The year before last, while helping my mom clean out the old house in preparation for selling it after my dad passed away, I came across a book that had once belonged to my grandmother — Expectant Motherhood, by Nicholson J. Eastman M.D. (2nd edition), originally published in 1947. Basically the “what to expect when you’re expecting” of a few generations past. I was intrigued enough at the time to hang onto it, and found it again while cleaning out the soon-to-be nursery — and being pregnant right now, I couldn’t resist cracking open the yellowed volume and reading through to see how much things have changed.
Granted, I’m no doctor or expert of any kind, but I think anyone who has been pregnant, experienced prenatal care, or given birth in recent years will have at least a vague idea of the state of modern obstetrics — enough to recognize some of the glaring differences between now and 1947. Reading through this book was fascinating, and sometimes funny, and sometimes a little scary — and so for today’s post, I wanted to share some of the more interesting tidbits.
To kick things off, here’s a little gem from the preface:
“During the six years which have elapsed since the first edition of Expectant Motherhood appeared, important changes have taken place in obstetrics as in the rest of the world. Most outstanding of these has been the increase in the number of expectant mothers. As the result of several factors associated with World War II, our birth rate in recent years has soared; physicians find their maternity work doubled or trebled; and hospitals everywhere are experiencing difficulty in accommodating the many obstetrical patients seeking care.”
How’s that for a sign of the times? An obstetrician remarking on the beginning of the post-World War II “baby boom” as it was happening.
On Diagnosing Pregnancy:
It’s easy to take modern home pregnancy tests for granted. Ninety-nine percent accurate within days of a missed period! Available at every grocery store! But the technology behind these wasn’t invented until the 1970’s (according to Wikipedia). Based on this book, the most common techniques for diagnosing pregnancy in the 1940’s seemed to rely on “physician’s observations” such as breast changes, fetal heart sounds, fetal movements, and pelvic examination. But there were a couple of higher-tech scientific methods and “laboratory tests” that really surprised me. Here is the passage describing these:
“Today, thanks to the studies of two German doctors, we have at last a sound and trustworthy test for pregnancy and interestingly enough it is performed on urine. In carrying out the test a small quantity of morning urine is injected into a mouse or rabbit. If the urine comes from a pregnant woman, definite and characteristic changes are produced in the ovaries of the animal within forty-eight or seventy-two hours; if the person is not pregnant no alterations whatsoever occur. This test is accurate in about 95 per cent of cases and in the presence of pregnancy will yield a positive reaction two weeks after the first missed menstrual period, sometimes earlier. It is expensive, however, quite unnecessary in most cases, and is generally performed only when the physician finds some medical reason for haste in making the diagnosis.”
So in other words, they would inject urine into a female mouse or rabbit, kill the animal, dissect it, and then inspect its ovaries, since apparently the same hormones detected by modern pregnancy tests will produce changes if injected into those animals. But the book also described a newer, better test that didn’t require killing any animals:
“During recent years a similar test which makes use of the South African toad as the test animal has gained wide popularity. Within eight to eighteen hours after the urine of a pregnant woman has been injected into female toads of this variety, myriads of eggs are extruded which can be plainly seen on the floor of the aquarium in which the toads are kept. This test is often loosely referred to as the “frog test.”
I have to admit, having never heard of this before, I actually had to look it up to make sure it was true. Interestingly enough, I came across an article about how harvesting these frogs for pregnancy testing apparently introduced a deadly fungus that’s been responsible the extinction of four frog species and “mass killings of frogs worldwide.”
As if laboratory tests on frogs and rabbits weren’t strange enough, I was pretty surprised that X-rays were also considered a method of diagnosing pregnancy. Though I guess it was the only way of being able to “see” the baby at the time, as ultrasounds didn’t exist yet and wouldn’t be invented until the 1960’s (again according to Wikipedia). Here is what the book had to say about this:
“X-Ray Diagnosis. – The skeleton of the growing baby is usually demonstrable in X-ray pictures of the mother’s abdomen from the beginning of the fifth month and when thus seen is, of course, absolute proof of pregnancy. Visualization of the infant is rarely possible before the middle of the fourth month (fourteen weeks); since by this time other types of evidence are usually conclusive, the X-ray is little used in the diagnosis of pregnancy.”
In modern times, abdominal X-rays during pregnancy are considered risky, and according to this article from the FDA only seem to only be done if necessary to diagnose some condition in the mother. I was curious about what this would even look like, though, and came across this image of an X-ray showing the baby’s skeleton:
There’s something kind of unsettling about seeing the baby’s skeleton superimposed over the mother’s like that, and it’s definitely not something you see every day. The chapter concluded with this bit about the uncertainty and time needed to diagnose pregnancy:
“Unless the mouse, rabbit, or frog test is used, the physician is unable, as a rule, to make a clear-cut diagnosis until after the second missed period and in some cases it is impossible until after the third missed period. Absolute proof of pregnancy, if you are skeptical of these “probable diagnoses,” must await the fifth month when the baby’s heart sounds become audible, when its movements begin to be palpable by the physician, and when its bony structure is demonstrable by the X-ray.”
