“Modern neurotic women” and the pains of childbirth: staging medicalized maternity in Sophie Treadwell’s Machinal

ABSTRACT

This article positions Sophie Treadwell’s depiction of maternity and hospital-based childbirth in Machinal (1928) as a crucial though underexplored dimension of the expressionistic play’s feminist social critique. Our argument focuses on the fourth of nine episodes, “Maternal,” and reads the protagonist’s traumatic postpartum experience alongside and in the context of contemporary media, medical, and literary publications that articulate emerging concerns about childbirth, maternity, and obstetric care. We illustrate how characters’ responses to the Young Woman’s intense distress resonate with a prevalent medical trend to either dismiss women’s anxieties about the risks and pain associated with childbirth or diagnose them as symptoms of modern women’s “weakness” or “nervous exhaustion.” Treadwell stages an argument that at once affirms the legitimacy of women’s potential fears and challenges the notion of mental-uplift as a panacea for maternal anxiety. Furthermore, through the scene’s medical figures and sonic backdrop, she presents a scathing portrait of institutionalized obstetric care. This scene reinforces the broader critique of modern, patriarchal hierarchies and their embeddedness in technological discourses that runs throughout Machinal. The postpartum scenario offers a unique vantage point to expose how intimate and institutional structures combine in ways both physically and psychologically damaging to women.

KEYWORDS:

• Sophie Treadwell
• Machinal
• American modernism
• medical discourse
• obstetrics
• women’s health

Only the prisoner who walks to execution can feel such inevitableness of misery. There can be no escape!—Anna Strunsky Walling, “Twilight Sleep–II,” McClure's Magazine, 1922

Competing birth narratives in early twentieth-century media and literature

In 1914, women’s magazine contributors such as Marguerite Tracey and Constance Leupp (in McClure’s Magazine) and Hanna Rion Ver Beck (in the Ladies’ Home Journal) extolled the wonders of “Painless Childbirth” that was now possible thanks to the scopolamine-morphine drug cocktail known as “Twilight Sleep.” The procedure had been developed in Freiburg, Germany by physicians Karl Gauss and Bernhardt Kroenig, and it was increasingly in demand in the United States as a way to avoid (as the epigraph above puts it) the “inevitableness of misery” that can accompany non-medicated birth.¹ That same year, the American avant-garde poet Mina Loy published her own account of childbirth, a poem titled “Parturition.” Loy’s poem stands in stark contrast to magazine-article descriptions of “fairy tale” Twilight Sleep experiences in which women “go to sleep and have a pleasant but vacuous night” before waking to “a brand new baby” they can hardly believe is their own.² Instead, Loy’s opening stanza reads: “I am the centre/Of a circle of pain/Exceeding its boundaries in every direction.” Labor, in this poetic rendering, is a “congested cosmos of agony/From which there is no escape,” and Loy offers a vision of birthing as an intense and all-consuming process of both physical and psychological transformation. The new mother becomes “Identical/With infinite Maternity” as she is “absorbed/Into/The was—is—ever—shall—be/Of cosmic reproductivity.”

Loy’s poem offers an arresting example of modernist literature’s engagements with the topic of birth and, more broadly, with experimental authors’ efforts to textually represent nuanced perspectives on women’s health-related experiences during the early twentieth century. Through Loy’s signature avant-garde (and often ironic) poetic style, “Parturition” draws readers’ attention to several significant aspects of the birth experience. In addition to pain as a dominant sensation, she registers the unsettling destabilization of the lines between interior and exterior that birth entails (“Locate an irritation without/It is within/ Within/It is without”). She also wryly draws readers’ attention to the stark difference between (observing) men’s and (laboring) women’s experiences (“He is running upstairs//I am climbing a distorted mountain of agony”). Loy even muses on the animalistic associations that can accrue to the event (“Impression of a cat/With blind kittens/ … I am that cat”).³

