When we think about birth in a cultural context, it may initially appear to be outside of the language of patriarchal control. However, when further examined, the modern birth process exercises a considerable amount of control over the female body. Interestingly the comfort with the male-managed birth process occurs in a time where patriarchal control over the female body is being questioned. The pro-choice movement has attempted to stress female autonomy in regards to their own body. In the case of Roe Vs. Wade, US Supreme Court Justice Blackmum said, "The right of privacy...is broad enough to encompass a woman's decision whether or not to terminate her pregnancy. The detriment that the state would impose upon the pregnant woman by denying this choice altogether is apparent." An image advocating for a woman's right to choose shows a woman's bathroom sign icon with the words "my mind" over her head, "my body" over her chest, and "my choice" over her reproductive organs. In 2014, Jerry Brown, the governor of California signed into law SB 967, a bill that required "affirmative consent" for sexual activity on college campuses. Under this law, in order for sex to be consensual, the partners must have a verbal "yes" before engaging in sexual activity. While these issues are still certainly controversial, they are generating conversations and questions. 

Remarkably, birth does not seem to figure into these discussions; patriarchal control over the birth process has increased, rather than decreased since the 19th century. 

The rhetoric surrounding birth seems to suggest that there are many choices and options: you can choose whether or not you get an epidural, you can schedule a C-section, you can have a doula. However these choices are often limited or dictated by the institutions in which women give birth, the biases of practitioners, and the limitations of insurance. While the trajectory for female physical autonomy generally improves over time, in the case of birth, the evaluation is more complex. 

Advances in birth technology have certainly improved the birth experience in several ways. On one hand, these technological advances have helped women improve the outcomes of their births. The maternal and infant death rate is significantly lower now than in the 19th century. However, these same technologies put limitations on the level of autonomy women have over their bodies during birth. 

In the 19th century the large majority of births took place at home. The average 19th century woman gave birth to six children, not including stillbirths. Only female midwives attended these births; it was considered improper for men to be present. Midwives comforted women without interfering much with the physical birth process. Midwives were trained as apprentices, observing deliveries and noting how to deal with the physical complications that could arise. However midwives were largely unequipped to deal with complications, so if they arose, it usually resulted in the death of the infant or the mother. 

In 1847 the discovery of the pain relieving properties of chloroform and ether were discovered and subsequently used for mothers in labor. This started the shift toward the medicalization of birth. An issue of The Scalpel, a medical journal, published an article titled, “Ether and Chloroform: Their Effect in Six Cases of Childbirth.” Case four is described thus: “January 29, 1848. Ann, age 33, confined with her second child, was relieved of great distress by a few drops of chloroform after the head had entered the pelvic cavity. The temporary relief afforded by so small a quantity, was extended at the entreaty of the patient, by a more liberal administration. Succeeding insensibly produced no variation in the activity of the womb; the child was soon born; the placenta followed in five minutes; and in no case have I observed less sanguineous discharge result from delivery. The patient awoke from her apparent sleep, to express her thankfulness for the pain she had been spared.” In this case, the language suggests that Ann is not giving birth, rather birth is happening to her. With or without her consciousness, birth occurs. Reading this passage, it becomes clear that birth was no longer in a woman's hands, neither mother nor midwife. Rather, birth had become a medical event that was managed by men.

The tone of the language in this passage is also indicative of the religious tensions caused by the use of anesthetics during birth. The passage ends, “The patient awoke from her apparent sleep, to express her thankfulness for the pain she had been spared.” The patient's gratitude combined with the word "spared" evokes images of a sinner grateful for forgiveness. Women were believed to be destined to endure the pain of childbirth because of the “curse of eve", referred to in Genesis 3:16, “Unto the woman, he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children; and thy desire shall be to thy husband, and he shall rule over thee.” People were unsure if the use of anesthetic was sinful in its avoidance of God's will. Women were either deserving of the pain the endured, or blessed that they had been allowed to avoid it. 

