Transitioning: The History of Childbirth in Puerto Rico, 1948-1990s.

Abstract

This dissertation documents and analyzes the dramatic transformations in birthing practices that accompanied broader economic, political and cultural shifts in Puerto Rico during the latter half of the twentieth century. Birthing changed from being a home-based event assisted by midwives to a hospital-based procedure, attended by medical experts, in fewer than 20 years. In 1950 the number of registered midwives was double that of registered doctors and they attended well over half of all deliveries. The Puerto Rican government grew after the 1950s and established itself as a colonial welfare system looking to uplift and remake itself following an industrial model, informed by rational, scientific planning, which ideally included even the most remote sectors of the island. These forces coalesced with the development of medical education, new medical technologies, significant improvements in the overall quality of life on the island, the urbanization of Puerto Rico, and a new faith in science, and moved labor and deliveries into the hospital while redefining childbirth and its practice altogether. I argue that as families ventured out of their more isolated, home-based daily lives to access basic needs, became active in public, urbanized spaces, and bought into a system based on colonial state panning, led by scientifically trained experts and organized by bureaucratic institutions, they also restructured their birthing practices. Midwives accepted these changes. They quietly stepped aside as the next generation delivered their babies in hospitals. Doctors came to hold the authoritative knowledge about the female body and its path towards birthing children and by the late 1970s midwifery disappeared. By the 1980s and 1990s, as a technocratic model of birth predominated obstetrics in Puerto Rico and cesarean rates skyrocketed, five newly trained midwives began delivering babies at home once again. The practice of these new midwives was the only birthing alternative to medicalized childbirth available to women on the island after the 1980s.