These themes set the stage for our reading of Sophie Treadwell’s play Machinal, which debuted on Broadway in 1928. Machinal was inspired by and based loosely on the sensational 1927 trial and execution of Ruth Snyder—the New York housewife who, together with her lover Judd Gray, was convicted of murdering her husband.⁴ Like Loy’s poem, Treadwell’s drama employs formally experimental techniques to starkly present audiences with what are typically interiorized experiences in a woman’s life. In Treadwell’s case, as previous critics such as Jerry Dickey, Barbara Ozieblo, and Julia A. Walker have pointed out, these formal features, such as “compressed syntax,” “abstracted types or caricatures,” and “rapidly changing sequence[s] of short scenes” link the play to the broader dramatic movement of expressionism.⁵ Over the course of Machinal’s nine short episodes, we witness the play’s protagonist, a “Young Woman” (anonymous through most of the script) as she struggles to navigate a series of mundane yet distressing social experiences. These include working at an office (where her “flabby hand[ed]” boss proposes to her⁶), eating a tedious dinner with her mother, reluctantly arriving at her honeymoon hotel, unwillingly becoming a mother, visiting a speakeasy (where she meets her soon-to-be lover), having an affair, conversing mechanically with her husband, facing trial for (and confessing to) his murder, and finally being executed. Treadwell’s staging of these episodes against a cacophonous and mechanical sonic backdrop offers a pointed critique of the strictly defined gender roles available to women in early twentieth-century modernity and the multiple, mutually reinforcing systems of patriarchal oppression that lead to the protagonist’s death by court-sanctioned electrocution. And, in ways that echo Loy’s poetic framing of childbirth as an experience that places a subject’s “within” and “without” in startling new orientations to one another, a key ambition of Treadwell’s drama is to illuminate the relationship between the protagonist’s interior (mental, psychological) and exterior (physical, social) worlds.

This essay focuses on the play’s fourth episode, titled “Maternal,” which depicts the protagonist’s traumatic postpartum experience. During the scene, she lays in a hospital bed and is attended by an authoritative Doctor who ignores her wishes, visited by her relentlessly cheerful Husband, and constantly bombarded by the jarring noise of riveting machines being operated just outside her window—a sound that “can’t be helped,” her Nurse proclaims, because the “Hospital’s got to have a new wing.”⁷ Barbara L. Bywaters’s reading of Machinal centers on this scene, which she labels “one of the most critical portraits of motherhood in modern literature,” but “Maternal” has rarely been the focus of scholars’ extended engagements with the play.⁸ Critics tend to instead foreground the episodes that more directly involve the Young Woman’s engagements with her professional and domestic social networks, or with broader legal and media systems.⁹ Even these accounts, however, position early twentieth-century medical discourse, not only its physical but also its mental dimensions, as a core concern in the play. Often, scholars draw parallels to Treadwell’s biography, noting how the author’s own struggles, diagnoses, and treatments for “nervous exhaustion” are reflected in the Young Woman’s experiences.¹⁰ Critics also analyze the play through explicitly psychiatric lenses such as electroshock therapy (Katherine Weiss), neurosis (Jennifer Jones), and madness (Bywaters). In addition, Walker and Jean Marie Lutes draw from more pseudo-scientific concepts such as “spiritual malaise” and “composure” to explain how the play forces audiences to confront, respectively, the Young Woman’s “alienation from the roles she is forced to play” or her perceived lack of “emotional authenticity.”¹¹ And the more explicitly trauma-based idea of “psychological abuse” is central to Miriam López Rodríguez’s broader analysis of the play’s gendered, structural violence.¹²

As we detail below, many of these individual interpretations inform and inflect our approach to the play’s depiction of maternity in the 1920s. Taken together, they make clear the basic premise that that the early twentieth-century medical system—its personnel, processes, infrastructure—constitutes an important institution in the context of the play’s broader commentary on the entangled nature of external social forces that pressure modern individuals and the internal psychological consequences of being forced to deal with those pressures. While societal expectations around motherhood certainly are brought to bear on some of these existing arguments, the ways in which mental health was embedded in early twentieth-century discourses of childbirth and maternity has yet to be fully explored in the context of Treadwell’s play. We demonstrate how an obstetrics-focused analysis of Machinal’s medical references further enriches the critical conversation, given childbirth’s unique status. First, it is a physically embodied event that also precipitates intense psychological adjustments for women (as they assume a new identity category while simultaneously navigating major physiological change); and second, during the early twentieth century, a dramatic shift occurred in which American women more and more frequently gave birth in medicalized, institutional settings. These characteristics offer a generative path for understanding how a set of obstetric discourses concerned specifically with middle- and upper-class, white women’s mental health not only play out in Treadwell’s drama, but also traverse literary, media-based, and medical contexts during the modernist era.¹³

