then would be the equivalent of an Operating Room; it was set up to do both if needed. Notice all the stock in the room! Precious space being taken up. Also, notice the midwife doesn't have gloves on. Of all things, that's probably the freakiest for me to see... how we rarely wore gloves.
This is the standard delivery set-up of the day. Mom's feet are in foot pedals ("stirrups" were replaced with these, but they aren't much better). Mom is on her back inbetween contractions and lifted by her partner to push during them. Notice the abundant drapes! Women were draped from top to bottom, leaving (barely) the vulva in view. The midwife at the bottom of the table has broken two rules: she's allowed the mom's leg to be seen and she doesn't have her face mask on. You can see the face mask around her neck. The dad is also not wearing a face mask; that was very rare and would only have happened with a CNM in attendance.
This (above) is how doctor-attended births looked. Everyone, even dad, in masks, the mom completely covered and her on her back. It's a sad picture to me. Mom isn't even looking at her baby. Babies were never put on mom's bellies. There was the beginning of the request to allow the cord to stop pulsating, but it was pretty much ignored (as it is today). The baby's head is born, the mouth and nose suctioned like mad, the baby born, the cord cut, the baby handed off (to the nurse on the right... who is not wearing gloves!!)
Across the room, the baby is wrapped, shown to mom and then taken to the Newborn Nursery where it was, in this hospital, SOP to "observe" the baby for a minimum of eight hours. Babies routinely were given bottles, or if mom said no bottles, then glucose water (in a bottle) was given. It's amazing any of us were able to successfully nurse.
Another part of what makes me sad in this picture is the cavalier way the nurse is standing there waiting for the baby. Almost like she's bored. The dad, at least, is taking some interest in the baby as a human being.
In a rare moment (which is, undoubtedly, why I took the picture), the dad was handed the baby. Note all of the nurses are not wearing gloves. Eek! There is a nurse crumpling a chux pad and she doesn't have gloves on, either. Hard to believe there was a time before HIV/AIDS, but there was. Someone pointed out the scrub dress. Those have gone bye bye... as have cloth scrub gowns. They were the best bathrobes, those scrub gowns.
Another very sad image... not that I saw it as such back then. This is another midwife (no mask) and she's suctioning the wincing baby. Mom's hands are reaching for her baby. They will not be filled.
One last photo.
A CNM had her husband construct this wedge so women didn't have to birth in the lithotomy position. I'd never seen anything like this -and still have not. I thought it was a wonderful gift to women pushing everywhere, to not have to be on their backs or have their necks nearly rupture from being pushed forward. I begged for the wedge for my clients. This was the only time a mom got to use it.
It's always good to peek back if we can... to see how things have changed and, sadly, how they haven't changed at all. It's been 23 years and we still have so, so far to go.