The Island of Alternatives: Power, Medical Science, and “Gentle Birthing” in Socialist Czechoslovakia

The Island of Alternatives: Power, Medical Science, and “Gentle Birthing” in Socialist... Abstract Beginning in the early 1980s, medical experts and birthing women increasingly voiced criticism of what had long been the technocratic, depersonalized nature of obstetric treatment in Czechoslovakia, despite the limited opportunities for them to do so publicly. A few maternity hospitals responded to the complaints by introducing radically different regimens of care. This article examines the history of one reformist project that took place in the small town of Ostrov nad Ohří. Ostrov means “island” in Czech and, during the last decade of Communist rule in Czechoslovakia, the Ostrov hospital became an island of alternative obstetric care, embracing Leboyer’s method of “gentle birthing,” acupuncture, fathers in delivery rooms, and assorted technological innovations that aimed to spark fundamental change in familial and social relationships, and humanize childbirth. While many medical professionals decried these reforms as nonsensical and dangerous, a number of parents-to-be flocked to Ostrov to give birth, circumventing the official rules mandating that they receive healthcare in their area of residence. This proactive consumerist behavior among expectant parents, in tandem with the call of some physicians for more attention to individual and family needs, despite the opposing official political discourse, is evidence of a grassroots movement for market-oriented principles in healthcare that reflected broader societal change during the last decade of the Communist regime. Maternity hospitals were not particularly homey, friendly places in socialist Czechoslovakia. In the 1950s, when most births moved to hospitals, care was highly depersonalized, resembling a factory assembly line.1 Providers focused primarily on the technical aspects of care and neglected to give birthing women emotional support.2 Nurses were known for their carelessness and indifference, occasionally scolding women for being noisy and demanding.3 Although criticism of these practices surfaced periodically in the pages of a major obstetrical journal,4 not much changed during the communist era. In the 1980s, most maternity hospitals still had multi-bed labor rooms, and delivery rooms often hosted several birthing women separated from each other by a mere screen. Most women understandably complained about a lack of privacy.5 Women had little voice in their care; under the command of an obstetrician or an obstetrical nurse, they received analgesics and oxytocin, and gave birth on their backs with their legs in stirrups.6 Immediately after birth, a nurse washed the baby from head to toe, measured him, weighed him, and put antibiotic drops in his eyes. Then the nurse swaddled the baby and held him up for his mother to see. Doctors interpreted a newborn’s cries during those rituals as a sign of his vitality.7 A mother did not spend any time with her newborn until eight hours later, when a pediatric nurse brought the baby in for his first 20-30 minute breastfeeding. Hospitals required new mothers to wear face masks while breastfeeding under the dubious theory that mothers were a primary source of infection.8 Babies were breastfed in three-hour intervals, six times a day. If they awoke at night, nurses sometimes fed them tea. The nurses performed all newborn care; infants’ mothers were not even permitted to unwrap their babies’ swaddling. Mothers left the hospital five to eight days after giving birth, never having seen their babies’ bodies and often wholly ignorant of appropriate infant care.9 No visitors, not even fathers, were permitted in the maternity ward. Instead, fathers competed for a phone at the hospital reception desk to get in touch with their wives; the less fortunate had to be content with standing in front of a hospital window and waving. Some hospitals built a small hatch between the postpartum ward and the hospital corridor so visitors could take a look at a new baby through a window as his mother held him up to see during visiting hours.10 Beginning in the early 1980s, medical experts, as well as birthing women and their partners, voiced increasing criticism of this sort of treatment despite limited venues to express their grievances publicly. In response, a few maternity hospitals introduced radically different regimens of care. These hospitals constituted isolated “islands of alternatives” within the larger system.11 Most notably, several midwives resurrected the psychoprophylactic method of painless childbirth,12 a system developed decades earlier in the Soviet Union that eventually became known as Lamaze in the United States.13 The psychoprophylatic method necessitated innovative childbirth education classes that furthered interest in an array of birth alternatives. A few obstetricians in some parts of the country also experimented with allowing fathers in delivery rooms and implementing a rooming-in arrangement in order to strengthen the mother-newborn bond. In this article, I examine the history of one reformist project—in a small maternity hospital in Ostrov nad Ohří—that represented a unique paradigmatic case.14Ostrov means “island” in Czech and the hospital, located near the German border, became an island of alternative obstetric care during the last decade of Communist rule in Czechoslovakia. The Ostrov maternity hospital experimented with several innovations, including the so-called “gentle birthing” method, an approach to childbirth designed by French obstetrician Frederick Leboyer. Ostrov physicians introduced these options to “humanize” childbirth and spark fundamental change in familial and social relationships.15 I argue that this thirst for more harmonious relationships reflected a broader societal movement heralding collapse of the system in the last decade of Communist rule in socialist Czechoslovakia. The Communist Party originally took over in February 1948, establishing a strict regime backed by the Soviet Union. By the early 1960s, political liberation had begun, culminating in a series of political reforms in the spring of 1968, dubbed the Prague Spring. These reforms paved the way for a general democratization of the regime and society, and development of Czechoslovakia’s own unique path to socialism—termed “socialism with a human face.” This reformist endeavor diverged from the Soviet-directed course; the Warsaw Pact Invasion, however, halted the process in August 1968.16 An era of political persecution known as the “Consolidation regime” followed, only to reverse course again in the mid-1970s. By the late 1970s, the overall social and political climate had gradually shifted toward tolerance for diverse values, desires, attitudes, and interests.17 Childbirth and maternity care constitute an especially apt domain to study these subtle changes. As historians and anthropologists of childbirth have demonstrated, birth practices in all societies mirror core societal values and contemporary social and political dynamics, reflecting the fact that a country’s future is dependent on the health and well-being of its infants.18 The developments in the Czech maternity system paralleled the demands for, and formation of, alternatives within the broader socialist and post-socialist Czechoslovak society. Ostrov and Its Maternity Hospital Ostrov nad Ohří is a small town near the German border, a few kilometers from what was then the Iron Curtain. Its unique location adjacent to both a valuable mining town and a politically conformist, administrative center allowed the local maternity hospital to introduce novel practices. On one side, the hospital was not far from Jáchymov, a town located in a deep valley containing uranium mines and an affiliated “work-camp” for political prisoners who were forced to mine -- with their bare hands. Because the town was unable in the 1950s to keep up with the Soviet Union’s demand for uranium, the Communist Party substantially enlarged Ostrov city to accommodate an influx of newcomers to work in the mines. On the other side of Ostrov was Karlovy Vary, the region’s main administrative center and tourist attraction, where only people with pristine political and public reputations were permitted to hold positions. Citizens with any political stain were not permitted to work in Karlovy Vary and often ended up in Ostrov, twelve kilometers away. This was precisely how several outstanding, innovative physicians ended up working in the Ostrov hospital.19 Dr. Hana Marková—a neonatologist and the daughter of a prominent Communist ex-leader—was among them. Authorities transferred her from Karlovy Vary clinic to the Ostrov hospital after she participated in public protests against the Warsaw Pact invasion in 1968. Along with the transfer, she was prohibited from publishing articles and delivering public lectures, including presenting at conferences. Her academic career in tatters, in September 1980 she nevertheless attended the Third Neonatological Conference in Olomouc, organized by the Czech Paediatric Society. The Conference turned out to be the most important event in years. Plenary speakers from a number of institutions across the country and abroad spoke to more than 250 participants, offering an unbridaled critique of the medical management of childbirth and its negative impact on mother-newborn bonding. Discussions centered on the advantages of an innovative rooming-in arrangement, and whether to allow fathers in delivery rooms. Highlighting the conference was a lecture given by French obstetrician, Michel Odent, who talked about the “gentle birthing” method used in his clinic in Pithiviers.20 Odent was a disciple of Frederick Leboyer, a French obstetrician known for his criticism of modern maternity hospitals that, he contended, ignored the emotional needs of newborns and their mothers.21 Particularly interested in a baby’s transition from the womb to the outer world, Leboyer proposed a change in obstetric procedures to ease this process. His technique included absolute silence in the delivery room, no direct light that could irritate the newborn’s eyes, no touching of a baby’s head, and postponing cutting the umbilical cord until it ceased pulsing. Under Leboyer’s system, the obstetrician gripped the baby’s neck during delivery, gently pulled the baby from the birth canal, and then placed the newborn on the mother’s belly.22 The new mother then stroked her baby’s back to stimulate breathing. Then she breastfed her baby, allowing the infant ample time to explore the world and lick and suck her nipple.23 Only after the first breastfeeding did a nurse wash the neonate in warm water while the mother remained nearby. As the infant relaxed in the warm water, his eyes slowly opened, and he studied his new world.24 Above all, Leboyer emphasized that treatment of the baby (and mother) be gentle. Healthcare providers were to be patient and avoid any tendency to rush.25 Marková, a neonatologist, was especially intrigued by Leboyer’s focus on the newborn. Enamored, she gathered a team of medical experts in the Ostrov hospital to implement the gentle birthing method.26 Her core team included Dr. Petr Goldmann, a young clinical psychologist interested in the overall well-being of families, new mothers, and the mother-child bond, and Dr. Václav Kozerovský, a young and devoted obstetrician who was—unlike Goldmann or Marková—a member of the Communist party, able to provide the radical project with political cover. Yet the person most responsible for the success of the project, who secretly protected and nurtured it, was Dr. František Vosátka, the head of the Ostrov maternity ward. All three members of the gentle birthing team appreciated Vosátka’s silent support as an act of bravery, extraordinary for that time. The Implementation Marková, Kozerovský and Goldmann took the initial steps toward implementing their alternative birth practices in 1980. Their first task was to win over their Ostrov colleagues. They approached each individually.27 While younger employees of the maternity hospital were happy to support innovation, the older obstetricians and midwives, accustomed to providing care in “strictly technical terms,” were highly resistant. Some simply left the hospital’s employ; others only pretended to go through the motions of the Leboyer method.28 In addition to introducing Leboyer, Marková and her colleagues also implemented a “rooming-in” arrangement. Their ultimate goal was to construct an entirely new system of birth and postpartum care aimed at strengthening the mother-child bond.29 The rooming-in arrangement was itself a substantial revolution in the organization of postpartum care, enabling babies to stay with their mothers instead of being placed in a separate newborn ward for most of the day and seeing their mothers only intermittently for breastfeeding.30 To fully accommodate the innovation, the Ostrov maternity hospital physically restructured its wards, joining the postpartum and newborn wards into one.31 Like Leboyer, the Ostrov team insisted on absolute silence in the delivery room, nurturance of the natural birthing process, not touching the baby’s head, guiding his body out by the armpits, and immediately placing the baby on his mother’s belly. “We get fully immersed in the birthing process, we forget time, we identify with the baby and perceive the tiniest details.”32 The team adhered slavishly to Leboyer’s method, cutting the umbilical cord only after it stopped pulsing, transferring the infant to a tub of warm water (approximately 100-102 degrees Fahrenheit), and easing the infant into the extrauterine world by imitating the intrauterine environment.33 The Ostrov team was unable to execute only one step: complete darkness in the delivery room. Instead, they only simulated darkness by placing a dark green rubber screen between the window and the baby’s tub to protect the newborn from a too-rapid transition to the outer world. The first witnesses to Leboyer’s method recalled being deeply moved.34 Ostrov medical personnel soon started keeping detailed records, compiling empirical data on forty “gentle” births, all from women whose baby’s gestational age was more than thirty-six weeks and whose labor was physiological. Primiparas as well as multiparas, and university-educated as well as “semi-literate Roma women,” were included in the cohort.35 Women participating in the quasi-study were allowed to remain ambulatory until the baby’s head entered their pelvic cavity.36 This differed from conventional socialist maternity hospitals, where women were frequently told precisely when to push, and scolded by health care providers if they complained too loudly of discomfort and pain.37 Diverging significantly from the “normal” medical management of childbirth, Ostrov obstetricians did not administer any medication during labor and delivery.38 Although doctors worried the method might prolong the second stage of labor, on average the second stage lasted only fourteen minutes.39 They also discovered that only one healthcare provider, either a midwife or an obstetrician, was necessary, and that the presence of a bevy of medical personnel inhibited a smooth birth process. After each birth in their study, Ostrov doctors conducted ten-minute, structured interviews with postpartum women about their experience. Only two women expressed dissatisfaction with having their babies placed on their abdomens immediately after the delivery. The vast majority were extremely positive; one Roma woman who planned to give her baby up for adoption changed her mind after bonding with her baby, a connection prompted by the Leboyer method.40 Most women were delighted by the opportunity to touch their baby immediately after delivery and were not repulsed, as doctors had long feared they would be, by their babies’ unwashed bodies.41 The majority also preferred having their babies with them for prolonged periods rather than isolated in faraway nurseries. Interviewees welcomed the future possibility of having their baby’s father with them during labor; sixty-four percent, mostly primiparas, said they would have chosen that option if it had been available.42 The results of their study pleased Marková, Goldmann, and Kozerovský. They viewed it as proof that the Leboyer method fostered an intimate bond among the mother, baby, and father; met the unique needs of every family; was safe, cheap, “practically feasible everywhere,” and highly satisfying to everyone, including the newborn.43 The Leboyer method offered “an individualized approach” to childbirth in the context of socialist care by allowing healthcare providers to respect the unique mental state and physiology of mothers and their newborns.44 Embrace of the method represented a covert critique of the socialist system of healthcare that demonstratively ignored individuality. On an ideological level, socialist health care was to be provided to all, in the identical manner, regardless of a patient’s unique characteristics. Healthcare, viewed as a set of tasks attending to a patient’s body and physical symptoms, neglected, and often wholly ignored, the emotional aspects of care-giving.45 With the overall organization of healthcare fragmented and built on highly specialized healthcare services, the system left no space for more holistic and integrative approaches.46 The Ostrov physicians’ adoption of Leboyer was, in part, a response to these shortcomings—inadequacies that became increasingly obvious to both dissidents and official state representatives.47 One of the key contentions of the Ostrov team was that childbirth was a transformational experience in family life. Five years after they conducted their first gentle births in Ostrov, the team introduced an additional concept to enhance their philosophy. They permitted husbands to accompany their wives into delivery rooms, as long as the couple had participated in designated childbirth education classes. These classes combined the Lamaze method with various relaxation and acupressure exercises inspired by Marek and De Lyser.48 Expectant parents practiced stimulating acupressure points to relax and suppress pain during labor, and they learned about special birthing positions and breathing techniques.49 They also learned how to communicate with their fetus via stroking, stimulation, massage, and music.50 Fathers learned that psychologically supporting their partner was their most important job during labor. Four times a year, during special “parental talks,” the maternity ward allowed couples to visit a delivery room. Fathers’ presence in particular required organizational changes. The hospital set aside a smaller delivery room for Leboyer births, separated from the large delivery rooms by a hallway. This arrangement ensured both silence—essential for the Leboyer approach—and easy access to an operating theater in case of emergency. Before entering a delivery room, a father donned special hospital garb and slippers and scrubbed his hands and forearms with a small brush, as if preparing to perform surgery. In exceptional cases, hospital personnel allowed a father to be present even during complicated forceps deliveries. Some obstetricians also allowed fathers to cut the umbilical cord when it stopped pulsing. After the birth, the family remained together for two hours in the delivery room. Fathers could purchase coffee, tea, or other refreshments at will. The Ostrov team claimed that most parents regarded those hours as the happiest of their lives.51 While today, those types of services are an everyday part of maternity hospitals’ offerings, they were extraordinary in the context of Czechoslovakia’s socialist healthcare system.52 In the mid-1980s, V. Joza, an obstetrician trained in acupuncture, joined the Ostrov team, expanding the scope of medical services. His unusual expertise was considered by many to be especially progressive.53 Not only did he and his colleagues apply acupuncture and acupressure to prevent, or ease, labor pain, they also used acupuncture to normalize the fetal position in the case of breech presentations.54 Joza also used acupuncture to resolve breastfeeding problems. In the medical team’s view, ensuring successful breastfeeding was essential to forging a close bond between a new mother and her baby in the alienating