To showcase this triangulation of textual approaches, we read Machinal’s “Maternal” episode (and its relationship to the surrounding scenes) alongside and in the context of contemporary media and medical publications that articulate emerging concerns about childbirth, maternity, and obstetric care. Our analysis is grounded in scholarship by medical historians who have tracked the significance of the early twentieth-century shift towards doctor-attended, hospital-based, medically managed birth practices and who have explored how these new practices were presented and received in diverse medical communities, media venues, and other discursive exchanges. These intertextual and historical contexts offer key insight into the scene’s status in the play: the “Maternal” episode’s medical backdrop becomes a rhetorical tool through which Treadwell advances her goal of presenting the play’s protagonist as an “ordinary young woman, any woman.”¹⁴ In addition, the Young Woman’s response to childbirth affirms the fundamental link between external forces (physical, social, institutional) and individuals’ internal (psychological, mental) states that is so central to the overall play. Put differently, this scene echoes and reinforces the broader social critique of modern, patriarchal hierarchies and their embeddedness in technological discourses that Treadwell stages in Machinal’s overall narrative arc; however, the postpartum scenario provides a unique moment for audiences to witness how intimate and institutional violence, internally and externally generated pressures, and mental and physical symptoms come together. In “Maternal,” Treadwell viscerally confirms that these purportedly separate aspects of modern life are, in fact, inextricably connected factors. She shows how they operate in concert to diminish the possibility of mental wellbeing, bodily autonomy, and individual agency for early twentieth-century women.

Public narratives of marriage and motherhood

As historians of motherhood and childbirth have argued, the role of mother has always been considered a presumed life goal and an important source of both personal fulfillment and social status for American women.¹⁵ These widespread convictions provide an important backdrop for Treadwell’s representation of marriage and maternity in Machinal. As Rima Apple explains, “throughout our history, motherhood has been considered a primary, if not the primary, role of women, a time-honored tradition in U.S. society, and most women did become mothers.”¹⁶ Jodi Vandenberg-Daves extends these ideas, emphasizing the political and psychological significance of public discourse about maternity: “motherhood—with its lofty ideals and its complex and sometimes gritty realities,” she notes, “has lurked behind nearly every debate about women’s place in [American] society, women’s psyches, and even the future of the nation’s moral rectitude.”¹⁷ Even with the growth in possibilities for women’s professional and economic independence during the early decades of the twentieth century, the expectation remained that they would both pursue and find fulfillment in marriage and motherhood: “motherhood,” Wendy Mitchinson writes, “was [still] women’s defining social role. It was the source of their prestige; and to be worthy of it, their commitment to mothering had to be total.”¹⁸ Indeed, twentieth-century modernity placed additional demands on women as the emergent ideology of what Apple labels “scientific motherhood” gained traction in middle- and upper-class circles—that is, “the image of the ‘good’ mother, the ‘proper’ mother” shifted to idealize the “woman who sought out experts for advice on childrearing and who followed the advice she was given.”¹⁹

This belief that women’s primary focus should be on having children and raising them properly is pervasive in media publications and medical texts from the years surrounding Machinal’s production. For instance, a 1917 eugenics-leaning McClure’s article by Cleveland Moffett begins from the premise that “normal women find their greatest happiness through a husband and children,” without which, “their lives are incomplete and unsatisfying”; Moffett frames motherhood as a necessary service performed by (white, upper-middle class) American women in exchange for their civic rights, since “the greatest service women can render to the State is to produce desirable future citizens.”²⁰ A women’s health book from the same year articulates a similar expectation by proclaiming that “a woman’s social duty can never be thoroughly performed while her maternal duty is neglected.”²¹ As Vandenberg-Daves comments, these types of media publications offer “windows onto modern motherhood ideals [since b]y the 1920s and 1930s, few mothers could escape the influence of such expertise and its cultural messages in their daily lives.”²²

