Birth Moves from the Home to the Hospital
In the 1890s, nearly 50% of all births were physician-attended, though the majority still occurred in women’s homes. Births in hospitals were mostly for homeless women or women who could not receive in-home assistance.
However, from 1900 to the 1930s, Hospitals began to increase in number and size, and the percentage of births in hospitals began to rise, though this varied widely by income and nationality of the mother.a In 1900, less than 5% of births occur in hospitals, and by 1930, 75% of births in various cities were in hospitals.
There are four main reasons the United States began to see a rise in hospital births and a decline in home births.
The first reason was the image of hospitals. Hospitals were seen as safe, comfortable, and clean as well as a place for the excitement of scientific advance. Many hospitals, such as the Boston Lying-In hospital, became adept in care for premature infants, for example. Hospitals were also seen as a place to rest. By 1918, the scarcity of domestic servants made the traditional lying-in period of rest virtually impossible, unless a family could afford domestic help. By 1920, American upper- and middle-class women began to accept the hospital as a consumer good,a and births at hospitals dramatically increased in numbers. b
The second reason hospital births began to rise was convenience. Doctors found hospitals more efficient than homes because they could centralize care and not need to travel from home to home. Hospitals also provided a regular supply of patients needed to train residents who were in medical education, and hospitals began to align with medical schools, such as the Boston Lying-In hospital moving to 221 Longwood Ave to provide training for Harvard Medical School students. In the 1840s, the American Medical Association stated that the hospital was indispensable in providing training for physicians.a
The third reason that the number of hospitals began to rise was that they offered a variety of services that couldn’t be as easily duplicated in the previous home arrangement. Nurses, social workers, and chaplains could take care of social care of patients, freeing doctors to use their skills more efficiently. Hospitals could also offer trained personnel and specialized facilities and services, such as X-rays and blood banks.
Finally, at the time, there was a widespread changing image of the home itself. In the 1920s, Women’s magazines made a crusade of making women feel embarrassed about germs at home. Advertising warned about the danger of the “household germ” and marketed cleaning products to women and the wider public. In 1932, Ladies Home Journal advertised products used by “hospital leaders” and marketed products “hospital-safe.”a
As a result, going to hospital meant not contaminating one’s home with soils of birth and not risking getting germs at home. Ladies Home Journal wrote that “motherhood is easier and safer due…to the modern hospital and great strides in obstetrics.” Other publications reinforced these ideas. The Atlantic, in 1939, argued that no one would consider having an appendectomy on their kitchen table, so a woman should deliver in the hospital because delivery was a “surgical procedure.” b
Birth in hospitals was very pricey for low and middle-income social classes. In the 1920s and 1930s, very few prepaid health plans existed, and birth was a largely out-of-pocket expense. b The cost of birth could range from $50-$300, b and a hospital birth could take approximately 25-35% of a middle-income man’s yearly salary. b Costs continued to rise as more specialists came on the scene and the costs of drugs and expensive equipment began to accelerate. b Around this same time, itemized billing began to take rise. b
The increase in the number of hospitals continued to gain steam well into the mid 20th century. In 1939, WWII led to a shortage of hospital personnel, which drastically shortened a woman’s hospital stay.
By 1950, nearly all urban births took place in a hospital.
a. Thomasson MA, Treber J. From Home to Hospital: The Evolution of Childbirth in the United States, 1927-1940 [Internet]. National Bureau of Economic Research; 2004 Nov [cited 2016 Mar 15]. Report No.: 10873. Available from: http://www.nber.org/papers/w10873
b. Wertz RW, Wertz DC. Lying-In: A History of Childbirth in America, Expanded Edition. New Haven: Yale University Press; 1989. 302 p.
c. 09 JMGSN, 2014. Tragedies to transplants, the history of Longwood – The Boston Globe [Internet]. BostonGlobe.com. [cited 2016 Mar 15]. Available from: https://www.bostonglobe.com/lifestyle/health-wellness/2014/11/09/tragedies-transplants-history-longwood/5I7WEMXXIcxUx2BbvaoVAN/story.html
d. Brigham and Women’s Hospital: Integrated Residency Program in Obstetrics and Gynecology [Internet]. [cited 2016 Mar 15]. Available from: http://www.partnersobgynres.org/aff-bwh.asp
e. Long T. Jan. 14, 1794: First Successful Cesarean in U.S. [Internet]. WIRED. 2011 [cited 2016 Mar 16]. Available from: http://www.wired.com/2011/01/0114caesarean-first-us/