hospital environment.55 In most hospitals—unlike Ostrov—breastfeeding was the only opportunity for women to see their babies. Consequently, breastfeeding rates were high in the hospital but decreased steeply within two weeks of the return home.56 In the West Bohemian region to which the Ostrov district belonged, 81.4 percent of babies were weaned by three months, the lowest breastfeeding rate in the eight Czech regions in 1986; the highest rates were in Prague where 41.1 percent babies were breastfed longer than three months. After the obstetric innovations, however, West Bohemia saw its breastfeeding rates become comparable to other regions.57 A Sharp Debate on “Gentle Birthing” After the Ostrov trio presented their initial successes with gentle births, they were met with harsh criticism from colleagues. The disapproval was largely unofficial, voiced during informal gatherings at professional meetings and conferences and in the lay press. Critics condemned Marková and her Ostrov colleagues for underestimating “common reflexive processes,” and overestimating a baby’s distress when it came into the world.58 In critics’ view, deliberately reducing stress on the newborn was detrimental, as the ability to cope with stress was vital later in life, assuring a child’s ability to adapt to all situations. Marková systematically refuted the objections.59 Based on the Ostrov’s experience with more than 1,500 births, she argued that detractors had a faulty interpretation of physiological childbirth. She insisted that only the “physiological stress” produced immediately before and after childbirth was necessary; any additional stress required a newborn to expend unnecessary energy, resulting in exhaustion.60 Opponents of Leboyer viewed a newborn’s post-natal cry as an essential physiological necessity; they contended that crying pushed amniotic fluid from the lungs and encouraged blood circulation.61 Leboyer and Marková countered that a newborn’s initial cries reflected a traumatic reaction to an unwelcoming hospital environment. They argued that the birth process, via compression of the chest in the birth canal, removed all amniotic fluid. Any that remained was insignificant and could easily be absorbed by the newborn’s alveoli and lymphatic vessels.62 While individual obstetricians like Bedřich Srp, a director of one of the largest Prague gynecological and obstetrical clinics, appreciated Leboyer’s emphasis on facilitating newborn care, encouraging laboring women, nurturing a physiological course of labor, and “humanizing” childbirth and postpartum care,63 most Czechoslovak obstetricians denounced the Leboyer approach as “a phoney, trendy fad” that contradicted modern scientific methods.64 Marková responded to the criticism by citing widely circulated findings in the fields of evolutionary biology and human psychology: “Leboyer’s method of giving birth is truly modern in the sense that it is the first approach in the history of obstetrics that fully respects the individuality of each birthing woman and her child; it respects their mental state as well as their physiological functions.”65 Fathers at births The Ostrov trio considered the presence of fathers during births to be an extension of Leboyer’s overall philosophy—in essence, birth done properly strengthened families. Thus, professional disputes about the Leboyer method became entangled with equally passionate disagreements over fathers in delivery rooms. For five years, Czechoslovak Gynecology and other journals published articles, commentaries, and essays airing both sides of this tempestuous debate.66 The first maternity hospital permitting husbands to accompany their wives to delivery was located in Znojmo, a town hundreds of kilometers away from Ostrov, in Moravia. The Znojmo obstetricians did not share their Ostrov colleagues’ interest in the Leboyer method, but they, too, wanted to promote more humane and ethical traditions in birth and society.67 Both medical teams also claimed to be influenced by professor Josef Švejcar, a doyen of Czech pediatrics and a harsh critic of women’s subordination in Czech families.68 Other than that, there did not seem to be any connection between the two hospitals. In the mid-1980s, the Moravian obstetricians published a positive report about their experience with fathers in delivery rooms based on couples’ questionnaires.69 The report claimed that fathers’ presence at births strengthened the bond between partners as well as parents’ bond with their newborns, transformed childbirth into a peaceful and harmonious family event, eased the stress on laboring women, and encouraged healthcare workers to be kinder to women and adhere to ethical rules of conduct.70 Slovak senior obstetricians Bárdoš and Blašková responded with outrage to the advocacy for fathers.71 They condemned the Znojmo obstetricians’ “recruitment of fathers” as degrading and unprofessional.72 They argued that welcoming laymen into maternity wards and delivery rooms trivialized medicine. They contended that the change may be acceptable in Western capitalist countries, where physicians compete for popularity and profit, but that in Czechoslovakia, where obstetricians concentrate solely on the health and well-being of their patients to prevent the spread of infection, the presence of nonmedical personnel hindered basic patient safety. Bárdoš and Blašková cited the Ministry of Health directives forbidding visitors in delivery, postpartum, and newborn wards.73 Other physicians agreed with them, declaring childbirth a serious medical procedure, not a sideshow attraction.74 Bárdoš and Blašková added that what Czechoslovak obstetrics really required was better medical technology, instruments, and drugs—not fathers. Laymen in delivery would only lead to misunderstandings, complaints, and additional work for medical professionals.75 They and other critics dismissed the “humanization of birth care” as “pseudopsychological speculation.”76 Representatives of the Section for Psychosomatics in Gynecology and Obstetrics of the Czech Gynecological and Obstetrical Society77 suggested, however, that the actual reason fathers in delivery rooms outraged so many Czechoslovak obstetricians was that they suffered “a kind of subconscious attempt to retain their professional prestige” which—they believed—was much lower under a socialist health care system where they toiled as state employees, compared to “Western developed countries.”78 They noted sarcastically, “The delivery room is our last bastion where—though being pushed aside, kicked and offended—an obstetrician is still the master.”79 In short, in the socialist healthcare system, as well as in society-at-large, doctors no longer enjoyed the elite status they had before WWII.80 After the socialist regime incorporated healthcare services into the system of state administration,81 all doctors became state employees. Simultaneously, their professional associations dissolved, their salaries diminished, and industrial occupations became the priority.82 Physicians lost their professional autonomy, and with it their right to self-regulation, which destroyed doctors’ sense of professional identity and soured relations within the profession and between doctors and patients.83 Rivkin-Fish describes a similar move toward medical deprofessionalization in the Soviet Union. As in Czechoslovakia, Soviet medical professionals had very little political and economic power; the Communist Party centrally directed the socialist health care system from Moscow.84 Nevertheless, in both countries, the political regime also put a strong ideological emphasis on technology and scientific expertise, which granted doctors a certain level of authority to exercise disciplinary power and dominance over their patients.85 Hospital settings became the primary environment in which doctors could ensure that patients fully submitted to their expertise. Thus, the relative disempowerment of doctors within the larger societal, political, and economic structures prompted their paternalistic approach to hospitalized patients.86 Ostrov physicians specifically disapproved of this sort of medical paternalism, and sensed there was a connection between the “sad state of familial relationships” and what was going on in maternity wards. In their view, the wider societal crisis was linked to the technocratic nature of maternity care.87 Marková, Kozerovský and Goldmann believed the solution lay in paying closer attention to the psychological and social aspects of maternity care.88 They soon followed in their Znojmo colleagues’ footsteps,89 welcoming fathers in their maternity hospital.90 Indeed, they became even better known for doing that, as popular magazines and newspapers soon published accounts of the activities at Ostrov. Marková, Kozerovský, and Goldmann believed that their innovations, especially fathers at births, reflected broader societal trends. They pointed to “new patients” who were both better informed about health care and more skeptical of medical treatment.91 These consumers of healthcare did not view doctors as gods. Other physicians made similar observations. In the early 1980s, Dr. Pečená, a psychologist with midwifery training who revived the psychoprophylactic method of childbirth preparation in the early 1980s, noticed that the women taking her childbirth education classes were increasingly critical of paternalism in medicine; they wanted to make their own medical decisions.92 Similarly, Jaroslav Kapr, a medical sociologist, and Čestmír Müller, a professor of social medicine at Charles University, considered use of the Leboyer method to be symptomatic of broader changes in medicine.93 As Czech society transformed, Czech citizens were increasingly critical of disrespectful, demeaning healthcare providers and less willing to be passive subjects of both medical and state paternalism.94 These tendencies very clearly surfaced in the heated debate about an adjustable birth chair, nicknamed “the chair for the princess,” that drew attention once again to the Ostrov maternity hospital. The Chair for the Princess The chair was one of several technologies invented for the Ostrov maternity hospital. Although it never made it into routine use, the chair was one of the most significant innovations coming out of the Ostrov because of the fiery debate it aroused in obstetrics and perinatology. Ostensibly concerning a woman’s comfort and needs during labor and delivery, the discussion shed light on the power dynamics between hospitals on the geographic and medical periphery versus those in the capital and regional centers. While the regime put a lot of emphasis on technological progress and development, in practice, contrary to its egalitarian ideology, the government was often unable to produce an adequate number of technological devices for local markets. Economic resources were lacking to provide up-to-date equipment at all healthcare facilities.95 The latest medical technologies produced in Western countries were usually too expensive for the socialist, state-controlled market.96 Even though, beginning in the late 1970s, the state had been increasingly able to adequately equip clinics and regional healthcare facilities,97 many district hospitals still faced scarcity and were left on their own to solve the problems caused by shortages. Consequently, many local experts became bricoleurs, incessantly experimenting, extemporizing, and mobilizing accessible resources. The Ostrov maternity hospital, for example, developed a small movable baby bath for use in delivery rooms, a baby cot on wheels for rooming-in, 98 and a lamp produced by a local factory to treat neonatal jaundice. The factory designed the lamp because of their association with Dr. Marková.99 These types of informal connections were crucial in most spheres of everyday life during this era, when the economy suffered from numerous scarcities.100 Still, such contraptions, the Ostrov doctors argued, however effective they might have been, were “only provisional solutions” and “could never fully substitute for factory-made products.”101 Yet the environment of scarity clearly offered creative opportunities for inventors and innovators. Jiří Soukup, a Renaissance man who was an excellent painter, pianist, and organist, and who mastered mechanical engineering to boot, designed and built the controversial birth chair and offered it to the head of the Ostrov maternity hospital.102 Despite Soukup’s genius, his political standing was tenuous, forcing him to live in the Ostrov region.103 While living there, he had a platonic affair with a woman who became pregnant by another man. Seeking to ease the birth process for her, and assure that she felt like royalty even as she labored, Soukup designed and assembled a chair that could be reconfigured so that each woman could push during second-stage labor in the most effective way. He designed the chair using his artistic skills and own body measurements, “without even basic ergonomic knowledge.”104 His colleague, Kaštánek, an engineer, helped him assemble it. Attached to the chair was a decompression device to elevate the pregnant belly and, theoretically, ease pain during labor.105 Soukup equated the chair for his “princess” with “a Lincoln among cars.”106 The enthusiasm, effort, time, and money that Soukup and Kaštánek put into the birth chair did not pay off. Not only did Soukup’s “princess” give birth the day before the chair was ready, except for the Ostrov’s physicians, who were all enthusiasts, the rest of the maternity hospital staff expressed only “sleepy interest” in Soukup’s masterpiece.107 The chair’s detractors voiced “thousands of complaints:” the “cushioning was too short, the arm rests were too complicated, and lowering the seat was too tricky.”108 Soukup found the imperfections easy to fix in technical terms but he feared that the complaints stemmed, not from the chair per se, but from the extra work it created for hospital staff, mainly nurses. What offended him most, however, was that “somebody who wanted to torpedo the idea and avoid any extra work” renamed his “chair for the princess” a funeral bier, not because of its shape but because of its color. Soukup had painted the birth chair dark violet—a favorite color of the woman he was so enamored with—and outlined it with an extra flourish, a double gold line. Ultimately, the hospital used the chair only twice and it ended up in a hospital corridor with only Soukup’s essay to commemorate it.109 Soukup wrote about his innovation in the Technický magazín [Technical Magazine], as part of his regular contribution published annually on the first day of April.110 The date of the publication—April Fool’s day—suggested ridicule of the inventions described by the magazine.111 Articles were meant to be parodies, with a critical political and social subtext. This type of humor and satire were widespread during the state socialist era and constituted an important part of Czech culture.112 While Soukup was serious about his invention and its potential to help birthing women, the article mocked physicians and described the medical paternalism that prompted development of the chair.113 Leading Czechoslovak obstetricians, especially those from Prague, were infuriated by what they believed was a diatribe against their work. Taťána Lomíčková and Zdeněk Štembera, obstetricians from Prague’s Institute for Mother and Child (ICMC), a research organization, responded in Czechoslovakia’s main obstetric journal, Československá gynekologie. They dismissed Soukup’s article as a “lay person’s demagogic campaign against us based on no scientific evidence and in which we are accused of an inhumane approach harmful to future generations.”114 They believed Soukup’s article damaged not only the reputation of Czechoslovak obstetricians and other maternity hospital staff, but also “in a broader sense, the reputation of all healthcare workers.”115 They insisted that any innovation in obstetric care, including a birth chair, be based on sound empirical research, and that, for at least three years, they had been conducting similar, but more systematic, investigations into managing second-stage labor with a birth chair.116 They challenged Ostrov obstetricians not only to justify this particular chair and its attached decompression device via “a sufficiently large research sample of women patients and meeting basic methodological criteria,” but also to defend their use of the Leboyer method.117 Professor František Macků, the chief obstetrics expert in the West Bohemian region that housed the Ostrov maternity hospital, likewise denounced Soukup’s article as dishonest and defamatory. In a letter to Professor Miroslav Břešťák, the Chief obstetrician-gynecologist at the Czechoslovakian ministry of health, Macků condemned the article as denigrating obstetricians’, indeed all healthcare providers,’ work.118 Břešťák agreed, but did not offer any remedy for Soukup’s alleged insults.119 A few doctors from different maternity hospitals did find Soukup’s invention inspiring. They expressed keen interest in it, especially as Soukup promised blueprints to anybody with access to a tinsmith’s facility.120 In a subsequent issue of the Technical Magazine, Pavel Ries, Soukup’s student and a film director, wrote an article supporting Soukup’s invention. In the article, he explicitly mentioned two physicians interested in the device: Dr. Běhal, head of the maternity hospital in Přerov who promised to test the chair in his health facility, and Dr. Zábranský who held the same position as Běhal in Zlín and wanted to see a video-recording of the chair in action. Soukup also received an expression of interest from a German obstetrician.121 Dr. Běhal was not happy that his name appeared in Ries’s article. In a response co-authored with his Přerov colleague, Dr. Sýkora, the two suggested that the publicity had gotten them into trouble with their superiors. The men insisted that their interest in “the chair” did not imply criticism of mainstream Czechoslovak obstetrics. Quite the contrary, they were opposed to any “lay assessment of healthcare providers’ work, especially the work of us obstetricians.”122 They condemned the “assault” on “obstetricians’ ethics in the eyes of the public.”123 Kowtowing to their more prominent colleagues, they agreed that only “authorized health facilities” and “competent experts should examine these issues and arrive at an ultimate verdict which will, certainly, mute emotions and non-constructive publicity outside the pages of Czechoslovak Gynecology.”124 The brouhaha implied that small maternity hospitals, such as the Ostrov, dare not conduct research, or do anything, to provoke controversy, especially if their work ended up being covered by the press. In this regard, the birth chair debate resembled the two previous debates about the Ostrov’s advances. Top obstetricians condemned each innovation as it appeared, revealing a significant schism in Czechoslovak perinatology. Yet the more high-ranking obstetricians condemned the innovations, the more enthusiastic parents became. In offering Leboyer’s gentle birthing method and fathers at births, the Ostrov maternity hospital became increasingly popular. Parents’ Move News of the hospital’s offerings spread quickly via articles in regional as well as national newspapers and magazines, such as Mladá Fronta, Mladý Svět, and Karlovarské noviny. But what was equally important was that new parents shared their positive birth experiences at the Ostrov maternity hospital with other couples. In the wake of the printed and word-of-mouth publicity, even though women were required to give birth in a maternity hospital in their residential district, many found a way to give birth at the Ostrov. One frequent strategy was to travel to Ostrov toward the end of a pregnancy, ostensibly to vacation. Other women headed to the Ostrov hospital at the onset of labor, preferring to risk giving birth in the back seat of their car rather than their assigned hospital.125 As Eva D. explained, in the Ostrov hospital “babies are not taken away from moms.”126 A university student of psychology at the time, she was frightened by standard, impersonal health care.127 She explained, “Simply put, we sought a different way and didn’t want to subject ourselves to a factory-like environment.” She was intrigued by the Ostrov’s “alternative to