That these predominant attitudes have been internalized by Treadwell’s protagonist and cause her mental strain is evident from Machinal’s opening scenes, in which the Young Woman debates whether or not to accept her boss’ proposal of marriage. In the disjointed inner monologue that closes “Episode One: To Business,” the fact that “all girls – most girls – [get] married” immediately segues into thoughts of “babies – a baby – curls.”²³ When she broaches the subject of her marriage proposal with her mother in “Episode Two: At Home,” the Young Woman reasons that she’s “got to get married” because “all women get married, don’t they?” and then laments that although she “always think[s] of children with curls – little curls all over their head,” her boss, the disappointingly straight-haired Jones, is “the only man that’s ever asked me – And I suppose I got to marry somebody – all girls do –.”²⁴ In accepting Jones’s proposal, Treadwell’s protagonist achieves precisely what media discourse says “woman [are supposed to] dream of, pray for, thrill over.”²⁵ The play, though, undercuts these assumptions about marriage’s positive associations by instead emphasizing the Young Woman’s visceral revulsion to her husband-to-be, whose touch makes her “skin … curl,” and whose advances on their wedding night leave her “terr[ified]” and “weeping.”²⁶ Underscoring the protagonist’s lack of consent and the impending sexual violence that hovers ever nearer as the “Honeymoon” episode unfolds, critics have explicitly labeled the scene as a depiction of “legalized rape” or “marriage rape.”²⁷ In a more general argument about the status of working women in several American plays from the 1920s, Dickey reads the Young Woman’s eventually lethal breakdown as product of the “contradictory demands” related to “work, marriage, and autonomy” that modern society placed on working women, which “fractured [their] notions of a unified self to such a degree that violence and murder emerged as legitimate responses.”²⁸ From these vantage points, the path to marriage (and subsequent motherhood) that Treadwell offers in the play’s early scenes is paved by distress, anxiety, and even trauma—it is an economic and social necessity to be dreaded and endured rather than a “thrill[ing]” source of social prestige, individual joy, and fulfillment.

Public narratives of childbirth and fear

In contrast to widespread public discourse that proclaimed the beneficial outcomes of marriage for women, many early twentieth-century media discussions of childbirth—the assumed next step for young wives—emphasize a looming sense of fear that could have a significant negative impact on a woman’s mental state. Giving birth during these decades, after all, presented many tangible risks. These included the possibility of miscarriage, mistreatment by medical practitioners (obstetrics being a relatively new specialty with inconsistent training standards and certification processes²⁹), infection due to unreliable antiseptic practices, long-term health complications, and even death.³⁰ In addition, expectant mothers assumed that intense pain was an inevitable part of labor; as Judith Walzer Leavitt puts it, “next to fear of death, pain was probably the single part of birth most hated by birthing women.”³¹ Media coverage of these fears varies widely in the way different authors cast women’s anxiety regarding pain during labor as either valid or unnecessary. This contested area of discourse offers insight into the interpersonal dynamics, hierarchies of power, and (as J. Jones describes it) “psychic pain” on display in Treadwell’s postpartum scene.³²

Media publications from the early twentieth century that feature women’s personal testimonies often validate women’s fears by affirming the painful and often long-lasting physical and psychological traumas that can accompany childbirth. A cluster of 1922 articles in McClure’s provide illustrative examples of this tendency: Walling describes her previous delivery as “a memory of torture which my companion only knows by name—the torture of the heavy and sorrowful hours of travail when the heart breaks with a kind of despair.”³³ Similarly, Rosalind Burton Blades writes that “although both of my parents are physicians and I was assured the best attention that medical science could provide, I felt that ahead of me was untold suffering, perhaps death.”³⁴ Zoe Beckley’s account of the interviews she conducted with “new mothers” in a German maternity home even more explicitly connects the widespread lore about painful childbirth experiences to pregnant women’s mental distress. She describes meeting “a woman of forty-four who had been in such fear and depression [about her upcoming birth] that she contemplated suicide,” and she quotes a friend who responded to a suggestion to visit Germany for the Twilight Sleep procedure by saying “I’d cross Europe to be relieved of this terrible dread!”³⁵

These affirmations of women’s lived experiences can be seen as responses to a counter perspective that was likewise prominent in early twentieth-century public health discourse about childbirth—and which, as we illustrate below, also features prominently in Treadwell’s “Maternal” episode. In these texts, medical writers who were addressing upper-class, white women in particular cast the dread of labor as a foolish over-reaction, or even as the primary cause of their pain. Adopting this latter argument, The New Tokology: Mother and Child Culture (1901) proclaims that “morbid fear of pain invites pain: all such weakness, if permitted to establish itself, paves the way for inefficiency and distress when the final hours come.”³⁶ Likewise, William Grant Hague, in The Eugenic Marriage: A Personal Guide to the New Science of Better Living and Better Babies (1914), disparages women for expressing anxiety about childbirth, labeling this fear as “undoubtedly an exhibition of weakness, an evidence of failure in the development of self-control” since “childbirth is a natural process” and “if you do your part you have no cause to fear.”³⁷