Another controversy was brewing with the growing publicity of birth control. Women in the 19th century used a variety of methods that were largely ineffective. These included the man withdrawing his penis from the vagina before ejaculation, melting suppositories that were supposed to form a coating over the cervix, diaphragms, douching after intercourse, abortifacient pills, and the rhythm method. In 1839, Charles Goodyear created vulcanized rubber and began manufacturing condoms. However, condoms were designed to limit venereal disease rather than pregnancy.

Abortions were considered tremendously immoral, however abortions were significantly more common in the 19th century that once suspected. It is estimated that one in thirty pregnancies in 1840 were terminated. In 1873, US congress passed an anti-obscenity law that outlawed the dissemination of information about birth control. The issue had come to the forefront of the American consciousness because suffragettes had made it a public issue. They brought up the idea of “voluntary motherhood” where women would have the right to “choose [her] own mate, to determine the time of childbearing and to regulate strictly the number of offspring” (Sanger, Woman and the New Race). While technology and cultural attitudes about birth control and the woman’s body were changing immensely near the end of the 19th century, birth itself was becoming more medicalized. The field of obstetrics became something studied in medical schools. Male physicians became the authorities over women in labor rather than midwives, shifting from a matriarchal support system to a patriarchal one. Births were moved out of the home and into hospitals. In 1900, ninety percent of births were performed at home, but by 1950 ninety percent of births had shifted to hospitals. Interestingly, the maternal mortality rate was not significantly reduced until 1935, when antibiotics were introduced. 

The introduction of the epidural between 1960 and 1970 changed the birth process significantly. Women were able to be awake during birth without feeling pain. While the epidural clearly had positive effects, this innovation also limited female autonomy. Women had to give birth in a hospital if they wanted access to an epidural. Once the epidural was administered, this also limited a woman’s ability to move. 

Birth is currently seen as a medical emergency, not a natural event, which is not necessarily surprising because women are still dying during childbirth. In April of 2013, the St. Louis Post-Dispatch published an article with the title, “Why Are So Many US Women Dying During Childbirth.” The article reports that the maternal death rate is nearly double what it was 25 years ago at 15 deaths per 100,000 births. With about 700 women in the US dying every year during childbirth, it’s clear that public concern for pregnant women is not unwarranted. It is understandable that people would like to give birth in hospitals where they can be assured of timely medical care and expertise--fetal monitors, IVs, and surgical tools all nearby, just in case. But the hospital version of birth is not without flaws. In an effort to prevent the rare disasters that can accompany birth, staff can sometimes prescribe interventions that are not necessary and can even be harmful. 

Pitocin, a medication based on the hormone oxytocin, is used to start labor or increase the speed of labor. The injection of Pitocin stimulates the uterus causing very strong contractions. These contractions can be so strong that they can actually cause fetal distress. Epidural anesthesia is the most popular form of pain relief for laboring mothers. The epidural does have side effects, however. Most lactation consultants suggest that the epidural slows the ability of the baby to begin breastfeeding. The babies will take the nipple in their mouth and not begin to suck. It can take several days for breastfeeding to normalize (Klaus 95-96). Some women make it through the majority of labor and request the epidural right before they are about to deliver. The hospital will give her the epidural without telling her that it is unlikely the epidural will have time to take effect. This woman would have none of the benefits of the epidural, but would still likely endure the side effects. There are other issues that come with a hospital birth. The hospital as an institution needs to be efficient. Doctors will recommend Pitocin without necessity simply to speed up the labor process in order to make room for other patients. Hospitals also often confine laboring women to their beds. Women lay on their backs, reclined with their feet above them. This position requires women to push against gravity. Other birthing positions like squatting are much more effective, however women are not encouraged, or even allowed to try these positions in many hospitals. 

The later part of the twentieth century has seen a response to the lack of female autonomy in the birth process. Many women enroll in childbirth education classes to gain more control of the process. Other women have become increasingly more interested in the natural birth movement, returning to giving birth with midwives at home and without medical intervention. Advances in medical technology have made low-risk pregnancies more comfortable and allowed some high-risk pregnancies to be successful. C-sections, fetal monitoring, and IV medication have undoubtedly saved the lives of both mothers and babies. Advances have also allowed women who would not be capable of giving birth to do so. However, these advances have also stripped women of their autonomy during the birth process.