the usual way of doing things” and the “protest against the standard way of doing things” that it represented. She also longed to experience the Leboyer method for professional reasons, as she had become acquianted with it from the medical literature. Other couples travelled to Ostrov to ensure a father would be present during childbirth.128 Pavel Ries claimed, “Such a man who sees his wife in labor and supports her during delivery can never abondon her. So powerful is the experience.”129 The Ostrov team’s reputation for kindness, hospitality, and support continued to attract new parents.130 Eva D. recalled that the friendly atmosphere manifested itself even in the colorful, striped baby caps and tiny socks that obstetrical nurses knitted during quiet shifts. “This was something completely different,” she marveled. The delightful infant clothing contrasted sharply with the stark white hospital uniforms and the general greyness of socialism.131 The Leboyer method met Eva’s expectations. Her baby was calm at birth, just as Leboyer had described in the books she read. She was delighted: “It was a maternity hospital where babies did not cry.” She credited the calm and comforting atmosphere to a hospital that put the needs of neonates first. “Babies could be breastfed anytime they wanted, and were not tormented by a forced three-hour interval of feeding. Unlike regular maternity hospitals that were linked to a strict regimen, all this nonsensical lack of freedom, I longed for a more relaxed, unrestricted, freer approach… . [I really appreciated] that there was no harm done [at the Ostrov] because of some [arbitrary set of] rules… I was really happy to find a small refuge where such a humane approach existed.” Eva’s observations are in line with Možný’s argument that in the late 1980s many were simply disgusted with the overall ritualization of everyday life, including endless celebrations of the Party’s anniversaries requiring decorations in shop windows and participation in official meetings and parades.132 Most women who gave birth in the Ostrov hospital were from the district. Yet, like Eva and the Rieses, a number of expectant parents came from all over the country, notably from bigger cities.133 One couple from Košice, Slovakia traveled 500 miles to give birth there.134 The consumer savvy that characterized market-driven healthcare reforms in the post-socialist era of the 1990s and 2000s prompted patients to travel long distances for a specific type of care. Reforms presupposed that citizens would choose healthcare services according to their needs and desires, fostering a competition among healthcare providers that would lead, in theory, to improved services. Consumerism represented the ideological antithesis of the socialist approach to healthcare.135 Yet the couples who decided to give birth in the Ostrov maternity hospital in the 1980s demonstrated that Czechoslovakians embraced healthcare consumerism well before the new political regime embraced patients’ desires as legitimate, legal, and beneficial options. They did not initiate those options, however. Heitlinger argued that in the 1980s, women, as consumers of maternity care, were not in a position to initiate change. Rather, they could only embrace the new, existing options. In Heitlinger’s view, pregnant women “had some input into decision-making about policy changes,” such as rooming-in, but their role in driving change was more limited than in the West. 136 Medical experts and the publicity their innovations engendered, not healthcare consumers, triggered the forays into improved maternity care. 137 In Ostrov, the first stirrings of change came from physicians, primarily Dr. Marková. Yet the Ostrov’s novel approaches to birthing would have never taken root so firmly if not for the interest of parents, especially mothers. Ultimately, doctors and parents worked in tandem to transform the existing system of birth care. In the late 1980s, the Ostrov hospital garnered additional attention, thanks to film-maker Pavel Ries. Preparing to attend the birth of his first child, Ries visited the Ostrov. Intrigued, he shot a documentary about the Leboyer method using a camera small and sensitive enough to shoot in semi-darkness.138 The documentary was subsequently screened on national television and distributed to secondary schools as part of a national program to ensure that the country’s future parents would be aware of, and possibly seek, humane methods of giving birth. “Polite Behavior” Eventually Spreads In spring 1989, six months before the end of Communist rule, Dr. Vosátka retired. As the head of the Ostrov’s maternity wards he had protected the “humanization project.” The gentle birthing team secretly hoped that Dr. Kozerovský, with his sound professional reputation and political profile, would replace Vosátka. Instead, another man who was not in the Communist party but was against gentle birthing, replaced Vosátka and soon restricted any practice of the Leboyer method due to his disinterest, despite the hospital director giving him direct orders not to do so. In the meantime, Dr. Kozerovský was transferred to Karlovy Vary, returning a few years later to finally become the head of the maternity ward and rejuvenate the gentle birthing option. Dr. Goldmann also left for a new appointment in Prague after the fall of the Communist regime. With the disintegration of her team and close to retirement, Dr. Marková departed the Ostrov hospital in May 1990 and moved with her husband to Prague.139 After Marková and her colleagues began to present the fruits of their work in a more systematic way, attacks against the Ostrov’s use of the Leboyer method increased despite the dispersal of the original team members to other hospitals and locales. In 1991, Karel Vízek from the Institute for Mother and Child in Prague responded to several articles published in newspapers and popular lifestyle magazines. He accused the Ostrov’s physicians, especially Marková, of manipulating public opinion by misinterpreting and distorting the results of clinical studies on the Leboyer method.140 In a derisive, arrogant tone, he accused the Ostrov’s obstetricians of ignoring how stress compromised newborns’ ability to fully adapt to the extra-uterine environment. He accused the Ostrov’s doctors of being inept scientists who misunderstood the crucial processes at play in a newborn’s body and contended that newborns’ reactions at the moment of birth were hard-wired by human evolution.141 He condemned the Ostrov team for neglecting the detrimental effects of the Leboyer method on the newborn circulatory system. He insisted that the salient characteristic of the Leboyer method, a warm bath immediately after delivery, caused a newborn’s blood to flow to his skin instead of his organs and lungs, prompting hypoxia. Some denounced Vízek’s disapproval. His colleague from the ICMC, Tomáš Poláček, found his condemnations of all alternative approaches to childbirth too harsh and wide-ranging. Poláček sided with Marková, agreeing that “traditional medicalized birth practices” in Czechoslovak maternity hospitals were caused by the communist regime’s elimination of competition in healthcare, allowing unprofessionalism and indifference toward patients to run rampant.142 Anna Mydlilová, a neonatologist and a respected promoter of breastfeeding, likewise dismissed Vízek’s position, pointing out that he was largely unfamiliar with Marková’s work. Mydlilová argued that any methods that enhanced the “psychological comfort” of laboring women and their newborns should be widely supported and practiced.143 According to Dr. Kozerovský that is exactly what happened in the 1990s; the “polite behavior towards a mother and a baby” that was the heart of the Leboyer method spread to other hospitals.144 Conclusion The Ostrov maternity hospital and its novel approaches to childbirth garnered the attention of Czechoslovak perinatologists and expectant parents at least three times during the last decade of Communist rule. Discussion of fathers’ presence in delivery rooms not only reflected obstetricians’ concerns about their tenuous professional status, the conversation prompted parents to seek a specific type of care. Debate about the scientific rigor of the Leboyer method highlighted the impersonal nature of socialist maternity care and encouraged women and families to seek treatment that nurtured the mother-newborn bond as the foundation of improved interpersonal and family relations. A dispute over an adjustable birth chair revealed the power dynamics at play between central healthcare facilities and those on the periphery, and the role each played in developing technological innovations and deciding to what extent the needs of birthing women should be accommodated. The controversial chair also highlighted growing discrepancies between the regime’s rhetoric and its economic capacity to fullfil its promises. Among perinatologists, the debates revealed a deeper schism. On the one hand, defenders of the dominant view insisted that physicians retain exclusive decision-making power. They perceived any attempts to redefine childbirth as a familial event rather than a medical one, to be a threat to their professional authority. They called for the advancement of medical technologies in Czechoslovak maternity hospitals in order to maintain a level of control. While the political regime was unable to secure a satisfactory supply of medical technologies, it nevertheless emphasized technology and scientific expertise. Obstetrics and gynecology reflected this technocratic focus as the political regime prioritized the field of reproductive medicine as a means of assuring that new generations of robust citizens would be able to contribute to the socialist establishment. On the other hand, the Ostrov physicians, and a number of neonatologists, psychologists, and a few obstetricians at other locales, promoted an individualized approach to birth and newborn care. They called for the provision of support and basic comforts to laboring mothers and an end to the assembly-line techniques so pervasive in socialist maternity wards. The Ostrov physicians, and other advocates of the “humanization” of maternity and newborn care, linked the technocratic nature of socialist healthcare to a more general crisis in societal and familial relations. Advocating a holistic approach to all aspects of family care, they asserted that healthcare providers should facilitate both mothers and fathers bonding with their child as a highly beneficial aspect of the psychological health and wellbeing of all family members. The development of this perspective in perinatology and obstetrics paralleled the emergence and establishment of alternative views in the broader society during the last decade of Communist rule. The change in thinking portended new morals, values, and demands. In particular, an emphasis on individualism, as opposed to the official ideology of collectivism, was a response to the general disregard for, and disdain of, individuals’ needs within the centrally directed socialist healthcare system and society. Increasingly critical of the dominant technocratic and paternalistic approaches to healthcare in general, and maternity care in particular, people longed for more respect in interpersonal relations, and attention to individual dignity and autonomy.145 In birth care, both medical professionals and lay parents sought options. Expectant parents even found a way around the official, residence-based organization of care, making their way to the hospital of their choice. Physicians supporting free choice leaned toward market-driven principles in healthcare, which they saw as essential for increasing their professional status. In the 1980s, as a series of ever-louder voices criticized the shortcomings of the Czechoslovakian healthcare system, the lack of competition among healthcare providers was offered as a reason for the system’s inadequacies. Physicians frequently argued that inadequacies were side effects of doctors being state employees earning low salaries. As demonstrated by the Ostrov experience, the market-oriented ideology and moral economy were evident, at least in medicine, before the fall of the communist regime, and before market-driven principles became part of the official political discourse. Not until 1987, after government policy started to change in response to the political and economic reforms initiated by Mikhail Gorbachev in the Soviet Union, were market-driven principles deemed beneficial within expert and government circles as a way of overcoming economic stagnation.146 Only then did the island become a mainland, as more maternity hospitals adopted a gentle(r) approach to birthing and offered more birth alternatives. ACKNOWLEDGEMENTS I wish to thank Jacqueline Wolf for her tremendous help with this article and insightful comments. My special thanks go to Dr. Marková, Pavel Ries, Dr. Kozerovský, Dr. Goldmann, Eva D. and to Mrs. Piškaninová from the Ostrov hospital. FUNDING This work was supported by the Jan Hus Foundation Fellowship, the Czech Republic (fellowship for 2015/2016) and partially supported by the Charles University Center for Excellence for the Study of Collective Memory. Footnotes 1 Ema Hrešanová, “Psychoprophylactic Method of Painless Childbirth: From State Propaganda to Activism of Enthusiasts,”Medical History 60 (2016): 534–556. https://doi.org/10.1017/mdh.2016.59; Zdeněk Štembera, Historie české perinatologie (Praha: Jessenius Maxdorf, 2004), 39. 2 Ema Hrešanová, “‘Nobody in a Maternity Hospital Really Talks to You’: Socialist Legacies and Consumerism in Czech Women’s Birth Narratives,” Sociologický časopis/Czech Sociological Review 50 (2014): 961-986, 964-965; C. Benoit and A. Heitlinger, “Women’s Health Care Work in Comparative Perspective: Canada, Sweden and Czechoslovakia/Czech Republic as Case Examples,“ Soc Sci Med 47 (1998): 1101–1111; Rosie Read, “Labour and Love: Competing Constructions of ‘Care’ in a Czech Nursing Home,“ Critique of Anthropology 27 (2007): 203–222, 206. 3 Alena Heitlinger, Reproduction, Medicine and the Socialist State (New York: St.Martin’s Press), 200, with a reference to M. Taufrová, “Odkaz stavu a změn společenského prostředí na hospitalizovaného pacienta,“ Československé zdravotnictví 29(1981): 166-171. Articles describing particular cases of birthing women being slapped across the face also appeared in the widely read weekly Mladý svět. Dana Emingerová, “Tatínkové v porodnicích a ještě něco navíc, aneb náš příchod na svět,“ Mladý svět 30 (1988): 9-15, 13, 15. 4 Hrešanová, “Nobody in a Maternity Hospital,” 964-965. 5 Heitlinger, Reproduction, Medicine, 201. 6 Heitlinger, Reproduction, Medicine, 202. 7 Dana Emingerová, “Podoby lásky. Děti narozené s láskou aneb PROČ nehledat odpověď i tam, kde život začíná,“ Mladý svět 30 (1988): 6-8, 7. 8 Heitlinger, Reproduction, Medicine, 222. 9 Ibid, 221; Letter of Thanks to Regional Institute of National Health, Karlovy Vary (KÚNZ), May 1982, Dr. Hana Marková’s private archive. 10 Heitlinger, Reproduction, Medicine, 222; Emingerová, “Tatínkové,” 15. 11 Ema Hrešanová, “The Natural Childbirth Movement in the Czech Republic,” in Rebellious Parents: Parental Movements in Central-Eastern Europe and Russia, ed. Katalin Fábián and Elżbieta Korolczuk (Bloomington: Indiana University Press, 2017), 277-307; 286, 290. 12 Hrešanová, “Psychoprophylactic Method.” 13 Paula Michaels, Lamaze: An International History (New York: Oxford University Press, 2014), 8. 14 I build here on the analyses of published studies in medical journals as well as popular newspapers and magazines, in-depth interviews with key figures, and materials from Dr. Hana Marková’s private archive. 15 Hana Marková, Václav Kozerovský and Petr Goldmann, “První zkušenosti s porodem podle Leboyera,” Praktický lékař 63 (1983): 766-768, 768; H. Marková, V. Kozerovský and P. Goldmann, “Význam a úloha otce v perinatálním období“, Sestra 1(1991): 11-15, 11. 16 The so-called Warsaw Pact, formally a Treaty of Friendship, Co-operation, and Mutual Assistance was a collective defense treaty among the Soviet Union and seven states in Central and Eastern Europe (Czechoslovakia, East Germany, Poland, Hungary, Romania, Bulgaria, and Albania) signed in May 1955. It was created in response to NATO’s presence in Europe and served to maintain Soviet hegemony in the region. The Soviet Union, and the other five countries of the Warsaw Pact, were deeply concerned that the political developments in Czechoslovakia had the potential to threaten the unity of the Eastern Soviet Bloc. Therefore, on 17 August 1968 the Soviet Communist Party Politburo decided to invade Czechoslovakia militarly, a move that the other five countries of the Warsaw Pact approved a day later. The military invasion violated the Warsaw Pact Treaty, the United Nations Charter and sovereignty of the Czechoslovakian state and as such was illegal. Ondřej Felcman, “Československá reforma 1968-1969,” in Slovníková příručka k československým dějinám 1948-1989, ed. Jiří Kocián (Praha: Ústav pro soudobé dějiny Akademie věd ČR, 2006), 21-30, 27; Ondřej Felcman, “Sovětská vojska v Československu 1968-1991,” in Slovníková příručka k československým dějinám 1948-1989, ed. Jiří Kocián (Praha: Ústav pro soudobé dějiny Akademie věd ČR, 2006), 31-35, 31. 17 Michal Pullman, Konec experimentu: přestavba a pád komunismu v Československu (Praha: Scriptorium, 2011), 21. 18 Ema Hrešanová, Kultury dvou porodnic: etnografická studie (Plzeň: Západočeská univerzita, 2008), 7; Robbie Davis-Floyd and Carolyn Sargent, “Introduction: the Anthropology of Birth,” in Childbirth and Authoritative Knowledge. Cross-cultural Perspectives, ed. R. Davis-Floyd and C. Sargent (Berkeley, Los Angeles: University of California Press,1997), 1-5, 6; Bonnie Fox and Diana Worts, “Revisiting the Critique of Medicalized Childbirth: A Contribution to Sociology of Birth,” Gender and Society 13 (1999): 326-346, 329; Wendy Kline, Bodies of Knowledge. Sexuality Reproduction, and Women’s Health in the Second Wave (Chicago and London: University of Chicago Press, 2010); Michaels, Lamaze; Jacqueline Wolf, Deliver Me from Pain. Anesthesia and Birth in America (Baltimore: The John Hopkins University Press, 2009). 19 In-depth interviews with H. Marková (February 2013, Prague) and P. Goldmann (November 2012, Prague). 20 Heitlinger, Reproduction, Medicine, 226. The date of the conference is specified in V. Melichar, J. Vocel, M. Janovský, “3. Neonatologické dny české pediatrické společnosti,” Československá pediatrie 36 (1981): 171-172, 171. A part of the lecture was translated by Dr Šráček and published in a gynecological journal: Michel Odent, “Bien naitre “phenomene Leboyer,” Československá gynaekologie 46 (1981): 193-195. This was not the first appearance of Leboyer’s ideas in the Czechoslovak context, as psychologist Marie Damborská presented his thinking in her article published in the first issue in 1980. Marie Damborská, “Co je nefyziologické v přístupu k dítěti nejútlejšího věku,” Psychológia a patopsychológia dieťaťa 15 (1980): 21-37. Czechoslovak neonatologists originally planned to invite Odent to the Czechoslovak Gynaecological and Obstetrical Society’s conference in 1984 in Podolánky since they proposed the humanization of birth care as the key theme. However, the Society’s federal board, meeting in Brno in October 1983, did not approve the offer in spite of invitations already having been printed. R.Uzel, M. Bendová, P. Čepický, V. Chvála, I. Koťátková and M. Pečená, “Quo usque tandem? (pokus o ukončení diskuse o přítomnosti otce u porodu),” Československá gynaekologie 54 (1989), 375-378; J. Šráček and D. Šráčková, “Chováme se k novorozenci jako k nošenci?” [online], Společnost pro plánování rodiny a sexuální výchovu, accessed 7 November 2013. 21 Marková, Kozerovský and Goldmann, “Význam otce v perinatálním období.” Frederick Leboyer, Porod bez násilí, trans. H. Marková (Praha: Alcor, 1995), 3. 22 Frederick Leboyer, “Porod bez násilí,” trans. H. Marková, Sestra 2 (1992): 19-21, 20; Frederick Leboyer, Childbirth without Violence, trans. Alfred A. Knopf (New York: Alfred A. Knopf, 1978), 37-67. 23 Leboyer, “Porod bez násilí,” 20-21. 24 Leboyer, Porod bez násilí, 40-41. 25 Leboyer, “Porod bez násilí,” 19. 26 An interview with H. Marková. 27 Marková, Kozerovský and Goldmann, “První zkušenosti,” 766. 