According to these types of texts, the remedies for such fear often simply involve lifestyle or mindset adjustments. Women are encouraged to “do [their] part” by choosing to maintain an upbeat and optimistic mental state. The New Tokology, for instance, prescribes “a proper course of regular open-air exercise” as the key to “preserving and improving [a woman’s] ability to pass successfully through the childbirth hours,” because it will “affec[t] favorably her mental as well as her physical condition.”³⁸ Hague reassures readers that “you can plant ahead of yourself a path of roses and be cheerful, or you can plant a bed of thorns and reap a thorny reward.”³⁹ In Nature’s Secrets Revealed (1915), the authors similarly reassure women that “a tranquil mind is of the first importance to the pregnant woman. Gloomy forebodings should not be encouraged,” before going on to write that “instead of desponding, science bids the woman to look forward with cheerfulness and hope to the joys of maternity.”⁴⁰ And Women and Marriage (1910) explains that “the patient should […] keep cheerfully calm. What has to be has to be, and should be met with the best grace possible.”⁴¹ Overall, these health guides minimize women’s mental distress about upcoming birth, and, by extension, the trauma they may experience during and after labor.

Staging media debates and medical authority in “Maternal”

Familiarity with the trends that characterize early twentieth-century media and medical discourse about childbirth enables a reading of the “Maternal” episode that is attuned to the significance of Treadwell’s engagement with contemporary obstetrics themes. In many ways, the Young Woman and her Husband reflect the two primary “sides” of the debate about women’s fears of childbirth; through them, Treadwell stages an argument that at once affirms the legitimacy of women’s potential fears and denigrates the notion of mental-uplift as a panacea for maternal anxiety. Furthermore, in the scene’s medical figures, Treadwell presents a critical portrait of institutionalized obstetric care, in which bedside manner is abrupt and callous and medical authority is absolute. This critique not only reinforces the play’s larger-scale argument about women’s precarious position in modern society, but it does so by incorporating a health context uniquely suited to exposing how accepted institutional structures can enact both physical and psychological damage on women.

Similar to the personal narratives published in women’s magazines as textual validations of the fears associated with childbirth, the Young Woman’s presence in the “Maternal” scene—lying prone on the hospital bed; nauseated and overwhelmed by the smells and sounds of her environment; barely speaking and mentally fractured—functions as a type of embodied personal testimony to the possibility that childbirth can cause lasting physical and psychological trauma. Previous critics have commented on how Treadwell’s staging of this postpartum experience “refuse[s] to let us romanticize the [birth] event.”⁴² Other scholars draw attention to how the episode’s sonic dimensions reinforce the protagonist’s lack of agency within the medical environment, both through absence (i.e. her “voiceless protestations against motherhood and nursing”) and bombardment (i.e. the mechanical construction noises that metaphorically render her “solidly ‘riveted’ to the system by giving birth”).⁴³ López Rodríguez reads the episode according to a trajectory that runs from “mental distress” to “mental breakdown.”⁴⁴ This argument highlights the psychological drama that unfolds as the new mother grapples with a multi-layered misery that is eventually articulated in a disjointed monologue of blurred associations that communicate fatigue (“let me alone”; “tired – too tired”; “I’ll rest – I’ll lie down”), disgust (“a little girl – with no hair - … a little bald girl”; “everybody loves God – they’ve got to – … even if he’s got fat hands”), and horror (“puppies … all drowned – drowned – drowned in blood – blood – oh God!”).⁴⁵

The contextual backdrop of early twentieth-century media discourse adds urgency to the project of so starkly showcasing the Young Woman’s anguish in response to the childbirth experience, and of emphasizing how childbirth’s repercussions traverse interior and exterior registers—an idea that appears in the closing monologue’s fixation on how even once the “inside … weight is gone,” the “weight” of societal pressures still remains “outside – all around.”⁴⁶ In light of the media trend to publish women’s testimonials about their negative birthing experiences, we can read Treadwell’s unapologetic representation as contributing to a broader female-centred discursive project to claim as legitimate the widespread—and often diminished—fears surrounding the entrance to motherhood.

