In 1915, in a coastal quarry town in Scotland, my great grandmother Catherine practiced as a well-respected midwife. When it came to the birth of a child, Catherine’s Mothers-to-be would have done what their Mothers and Grandmothers had done. They would seek out people they knew and trusted and had probably known all their lives. A midwife’s qualifications were typically based on experience, trust and reputation in the community she served.
Catherine was well-respected and would have delivered hundreds of babies in the region over her career. Yet sadly, many women of the age were not as well-cared for as Catherine’s Mothers.
In 1915, women and newborns in the UK were dying from childbirth complications at an alarming rate. (The principal culprit being ‘childbed fever”, brought about by poor hygiene causing sepsis after the birth.) This concerned many government officials, who, in the midst of a World War, fretted over whether current birthrates would be high enough to support the population of the future. The health of Mothers soon became a topic of national attention and security.
As a result, in 1915, the Scottish Midwives Act was passed. The Act made it illegal for a midwife to charge for attending a birth without a formal qualification from one of a handful of approved institutions in the United Kingdom. It sought to ensure access to formally trained midwives for all women and thereby reduce the chances of inexperienced individuals threatening the health of Scottish mothers and their infants. (The Act was preceded by the 1902 Midwives Act in England, an act with similar reformist aims. )
Thanks to the professionalisation of the practice of midwifery, antibiotics and developments in obstetrics, hygiene in the birth arena became job one. The safeguarding of a woman’s health in childbearing became something that Mothers and their families could begin to rely upon with as much assurance as the timeless ‘folkways’ of child-rearing that would help shape their children’s futures.
The future seemed bright. Post-war, the world could now look forward to healthy mothers, healthy babies and healthy families.
Fast forward to today. At the time of writing this article, it is (historically speaking) a very healthy time to give birth to a child. The World Health Organisation reports a worldwide reduction in maternal deaths from 523,000 in 1990 to 303,000 in 2015. Yet given the World Health Organisation’s definition of health as ‘A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity', is it reasonable to say that Mothers are afforded as optimistic an outlook with regards to their emotional and societal well-being as they are their physical health?
By expanding the traditional view of maternal well-being from a healthy body giving birth to a healthy child to include aspects of her inner world and the wider social world she inhabits, the acceptance that Motherhood is a presumably ‘healthy’ endeavour in the twenty-first century is arguably less assured.
Long after a new baby is delivered into our gleaming age, it appears that Mothers continue to remain emotionally and socially vulnerable. Pregnancy, childbirth and new Motherhood are widely reported to be accompanied by intense emotion, swift changes in identity, and extreme demands placed on physical and psychological resources.
New Mothers typically manage the transition to parenthood without significant or long-term impact on their well-being yet up to 30-75% of new Mothers experience some form of the “baby blues” ( a milder form of post-natal depression) in the first week after birth. In some instances (up to 20%) women develop clinical mental health disorders that require treatment.
One could argue that, while ‘life’ is a reliable expectation for mother and baby today in the developed world, the need for an otherwise healthy new Mother to adjust physically, emotionally and spiritually has somehow lost its way.
Paradoxically, while most of us live materially better than our great-grandparents could have imagined, in some key ways, we are less well as a result. Modern affluence has a price: Obesity, diabetes, addiction, anxiety and depression being some of the principal outcomes of societal progress.
A mother in the English-speaking world today will live a very different experience than she would have in 1915. She can vote. Own a credit card. Attend a university. Surf the web. If she has a measure of disposable income, she has choices on almost everything she comes into contact with. And with choices come the three horsemen of modern wealth (psychologically speaking): Anxiety (Have I chosen correctly? Was there a better option? Did I miss out?) Upward Comparison (Does someone have more than me?) And Judgment (What will people think of my decision? And what do I think about other people’s?)
Mothers living in less affluent communities can suffer from the opposite concern - the challenges that have always come from a lack of enough options. In the United States, Mothers in lower income communities can have little to no access to adequate schools, jobs, food, and community health resources. In neighbourhoods where violence and poverty are commonplace, mothers have a dramatically higher rate of post-traumatic stress disorder and depression than do the general population.
One overlap that spans the economic strata of American Mothers for example, is the need to balance employment and Motherhood. It is biologically typical to have a baby, and, in the Unites States, with over three-quarters of American mothers in employment, it is also typical for a Mother to work. Yet the United States is the only developed country in the world with no legally mandated parental leave policy for new mothers. Women have babies. Women work. Yet lagging laws mean the burden falls entirely on the mother to figure out how to make this happen. Working American mothers are the most ‘time-poor” members of the population. In an unsustainable crunch, burnout, illness and depression are rarely far behind.
One hundred years ago, it seemed like society fixed one motherhood problem very well. Mothers were dying in childbirth and we hit the challenge head on with better hygiene. Yet is the battle for maternal health really over? Today, we seem to have a different problem. Mothers are suffering emotionally. Everywhere. Physical hygiene in the delivery setting may be job one (on day one) - but what about ensuring emotional hygiene for a woman as she ventures forth from the hospital bed and adapts to her new role? What happens when day one turns into day 30? And beyond that?
Most new Mothers are educated on how to care for their bodies after birth. But how many are taught to care for their minds? Do we feel as comfortable talking about our loneliness, anxiety or fragility as we do about our sleepless nights? Do we know how to recognise what will nourish the part of Motherhood that no one can see - the one that goes on in our heads? Do we know how to build a supportive environment? Are we equipped to see risks to our emotional well-being, and strengthen our resources for fixing them?
For if a mother’s mind isn’t well - how can she be what she must be for the people who depend on her?
It is difficult to say whether Mothers today are more likely to feel overwhelmed, isolated, depressed or anxious than our ancestors because historical records of maternal mental health were not well kept, and even today, true numbers can be vastly under-reported due the the stigma attached to challenges fought in the mind.
Yet a casual observation of our own experiences and those of our sisters leads us to feel uneasy with the way the modern world is shaping up. We wonder how likely the world’s economic progression is poised to deplete, instead of sustain, its Mothers.
Read part two of this article here.
Hong, S. & Burnett-Zeigler, I. J. Racial and Ethnic Health Disparities (2016). doi:10.1007/s40615-016-0311-3
Schulte, B. (2014) Overwhelmed: Work, Love and Play When No One Has The Time. Sarah Chrichton Books. Farrar, Strauss and Giroux, New York.
Figes, K. (1996) Life After Birth. Virago. London.