28 Ibid. In their later text, Marková, Kozerovský and Goldmann even state that for these employees it was too difficult to “re-evaluate their own position of unrestricted rules to a role of qualified helpers full of empathy…” V. Kozerovský, H. Marková and P. Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” Sestra 1 (1991): 24-27, 25. 29 Marková, Kozerovský and Goldmann, “První zkušenosti,” 766. 30 Melichar, Vocel and Janovský, “3. Neonatologické dny,” 171-172; Heitlinger, Reproduction, Medicine, 223-234. Rooming-in was yet another widely discussed issue in Czechoslovak perinatology in the early 1980s. However, its introduction was not specifically related to the Ostrov maternity ward (even though the Ostrov hospital was among the first establishments to implement it), and therefore I do not analyze it here in depth. 31 Kozerovský, Marková and Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” 26. 32 Marková, Kozerovský and Goldmann, “První zkušenosti,” 766. 33 Ibid., 767. 34 Ibid. 35 Ibid., 768. 36 Ibid., 767. 37 Heitlinger, Reproduction, Medicine, 201; This corresponds to similar accounts from Soviet maternity hospitals. Michaels, Lamaze, 29; Michele Rivkin-Fish, Women‘s Health in Post-Soviet Russia. The Politics of Intervention (Bloomington and Indianapolis: Indiana University Press, 2005), 75-76 ; Maya Haber, “Concealing Labor Pain. The Evil Eye and the Psychoprophylactic Method of Painless Childbirth in Soviet Russia,” Kritika: Explorations in Russian and Eurasian History 14 (2013): 535-559, 553. 38 Professor Antonín Ostrčil, whose definition of the medical management of childbirth became foundational for Czech obstetrics, established analgesics as an inherent part of childbirth in the 1920s. Antonín Pařízek, “Historický vývoj porodnické analgezie a anestezie v České republice“, in Porodnická analgezie a anestezie, ed. A. Pařízek et al. (Praha: Grada Publishing, 2002), 43-49. 39 Marková, Kozerovský and Goldmann, “První zkušenosti,” 767. 40 Ibid., 768. 41 Mothers were evenly divided on whether their newborns should be swiftly removed from their arms in the delivery room. Ibid., 768. 42 Marková, Kozerovský and Goldmann, “První zkušenosti,” 768. 43 Ibid. 44 Ibid., 768; H. Marková, “Odpověď na námitky proti vedení fyziologického porodu metodou podle Fredericka Leboyera: Výběr z referátů přednesených na sjezdu čs. Společnosti gynekologicko-porodnické, Košice, 20-22.9.1984,“ Československá gynekologie 50 (1985): 698-699, 699. 45 Hrešanová, “Nobody in a Maternity Hospital,” 964-965; Heitlinger, Reproduction, Medicine, 83; Read, “Labour and Love,” 206. 46 Healthcare was provided to patients according to their particular health problems, or according to their age (in the case of pediatrics), gender (in the case of obstetrics and gynecology) or occupation (in the case of corporate or industrial workers). Heitlinger, Reproduction, Medicine, 77, 81-82. 47 Petr Svobodný and Ludmila Hlaváčková, Dějiny lékařství v českých zemích (Praha: Triton, 2004), 221. Marková, Goldmann, and Kozerovský were not the only advocates of a more individualized approach to birth in the 1980s. In 1984, Pavel Čepický, a Czech gynecologist and psychologist, advocated for providing psychoprophylactic childbirth education classes, but only to women who needed them most. Pavel Čepický, “Psychoprofylaktická příprava k porodu,” Československá gynekologie, 49 no. 2 (1984): 119-24. A few years later, he and his colleagues from the Institute for the Care of Mother and Child in Prague (ICMC), published an article on a different topic; they compared the labors and deliveries of eighty-one women who received the “individualized care of their obstetrician-gynecologists on request” with the same number of women who—in line with official practice—gave birth attended by the random obstetrician on duty. Finding no substantial differences between the groups, including lengths of labors and medical interventions, they argued that the ICMC obstetricians served all women as best as they could regardless of established relationships. Although in 1987 and 1988, when Čepický’s study took place, maternity care was still provided to women according to their place of residence, doctors in the ICMC could, and did, skirt their supervisors to obtain special care for female acquaintances. These practices, not sanctioned by official socialist ideology or rules, heralded change in Czechoslovakia, occurring just as similar calls for commercialized (i.e. private) and more individualized services became central to the political discourse on healthcare in the post-socialist era. P. Čepický, S. Horská and F. Mandys, “Porody žen v individuální péči porodníka,” Československá gynekologie 55 (1990): 519-520; Hrešanová, “Psychoprophylactic method,” 540, 553. 48 F. De Lyser, Workout Book for Pregnancy, Birth and Recovery (New York: Simon Schuster, 1985).Quoted in Kozerovský, Marková and Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” 25. 49 Kozerovský, Marková and Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” 25. 50 Ibid. 51 Ibid., 24-27. 52 Most maternity hospitals introduced similar services in response to post-socialist market-driven reforms of the Czechoslovakian health care system in the 1990s. Hrešanová, Kultury dvou porodnic. 53 Interview with H. Piškaninová (September 2016, Ostrov), who worked as a midwife in the Ostrov maternity hospital in the 1980s; H. Marková, J. Marek, V. Joza, “K ‘ovlivnění laktace akupunkturou’,” Československá gynekologie 52 (1987): 783-786. 54 Interview with H. Piškaninová. 55 Marková, Marek and Joza, “K ‘ovlivnění laktace akupunkturou,’” 783. 56 Heitlinger, Reproduction, Medicine, 234. 57 The number of babies that were not breastfed at all, or up to a week, was 12 percent. A. Svobodová, “Výsledky sledování kojení pediatrickými a zdravotně výchovnými pracovníky v letech 1983-1987,” Československé zdravotnictví 37 (1989), 363-371. 58 Marková, “Odpověď na námitky,” 698; Bedřich Srp, “Porod podle Leboyera,” Zdravotnické noviny 32 (1983): 26. 59 Marková, “Odpověď na námitky.” 60 Ibid., 698. 61 Srp, “Leboyer,“ 26. 62 Marková, “Odpověď na námitky,” 698. 63 Srp offered a balanced view, citing some benefits of that approach to birthing as well as its weaknesses; Srp, “Leboyer,” 26. 64 Marková, “Odpověď na námitky,” 698, 699; Čepický, “Psychoprofylaktická příprava k porodu,”124; Štembera, Historie české perinatologie, 296; an oblique critique in Zdeněk Štembera, “Nový význam sociálních aspektů v péči o těhotnou ženu,” Československá gynaekologie 48 (1983): 633-637, 636-637. 65 Marková, “Odpověď na námitky,” 699. 66 Uzel, Bendová, Čepický, Chvála, Koťátková and Pečená, “Quo usque tandem,” 375. 67 M. Štimpl, J. Hrdinová, L. Slezák, “Otec u porodu,” Zdravotnické noviny 34, 25(1985), 7; M. Štimpl, L. Slezák, “Nejde o experiment,“ Československá gynekologie 51 (1986), 565-567, 566. 68 Josef Švejcar, “Rooming-in v životě dítěte,” Československá pediatrie 41 (1986), 290-291; Heitlinger, Reproduction, Medicine, 222-223. Minutes from the Inspection at the Pre-term Newborn Unit, Children’s Ward, Hospital with Polyclinic in Ostrov, 9 June 1986, Dr. Marková’s private archive. 69 Štimpl, Hrdinová and Slezák, “Otec u porodu,” 7; Štimpl and Slezák, “Nejde o experiment,“ 566; M. Štimpl and L. Slezák, “Otec u porodu a naše současnost. K diskuznímu příspěvku MUDr. J. Presla, CSc.,” Československá gynaekologie 52 (1987): 793-794. 70 Štimpl, Hrdinová and Slezák, “Otec u porodu,” 7. 71 Augustín Bárdoš and Oĺga Blašková, “Replika na verbovanie otca k porodu: Štimpl, M., Slezák, L.: Nejde o experiment,” Československá gynekologie 52 (1987), 232-235. Both were Associate Professors at the 1st Obstetrical-gynecological clinic at the School of Medicine, Comenius University in Bratislava, and Blašková was even its chief physician. 72 Ibid., 233-234. 73 Ibid., 234. However, an article published in the Mladý svět a year later brought a statement from the Ministry of Health that neither supported nor forbid fathers‘ presence at childbirth in Czechoslovak hospitals. Emingerová, “Tatínkové,” 9. Some experts Marková was corresponding with read Bárdoš and Blašková’s arguments as a “rude political demagogy” supportive of the Consolidation regime. Dr Marková private archive, a letter from 11 April 1988. 74 Srp, “Leboyer,“ 26; V. Puchmeltr, “K replice na verbovaní otce k porodu,” Československá gynekologie 57 (1987), 717-718, 717; D. Kviz, “Ještě glosa k otázce přítomnosti otce na porodním sále,” Československá gynekologie 53 (1988), 122. 75 Bárdoš and Blašková, “Replika na verbovanie,” 234. 76 Ibid., 233. 77 The Gynecological and Obstetrical Society was part of the Czechoslovak Association of Physicians, which was an umbrella interest organization of physicians aiming to deepen specialized medical knowledge. It was founded after the Communist takover in June 1949 and included the oldest association of Czech physicians (the Society of Czech Medical Doctors) and all specialized medical associations. Svobodný and Hlaváčková, Dějiny lékařství, 228-229; Štembera, Historie české perinatologie, 48. 78 Uzel, Bendová, Čepický, Chvála, Koťátková and Pečená, “Quo usque tandem,” 377. In the West, and particularly in the United States, physicians embraced identical opinions of fathers’presence in delivery rooms. Wolf, Deliver me from Pain, 150-151. For more on the history of fathers’ role during birth in the United States, see also Judith Walzer Leavitt, Make Room for Daddy: The Journey from Waiting Room to Birthing Room (University of North Carolina Press, 2009). 79 Uzel, Bendová, Čepický, Chvála, Koťátková and Pečená, “Quo usque tandem,” 377. 80 Eva Křížová, Proměny lékařské profese z pohledu sociologie (Praha: Sociologické nakladatelství SLON, 2006), 108; Hrešanová, “Nobody in a maternity hospital,” 964. 81 In July 1948, the Central Union of Czechoslovak Physicians and the Central Union of Midwives were dissolved. The Revolutionary Trade Union (ROH) was established instead and became the umbrella body for all health care workers. In 1950, a new Health Occupations Act (no. 170, 1950 Coll.) was passed that established administrative control over physicians’ work and dissolved medical chambers whose jurisdiction was transferred to the ministry of health, ROH, medical colleges and District National Committees (národní výbory). Svobodný and Hlaváčková, Dějiny lékařství, 220; J. Rákosník and I. Tomeš, Sociální stát v Československu. Právně-institucionální vývoj v letech 1918-1992 (Praha: Auditorium, 2012), 306-307. 82 Hrešanová, “Nobody in a maternity hospital,” 964; Štembera, Historie české perinatologie, 44; Křížová, Proměny lékařské profese, 111; Heitlinger, Reproduction, Medicine, 76-77. 83 Hrešanová, “Nobody in a maternity hospital,” 964; Křížová, Proměny lékařské profese, 11-114. 84 Rivkin-Fish, Women’s Health, 73. 85 Ibid. 86 Ibid., 73-74. 87 Marková, “Odpověď na námitky,” 699; P. Goldmann, H. Marková, V. Kozerovský, “Odpověď na repliku A. Bárdoše a O. Blaškové,” Československá gynekologie 53 (1988), 455-457; Marková, V. Kozerovský, P. Goldmann, “Význam otce v perinatálním období,” Praktický lékař 71 (1991): 377-381; Kozerovský, Marková and Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” 24-27. 88 H. Marková, V. Kozerovský and P. Goldmann, “Význam otce v perinatálním období,” 13. 89 A. Mlynářová and J. Tošner, “Historie přítomnosti muže u porodu,” Gynekolog 4 (1995), 216-218. 90 Hana Marková, “Otevřme porodnice otcům,” Sestra 1 (1991), 16-17. 91 Ibid. 92 Hrešanová, “Psychoprophylactic Method.” 93 J. Kapr and Č. Müller, “Teoretický kontext nových porodnických metod. K diskusi o porodu podle Leboyera,” Praktický lékař 65 (1985): 928-930. 94 Hrešanová, “Psychoprophylactic Method,” 552-553. 95 “Dopis České národní radě a Ministerstvu zdravotnictví ČSR s analýzou československého zdravotnictví, 1984” [Letter to Czech National Council and Ministry of Health, Czech Socialist Republic, with an Analysis of Czechoslovak Health Care], 15 August, Prague. (Document 14/84), in Charta 77: Dokumenty 1977-1989, ed. Blanka Císařovská and Vilém Prečan, vol. 1 (Praha: Ústav pro soudobé dějiny, 2007), 642-657. 96 Heitlinger, Reproduction, Medicine, 93-95; D. Šráčková and J. Šráček, “Obtíže při zavádění systému rooming-in,” Československá gynekologie 50 (1985), 605-606; Štembera, Historie české perinatologie, 234, 256; Charta 77 to Prime Minister of the Czechoslovak Socialist Republic L. Štrougal, State Planning Committee, Czechoslovak Academy of Science Committee, and Ministry of Education, “Analýza stavu vědeckého výzkumu v Československu,“ Document No. 26/82, in Charta 77: Dokumenty 1977-1989, ed. Blanka Císařovská and Vilém Prečan, vol. 1 (Praha: Ústav pro soudobé dějiny, 2007), 464-468, 464. 97 Štembera, Historie české perinatologie, 199. 98 In-depth interview with Dr. Kozerovský (April 2013, Karlovy Vary). 99 Interview with H. Marková and Marková’s “Complex work-political assessment” from August 1972; and Minutes from the Inspection at the Pre-term Newborn Unit, Children’s Ward, Hospital with Polyclinic in Ostrov, 9 June 1986, Dr. Marková’s private archive. 100 Ivo Možný, Proč tak snadno?(Praha: Sociologické nakladatelství SLON, 1991). 101 Minutes from the Inspection at the Pre-term Newborn Unit, Children’s Ward, Hospital with Polyclinic in Ostrov, 9 June 1986, Dr. Marková’s private archive. 102 In particular, Soukup offered it to Dr. Vosátka, the Ostrov maternity ward head. In-depth interview with Pavel Ries (August 2016, Prague). 103 Jiří Soukup was a typical “pábitel” (sometimes translated as “palaverer“ into English). Czech writer Bohumil Hrabal coined this term for marginalized people - dreamers living at the outskirts of society who nevertheless exhibited their own unique brilliance. B. Hrabal, Pábitelé, (Praha: Nakladatelství Mladá Fronta, 1969). Film director Petr Slavík was so fascinated by the palaverer’ character of Soukup’s personality that he shot a short documentary about him in 1990 (named Four-Beat Waltz [Valčík na čtyři doby]). 104 Jiří Soukup, “Křeslo pro princeznu,” Technický magazín 32 (1989): 16-25, 22. 105 In constructing the decompression device, Soukup was inspired by the earlier work of Prague obstetrician Antonín Doležal who built his own device on the assumption that gravity caused labor pain. Doležal presumed the added weight of pregnancy forced the belly to press on nerves. Thus he theorized that levitating the abdomen would eliminate the pain of labor. Doležal had excellent results, the method substantially reduced pain during labor, but many technological imperfections remained. A. Doležal, J. Lukáš and J. Vajsová, “Naše zkušenosti s použitím abdominální dekomprese podle Heynse za porodu,“ Československá gynekologie 32 (1967): 723-726; Soukup, “Křeslo,” 21. 106 Soukup, “Křeslo,” 23. 107 Ibid., 23. 108 Ibid., 23. 109 Ibid. interview with Pavel Ries. 110 This was a leading journal; its editor-in-chief was Dr. Vladimír Petřík. In August 1989, the journal published a famous article written by Miloš Zeman, today’s president of the Czech Republic, that was the first open critique of the management of the Czechoslovak state. See also Pullman, Konec experimentu, 210-211. 111 In-depth interview with Pavel Ries. Some of Soukup’s other articles described an innovative way to drive a nail with a drop of nitroglycerine and an impregnable safe – it had no interior. 112 A. Brzezinska, “Mystification in Czech Cinematography and Culture,“ Journal of Education Culture and Society 3 (2013): 309-315; Maruška Svašek, “The Limits of Humour and Play,” Etnofoor 12 no. 2 (1999): 117-131. On political use of humor in Czech culture see also Kevin McDermott, Communist Czechoslovakia, 1945-1989: A Political and Social History (Palgrave Macmillan, 2015). 113 Soukup, “Křeslo,” 18-19. 114 Taťána Lomíčková and Zdeněk Štembera, “Quo usque tandem abutere patientia nostra?,“ Československá gynaekologie 54 (1989):604 115 Ibid. 116 Ibid.; Taťána, Lomíčková, “Otevřený dopis PhDr. V. Petříkovi, šéfredaktoru Technického magazínu aneb Audiatur et altera pars,“ Československá gynekologie 55 (1990): 541-543. 117 Lomíčková and Štembera, “Quo usque tandem,” 604. 118 The so-called chief specialist or expert is “a full-time administrative official of the national Ministry of Health, who is responsible for the expert direction and the improvement of standards of individual medical branches;” Heitlinger, Reproduction, Medicine, 91. Heitlinger noted that not all medical specialties had a chief specialist but obstetrics and gynecology had one because maternity and reproductive care was a high priority for the Communist government because it secured the health of the state’s future citizenry; ibid., 77. 119 Pavel Ries, “Křeslo pro…koho?,” Technický magazín 33 (1990): 30-31, 31. 120 Ibid. 121 Ibid. 122 K. Sýkora and B. Běhal, “K článku ‚Křeslo pro…koho?” Československá gynekologie 55 (1990): 625. 123 Ibid. 124 Ibid. 125 Interview with Dr. Eva D., a psychologist who gave birth in the Ostrov hospital to her first child in 1986 (August 2017, Prague). 126 Ibid. 127 Cf. Hrešanová “Psychoprophylactic Method,” 552-553. 128 Emingerová, “Tatínkové.” 129 Interview with P. Ries. 130 Numerous letters of thanks to Dr. Marková and Dr. Váchová, a director of the Karlovy Vary hospital, Dr. Marková private archive; in-depth interviews with Ries and Eva D., and Dagmar S. (November 2015). 131 Everyday life as well as e.g. an architecture and environment were often depicted as having grey shades under the state socialism. See e.g. Susanna Trnka, “When the World Went Color: Emotions, Senses and Spaces in Contemporary Accounts of the Czechoslovak Velvet Revolution,” Emotion, Space and Society 5 (2012): 45-51, 49; Maroš Krivý, “Greyness and Colour Desires: the Chromatic Politics of the Panelák in Late Socialist and Post-Socialist Czechoslovakia,“ The Journal of Architecture 20 (2015): 765-802; Jacek Kochanowitz and Bogdan Murgescu, “Rural and Urban Worlds: Between Economic Modernization and Persistant Backwardness,“ in The Routledge History of East Central Europe since 1700, ed. Irina Livezeanu and Árpád von Klimó (Routledge: London, 2017), 81-125. 132 Možný, Proč tak snadno, 75-76. 133 In-depth interview with Dr Goldmann. 134 Letters of thanks, Dr Marková private archive; in-depth interviews with Dr. Marková and Piškaninová. Unfortunately, exact statistical figures are not available, as the documentary materials were discarded in the early 1990s when the Ostrov hospital became privatized (in-depth interview with H. Piškaninová who currently holds a position of assistant director for nursing care at the Ostrov hospital). 135 E.Hrešanová and J. Hasmanová Marhánková, “Nové trendy v českém porodnictví a sociální nerovnosti mezi rodičkami,” Sociologický časopis, 44 (2008), 87-111; Hrešanová, “Nobody in a Maternity Hospital,” 965; D. Lupton, “Consumerism, Reflexivity, and the Medical Encounter,” Soc Sci Med 45 (1997), 373-381. 136 Heitlinger, Reproduction, Medicine, 230. 137 Ibid., 230, 233. 138 The new type of video camera was yet another technological innovation contributing to the fame of the Ostrov maternity hospital. 139 Marková, H. “Pravda o nemocnici v Ostrově nad Ohří.“ Karlovarské noviny 45 (1990): 2; Report “Pravda o nemocnici v Ostrově nad Ohří, undated Dr. Marková’s private archive; interview with Dr. Hana Marková. 140 Karel Vízek, “Volná tribuna,“ Neonatologický zpravodaj 2 (1992): 229; Karel Vízek, “Novoroční zamyšlení o porodu dle Leboyera,” Neonatologický zpravodaj 1 (1991): 161-166. 141 He argued that the transfer from water to dry land made humans who they were and birth necessarily mimicked that ancient move. Vízek, “Novoroční zamyšlení,”166. 142 Tomáš Poláček, “Jarní zamyšlení o porodu nejen dle Leboyera,“ Neonatologický zpravodaj 2 (1992): 50-51, 50. 143 Anna Mydlilová, “Názor na porod dle Leboyera,” Neonatologický zpravodaj 2 (1992): 51-52. 144 Interview with Dr. Kozerovský; and Eva D. who gave birth to her second child in a different hospital in the early 1990s confirmed this as well. 145 Pullman, Konec experimentu, 195, 198, 231-232. 146 Pullman, Konec experimentu, 72-73. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the History of Medicine and Allied Sciences Oxford University Press

The Island of Alternatives: Power, Medical Science, and “Gentle Birthing” in Socialist Czechoslovakia

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Oxford University Press