The Husband’s role in the scene reinforces this argument through contrast. In response to his wife’s lack of engagement with her surroundings and baby, the Husband offers a kind of postpartum pep-talk that, as Bywaters puts it, “minimizes the pain of her pregnancy.”⁴⁷ In doing so, he echoes contemporary medical guides’ dismissal of women’s fears and their injunctions to cheerfulness as a fail-proof strategy for making it through childbirth in good spirits. The exclamation-point-riddled litany of advice begins with “you’ve got to brace up now,” and goes on with gusto: “Make an effort! Pull yourself together! Start the uphill climb! … Face the music! Stand the gaff! Take life by the horns! Look it in the face! – Having a baby’s natural! Perfectly natural thing.”⁴⁸ By parroting medical writers’ simplistic proposed remedies through the play’s unsympathetic and loathsome Husband figure, Treadwell satirically undercuts some of the pervasive, so-called “scientific” health discourses of her day. The Husband’s disregard for his wife’s obvious distress at this moment therefore not only contributes to our impression of the Young Woman as a “voiceless” figure with “little control over her fate” within the broader patriarchal institution of marriage, as others have pointed out, but also illuminates the specific ways in which domestic and obstetric discourses reinforce one another as they exert pressures on women to conform to social norms.⁴⁹

The proximity of marital and medical authority-structures is literalized in the scene when the Young Woman’s Doctor (in the company of a “YOUNG DOCTOR [and] NURSE”) enters on the heels of her Husband’s departure.⁵⁰ Critics have stressed how the Doctor’s status within the medical system grants him nearly unchecked “control,” “authority,” and “jurisdiction” over the Young Woman’s body—within the walls of the hospital, his word is law.⁵¹ This fact enables the episode to smoothly stage the play’s shift from its earlier emphasis on the Husband’s domestic range of power (which was absolute on their “Honeymoon” but is limited in this setting, as illustrated by the nurse’s ability to quietly usher him out of the ward) to upcoming scenes’ focus on larger, more public institutions and infrastructures (legal, carceral, and peripherally, journalistic and religious). We witness that shift when the Doctor replicates the Husband’s clear lack of empathy for the Young Woman’s professed needs, but does so with an additional layer of medically sanctioned power. In response to her signed “No” regarding his instruction to “Put the child to the breast,” he commands “Bring the baby!”; and even when her Nurse comments that “she’s behaved very badly every time [the baby has been here], Doctor – very upset – maybe we better not,” he retorts, “I decide what we better and better not here, Nurse!” and repeats his original command.⁵² He is similarly rigid in his determination to “change the [Young Woman’s] diet” from “liquids” to “solids,” dismissing the nurse’s report that “she says she can’t swallow solids” in what amounts to, as Bywaters notes, “a kind of forced feeding.”⁵³ And despite his patient having uttered a grand total of six words during their exchange (“No! … No! … [I want to be] Let alone – let alone”), he elects at the last minute, with no explanation, to “change her medicine,” repeats his instruction to “bring the baby,” and then exits with his team.⁵⁴ Walker’s gloss on the scene sums up its hierarchical dynamic in ways that gesture to the play’s entwined mental and physical health commentary and trace a line forward to the institutional contexts that will appear in future episodes. As the Doctor repeatedly “asserts his authority” to the “physically and emotionally exhausted” Young Woman—who at this moment, “literally has no voice”—he provides a medicalized preview of a fact that will become even more violently clear in the play’s final scene: namely that “any resistance to her assigned role will be disciplined by force.”⁵⁵