From a modern perspective of home pregnancy tests and ultrasounds as early as 6 or 7 weeks, it’s hard to imagine having to wait that long to know for sure if you’re pregnant or not.
On Determining The Gender:
Not surprisingly, without ultrasounds, there was no way to know ahead of time whether you were having a boy or a girl:
“Although many attempts have been made to influence Nature’s roulette wheel of sex, no success has been met. Nor can a physician predict with any degree of assurance, even late in pregnancy, whether the baby will be a girl or a boy. To be sure, there are ways and means by which he may speculate, but this amounts to little more than guessing, with even chances of being right.”
Thanks to a modern DNA-screening blood test, this time around we were able to find out whether we were having a boy or a girl at around 14 weeks — and it’s a little crazy to think about how in the 1940’s, you’d be lucky to even know for certain if you were pregnant by then.
On Maternity Wear (And Maternity Corsets?)
There was an entire section discussing clothing, and I was left with the impression that the attitude toward the pregnant body in the 1940’s was a bit different than it is today:
“As the appearance of many expectant mothers attests, it is possible to look as attractive at this time as at any other. To be sure, the abdominal rotundity is a handicap, but, for some reason, during the middle months of pregnancy women develop a special radiance which is most becoming and tends to offset this.”
It’s funny how today women shamelessly post baby bump pictures on blogs and Facebook, and generally don’t seem all that concerned with whether they look visibly pregnant or not. (Heck, when it comes to maternity clothing I actually prefer tops that accent the belly in a way that says “I’m pregnant, not just flabby.”) But it seems like the tendency in the 1940’s was to try to disguise the pregnancy with maternity dresses that “resemble an optical illusion in their ability to beguile the eye in regard to your real contour.”
Taking it a step further, there were apparently maternity corsets. I wasn’t even aware maternity corsets were a thing before reading this book.
“In choosing a maternity corset, several considerations should be borne in mind. Since it should be put on lying down, a type with hooks or a zipper in front is most convenient. In the lying posture the uterus naturally falls backward into its most inconspicuous and natural position and if the corset is applied under these circumstances, the support it gives is not only greater but is more evenly distributed.”
I wanted to find out more about these maternity corsets, and upon searching around I came across this fascinating blog post showcasing pages from a Lane Bryant maternity catalog from 1945 — here are tiny-sized previews of a couple of the pages shown, including one of an “adjustable maternity girdle”:
The page full of shoes on the right seems to be right in line with what the book had to say about shoes during pregnancy — mainly that high heels should be avoided, and recommending “a heel in the neighborhood of one and a half inches high.” After having spent pretty much this entire pregnancy in sneakers and flip-flops, I can’t say I’d be too keen about wearing any kind of heel at all.
On Diet During Pregnancy:
Today, it seems like there’s an endless list of foods pregnant women should avoid — from seafood to caffeine to cold lunchmeat to soft cheeses — but the “Foods to Avoid” section of this book really only had two things on it: (1) “any article of diet which you know disagrees with you,” and (2) excessive salt. From there, it just goes through all the food groups discussing why each is important during pregnancy.
Interestingly, butter was considered a whole food group back in the 1940’s:
At least they recognized it as the least important of the “essential” foods, and how it could be fattening? Although on that note, the food group divisions of the 1940’s didn’t make that much sense to me in general, at least compared to the modern food pyramid (or food plate or whatever the preferred illustration is now) — in addition to the butter thing, it seemed like they divided fruits and vegetables up in a pretty weird and arbitrary way. Here is a glimpse of the whole “food wheel” from the 1940’s:
That food wheel illustration wasn’t actually included in the book, I just found it while searching around online. But the book did include this helpful illustration of a measuring cup in case anyone was confused about what one looked like:
I have to say I was a little puzzled by this one — the book didn’t have a ton of illustrations, so of all the things they could have shown in a book about pregnancy, this seemed like it should have been toward the bottom of the priority list.
Here is what they had to say about smoking during pregnancy in the 1940’s:
Smoking. – A few years ago, Dr. Alexander M. Campbell of Grand Rapids, Michigan, sent a questionnaire to leading obstetricians in the United States asking the question: In your opinion does the smoking and inhalation of twenty-five or more cigarettes daily have an unfavorable effect on maternal health? Seventy-five replies were returned. Sixty-three, or 84 per cent, answered the question with “yes.” Two, or 2.6 per cent, answered the question with “no.” The ten others, that is 13.3 per cent, made replies which indicated some uncertainty. A number of the obstetricians who answered “yes” qualified their replies by saying that moderate smoking is harmless.
While most obstetrical authorities, then, disapprove of excessive smoking in pregnancy (twenty-five or more cigarettes daily), there is no reason for believing that a woman who smokes moderately, let us say ten cigarettes or less a day, need change her custom at this time. If you have been used to smoking considerably more than this for several years, by no means try to give them up in pregnancy. There is no surer way of upsetting the nerves at a period when you should be calm and happy, or of converting a placid, sweet-tempered girl into an intolerable shrew. With negligible effort, even the most inveterate smoker can usually be content with a package a day or somewhat less, and if you arrange this there is no great cause for concern.