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© The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com
ISSN
0022-5045
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1468-4373
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10.1093/jhmas/jrx056
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Abstract

Abstract Beginning in the early 1980s, medical experts and birthing women increasingly voiced criticism of what had long been the technocratic, depersonalized nature of obstetric treatment in Czechoslovakia, despite the limited opportunities for them to do so publicly. A few maternity hospitals responded to the complaints by introducing radically different regimens of care. This article examines the history of one reformist project that took place in the small town of Ostrov nad Ohří. Ostrov means “island” in Czech and, during the last decade of Communist rule in Czechoslovakia, the Ostrov hospital became an island of alternative obstetric care, embracing Leboyer’s method of “gentle birthing,” acupuncture, fathers in delivery rooms, and assorted technological innovations that aimed to spark fundamental change in familial and social relationships, and humanize childbirth. While many medical professionals decried these reforms as nonsensical and dangerous, a number of parents-to-be flocked to Ostrov to give birth, circumventing the official rules mandating that they receive healthcare in their area of residence. This proactive consumerist behavior among expectant parents, in tandem with the call of some physicians for more attention to individual and family needs, despite the opposing official political discourse, is evidence of a grassroots movement for market-oriented principles in healthcare that reflected broader societal change during the last decade of the Communist regime. Maternity hospitals were not particularly homey, friendly places in socialist Czechoslovakia. In the 1950s, when most births moved to hospitals, care was highly depersonalized, resembling a factory assembly line.1 Providers focused primarily on the technical aspects of care and neglected to give birthing women emotional support.2 Nurses were known for their carelessness and indifference, occasionally scolding women for being noisy and demanding.3 Although criticism of these practices surfaced periodically in the pages of a major obstetrical journal,4 not much changed during the communist era. In the 1980s, most maternity hospitals still had multi-bed labor rooms, and delivery rooms often hosted several birthing women separated from each other by a mere screen. Most women understandably complained about a lack of privacy.5 Women had little voice in their care; under the command of an obstetrician or an obstetrical nurse, they received analgesics and oxytocin, and gave birth on their backs with their legs in stirrups.6 Immediately after birth, a nurse washed the baby from head to toe, measured him, weighed him, and put antibiotic drops in his eyes. Then the nurse swaddled the baby and held him up for his mother to see. Doctors interpreted a newborn’s cries during those rituals as a sign of his vitality.7 A mother did not spend any time with her newborn until eight hours later, when a pediatric nurse brought the baby in for his first 20-30 minute breastfeeding. Hospitals required new mothers to wear face masks while breastfeeding under the dubious theory that mothers were a primary source of infection.8 Babies were breastfed in three-hour intervals, six times a day. If they awoke at night, nurses sometimes fed them tea. The nurses performed all newborn care; infants’ mothers were not even permitted to unwrap their babies’ swaddling. Mothers left the hospital five to eight days after giving birth, never having seen their babies’ bodies and often wholly ignorant of appropriate infant care.9 No visitors, not even fathers, were permitted in the maternity ward. Instead, fathers competed for a phone at the hospital reception desk to get in touch with their wives; the less fortunate had to be content with standing in front of a hospital window and waving. Some hospitals built a small hatch between the postpartum ward and the hospital corridor so visitors could take a look at a new baby through a window as his mother held him up to see during visiting hours.10 Beginning in the early 1980s, medical experts, as well as birthing women and their partners, voiced increasing criticism of this sort of treatment despite limited venues to express their grievances publicly. In response, a few maternity hospitals introduced radically different regimens of care. These hospitals constituted isolated “islands of alternatives” within the larger system.11 Most notably, several midwives resurrected the psychoprophylactic method of painless childbirth,12 a system developed decades earlier in the Soviet Union that eventually became known as Lamaze in the United States.13 The psychoprophylatic method necessitated innovative childbirth education classes that furthered interest in an array of birth alternatives. A few obstetricians in some parts of the country also experimented with allowing fathers in delivery rooms and implementing a rooming-in arrangement in order to strengthen the mother-newborn bond. In this article, I examine the history of one reformist project—in a small maternity hospital in Ostrov nad Ohří—that represented a unique paradigmatic case.14Ostrov means “island” in Czech and the hospital, located near the German border, became an island of alternative obstetric care during the last decade of Communist rule in Czechoslovakia. The Ostrov maternity hospital experimented with several innovations, including the so-called “gentle birthing” method, an approach to childbirth designed by French obstetrician Frederick Leboyer. Ostrov physicians introduced these options to “humanize” childbirth and spark fundamental change in familial and social relationships.15 I argue that this thirst for more harmonious relationships reflected a broader societal movement heralding collapse of the system in the last decade of Communist rule in socialist Czechoslovakia. The Communist Party originally took over in February 1948, establishing a strict regime backed by the Soviet Union. By the early 1960s, political liberation had begun, culminating in a series of political reforms in the spring of 1968, dubbed the Prague Spring. These reforms paved the way for a general democratization of the regime and society, and development of Czechoslovakia’s own unique path to socialism—termed “socialism with a human face.” This reformist endeavor diverged from the Soviet-directed course; the Warsaw Pact Invasion, however, halted the process in August 1968.16 An era of political persecution known as the “Consolidation regime” followed, only to reverse course again in the mid-1970s. By the late 1970s, the overall social and political climate had gradually shifted toward tolerance for diverse values, desires, attitudes, and interests.17 Childbirth and maternity care constitute an especially apt domain to study these subtle changes. As historians and anthropologists of childbirth have demonstrated, birth practices in all societies mirror core societal values and contemporary social and political dynamics, reflecting the fact that a country’s future is dependent on the health and well-being of its infants.18 The developments in the Czech maternity system paralleled the demands for, and formation of, alternatives within the broader socialist and post-socialist Czechoslovak society. Ostrov and Its Maternity Hospital Ostrov nad Ohří is a small town near the German border, a few kilometers from what was then the Iron Curtain. Its unique location adjacent to both a valuable mining town and a politically conformist, administrative center allowed the local maternity hospital to introduce novel practices. On one side, the hospital was not far from Jáchymov, a town located in a deep valley containing uranium mines and an affiliated “work-camp” for political prisoners who were forced to mine -- with their bare hands. Because the town was unable in the 1950s to keep up with the Soviet Union’s demand for uranium, the Communist Party substantially enlarged Ostrov city to accommodate an influx of newcomers to work in the mines. On the other side of Ostrov was Karlovy Vary, the region’s main administrative center and tourist attraction, where only people with pristine political and public reputations were permitted to hold positions. Citizens with any political stain were not permitted to work in Karlovy Vary and often ended up in Ostrov, twelve kilometers away. This was precisely how several outstanding, innovative physicians ended up working in the Ostrov hospital.19 Dr. Hana Marková—a neonatologist and the daughter of a prominent Communist ex-leader—was among them. Authorities transferred her from Karlovy Vary clinic to the Ostrov hospital after she participated in public protests against the Warsaw Pact invasion in 1968. Along with the transfer, she was prohibited from publishing articles and delivering public lectures, including presenting at conferences. Her academic career in tatters, in September 1980 she nevertheless attended the Third Neonatological Conference in Olomouc, organized by the Czech Paediatric Society. The Conference turned out to be the most important event in years. Plenary speakers from a number of institutions across the country and abroad spoke to more than 250 participants, offering an unbridaled critique of the medical management of childbirth and its negative impact on mother-newborn bonding. Discussions centered on the advantages of an innovative rooming-in arrangement, and whether to allow fathers in delivery rooms. Highlighting the conference was a lecture given by French obstetrician, Michel Odent, who talked about the “gentle birthing” method used in his clinic in Pithiviers.20 Odent was a disciple of Frederick Leboyer, a French obstetrician known for his criticism of modern maternity hospitals that, he contended, ignored the emotional needs of newborns and their mothers.21 Particularly interested in a baby’s transition from the womb to the outer world, Leboyer proposed a change in obstetric procedures to ease this process. His technique included absolute silence in the delivery room, no direct light that could irritate the newborn’s eyes, no touching of a baby’s head, and postponing cutting the umbilical cord until it ceased pulsing. Under Leboyer’s system, the obstetrician gripped the baby’s neck during delivery, gently pulled the baby from the birth canal, and then placed the newborn on the mother’s belly.22 The new mother then stroked her baby’s back to stimulate breathing. Then she breastfed her baby, allowing the infant ample time to explore the world and lick and suck her nipple.23 Only after the first breastfeeding did a nurse wash the neonate in warm water while the mother remained nearby. As the infant relaxed in the warm water, his eyes slowly opened, and he studied his new world.24 Above all, Leboyer emphasized that treatment of the baby (and mother) be gentle. Healthcare providers were to be patient and avoid any tendency to rush.25 Marková, a neonatologist, was especially intrigued by Leboyer’s focus on the newborn. Enamored, she gathered a team of medical experts in the Ostrov hospital to implement the gentle birthing method.26 Her core team included Dr. Petr Goldmann, a young clinical psychologist interested in the overall well-being of families, new mothers, and the mother-child bond, and Dr. Václav Kozerovský, a young and devoted obstetrician who was—unlike Goldmann or Marková—a member of the Communist party, able to provide the radical project with political cover. Yet the person most responsible for the success of the project, who secretly protected and nurtured it, was Dr. František Vosátka, the head of the Ostrov maternity ward. All three members of the gentle birthing team appreciated Vosátka’s silent support as an act of bravery, extraordinary for that time. The Implementation Marková, Kozerovský and Goldmann took the initial steps toward implementing their alternative birth practices in 1980. Their first task was to win over their Ostrov colleagues. They approached each individually.27 While younger employees of the maternity hospital were happy to support innovation, the older obstetricians and midwives, accustomed to providing care in “strictly technical terms,” were highly resistant. Some simply left the hospital’s employ; others only pretended to go through the motions of the Leboyer method.28 In addition to introducing Leboyer, Marková and her colleagues also implemented a “rooming-in” arrangement. Their ultimate goal was to construct an entirely new system of birth and postpartum care aimed at strengthening the mother-child bond.29 The rooming-in arrangement was itself a substantial revolution in the organization of postpartum care, enabling babies to stay with their mothers instead of being placed in a separate newborn ward for most of the day and seeing their mothers only intermittently for breastfeeding.30 To fully accommodate the innovation, the Ostrov maternity hospital physically restructured its wards, joining the postpartum and newborn wards into one.31 Like Leboyer, the Ostrov team insisted on absolute silence in the delivery room, nurturance of the natural birthing process, not touching the baby’s head, guiding his body out by the armpits, and immediately placing the baby on his mother’s belly. “We get fully immersed in the birthing process, we forget time, we identify with the baby and perceive the tiniest details.”32 The team adhered slavishly to Leboyer’s method, cutting the umbilical cord only after it stopped pulsing, transferring the infant to a tub of warm water (approximately 100-102 degrees Fahrenheit), and easing the infant into the extrauterine world by imitating the intrauterine environment.33 The Ostrov team was unable to execute only one step: complete darkness in the delivery room. Instead, they only simulated darkness by placing a dark green rubber screen between the window and the baby’s tub to protect the newborn from a too-rapid transition to the outer world. The first witnesses to Leboyer’s method recalled being deeply moved.34 Ostrov medical personnel soon started keeping detailed records, compiling empirical data on forty “gentle” births, all from women whose baby’s gestational age was more than thirty-six weeks and whose labor was physiological. Primiparas as well as multiparas, and university-educated as well as “semi-literate Roma women,” were included in the cohort.35 Women participating in the quasi-study were allowed to remain ambulatory until the baby’s head entered their pelvic cavity.36 This differed from conventional socialist maternity hospitals, where women were frequently told precisely when to push, and scolded by health care providers if they complained too loudly of discomfort and pain.37 Diverging significantly from the “normal” medical management of childbirth, Ostrov obstetricians did not administer any medication during labor and delivery.38 Although doctors worried the method might prolong the second stage of labor, on average the second stage lasted only fourteen minutes.39 They also discovered that only one healthcare provider, either a midwife or an obstetrician, was necessary, and that the presence of a bevy of medical personnel inhibited a smooth birth process. After each birth in their study, Ostrov doctors conducted ten-minute, structured interviews with postpartum women about their experience. Only two women expressed dissatisfaction with having their babies placed on their abdomens immediately after the delivery. The vast majority were extremely positive; one Roma woman who planned to give her baby up for adoption changed her mind after bonding with her baby, a connection prompted by the Leboyer method.40 Most women were delighted by the opportunity to touch their baby immediately after delivery and were not repulsed, as doctors had long feared they would be, by their babies’ unwashed bodies.41 The majority also preferred having their babies with them for prolonged periods rather than isolated in faraway nurseries. Interviewees welcomed the future possibility of having their baby’s father with them during labor; sixty-four percent, mostly primiparas, said they would have chosen that option if it had been available.42 The results of their study pleased Marková, Goldmann, and Kozerovský. They viewed it as proof that the Leboyer method fostered an intimate bond among the mother, baby, and father; met the unique needs of every family; was safe, cheap, “practically feasible everywhere,” and highly satisfying to everyone, including the newborn.43 The Leboyer method offered “an individualized approach” to childbirth in the context of socialist care by allowing healthcare providers to respect the unique mental state and physiology of mothers and their newborns.44 Embrace of the method represented a covert critique of the socialist system of healthcare that demonstratively ignored individuality. On an ideological level, socialist health care was to be provided to all, in the identical manner, regardless of a patient’s unique characteristics. Healthcare, viewed as a set of tasks attending to a patient’s body and physical symptoms, neglected, and often wholly ignored, the emotional aspects of care-giving.45 With the overall organization of healthcare fragmented and built on highly specialized healthcare services, the system left no space for more holistic and integrative approaches.46 The Ostrov physicians’ adoption of Leboyer was, in part, a response to these shortcomings—inadequacies that became increasingly obvious to both dissidents and official state representatives.47 One of the key contentions of the Ostrov team was that childbirth was a transformational experience in family life. Five years after they conducted their first gentle births in Ostrov, the team introduced an additional concept to enhance their philosophy. They permitted husbands to accompany their wives into delivery rooms, as long as the couple had participated in designated childbirth education classes. These classes combined the Lamaze method with various relaxation and acupressure exercises inspired by Marek and De Lyser.48 Expectant parents practiced stimulating acupressure points to relax and suppress pain during labor, and they learned about special birthing positions and breathing techniques.49 They also learned how to communicate with their fetus via stroking, stimulation, massage, and music.50 Fathers learned that psychologically supporting their partner was their most important job during labor. Four times a year, during special “parental talks,” the maternity ward allowed couples to visit a delivery room. Fathers’ presence in particular required organizational changes. The hospital set aside a smaller delivery room for Leboyer births, separated from the large delivery rooms by a hallway. This arrangement ensured both silence—essential for the Leboyer approach—and easy access to an operating theater in case of emergency. Before entering a delivery room, a father donned special hospital garb and slippers and scrubbed his hands and forearms with a small brush, as if preparing to perform surgery. In exceptional cases, hospital personnel allowed a father to be present even during complicated forceps deliveries. Some obstetricians also allowed fathers to cut the umbilical cord when it stopped pulsing. After the birth, the family remained together for two hours in the delivery room. Fathers could purchase coffee, tea, or other refreshments at will. The Ostrov team claimed that most parents regarded those hours as the happiest of their lives.51 While today, those types of services are an everyday part of maternity hospitals’ offerings, they were extraordinary in the context of Czechoslovakia’s socialist healthcare system.52 In the mid-1980s, V. Joza, an obstetrician trained in acupuncture, joined the Ostrov team, expanding the scope of medical services. His unusual expertise was considered by many to be especially progressive.53 Not only did he and his colleagues apply acupuncture and acupressure to prevent, or ease, labor pain, they also used acupuncture to normalize the fetal position in the case of breech presentations.54 Joza also used acupuncture to resolve breastfeeding problems. In the medical team’s view, ensuring successful breastfeeding was