In 1907, researchers Bernhardt Kronig and Carl Gauss combined the drugs morphine and scopolamine to induce twilight sleep in women during childbirth. Physicians in the early twentieth century in Germany used twilight sleep, Dammerschlaf, to cause women to enter a state of consciousness in which they felt no pain and did not remember giving birth. Twilight sleep was associated with increased use of forceps during delivery, prolonged labor, and increased risk of infant suffocation. Because of those disadvantages, physicians stopped using morphine and scopolamine to prevent pain during childbirth. Morphine and scopolamine were among the first anesthetics to be used during childbirth, and after physicians stopped using them, researchers searched for safer alternatives.

In 1987, the World Health Organization, or WHO, took action to improve the quality of maternal health around the world through the declaration of the Safe Motherhood Initiative, or the SMI, at an international conference concerning maternal mortality in Nairobi, Kenya. Initially, the SMI aimed to reduce the prevalence of maternal mortality around the world, as over 500,000 women died during pregnancy and childbirth annually at the time of its inception, while about 98 percent of those deaths occurred in low-income countries. While WHO led the initiative, many organizations in various countries participated in additional programs in order to implement the goals of the SMI. WHO developed the SMI in order to reduce the prevalence of maternal death, developing one of the first proposals that brought attention to maternal health on a global basis at a time when global maternal mortality was high.

Jesse Bennett, sometimes spelled Bennet, practiced medicine in the US during the late eighteenth century and performed one of the first successful cesarean operations, later called cesarean sections, in 1794. Following complications during his wife’s childbirth, Bennett made an incision through her lower abdomen and uterus to deliver their infant. Bennett’s biographers report that his operation was the first cesarean section where both the pregnant woman and the infant survived. Previously, physicians used cesarean sections to save the fetus from a pregnant woman who had already died during childbirth. Bennett successfully performed a cesarean section, a procedure used worldwide in the twenty-first century when a vaginal delivery is not possible or would pose a risk to the woman or fetus.

In 2010, the Catholic Church excommunicated Margaret McBride, a nun and ethics board member at St. Joseph’s Hospital and Medical Center in Phoenix, Arizona. McBride was excommunicated latae sententiae, or automatically, for approving a therapeutic abortion, which is an abortion that is required to save a pregnant woman’s life. McBride approved an abortion for a woman who was twenty-seven years old, eleven weeks pregnant with her fifth child, and suffered from pulmonary hypertension, a life-threatening condition during pregnancy. Following McBride’s decision, St. Joseph’s lost its affiliation with the Catholic Church, which it had maintained since the late 1800s. Affiliation with the Catholic Church required that the hospital abide by Canon Law, which is the law of the Catholic Church. Under Canon Law, abortion is serious wrongdoing that could result in excommunication, as it did in the case of McBride. McBride’s excommunication illustrated the impact that affiliation of Catholicism with hospitals had on patients’ ability to receive comprehensive reproductive health care.

In 2008, Barranca Productions released a documentary called The Business of Being Born, detailing the topic of childbirth. Ricki Lake and Abby Epstein produced and directed the documentary. The documentary explores pregnancy related healthcare in the US, including the history of midwives and obstetrics. The film also discusses potential consequences of medicalized childbirth common in the twenty-first century. The Business of Being Born provides viewers with information about home-births, midwives, and the positive and negative aspects of going to the hospital for childbirth.

In 1992, five maternal-infant health researchers founded Doulas of North America, later renamed DONA International to train certified birth attendants called doulas to provide care to pregnant women both before and after the birthing process. Annie Kennedy, John Kennell, Marshall Klaus, Phyllis Klaus, and Penny Simkin used the term doula, derived from the Greek word for woman servant, to describe a female birthing aide who provides non-medical emotional and physical support to laboring pregnant women. Eventually renamed DONA International, the organization has certified over 12,000 doulas as of 2017. Though the organization aims to provide a doula to everyone who wants one, there have been controversies surrounding the accessibility, affordability, and necessity of pregnant women using a doula before and after birth. DONA International is the largest doula-certifying program in the world and has created global awareness of the risks and benefits associated with using a doula during the birthing process.

Twilight Sleep (Dammerschlaf) was a form of childbirth first used in the early twentieth century in Germany in which drugs caused women in labor to enter a state of sleep prior to giving birth and awake from childbirth with no recollection of the procedure. Prior to the early twentieth century, childbirth was performed at home and women did not have anesthetics to alleviate the pain of childbirth. In 1906, obstetricians Bernhardt Kronig and Karl Gauss developed the twilight sleep method in 1906 to relieve the pain of childbirth using a combination of the drugs scopolamine and morphine. Twilight sleep contributed to changing childbirth from an at home process to a hospital procedure and increased the use of anesthetics in obstetrics.

In 1861, William John Little published, “On The Influence of Abnormal Parturition, Difficult Labors, Premature Birth, and Asphyxia Neonatorum, on the Mental and Physical Condition of the Child, Especially in Relation to Deformities,” hereafter “Abnormal Parturition,” in the Transactions of the Obstetrical Society of London. In the article, Little discussed the causes and types of what he refers to as abnormal births, and theorized how those births affect an infant’s likelihood of exhibiting a deformity. Little defined abnormal births as those involving an atypical maternal or fetal presentation, such as a slow birthing process or a fetus exiting the birth canal feet first rather than head first. In his article, Little published one of the first definitional frameworks to describe a condition causing rigidity and stiffness in the limbs that is often associated with birth-related trauma, which was then called Little’s disease, but is modernly known as spastic Cerebral Palsy.

William John Little was one of the first orthopedic surgeons to research congenital malformations and their causes in the nineteenth century and presented preliminary research on a condition modernly known as cerebral palsy, a condition of varying severity that affects a person’s ability to move. Little worked throughout the United Kingdom for the majority of the time he practiced medicine, and eventually founded one of the first orthopedic infirmaries, the Royal Orthopedic Hospital in London, England. Throughout his career, Little studied congenital malformations, which are medical conditions inherited before birth, as well as how certain medical circumstances during delivery affect the neonate. In 1861, he described a condition with motor, behavioral, and cognitive irregularities in neonates, linked with oxygen deprivation during birth. Little’s research on that condition, originally called Little’s disease, and modernly, spastic cerebral palsy, was one of the first accounts of cerebral palsy in infants.