The Birth of Prenatal Care (Spoiler Alert: There's More to Life than Literal Survival)

Did you know that prenatal care didn't even really exist until *sort of* the mid 1800's? And even then, there was no structure to it - it was all just sort of guessing. It's not really surprising given that you didn't even need medical training to claim to be a doctor (seriously, you could just say you're a doctor). Plus, we didn't have the transportation and systems we have now to get to medical care centers. Long story short: it was a mess. Most prenatal care was guess-based suggestions and care from other women in the community where you lived.

One thing us pregnant people did have going for us is that some dude in Europe in 1843 did have some lightbulbs going off about eclampsia and pre-eclampsia and they figured out a relationship between blood pressure and eclampsia. Around the same time, people began to figure out how to test blood and urine. The combination of blood pressure, urine and blood testing lead to deepening the understanding of prenatal care and intervention. It was sort of the jumping off point for prenatal care. 

Now, don't get me wrong, I'm so grateful for the evolution of prenatal care. But can we also leave some room for anger here? It literally took women and babies DYING for people to pay attention (for reference, erectile dysfunction had been studied as early as the 8th century BC - yes, you read that right). 

Anyway, back to my point: By the mid 1800's the US got a little more organized around medical care and formed the American Medical Association (so you actually had to do something to say you're a doctor) and specialty medicine wasn't far behind (think OB/GYN). In the early 1900's doctors began to advocate for prenatal care and began using X-Rays and pulse monitoring. But things really picked up in the teen years (as often happens) when nurses in Boston began prenatal home visiting because infant mortality rates were so high AND they figured out that at least 40% could be prevented with prenatal care. Once again, it took lots of infant death for people to start paying attention (don't worry, though - penile and testicular implants were a "thing" by now - they got right on that one). 

The 19-teen years sparked a lot of research that essentially revealed health disparities between Black women and white women and that more care during pregnancy reduced infant and maternal mortality rates. I know, shocking, right? Women's groups were also catching fire around this time so it was a good combo that ultimately pushed for prenatal and birth center funding across the country. This uptick in funding lead to more books being released about prenatal care as well as a variety of prenatal wellness visit markers (apx 12-14 prenatal visits).

By the mid 1900's births moved from happening in peoples' homes to medical centers and hospitals. This is really where we begin to see the medicalization of birth. The later 1900's continued to really refine research in prenatal care and spawned a lot of medical testing advances like testing HCG levels/pregnancy tests, ultrasounds and fetal heartbeat technologies. 

The 1980's was the first time we start to see dollar signs attached to birth. There was a push to focus on birth weight and prenatal care and how much money could be saved by attending to challenges prenatally - essentially it was cheaper to treat prenatally than postpartum. Part of me here is like, duhhh, but also are we just going to gloss over the fact that we aren't even talking about people's lives anymore? At least we used to say that too many people were dying, but now we're just talking about how much money we can save?

Unsurprisingly, by the late 80's the recommended schedule of prenatal visits dropped by nearly half from 12-14 down to 7-9. This really triggered the era of decisions being made based on money. Seriously. Doctors bawked at the reduction in prenatal care, but ultimately government decision makers pushed the reduction through. Over time, there was research that showed that more prenatal care didn't really improve birth outcomes, which is pretty much how we got to where we are now. Low risk situations get fewer prenatal visits and high risk situations get more. Makes sense, right? 

By now have you noticed anything missing? Not once in the history of pregnancy and birth is there any mention of parental mental health and wellness. While there is mention of socioeconomics and social welfare situations impacting birth outcomes, there is zero discussion about what happens to parents and babies after the baby is born. It's kind of like, cool we checked off that most people won't die and babies will be born at higher weights - done. 

It's no wonder the 2024 surgeon general's report noted that parents aren't ok. DUH. There is so much more to life than literally being alive. Obviously it's great that fewer people are dying (though we didn't solve health disparities by race AT ALL) and babies are being born healthier. But there is so much more life to live beyond literal survival. 

Let's fold in some prenatal care for parents so they can do more than simply survive the transition. We all deserve supported parents because supported parents means supported kids. So when did we lose the narrative about supporting parents? We didn't lose it - we never had it. 

Very long story short: Postpartum Mental Health Care begins Prenatally. It's time, folks. Let's go.