essential to forging a close bond between a new mother and her baby in the alienating hospital environment.55 In most hospitals—unlike Ostrov—breastfeeding was the only opportunity for women to see their babies. Consequently, breastfeeding rates were high in the hospital but decreased steeply within two weeks of the return home.56 In the West Bohemian region to which the Ostrov district belonged, 81.4 percent of babies were weaned by three months, the lowest breastfeeding rate in the eight Czech regions in 1986; the highest rates were in Prague where 41.1 percent babies were breastfed longer than three months. After the obstetric innovations, however, West Bohemia saw its breastfeeding rates become comparable to other regions.57 A Sharp Debate on “Gentle Birthing” After the Ostrov trio presented their initial successes with gentle births, they were met with harsh criticism from colleagues. The disapproval was largely unofficial, voiced during informal gatherings at professional meetings and conferences and in the lay press. Critics condemned Marková and her Ostrov colleagues for underestimating “common reflexive processes,” and overestimating a baby’s distress when it came into the world.58 In critics’ view, deliberately reducing stress on the newborn was detrimental, as the ability to cope with stress was vital later in life, assuring a child’s ability to adapt to all situations. Marková systematically refuted the objections.59 Based on the Ostrov’s experience with more than 1,500 births, she argued that detractors had a faulty interpretation of physiological childbirth. She insisted that only the “physiological stress” produced immediately before and after childbirth was necessary; any additional stress required a newborn to expend unnecessary energy, resulting in exhaustion.60 Opponents of Leboyer viewed a newborn’s post-natal cry as an essential physiological necessity; they contended that crying pushed amniotic fluid from the lungs and encouraged blood circulation.61 Leboyer and Marková countered that a newborn’s initial cries reflected a traumatic reaction to an unwelcoming hospital environment. They argued that the birth process, via compression of the chest in the birth canal, removed all amniotic fluid. Any that remained was insignificant and could easily be absorbed by the newborn’s alveoli and lymphatic vessels.62 While individual obstetricians like Bedřich Srp, a director of one of the largest Prague gynecological and obstetrical clinics, appreciated Leboyer’s emphasis on facilitating newborn care, encouraging laboring women, nurturing a physiological course of labor, and “humanizing” childbirth and postpartum care,63 most Czechoslovak obstetricians denounced the Leboyer approach as “a phoney, trendy fad” that contradicted modern scientific methods.64 Marková responded to the criticism by citing widely circulated findings in the fields of evolutionary biology and human psychology: “Leboyer’s method of giving birth is truly modern in the sense that it is the first approach in the history of obstetrics that fully respects the individuality of each birthing woman and her child; it respects their mental state as well as their physiological functions.”65 Fathers at births The Ostrov trio considered the presence of fathers during births to be an extension of Leboyer’s overall philosophy—in essence, birth done properly strengthened families. Thus, professional disputes about the Leboyer method became entangled with equally passionate disagreements over fathers in delivery rooms. For five years, Czechoslovak Gynecology and other journals published articles, commentaries, and essays airing both sides of this tempestuous debate.66 The first maternity hospital permitting husbands to accompany their wives to delivery was located in Znojmo, a town hundreds of kilometers away from Ostrov, in Moravia. The Znojmo obstetricians did not share their Ostrov colleagues’ interest in the Leboyer method, but they, too, wanted to promote more humane and ethical traditions in birth and society.67 Both medical teams also claimed to be influenced by professor Josef Švejcar, a doyen of Czech pediatrics and a harsh critic of women’s subordination in Czech families.68 Other than that, there did not seem to be any connection between the two hospitals. In the mid-1980s, the Moravian obstetricians published a positive report about their experience with fathers in delivery rooms based on couples’ questionnaires.69 The report claimed that fathers’ presence at births strengthened the bond between partners as well as parents’ bond with their newborns, transformed childbirth into a peaceful and harmonious family event, eased the stress on laboring women, and encouraged healthcare workers to be kinder to women and adhere to ethical rules of conduct.70 Slovak senior obstetricians Bárdoš and Blašková responded with outrage to the advocacy for fathers.71 They condemned the Znojmo obstetricians’ “recruitment of fathers” as degrading and unprofessional.72 They argued that welcoming laymen into maternity wards and delivery rooms trivialized medicine. They contended that the change may be acceptable in Western capitalist countries, where physicians compete for popularity and profit, but that in Czechoslovakia, where obstetricians concentrate solely on the health and well-being of their patients to prevent the spread of infection, the presence of nonmedical personnel hindered basic patient safety. Bárdoš and Blašková cited the Ministry of Health directives forbidding visitors in delivery, postpartum, and newborn wards.73 Other physicians agreed with them, declaring childbirth a serious medical procedure, not a sideshow attraction.74 Bárdoš and Blašková added that what Czechoslovak obstetrics really required was better medical technology, instruments, and drugs—not fathers. Laymen in delivery would only lead to misunderstandings, complaints, and additional work for medical professionals.75 They and other critics dismissed the “humanization of birth care” as “pseudopsychological speculation.”76 Representatives of the Section for Psychosomatics in Gynecology and Obstetrics of the Czech Gynecological and Obstetrical Society77 suggested, however, that the actual reason fathers in delivery rooms outraged so many Czechoslovak obstetricians was that they suffered “a kind of subconscious attempt to retain their professional prestige” which—they believed—was much lower under a socialist health care system where they toiled as state employees, compared to “Western developed countries.”78 They noted sarcastically, “The delivery room is our last bastion where—though being pushed aside, kicked and offended—an obstetrician is still the master.”79 In short, in the socialist healthcare system, as well as in society-at-large, doctors no longer enjoyed the elite status they had before WWII.80 After the socialist regime incorporated healthcare services into the system of state administration,81 all doctors became state employees. Simultaneously, their professional associations dissolved, their salaries diminished, and industrial occupations became the priority.82 Physicians lost their professional autonomy, and with it their right to self-regulation, which destroyed doctors’ sense of professional identity and soured relations within the profession and between doctors and patients.83 Rivkin-Fish describes a similar move toward medical deprofessionalization in the Soviet Union. As in Czechoslovakia, Soviet medical professionals had very little political and economic power; the Communist Party centrally directed the socialist health care system from Moscow.84 Nevertheless, in both countries, the political regime also put a strong ideological emphasis on technology and scientific expertise, which granted doctors a certain level of authority to exercise disciplinary power and dominance over their patients.85 Hospital settings became the primary environment in which doctors could ensure that patients fully submitted to their expertise. Thus, the relative disempowerment of doctors within the larger societal, political, and economic structures prompted their paternalistic approach to hospitalized patients.86 Ostrov physicians specifically disapproved of this sort of medical paternalism, and sensed there was a connection between the “sad state of familial relationships” and what was going on in maternity wards. In their view, the wider societal crisis was linked to the technocratic nature of maternity care.87 Marková, Kozerovský and Goldmann believed the solution lay in paying closer attention to the psychological and social aspects of maternity care.88 They soon followed in their Znojmo colleagues’ footsteps,89 welcoming fathers in their maternity hospital.90 Indeed, they became even better known for doing that, as popular magazines and newspapers soon published accounts of the activities at Ostrov. Marková, Kozerovský, and Goldmann believed that their innovations, especially fathers at births, reflected broader societal trends. They pointed to “new patients” who were both better informed about health care and more skeptical of medical treatment.91 These consumers of healthcare did not view doctors as gods. Other physicians made similar observations. In the early 1980s, Dr. Pečená, a psychologist with midwifery training who revived the psychoprophylactic method of childbirth preparation in the early 1980s, noticed that the women taking her childbirth education classes were increasingly critical of paternalism in medicine; they wanted to make their own medical decisions.92 Similarly, Jaroslav Kapr, a medical sociologist, and Čestmír Müller, a professor of social medicine at Charles University, considered use of the Leboyer method to be symptomatic of broader changes in medicine.93 As Czech society transformed, Czech citizens were increasingly critical of disrespectful, demeaning healthcare providers and less willing to be passive subjects of both medical and state paternalism.94 These tendencies very clearly surfaced in the heated debate about an adjustable birth chair, nicknamed “the chair for the princess,” that drew attention once again to the Ostrov maternity hospital. The Chair for the Princess The chair was one of several technologies invented for the Ostrov maternity hospital. Although it never made it into routine use, the chair was one of the most significant innovations coming out of the Ostrov because of the fiery debate it aroused in obstetrics and perinatology. Ostensibly concerning a woman’s comfort and needs during labor and delivery, the discussion shed light on the power dynamics between hospitals on the geographic and medical periphery versus those in the capital and regional centers. While the regime put a lot of emphasis on technological progress and development, in practice, contrary to its egalitarian ideology, the government was often unable to produce an adequate number of technological devices for local markets. Economic resources were lacking to provide up-to-date equipment at all healthcare facilities.95 The latest medical technologies produced in Western countries were usually too expensive for the socialist, state-controlled market.96 Even though, beginning in the late 1970s, the state had been increasingly able to adequately equip clinics and regional healthcare facilities,97 many district hospitals still faced scarcity and were left on their own to solve the problems caused by shortages. Consequently, many local experts became bricoleurs, incessantly experimenting, extemporizing, and mobilizing accessible resources. The Ostrov maternity hospital, for example, developed a small movable baby bath for use in delivery rooms, a baby cot on wheels for rooming-in, 98 and a lamp produced by a local factory to treat neonatal jaundice. The factory designed the lamp because of their association with Dr. Marková.99 These types of informal connections were crucial in most spheres of everyday life during this era, when the economy suffered from numerous scarcities.100 Still, such contraptions, the Ostrov doctors argued, however effective they might have been, were “only provisional solutions” and “could never fully substitute for factory-made products.”101 Yet the environment of scarity clearly offered creative opportunities for inventors and innovators. Jiří Soukup, a Renaissance man who was an excellent painter, pianist, and organist, and who mastered mechanical engineering to boot, designed and built the controversial birth chair and offered it to the head of the Ostrov maternity hospital.102 Despite Soukup’s genius, his political standing was tenuous, forcing him to live in the Ostrov region.103 While living there, he had a platonic affair with a woman who became pregnant by another man. Seeking to ease the birth process for her, and assure that she felt like royalty even as she labored, Soukup designed and assembled a chair that could be reconfigured so that each woman could push during second-stage labor in the most effective way. He designed the chair using his artistic skills and own body measurements, “without even basic ergonomic knowledge.”104 His colleague, Kaštánek, an engineer, helped him assemble it. Attached to the chair was a decompression device to elevate the pregnant belly and, theoretically, ease pain during labor.105 Soukup equated the chair for his “princess” with “a Lincoln among cars.”106 The enthusiasm, effort, time, and money that Soukup and Kaštánek put into the birth chair did not pay off. Not only did Soukup’s “princess” give birth the day before the chair was ready, except for the Ostrov’s physicians, who were all enthusiasts, the rest of the maternity hospital staff expressed only “sleepy interest” in Soukup’s masterpiece.107 The chair’s detractors voiced “thousands of complaints:” the “cushioning was too short, the arm rests were too complicated, and lowering the seat was too tricky.”108 Soukup found the imperfections easy to fix in technical terms but he feared that the complaints stemmed, not from the chair per se, but from the extra work it created for hospital staff, mainly nurses. What offended him most, however, was that “somebody who wanted to torpedo the idea and avoid any extra work” renamed his “chair for the princess” a funeral bier, not because of its shape but because of its color. Soukup had painted the birth chair dark violet—a favorite color of the woman he was so enamored with—and outlined it with an extra flourish, a double gold line. Ultimately, the hospital used the chair only twice and it ended up in a hospital corridor with only Soukup’s essay to commemorate it.109 Soukup wrote about his innovation in the Technický magazín [Technical Magazine], as part of his regular contribution published annually on the first day of April.110 The date of the publication—April Fool’s day—suggested ridicule of the inventions described by the magazine.111 Articles were meant to be parodies, with a critical political and social subtext. This type of humor and satire were widespread during the state socialist era and constituted an important part of Czech culture.112 While Soukup was serious about his invention and its potential to help birthing women, the article mocked physicians and described the medical paternalism that prompted development of the chair.113 Leading Czechoslovak obstetricians, especially those from Prague, were infuriated by what they believed was a diatribe against their work. Taťána Lomíčková and Zdeněk Štembera, obstetricians from Prague’s Institute for Mother and Child (ICMC), a research organization, responded in Czechoslovakia’s main obstetric journal, Československá gynekologie. They dismissed Soukup’s article as a “lay person’s demagogic campaign against us based on no scientific evidence and in which we are accused of an inhumane approach harmful to future generations.”114 They believed Soukup’s article damaged not only the reputation of Czechoslovak obstetricians and other maternity hospital staff, but also “in a broader sense, the reputation of all healthcare workers.”115 They insisted that any innovation in obstetric care, including a birth chair, be based on sound empirical research, and that, for at least three years, they had been conducting similar, but more systematic, investigations into managing second-stage labor with a birth chair.116 They challenged Ostrov obstetricians not only to justify this particular chair and its attached decompression device via “a sufficiently large research sample of women patients and meeting basic methodological criteria,” but also to defend their use of the Leboyer method.117 Professor František Macků, the chief obstetrics expert in the West Bohemian region that housed the Ostrov maternity hospital, likewise denounced Soukup’s article as dishonest and defamatory. In a letter to Professor Miroslav Břešťák, the Chief obstetrician-gynecologist at the Czechoslovakian ministry of health, Macků condemned the article as denigrating obstetricians’, indeed all healthcare providers,’ work.118 Břešťák agreed, but did not offer any remedy for Soukup’s alleged insults.119 A few doctors from different maternity hospitals did find Soukup’s invention inspiring. They expressed keen interest in it, especially as Soukup promised blueprints to anybody with access to a tinsmith’s facility.120 In a subsequent issue of the Technical Magazine, Pavel Ries, Soukup’s student and a film director, wrote an article supporting Soukup’s invention. In the article, he explicitly mentioned two physicians interested in the device: Dr. Běhal, head of the maternity hospital in Přerov who promised to test the chair in his health facility, and Dr. Zábranský who held the same position as Běhal in Zlín and wanted to see a video-recording of the chair in action. Soukup also received an expression of interest from a German obstetrician.121 Dr. Běhal was not happy that his name appeared in Ries’s article. In a response co-authored with his Přerov colleague, Dr. Sýkora, the two suggested that the publicity had gotten them into trouble with their superiors. The men insisted that their interest in “the chair” did not imply criticism of mainstream Czechoslovak obstetrics. Quite the contrary, they were opposed to any “lay assessment of healthcare providers’ work, especially the work of us obstetricians.”122 They condemned the “assault” on “obstetricians’ ethics in the eyes of the public.”123 Kowtowing to their more prominent colleagues, they agreed that only “authorized health facilities” and “competent experts should examine these issues and arrive at an ultimate verdict which will, certainly, mute emotions and non-constructive publicity outside the pages of Czechoslovak Gynecology.”124 The brouhaha implied that small maternity hospitals, such as the Ostrov, dare not conduct research, or do anything, to provoke controversy, especially if their work ended up being covered by the press. In this regard, the birth chair debate resembled the two previous debates about the Ostrov’s advances. Top obstetricians condemned each innovation as it appeared, revealing a significant schism in Czechoslovak perinatology. Yet the more high-ranking obstetricians condemned the innovations, the more enthusiastic parents became. In offering Leboyer’s gentle birthing method and fathers at births, the Ostrov maternity hospital became increasingly popular. Parents’ Move News of the hospital’s offerings spread quickly via articles in regional as well as national newspapers and magazines, such as Mladá Fronta, Mladý Svět, and Karlovarské noviny. But what was equally important was that new parents shared their positive birth experiences at the Ostrov maternity hospital with other couples. In the wake of the printed and word-of-mouth publicity, even though women were required to give birth in a maternity hospital in their residential district, many found a way to give birth at the Ostrov. One frequent strategy was to travel to Ostrov toward the end of a pregnancy, ostensibly to vacation. Other women headed to the Ostrov hospital at the onset of labor, preferring to risk giving birth in the back seat of their car rather than their assigned hospital.125 As Eva D. explained, in the Ostrov hospital “babies are not taken away from moms.”126 A university student of psychology at the time, she was frightened by standard, impersonal health care.127 She explained, “Simply put, we sought a different way and didn’t want to subject ourselves