With all the Surgeon General warnings about birth defects, I can’t imagine anyone, let alone a doctor, giving this kind of advice today. (Smoking during pregnancy is totally cool as long as it’s only a pack or so per day! And whatever you do, don’t try to quit while pregnant, it will just turn you into an intolerable shrew!)
On Home Birth vs. Hospital Birth:
In this day and age, virtually everyone in the United States will end up giving birth in a hospital, and home births are very uncommon (something like 1%). The relative safety of home birth vs. hospital birth is a subject that has sparked much online debate in recent years, and the expert / scientific consensus today seems to be that giving birth at home is significantly riskier than giving birth in the hospital. But here is what they had to say about it in the 1940’s:
Home versus Hospital Delivery. – Of the two and a half million babies born in the United States every year, about one quarter are still delivered in their own homes. The percentage of births occurring in hospitals varies greatly in different parts of the country, ranging from 10 per cent in certain states which are predominantly rural to more than 90 per cent in large metropolitan centers. The vast majority of maternity cases can be conducted at home with complete safety and a large number of women prefer to have their babies in the familiar surroundings of their own household. Moreover, with the help of a competent nurse, suitable supplies and a little ingenuity, home delivery can be carried out in such a way that the facilities of the hospital are not greatly missed.
If you are planning to be confined at home, it is important to review with your doctor, before the sixth month of pregnancy, the specific supplies he expects you to have in readiness. Some physicians are accustomed to bring such complete kits to the home that very little is left for the expectant mother to prepare; the majority, however, prefer that certain articles, especially the more bulky ones, be procured by the patient. Since doctors pursue different practices in this matter, it is advisable to secure detailed instructions from your own physician rather than to follow any list made for general use.
Those two paragraphs are about all it has to say on the subject, and the rest of the chapter focuses mainly on giving birth in the hospital. It’s interesting how different the attitude was back then, although I imagine a lot of that has to do with the fact that a lot of the potentially life-saving technology found in modern labor and delivery wards hadn’t been invented yet.
I also thought it was interesting that they talked about doctors attending home births, since I’m not sure there’s any such thing as an obstetrician who will do home deliveries anymore — from what I understand, home births in the U.S. today are only attended by midwives.
In the U.S. today, the C-section rate is something like 32%, but here’s what it looked like in 1947:
“During the past quarter of a century the incidence of cesarean section in this country has increased more than fivefold and today approximately one American baby in fifty is delivered by this means. So common has the operation become that a number of women have gained the impression that this is the easiest way of having a baby and even ask the doctor if it is not possible for them to be delivered in this fashion.”
Interesting how the C-section rate was 2% and this was considered very common at the time!
On Pain Relief In Labor:
There was an entire chapter entitled “Painless Childbirth” which discussed the various pain relief options that were available in the 1940’s. The most common of these seemed to be morphine and the infamous Twilight Sleep, which was described as follows:
“Twilight Sleep. – By “Twilight Sleep” is meant a regime in which morphine is combined with scopolamine, a drug which obliterates memory of whatever events occur when under its influence. Its aim is not so much actual pain relief as forgetfulness, or amnesia (Greek for “without memory”). Thus, a woman under Twilight Sleep may shriek, make grimaces and show other evidences of pain, but upon awakening from the drug will remember nothing about her labor and will vow that she experienced no pain whatsoever.”
As someone who experienced the magic of a modern epidural — which resulted in both a 100% pain-free delivery and a crystal-clear memory of the moment our daughter entered the world — this pain relief method sounds outright horrifying.
Although speaking of epidurals, these were actually already being developed when this book was published, and it devotes a couple of paragraphs to this “continuous caudal anesthesia” method:
“When this continuous caudal anesthesia was first introduced in 1942 it was received with wide acclaim by popular magazines and everyone hoped it was the long-sought, ideal method of eliminating pain in every labor. Time and experience have shown, however, that these early hopes were not justified and that it is suitable and efficacious only in certain cases; and then it has its drawbacks as well as its advantages.”
Today I’m pretty sure epidurals are considered the safest and most effective method of pain relief during labor and childbirth, so it’s kind of interesting that they got off to such a rocky start as to warrant pessimistic descriptions like this one.
There were a few other odd things that struck me as I was reading through this book, and since they didn’t necessarily fit into any one section, I figured I would just collect them in a list here:
- The word “confinement” to refer to delivery / childbirth
- Offhand use of terminology that would be considered horribly inappropriate and offensive today, like “the white race” and “negroes”
- References to things like a “5-cent chocolate bar”
- Obstetricians invariably referred to as “he”
Maybe because of that last one, the book came across as vaguely paternalistic and condescending in a lot of places, which was a bit off-putting — especially since we’re getting to a place in modern times where the majority of obstetricians are women.
But anyway, this post ended up being much longer than I originally intended, so I’ll wrap it up here. I hope you enjoyed this glimpse back into a bygone era of obstetrics and pregnancy advice — was there anything you found particularly surprising or interesting? Any interesting historical tidbits you’ve heard that didn’t make it into this post? Feel free to share in the comments, or to pass this along to any modern (or modern-ish) moms who might find all this stuff as interesting as I did!