Attention to the doctor’s status as not merely a medical professional but specifically an obstetrics specialist offers additional insight into the cultural significance of his attitude and behavior towards his patient, and of their negative repercussions for her mental wellbeing. Throughout the episode’s clipped vocal exchanges, embodied displays of disengagement and revulsion, and final monologue, Treadwell emphasizes the distressing nature of the Young Woman’s surroundings. The play thus implicitly flips the script on publicly circulating obstetric narratives that fault parturient mothers whose behavior deviates from medical rule. As Hague frames it, when pregnant women “willfully ignore all the instructions given” by medical professionals, they “desperately and foolishly try to escape what they cannot escape.”⁵⁶ Although this passage appears in a section on labor, its sentiments read as equally applicable to Treadwell’s obstetrician in his attitude towards his patient’s postpartum distress. “There is absolutely no excuse for this kind of conduct,” Hague continues, referring to a type of patient who “cries and moans … until she succeeds in giving everyone except the physician and nurse the impression that she is suffering unnecessarily.”⁵⁷ In this scenario, as in Machinal, the perceived “willful” woman is assumed to exaggerate her pain, and the trained physician is considered to have a better understanding of her condition. What the medical text demonstrates—and what Treadwell’s scene pointedly critiques—is a belief that women’s unruly conduct can give a deceptive impression of pain, fear, and distress, but that the (typically male) obstetric practitioners can see through these performances.⁵⁸ New mothers are precluded, in this situation, from retaining authority over their own care and rendered voiceless by the medical institution—both its practitioners and its spaces—that purports to care for them. Instead, women encounter a system resolutely unsympathetic and unresponsive to any divergence from the standardized narrative of medical subservience and maternal joy.⁵⁹

Public narratives of modernity, technology, and maternity

Importantly, the Doctor’s attitude (and the broader institutional discourse it represents) is founded on widely circulating beliefs about modern, upper-class, white women’s frailty.⁶⁰ While fears related to childbirth are certainly not unique to the twentieth-century moment, a new eugenics-inflected claim emerged during the decades around Machinal’s publication: that women were inherently weaker and more susceptible to pain than they had been in previous generations. This status held implications for many aspects of women’s lives, including within the realm of obstetrics, where their perceived mental and physical weaknesses resulted in physicians being more frequently called upon to medically intervene during childbirth. Mitchinson explains this medical myth, noting that:

Modern woman was [considered to be] at risk because her lifestyle interfered with the natural functioning of her body. […] Their bodies no longer functioned as well as they once had, but in order to have them do so they would have to give up being modern, being civilized. Doctors saw themselves as the solution; they would be there to help women in their hour (actually months) of need. Such beliefs had become part of medical culture.⁶¹

These assumptions permeate early twentieth-century medical and media discourse throughout North America. Eugenics-focused authors explicitly link women’s perceived weakness to race, making claims that white, American/European women were at the highest risk of experiencing pain and other complications during labor—this perspective connected women’s “nervous” attitudes towards childbirth with broader concerns about falling birthrates.⁶² Others blame wealth and social class (since wealthier women were considered to lead a more pampered lifestyle and to therefore experience more pain) or intellect and education (even claiming that educated and upper-class women were more likely to have babies with larger heads).⁶³

Weaving together several of these concerns, a 1914 McClure’s article quotes Bernhardt Kroenig, the German physician credited with creating Twilight Sleep, as saying that

… the modern woman, on whose nervous system nowadays quite other demands are made than was formerly the case, responds to the stimulus of severe pain more rapidly with nervous exhaustion and paralysis of the will to carry the labor to a conclusion. The sensitiveness of those who carry on hard mental work is much greater than that of those who earn their living by manual labor.⁶⁴

In 1922, an article making a similar argument appeared in the same journal, claiming that “the complex life with its increased call upon our energies and the nervous tension it creates has made modern women incapable of bearing children without a degree of suffering which prostrates her and brings on nervous exhaustion.”⁶⁵ And a decade later, James Hitchcock’s piece “In Defense of Caesareans” (published in Forum and Century) illustrates the continued presence of a more general version of this narrative: in “this age of speed,” he argues, “nerves are generally more taut, people more highly strung, women less bovine than they used to be.”⁶⁶ Each of these examples draws attention to the notion that the complexity, speed, and demands of “modern life” have negatively affected women. Overall, a narrative emerges in which the over-stimulating aspects of modern life are seen as causal factors in women’s lack of both the mental and the physical capacity to endure childbirth and emerge from the experience in good health.