to a factory-like environment.” She was intrigued by the Ostrov’s “alternative to the usual way of doing things” and the “protest against the standard way of doing things” that it represented. She also longed to experience the Leboyer method for professional reasons, as she had become acquianted with it from the medical literature. Other couples travelled to Ostrov to ensure a father would be present during childbirth.128 Pavel Ries claimed, “Such a man who sees his wife in labor and supports her during delivery can never abondon her. So powerful is the experience.”129 The Ostrov team’s reputation for kindness, hospitality, and support continued to attract new parents.130 Eva D. recalled that the friendly atmosphere manifested itself even in the colorful, striped baby caps and tiny socks that obstetrical nurses knitted during quiet shifts. “This was something completely different,” she marveled. The delightful infant clothing contrasted sharply with the stark white hospital uniforms and the general greyness of socialism.131 The Leboyer method met Eva’s expectations. Her baby was calm at birth, just as Leboyer had described in the books she read. She was delighted: “It was a maternity hospital where babies did not cry.” She credited the calm and comforting atmosphere to a hospital that put the needs of neonates first. “Babies could be breastfed anytime they wanted, and were not tormented by a forced three-hour interval of feeding. Unlike regular maternity hospitals that were linked to a strict regimen, all this nonsensical lack of freedom, I longed for a more relaxed, unrestricted, freer approach… . [I really appreciated] that there was no harm done [at the Ostrov] because of some [arbitrary set of] rules… I was really happy to find a small refuge where such a humane approach existed.” Eva’s observations are in line with Možný’s argument that in the late 1980s many were simply disgusted with the overall ritualization of everyday life, including endless celebrations of the Party’s anniversaries requiring decorations in shop windows and participation in official meetings and parades.132 Most women who gave birth in the Ostrov hospital were from the district. Yet, like Eva and the Rieses, a number of expectant parents came from all over the country, notably from bigger cities.133 One couple from Košice, Slovakia traveled 500 miles to give birth there.134 The consumer savvy that characterized market-driven healthcare reforms in the post-socialist era of the 1990s and 2000s prompted patients to travel long distances for a specific type of care. Reforms presupposed that citizens would choose healthcare services according to their needs and desires, fostering a competition among healthcare providers that would lead, in theory, to improved services. Consumerism represented the ideological antithesis of the socialist approach to healthcare.135 Yet the couples who decided to give birth in the Ostrov maternity hospital in the 1980s demonstrated that Czechoslovakians embraced healthcare consumerism well before the new political regime embraced patients’ desires as legitimate, legal, and beneficial options. They did not initiate those options, however. Heitlinger argued that in the 1980s, women, as consumers of maternity care, were not in a position to initiate change. Rather, they could only embrace the new, existing options. In Heitlinger’s view, pregnant women “had some input into decision-making about policy changes,” such as rooming-in, but their role in driving change was more limited than in the West. 136 Medical experts and the publicity their innovations engendered, not healthcare consumers, triggered the forays into improved maternity care. 137 In Ostrov, the first stirrings of change came from physicians, primarily Dr. Marková. Yet the Ostrov’s novel approaches to birthing would have never taken root so firmly if not for the interest of parents, especially mothers. Ultimately, doctors and parents worked in tandem to transform the existing system of birth care. In the late 1980s, the Ostrov hospital garnered additional attention, thanks to film-maker Pavel Ries. Preparing to attend the birth of his first child, Ries visited the Ostrov. Intrigued, he shot a documentary about the Leboyer method using a camera small and sensitive enough to shoot in semi-darkness.138 The documentary was subsequently screened on national television and distributed to secondary schools as part of a national program to ensure that the country’s future parents would be aware of, and possibly seek, humane methods of giving birth. “Polite Behavior” Eventually Spreads In spring 1989, six months before the end of Communist rule, Dr. Vosátka retired. As the head of the Ostrov’s maternity wards he had protected the “humanization project.” The gentle birthing team secretly hoped that Dr. Kozerovský, with his sound professional reputation and political profile, would replace Vosátka. Instead, another man who was not in the Communist party but was against gentle birthing, replaced Vosátka and soon restricted any practice of the Leboyer method due to his disinterest, despite the hospital director giving him direct orders not to do so. In the meantime, Dr. Kozerovský was transferred to Karlovy Vary, returning a few years later to finally become the head of the maternity ward and rejuvenate the gentle birthing option. Dr. Goldmann also left for a new appointment in Prague after the fall of the Communist regime. With the disintegration of her team and close to retirement, Dr. Marková departed the Ostrov hospital in May 1990 and moved with her husband to Prague.139 After Marková and her colleagues began to present the fruits of their work in a more systematic way, attacks against the Ostrov’s use of the Leboyer method increased despite the dispersal of the original team members to other hospitals and locales. In 1991, Karel Vízek from the Institute for Mother and Child in Prague responded to several articles published in newspapers and popular lifestyle magazines. He accused the Ostrov’s physicians, especially Marková, of manipulating public opinion by misinterpreting and distorting the results of clinical studies on the Leboyer method.140 In a derisive, arrogant tone, he accused the Ostrov’s obstetricians of ignoring how stress compromised newborns’ ability to fully adapt to the extra-uterine environment. He accused the Ostrov’s doctors of being inept scientists who misunderstood the crucial processes at play in a newborn’s body and contended that newborns’ reactions at the moment of birth were hard-wired by human evolution.141 He condemned the Ostrov team for neglecting the detrimental effects of the Leboyer method on the newborn circulatory system. He insisted that the salient characteristic of the Leboyer method, a warm bath immediately after delivery, caused a newborn’s blood to flow to his skin instead of his organs and lungs, prompting hypoxia. Some denounced Vízek’s disapproval. His colleague from the ICMC, Tomáš Poláček, found his condemnations of all alternative approaches to childbirth too harsh and wide-ranging. Poláček sided with Marková, agreeing that “traditional medicalized birth practices” in Czechoslovak maternity hospitals were caused by the communist regime’s elimination of competition in healthcare, allowing unprofessionalism and indifference toward patients to run rampant.142 Anna Mydlilová, a neonatologist and a respected promoter of breastfeeding, likewise dismissed Vízek’s position, pointing out that he was largely unfamiliar with Marková’s work. Mydlilová argued that any methods that enhanced the “psychological comfort” of laboring women and their newborns should be widely supported and practiced.143 According to Dr. Kozerovský that is exactly what happened in the 1990s; the “polite behavior towards a mother and a baby” that was the heart of the Leboyer method spread to other hospitals.144 Conclusion The Ostrov maternity hospital and its novel approaches to childbirth garnered the attention of Czechoslovak perinatologists and expectant parents at least three times during the last decade of Communist rule. Discussion of fathers’ presence in delivery rooms not only reflected obstetricians’ concerns about their tenuous professional status, the conversation prompted parents to seek a specific type of care. Debate about the scientific rigor of the Leboyer method highlighted the impersonal nature of socialist maternity care and encouraged women and families to seek treatment that nurtured the mother-newborn bond as the foundation of improved interpersonal and family relations. A dispute over an adjustable birth chair revealed the power dynamics at play between central healthcare facilities and those on the periphery, and the role each played in developing technological innovations and deciding to what extent the needs of birthing women should be accommodated. The controversial chair also highlighted growing discrepancies between the regime’s rhetoric and its economic capacity to fullfil its promises. Among perinatologists, the debates revealed a deeper schism. On the one hand, defenders of the dominant view insisted that physicians retain exclusive decision-making power. They perceived any attempts to redefine childbirth as a familial event rather than a medical one, to be a threat to their professional authority. They called for the advancement of medical technologies in Czechoslovak maternity hospitals in order to maintain a level of control. While the political regime was unable to secure a satisfactory supply of medical technologies, it nevertheless emphasized technology and scientific expertise. Obstetrics and gynecology reflected this technocratic focus as the political regime prioritized the field of reproductive medicine as a means of assuring that new generations of robust citizens would be able to contribute to the socialist establishment. On the other hand, the Ostrov physicians, and a number of neonatologists, psychologists, and a few obstetricians at other locales, promoted an individualized approach to birth and newborn care. They called for the provision of support and basic comforts to laboring mothers and an end to the assembly-line techniques so pervasive in socialist maternity wards. The Ostrov physicians, and other advocates of the “humanization” of maternity and newborn care, linked the technocratic nature of socialist healthcare to a more general crisis in societal and familial relations. Advocating a holistic approach to all aspects of family care, they asserted that healthcare providers should facilitate both mothers and fathers bonding with their child as a highly beneficial aspect of the psychological health and wellbeing of all family members. The development of this perspective in perinatology and obstetrics paralleled the emergence and establishment of alternative views in the broader society during the last decade of Communist rule. The change in thinking portended new morals, values, and demands. In particular, an emphasis on individualism, as opposed to the official ideology of collectivism, was a response to the general disregard for, and disdain of, individuals’ needs within the centrally directed socialist healthcare system and society. Increasingly critical of the dominant technocratic and paternalistic approaches to healthcare in general, and maternity care in particular, people longed for more respect in interpersonal relations, and attention to individual dignity and autonomy.145 In birth care, both medical professionals and lay parents sought options. Expectant parents even found a way around the official, residence-based organization of care, making their way to the hospital of their choice. Physicians supporting free choice leaned toward market-driven principles in healthcare, which they saw as essential for increasing their professional status. In the 1980s, as a series of ever-louder voices criticized the shortcomings of the Czechoslovakian healthcare system, the lack of competition among healthcare providers was offered as a reason for the system’s inadequacies. Physicians frequently argued that inadequacies were side effects of doctors being state employees earning low salaries. As demonstrated by the Ostrov experience, the market-oriented ideology and moral economy were evident, at least in medicine, before the fall of the communist regime, and before market-driven principles became part of the official political discourse. Not until 1987, after government policy started to change in response to the political and economic reforms initiated by Mikhail Gorbachev in the Soviet Union, were market-driven principles deemed beneficial within expert and government circles as a way of overcoming economic stagnation.146 Only then did the island become a mainland, as more maternity hospitals adopted a gentle(r) approach to birthing and offered more birth alternatives. ACKNOWLEDGEMENTS I wish to thank Jacqueline Wolf for her tremendous help with this article and insightful comments. My special thanks go to Dr. Marková, Pavel Ries, Dr. Kozerovský, Dr. Goldmann, Eva D. and to Mrs. Piškaninová from the Ostrov hospital. FUNDING This work was supported by the Jan Hus Foundation Fellowship, the Czech Republic (fellowship for 2015/2016) and partially supported by the Charles University Center for Excellence for the Study of Collective Memory. Footnotes 1 Ema Hrešanová, “Psychoprophylactic Method of Painless Childbirth: From State Propaganda to Activism of Enthusiasts,”Medical History 60 (2016): 534–556. https://doi.org/10.1017/mdh.2016.59; Zdeněk Štembera, Historie české perinatologie (Praha: Jessenius Maxdorf, 2004), 39. 2 Ema Hrešanová, “‘Nobody in a Maternity Hospital Really Talks to You’: Socialist Legacies and Consumerism in Czech Women’s Birth Narratives,” Sociologický časopis/Czech Sociological Review 50 (2014): 961-986, 964-965; C. Benoit and A. Heitlinger, “Women’s Health Care Work in Comparative Perspective: Canada, Sweden and Czechoslovakia/Czech Republic as Case Examples,“ Soc Sci Med 47 (1998): 1101–1111; Rosie Read, “Labour and Love: Competing Constructions of ‘Care’ in a Czech Nursing Home,“ Critique of Anthropology 27 (2007): 203–222, 206. 3 Alena Heitlinger, Reproduction, Medicine and the Socialist State (New York: St.Martin’s Press), 200, with a reference to M. Taufrová, “Odkaz stavu a změn společenského prostředí na hospitalizovaného pacienta,“ Československé zdravotnictví 29(1981): 166-171. Articles describing particular cases of birthing women being slapped across the face also appeared in the widely read weekly Mladý svět. Dana Emingerová, “Tatínkové v porodnicích a ještě něco navíc, aneb náš příchod na svět,“ Mladý svět 30 (1988): 9-15, 13, 15. 4 Hrešanová, “Nobody in a Maternity Hospital,” 964-965. 5 Heitlinger, Reproduction, Medicine, 201. 6 Heitlinger, Reproduction, Medicine, 202. 7 Dana Emingerová, “Podoby lásky. Děti narozené s láskou aneb PROČ nehledat odpověď i tam, kde život začíná,“ Mladý svět 30 (1988): 6-8, 7. 8 Heitlinger, Reproduction, Medicine, 222. 9 Ibid, 221; Letter of Thanks to Regional Institute of National Health, Karlovy Vary (KÚNZ), May 1982, Dr. Hana Marková’s private archive. 10 Heitlinger, Reproduction, Medicine, 222; Emingerová, “Tatínkové,” 15. 11 Ema Hrešanová, “The Natural Childbirth Movement in the Czech Republic,” in Rebellious Parents: Parental Movements in Central-Eastern Europe and Russia, ed. Katalin Fábián and Elżbieta Korolczuk (Bloomington: Indiana University Press, 2017), 277-307; 286, 290. 12 Hrešanová, “Psychoprophylactic Method.” 13 Paula Michaels, Lamaze: An International History (New York: Oxford University Press, 2014), 8. 14 I build here on the analyses of published studies in medical journals as well as popular newspapers and magazines, in-depth interviews with key figures, and materials from Dr. Hana Marková’s private archive. 15 Hana Marková, Václav Kozerovský and Petr Goldmann, “První zkušenosti s porodem podle Leboyera,” Praktický lékař 63 (1983): 766-768, 768; H. Marková, V. Kozerovský and P. Goldmann, “Význam a úloha otce v perinatálním období“, Sestra 1(1991): 11-15, 11. 16 The so-called Warsaw Pact, formally a Treaty of Friendship, Co-operation, and Mutual Assistance was a collective defense treaty among the Soviet Union and seven states in Central and Eastern Europe (Czechoslovakia, East Germany, Poland, Hungary, Romania, Bulgaria, and Albania) signed in May 1955. It was created in response to NATO’s presence in Europe and served to maintain Soviet hegemony in the region. The Soviet Union, and the other five countries of the Warsaw Pact, were deeply concerned that the political developments in Czechoslovakia had the potential to threaten the unity of the Eastern Soviet Bloc. Therefore, on 17 August 1968 the Soviet Communist Party Politburo decided to invade Czechoslovakia militarly, a move that the other five countries of the Warsaw Pact approved a day later. The military invasion violated the Warsaw Pact Treaty, the United Nations Charter and sovereignty of the Czechoslovakian state and as such was illegal. Ondřej Felcman, “Československá reforma 1968-1969,” in Slovníková příručka k československým dějinám 1948-1989, ed. Jiří Kocián (Praha: Ústav pro soudobé dějiny Akademie věd ČR, 2006), 21-30, 27; Ondřej Felcman, “Sovětská vojska v Československu 1968-1991,” in Slovníková příručka k československým dějinám 1948-1989, ed. Jiří Kocián (Praha: Ústav pro soudobé dějiny Akademie věd ČR, 2006), 31-35, 31. 17 Michal Pullman, Konec experimentu: přestavba a pád komunismu v Československu (Praha: Scriptorium, 2011), 21. 18 Ema Hrešanová, Kultury dvou porodnic: etnografická studie (Plzeň: Západočeská univerzita, 2008), 7; Robbie Davis-Floyd and Carolyn Sargent, “Introduction: the Anthropology of Birth,” in Childbirth and Authoritative Knowledge. Cross-cultural Perspectives, ed. R. Davis-Floyd and C. Sargent (Berkeley, Los Angeles: University of California Press,1997), 1-5, 6; Bonnie Fox and Diana Worts, “Revisiting the Critique of Medicalized Childbirth: A Contribution to Sociology of Birth,” Gender and Society 13 (1999): 326-346, 329; Wendy Kline, Bodies of Knowledge. Sexuality Reproduction, and Women’s Health in the Second Wave (Chicago and London: University of Chicago Press, 2010); Michaels, Lamaze; Jacqueline Wolf, Deliver Me from Pain. Anesthesia and Birth in America (Baltimore: The John Hopkins University Press, 2009). 19 In-depth interviews with H. Marková (February 2013, Prague) and P. Goldmann (November 2012, Prague). 20 Heitlinger, Reproduction, Medicine, 226. The date of the conference is specified in V. Melichar, J. Vocel, M. Janovský, “3. Neonatologické dny české pediatrické společnosti,” Československá pediatrie 36 (1981): 171-172, 171. A part of the lecture was translated by Dr Šráček and published in a gynecological journal: Michel Odent, “Bien naitre “phenomene Leboyer,” Československá gynaekologie 46 (1981): 193-195. This was not the first appearance of Leboyer’s ideas in the Czechoslovak context, as psychologist Marie Damborská presented his thinking in her article published in the first issue in 1980. Marie Damborská, “Co je nefyziologické v přístupu k dítěti nejútlejšího věku,” Psychológia a patopsychológia dieťaťa 15 (1980): 21-37. Czechoslovak neonatologists originally planned to invite Odent to the Czechoslovak Gynaecological and Obstetrical Society’s conference in 1984 in Podolánky since they proposed the humanization of birth care as the key theme. However, the Society’s federal board, meeting in Brno in October 1983, did not approve the offer in spite of invitations already having been printed. R.Uzel, M. Bendová, P. Čepický, V. Chvála, I. Koťátková and M. Pečená, “Quo usque tandem? (pokus o ukončení diskuse o přítomnosti otce u porodu),” Československá gynaekologie 54 (1989), 375-378; J. Šráček and D. Šráčková, “Chováme se k novorozenci jako k nošenci?” [online], Společnost pro plánování rodiny a sexuální výchovu, accessed 7 November 2013. 21 Marková, Kozerovský and Goldmann, “Význam otce v perinatálním období.” Frederick Leboyer, Porod bez násilí, trans. H. Marková (Praha: Alcor, 1995), 3. 22 Frederick Leboyer, “Porod bez násilí,” trans. H. Marková, Sestra 2 (1992): 19-21, 20; Frederick Leboyer, Childbirth without Violence, trans. Alfred A. Knopf (New York: Alfred A. Knopf, 1978), 37-67. 23 Leboyer, “Porod bez násilí,” 20-21. 24 Leboyer, Porod bez násilí, 40-41. 25 Leboyer, “Porod bez násilí,” 19. 