By the end of the 19th century, the medical specialties of gynecology and obstetrics established a new trend in women’s healthcare. In the 20th century, more and more American mothers gave birth under the care of a university-trained physician. The transition from laboring and delivering with the assistance of female family, neighbors, and midwives to giving birth under medical supervision is one of the most defining shifts in the history of childbirth. By the 1940s, the majority of American mothers no longer expected to give birth at home, but instead traveled to hospitals, where they sought reassurance from medical experts as well as access to pain-relieving drugs and life-saving technologies. Infant feeding followed a similar trajectory. Traditionally, infant feeding in the West had been synonymous with breastfeeding, although alternatives such as wet nursing and the use of animal milks and broths had existed as well. By the early 20th century, the experiences of women changed in relation to sweeping historical shifts in immigration, urbanization, and industrialization, and so too did their abilities and interests in breastfeeding. Scientific study of infant feeding yielded increasingly safer substitutes for breastfeeding, and by the 1960s fewer than 1 in 5 mothers breastfed. In the 1940s and 1950s, however, mothers began to organize and to resist the medical management of childbirth and infant feeding. The formation of childbirth education groups helped spread information about natural childbirth methods and the first dedicated breastfeeding support organization, La Leche League, formed in 1956. By the 1970s, the trend toward medicalized childbirth and infant feeding that had defined the first half of the century was in significant flux. By the end of the 20th century, efforts to harmonize women’s interests in more “natural” motherhood experiences with the existing medical system led to renewed interest in midwifery, home birth, and birth centers. Despite the cultural shift in favor of fewer medical interventions, rates of cesarean sections climbed to new heights by the end of the 1990s. Similarly, although pressures on mothers to breastfeed mounted by the end of the century, the practice itself increasingly relied upon the use of technologies such as the breast pump. By the close of the century, women’s agency in pursuing more natural options proceeded in tension with the technological, social, medical, and political systems that continued to shape their options.
Chinese were one of the few immigrant groups who brought with them a deep-rooted medical tradition. Chinese herbal doctors and stores came and appeared in California as soon as the Gold Rush began. Traditional Chinese medicine had a long history and was an important part of Chinese culture. Herbal medical knowledge and therapy was popular among Chinese immigrants. Chinese herbal doctors treated American patients as well. Established herbal doctors had more white patients than Chinese patients especially after Chinese population declined due to Chinese Exclusion laws. Chinese herbal medicine attracted American patients in the late 19th and early 20th century because Western medicine could not cure many diseases and symptoms during that period. Thriving Chinese herbal medical business made some doctors of Western medicine upset. California State Board of Medical Examiners did not allow Chinese herbal doctors to practice as medical doctors and had them arrested as practitioners without doctor license. Many of Chinese herbal doctors managed to operate their medical business as merchants selling herbs. Chinese herbal doctors often defended their career in court and newspaper articles. Their profession eventually discontinued when People’s Republic of China was established in 1949 and the United States passed the Trading with Enemy Economy Act in December 1950 that cut herbal medical imports from China.
Throughout American history, gender, meaning notions of essential differences between women and men, has shaped how Americans have defined and engaged in productive activity. Work has been a key site where gendered inequalities have been produced, but work has also been a crucible for rights claims that have challenged those inequalities. Federal and state governments long played a central role in generating and upholding gendered policy. Workers and advocates have debated whether to advance laboring women’s cause by demanding equality with men or different treatment that accounted for women’s distinct responsibilities and disadvantages. Beginning in the colonial period, constructions of dependence and independence derived from the heterosexual nuclear family underscored a gendered division of labor that assigned distinct tasks to the sexes, albeit varied by race and class. In the 19th century, gendered expectations shaped all workers’ experiences of the Industrial Revolution, slavery and its abolition, and the ideology of free labor. Early 20th-century reform movements sought to beat back the excesses of industrial capitalism by defining the sexes against each other, demanding protective labor laws for white women while framing work done by women of color and men as properly unregulated. Policymakers reinforced this framework in the 1930s as they built a welfare state that was rooted in gendered and racialized constructions of citizenship. In the second half of the 20th century, labor rights claims that reasoned from the sexes’ distinctiveness increasingly gave way to assertions of sex equality, even as the meaning of that equality was contested. As the sex equality paradigm triumphed in the late 20th and early 21st centuries, seismic economic shifts and a conservative business climate narrowed the potential of sex equality laws to deliver substantive changes to workers.