26 An interview with H. Marková. 27 Marková, Kozerovský and Goldmann, “První zkušenosti,” 766. 28 Ibid. In their later text, Marková, Kozerovský and Goldmann even state that for these employees it was too difficult to “re-evaluate their own position of unrestricted rules to a role of qualified helpers full of empathy…” V. Kozerovský, H. Marková and P. Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” Sestra 1 (1991): 24-27, 25. 29 Marková, Kozerovský and Goldmann, “První zkušenosti,” 766. 30 Melichar, Vocel and Janovský, “3. Neonatologické dny,” 171-172; Heitlinger, Reproduction, Medicine, 223-234. Rooming-in was yet another widely discussed issue in Czechoslovak perinatology in the early 1980s. However, its introduction was not specifically related to the Ostrov maternity ward (even though the Ostrov hospital was among the first establishments to implement it), and therefore I do not analyze it here in depth. 31 Kozerovský, Marková and Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” 26. 32 Marková, Kozerovský and Goldmann, “První zkušenosti,” 766. 33 Ibid., 767. 34 Ibid. 35 Ibid., 768. 36 Ibid., 767. 37 Heitlinger, Reproduction, Medicine, 201; This corresponds to similar accounts from Soviet maternity hospitals. Michaels, Lamaze, 29; Michele Rivkin-Fish, Women‘s Health in Post-Soviet Russia. The Politics of Intervention (Bloomington and Indianapolis: Indiana University Press, 2005), 75-76 ; Maya Haber, “Concealing Labor Pain. The Evil Eye and the Psychoprophylactic Method of Painless Childbirth in Soviet Russia,” Kritika: Explorations in Russian and Eurasian History 14 (2013): 535-559, 553. 38 Professor Antonín Ostrčil, whose definition of the medical management of childbirth became foundational for Czech obstetrics, established analgesics as an inherent part of childbirth in the 1920s. Antonín Pařízek, “Historický vývoj porodnické analgezie a anestezie v České republice“, in Porodnická analgezie a anestezie, ed. A. Pařízek et al. (Praha: Grada Publishing, 2002), 43-49. 39 Marková, Kozerovský and Goldmann, “První zkušenosti,” 767. 40 Ibid., 768. 41 Mothers were evenly divided on whether their newborns should be swiftly removed from their arms in the delivery room. Ibid., 768. 42 Marková, Kozerovský and Goldmann, “První zkušenosti,” 768. 43 Ibid. 44 Ibid., 768; H. Marková, “Odpověď na námitky proti vedení fyziologického porodu metodou podle Fredericka Leboyera: Výběr z referátů přednesených na sjezdu čs. Společnosti gynekologicko-porodnické, Košice, 20-22.9.1984,“ Československá gynekologie 50 (1985): 698-699, 699. 45 Hrešanová, “Nobody in a Maternity Hospital,” 964-965; Heitlinger, Reproduction, Medicine, 83; Read, “Labour and Love,” 206. 46 Healthcare was provided to patients according to their particular health problems, or according to their age (in the case of pediatrics), gender (in the case of obstetrics and gynecology) or occupation (in the case of corporate or industrial workers). Heitlinger, Reproduction, Medicine, 77, 81-82. 47 Petr Svobodný and Ludmila Hlaváčková, Dějiny lékařství v českých zemích (Praha: Triton, 2004), 221. Marková, Goldmann, and Kozerovský were not the only advocates of a more individualized approach to birth in the 1980s. In 1984, Pavel Čepický, a Czech gynecologist and psychologist, advocated for providing psychoprophylactic childbirth education classes, but only to women who needed them most. Pavel Čepický, “Psychoprofylaktická příprava k porodu,” Československá gynekologie, 49 no. 2 (1984): 119-24. A few years later, he and his colleagues from the Institute for the Care of Mother and Child in Prague (ICMC), published an article on a different topic; they compared the labors and deliveries of eighty-one women who received the “individualized care of their obstetrician-gynecologists on request” with the same number of women who—in line with official practice—gave birth attended by the random obstetrician on duty. Finding no substantial differences between the groups, including lengths of labors and medical interventions, they argued that the ICMC obstetricians served all women as best as they could regardless of established relationships. Although in 1987 and 1988, when Čepický’s study took place, maternity care was still provided to women according to their place of residence, doctors in the ICMC could, and did, skirt their supervisors to obtain special care for female acquaintances. These practices, not sanctioned by official socialist ideology or rules, heralded change in Czechoslovakia, occurring just as similar calls for commercialized (i.e. private) and more individualized services became central to the political discourse on healthcare in the post-socialist era. P. Čepický, S. Horská and F. Mandys, “Porody žen v individuální péči porodníka,” Československá gynekologie 55 (1990): 519-520; Hrešanová, “Psychoprophylactic method,” 540, 553. 48 F. De Lyser, Workout Book for Pregnancy, Birth and Recovery (New York: Simon Schuster, 1985).Quoted in Kozerovský, Marková and Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” 25. 49 Kozerovský, Marková and Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” 25. 50 Ibid. 51 Ibid., 24-27. 52 Most maternity hospitals introduced similar services in response to post-socialist market-driven reforms of the Czechoslovakian health care system in the 1990s. Hrešanová, Kultury dvou porodnic. 53 Interview with H. Piškaninová (September 2016, Ostrov), who worked as a midwife in the Ostrov maternity hospital in the 1980s; H. Marková, J. Marek, V. Joza, “K ‘ovlivnění laktace akupunkturou’,” Československá gynekologie 52 (1987): 783-786. 54 Interview with H. Piškaninová. 55 Marková, Marek and Joza, “K ‘ovlivnění laktace akupunkturou,’” 783. 56 Heitlinger, Reproduction, Medicine, 234. 57 The number of babies that were not breastfed at all, or up to a week, was 12 percent. A. Svobodová, “Výsledky sledování kojení pediatrickými a zdravotně výchovnými pracovníky v letech 1983-1987,” Československé zdravotnictví 37 (1989), 363-371. 58 Marková, “Odpověď na námitky,” 698; Bedřich Srp, “Porod podle Leboyera,” Zdravotnické noviny 32 (1983): 26. 59 Marková, “Odpověď na námitky.” 60 Ibid., 698. 61 Srp, “Leboyer,“ 26. 62 Marková, “Odpověď na námitky,” 698. 63 Srp offered a balanced view, citing some benefits of that approach to birthing as well as its weaknesses; Srp, “Leboyer,” 26. 64 Marková, “Odpověď na námitky,” 698, 699; Čepický, “Psychoprofylaktická příprava k porodu,”124; Štembera, Historie české perinatologie, 296; an oblique critique in Zdeněk Štembera, “Nový význam sociálních aspektů v péči o těhotnou ženu,” Československá gynaekologie 48 (1983): 633-637, 636-637. 65 Marková, “Odpověď na námitky,” 699. 66 Uzel, Bendová, Čepický, Chvála, Koťátková and Pečená, “Quo usque tandem,” 375. 67 M. Štimpl, J. Hrdinová, L. Slezák, “Otec u porodu,” Zdravotnické noviny 34, 25(1985), 7; M. Štimpl, L. Slezák, “Nejde o experiment,“ Československá gynekologie 51 (1986), 565-567, 566. 68 Josef Švejcar, “Rooming-in v životě dítěte,” Československá pediatrie 41 (1986), 290-291; Heitlinger, Reproduction, Medicine, 222-223. Minutes from the Inspection at the Pre-term Newborn Unit, Children’s Ward, Hospital with Polyclinic in Ostrov, 9 June 1986, Dr. Marková’s private archive. 69 Štimpl, Hrdinová and Slezák, “Otec u porodu,” 7; Štimpl and Slezák, “Nejde o experiment,“ 566; M. Štimpl and L. Slezák, “Otec u porodu a naše současnost. K diskuznímu příspěvku MUDr. J. Presla, CSc.,” Československá gynaekologie 52 (1987): 793-794. 70 Štimpl, Hrdinová and Slezák, “Otec u porodu,” 7. 71 Augustín Bárdoš and Oĺga Blašková, “Replika na verbovanie otca k porodu: Štimpl, M., Slezák, L.: Nejde o experiment,” Československá gynekologie 52 (1987), 232-235. Both were Associate Professors at the 1st Obstetrical-gynecological clinic at the School of Medicine, Comenius University in Bratislava, and Blašková was even its chief physician. 72 Ibid., 233-234. 73 Ibid., 234. However, an article published in the Mladý svět a year later brought a statement from the Ministry of Health that neither supported nor forbid fathers‘ presence at childbirth in Czechoslovak hospitals. Emingerová, “Tatínkové,” 9. Some experts Marková was corresponding with read Bárdoš and Blašková’s arguments as a “rude political demagogy” supportive of the Consolidation regime. Dr Marková private archive, a letter from 11 April 1988. 74 Srp, “Leboyer,“ 26; V. Puchmeltr, “K replice na verbovaní otce k porodu,” Československá gynekologie 57 (1987), 717-718, 717; D. Kviz, “Ještě glosa k otázce přítomnosti otce na porodním sále,” Československá gynekologie 53 (1988), 122. 75 Bárdoš and Blašková, “Replika na verbovanie,” 234. 76 Ibid., 233. 77 The Gynecological and Obstetrical Society was part of the Czechoslovak Association of Physicians, which was an umbrella interest organization of physicians aiming to deepen specialized medical knowledge. It was founded after the Communist takover in June 1949 and included the oldest association of Czech physicians (the Society of Czech Medical Doctors) and all specialized medical associations. Svobodný and Hlaváčková, Dějiny lékařství, 228-229; Štembera, Historie české perinatologie, 48. 78 Uzel, Bendová, Čepický, Chvála, Koťátková and Pečená, “Quo usque tandem,” 377. In the West, and particularly in the United States, physicians embraced identical opinions of fathers’presence in delivery rooms. Wolf, Deliver me from Pain, 150-151. For more on the history of fathers’ role during birth in the United States, see also Judith Walzer Leavitt, Make Room for Daddy: The Journey from Waiting Room to Birthing Room (University of North Carolina Press, 2009). 79 Uzel, Bendová, Čepický, Chvála, Koťátková and Pečená, “Quo usque tandem,” 377. 80 Eva Křížová, Proměny lékařské profese z pohledu sociologie (Praha: Sociologické nakladatelství SLON, 2006), 108; Hrešanová, “Nobody in a maternity hospital,” 964. 81 In July 1948, the Central Union of Czechoslovak Physicians and the Central Union of Midwives were dissolved. The Revolutionary Trade Union (ROH) was established instead and became the umbrella body for all health care workers. In 1950, a new Health Occupations Act (no. 170, 1950 Coll.) was passed that established administrative control over physicians’ work and dissolved medical chambers whose jurisdiction was transferred to the ministry of health, ROH, medical colleges and District National Committees (národní výbory). Svobodný and Hlaváčková, Dějiny lékařství, 220; J. Rákosník and I. Tomeš, Sociální stát v Československu. Právně-institucionální vývoj v letech 1918-1992 (Praha: Auditorium, 2012), 306-307. 82 Hrešanová, “Nobody in a maternity hospital,” 964; Štembera, Historie české perinatologie, 44; Křížová, Proměny lékařské profese, 111; Heitlinger, Reproduction, Medicine, 76-77. 83 Hrešanová, “Nobody in a maternity hospital,” 964; Křížová, Proměny lékařské profese, 11-114. 84 Rivkin-Fish, Women’s Health, 73. 85 Ibid. 86 Ibid., 73-74. 87 Marková, “Odpověď na námitky,” 699; P. Goldmann, H. Marková, V. Kozerovský, “Odpověď na repliku A. Bárdoše a O. Blaškové,” Československá gynekologie 53 (1988), 455-457; Marková, V. Kozerovský, P. Goldmann, “Význam otce v perinatálním období,” Praktický lékař 71 (1991): 377-381; Kozerovský, Marková and Goldmann, “Význam a úloha otce v průběhu těhotenství a porodu,” 24-27. 88 H. Marková, V. Kozerovský and P. Goldmann, “Význam otce v perinatálním období,” 13. 89 A. Mlynářová and J. Tošner, “Historie přítomnosti muže u porodu,” Gynekolog 4 (1995), 216-218. 90 Hana Marková, “Otevřme porodnice otcům,” Sestra 1 (1991), 16-17. 91 Ibid. 92 Hrešanová, “Psychoprophylactic Method.” 93 J. Kapr and Č. Müller, “Teoretický kontext nových porodnických metod. K diskusi o porodu podle Leboyera,” Praktický lékař 65 (1985): 928-930. 94 Hrešanová, “Psychoprophylactic Method,” 552-553. 95 “Dopis České národní radě a Ministerstvu zdravotnictví ČSR s analýzou československého zdravotnictví, 1984” [Letter to Czech National Council and Ministry of Health, Czech Socialist Republic, with an Analysis of Czechoslovak Health Care], 15 August, Prague. (Document 14/84), in Charta 77: Dokumenty 1977-1989, ed. Blanka Císařovská and Vilém Prečan, vol. 1 (Praha: Ústav pro soudobé dějiny, 2007), 642-657. 96 Heitlinger, Reproduction, Medicine, 93-95; D. Šráčková and J. Šráček, “Obtíže při zavádění systému rooming-in,” Československá gynekologie 50 (1985), 605-606; Štembera, Historie české perinatologie, 234, 256; Charta 77 to Prime Minister of the Czechoslovak Socialist Republic L. Štrougal, State Planning Committee, Czechoslovak Academy of Science Committee, and Ministry of Education, “Analýza stavu vědeckého výzkumu v Československu,“ Document No. 26/82, in Charta 77: Dokumenty 1977-1989, ed. Blanka Císařovská and Vilém Prečan, vol. 1 (Praha: Ústav pro soudobé dějiny, 2007), 464-468, 464. 97 Štembera, Historie české perinatologie, 199. 98 In-depth interview with Dr. Kozerovský (April 2013, Karlovy Vary). 99 Interview with H. Marková and Marková’s “Complex work-political assessment” from August 1972; and Minutes from the Inspection at the Pre-term Newborn Unit, Children’s Ward, Hospital with Polyclinic in Ostrov, 9 June 1986, Dr. Marková’s private archive. 100 Ivo Možný, Proč tak snadno?(Praha: Sociologické nakladatelství SLON, 1991). 101 Minutes from the Inspection at the Pre-term Newborn Unit, Children’s Ward, Hospital with Polyclinic in Ostrov, 9 June 1986, Dr. Marková’s private archive. 102 In particular, Soukup offered it to Dr. Vosátka, the Ostrov maternity ward head. In-depth interview with Pavel Ries (August 2016, Prague). 103 Jiří Soukup was a typical “pábitel” (sometimes translated as “palaverer“ into English). Czech writer Bohumil Hrabal coined this term for marginalized people - dreamers living at the outskirts of society who nevertheless exhibited their own unique brilliance. B. Hrabal, Pábitelé, (Praha: Nakladatelství Mladá Fronta, 1969). Film director Petr Slavík was so fascinated by the palaverer’ character of Soukup’s personality that he shot a short documentary about him in 1990 (named Four-Beat Waltz [Valčík na čtyři doby]). 104 Jiří Soukup, “Křeslo pro princeznu,” Technický magazín 32 (1989): 16-25, 22. 105 In constructing the decompression device, Soukup was inspired by the earlier work of Prague obstetrician Antonín Doležal who built his own device on the assumption that gravity caused labor pain. Doležal presumed the added weight of pregnancy forced the belly to press on nerves. Thus he theorized that levitating the abdomen would eliminate the pain of labor. Doležal had excellent results, the method substantially reduced pain during labor, but many technological imperfections remained. A. Doležal, J. Lukáš and J. Vajsová, “Naše zkušenosti s použitím abdominální dekomprese podle Heynse za porodu,“ Československá gynekologie 32 (1967): 723-726; Soukup, “Křeslo,” 21. 106 Soukup, “Křeslo,” 23. 107 Ibid., 23. 108 Ibid., 23. 109 Ibid. interview with Pavel Ries. 110 This was a leading journal; its editor-in-chief was Dr. Vladimír Petřík. In August 1989, the journal published a famous article written by Miloš Zeman, today’s president of the Czech Republic, that was the first open critique of the management of the Czechoslovak state. See also Pullman, Konec experimentu, 210-211. 111 In-depth interview with Pavel Ries. Some of Soukup’s other articles described an innovative way to drive a nail with a drop of nitroglycerine and an impregnable safe – it had no interior. 112 A. Brzezinska, “Mystification in Czech Cinematography and Culture,“ Journal of Education Culture and Society 3 (2013): 309-315; Maruška Svašek, “The Limits of Humour and Play,” Etnofoor 12 no. 2 (1999): 117-131. On political use of humor in Czech culture see also Kevin McDermott, Communist Czechoslovakia, 1945-1989: A Political and Social History (Palgrave Macmillan, 2015). 113 Soukup, “Křeslo,” 18-19. 114 Taťána Lomíčková and Zdeněk Štembera, “Quo usque tandem abutere patientia nostra?,“ Československá gynaekologie 54 (1989):604 115 Ibid. 116 Ibid.; Taťána, Lomíčková, “Otevřený dopis PhDr. V. Petříkovi, šéfredaktoru Technického magazínu aneb Audiatur et altera pars,“ Československá gynekologie 55 (1990): 541-543. 117 Lomíčková and Štembera, “Quo usque tandem,” 604. 118 The so-called chief specialist or expert is “a full-time administrative official of the national Ministry of Health, who is responsible for the expert direction and the improvement of standards of individual medical branches;” Heitlinger, Reproduction, Medicine, 91. Heitlinger noted that not all medical specialties had a chief specialist but obstetrics and gynecology had one because maternity and reproductive care was a high priority for the Communist government because it secured the health of the state’s future citizenry; ibid., 77. 119 Pavel Ries, “Křeslo pro…koho?,” Technický magazín 33 (1990): 30-31, 31. 120 Ibid. 121 Ibid. 122 K. Sýkora and B. Běhal, “K článku ‚Křeslo pro…koho?” Československá gynekologie 55 (1990): 625. 123 Ibid. 124 Ibid. 125 Interview with Dr. Eva D., a psychologist who gave birth in the Ostrov hospital to her first child in 1986 (August 2017, Prague). 126 Ibid. 127 Cf. Hrešanová “Psychoprophylactic Method,” 552-553. 128 Emingerová, “Tatínkové.” 129 Interview with P. Ries. 130 Numerous letters of thanks to Dr. Marková and Dr. Váchová, a director of the Karlovy Vary hospital, Dr. Marková private archive; in-depth interviews with Ries and Eva D., and Dagmar S. (November 2015). 131 Everyday life as well as e.g. an architecture and environment were often depicted as having grey shades under the state socialism. See e.g. Susanna Trnka, “When the World Went Color: Emotions, Senses and Spaces in Contemporary Accounts of the Czechoslovak Velvet Revolution,” Emotion, Space and Society 5 (2012): 45-51, 49; Maroš Krivý, “Greyness and Colour Desires: the Chromatic Politics of the Panelák in Late Socialist and Post-Socialist Czechoslovakia,“ The Journal of Architecture 20 (2015): 765-802; Jacek Kochanowitz and Bogdan Murgescu, “Rural and Urban Worlds: Between Economic Modernization and Persistant Backwardness,“ in The Routledge History of East Central Europe since 1700, ed. Irina Livezeanu and Árpád von Klimó (Routledge: London, 2017), 81-125. 132 Možný, Proč tak snadno, 75-76. 133 In-depth interview with Dr Goldmann. 134 Letters of thanks, Dr Marková private archive; in-depth interviews with Dr. Marková and Piškaninová. Unfortunately, exact statistical figures are not available, as the documentary materials were discarded in the early 1990s when the Ostrov hospital became privatized (in-depth interview with H. Piškaninová who currently holds a position of assistant director for nursing care at the Ostrov hospital). 135 E.Hrešanová and J. Hasmanová Marhánková, “Nové trendy v českém porodnictví a sociální nerovnosti mezi rodičkami,” Sociologický časopis, 44 (2008), 87-111; Hrešanová, “Nobody in a Maternity Hospital,” 965; D. Lupton, “Consumerism, Reflexivity, and the Medical Encounter,” Soc Sci Med 45 (1997), 373-381. 136 Heitlinger, Reproduction, Medicine, 230. 137 Ibid., 230, 233. 138 The new type of video camera was yet another technological innovation contributing to the fame of the Ostrov maternity hospital. 139 Marková, H. “Pravda o nemocnici v Ostrově nad Ohří.“ Karlovarské noviny 45 (1990): 2; Report “Pravda o nemocnici v Ostrově nad Ohří, undated Dr. Marková’s private archive; interview with Dr. Hana Marková. 140 Karel Vízek, “Volná tribuna,“ Neonatologický zpravodaj 2 (1992): 229; Karel Vízek, “Novoroční zamyšlení o porodu dle Leboyera,” Neonatologický zpravodaj 1 (1991): 161-166. 141 He argued that the transfer from water to dry land made humans who they were and birth necessarily mimicked that ancient move. Vízek, “Novoroční zamyšlení,”166. 142 Tomáš Poláček, “Jarní zamyšlení o porodu nejen dle Leboyera,“ Neonatologický zpravodaj 2 (1992): 50-51, 50. 143 Anna Mydlilová, “Názor na porod dle Leboyera,” Neonatologický zpravodaj 2 (1992): 51-52. 144 Interview with Dr. Kozerovský; and Eva D. who gave birth to her second child in a different hospital in the early 1990s confirmed this as well. 145 Pullman, Konec experimentu, 195, 198, 231-232. 146 Pullman, Konec experimentu, 72-73. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

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Journal of the History of Medicine and Allied SciencesOxford University Press

Published: Jan 1, 2018

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