This idea appears throughout Machinal, where the Young Woman fails in numerous ways to thrive amidst the speed and intensity of modern life. In “Episode One: To Business,” she struggles to keep up with her colleagues, to complete her work on time, and even to tolerate taking the subway. In the monologue that ends the episode, her exhaustion in the face of modernity’s highly-regulated temporalities is apparent: “no rest–must rest–no rest–late today–yesterday–before–late–subway–air–pressing […] late–job–no job–fired–late–alarm clock–alarm clock–alarm clock–hurry–job … ”⁶⁷ The disjointed syntax and constant refrain of “late” and “no rest” suggest that the Young Woman may be on the verge of the type of nervous exhaustion that was believed to plague so many modern women. When read alongside the examples of contemporary media and medical discourse quoted above, her susceptibility to psychological distress (as she attempts to navigate the noisy, claustrophobic, fast-paced spaces and social obligations that are required for modern American urban living) holds direct implications for her experience of childbirth and increases the likelihood that the event will cause profound trauma.

In her retreat from verbal interaction following her daughter’s birth and her refusal to engage with her newborn, the Young Woman conforms precisely to the pathologized narratives of modern femininity put forward by the medical community and magnified by its media coverage. “These modern neurotic women, eh, Doctor? What are we going to do with ‘em?” quips the attending physician to the younger doctor who accompanies him.⁶⁸ As J. Jones points out, this comment “echo[es]” the sweeping diagnosis that Dr. Abraham Myerson articulates in his 1920 treatise, The Nervous Housewife (in which he argues that modern women’s access to more “individualized” life choices in modernity make them discontent with the traditional marriage structure).⁶⁹ From an obstetrics-specific perspective, in labeling the Young Woman “neurotic,” the doctor marks his patient as a common type, making assumptions about not only her current mental state but also her longer-term postpartum prognosis. For example, the Young Woman’s behavior eerily aligns with earlier diagnoses of “Perpeural Insanity,” in which a mother “expresses no interest in her child, and, in fact, does not care to see it, and when it is placed by her she is indifferent or asks for it to be taken away. She turns against her husband […]and she hears voices urging her to kill herself or some one else.”⁷⁰ Importantly, the public conversation about modern women and the risks of childbirth was concerned with the potential for negative birth experiences to generate enduring mental-health problems. As Leupp and Hendrick report, while the physical pain women experience during labor only impacts them temporarily, “what is not temporary is the nervous shock that so frequently follows, especially in women of delicate nervous organization.”⁷¹ Hitchcock makes a similar argument in his observation that “those who suffer definite psychological damage from the task of normal childbirth are becoming more numerous.”⁷² Throughout these diagnostic narratives, we witness an embedded validation of the idea that a causal relationship not only can exist between a materially embodied, physically painful event (birth) and its more intangible, psychological repercussions, but is especially likely to occur within modernity among a specifically classed and racialized—i.e. wealthy and white—female demographic.

Modern obstetrics as preventative mental-health intervention?

Hitchcock’s Caesarian advocacy also points to an emerging belief that modern medical obstetric care constitutes a valuable preventative intervention in the service of protecting modern women’s mental health. As the flip-side to the arguments about modern culture as detrimental to new mothers’ mental wellbeing, modernity—i.e. its new technological developments and approaches to managing childbirth—is also pitched as a source of valuable solutions that will alleviate women’s fears. Perhaps most famously, the Twilight Sleep procedure, by causing women to forget the birth experience, was welcomed by both individual women who, like the authors we cited at the beginning of this article, relished the thought of a painless delivery, and by leaders of the broader eugenics social movement who saw fear of childbirth as a significant cause in falling birth-rates.⁷³

In an apparent modernist counter-example to Treadwell’s unequivocally negative depiction of hospitalized birth, the first chapter of Edith Wharton’s novel Twilight Sleep (1927) seems to braid these positive-leaning perspectives together. Here, Wharton focuses on two of the novel’s central characters, the middle-aged, high-society New Yorker Pauline Manford, as she undertakes preparations for her daughter-in-law Lita’s upcoming delivery; and Lita herself, who, like “most of the young women of her set” has a “blind dread of physical pain” and therefore wishes only “that nothing should ‘hurt’ her.”⁷⁴ Pauline is happy to oblige, believing as she does that “there ought to be no Pain … nothing but Beauty … It ought to be one of the loveliest, most poetic things in the world to have a baby.”⁷⁵ In phrasing that recalls Treadwell’s “biggest maternity hospital in the world,” Wharton characterizes Pauline’s voice here as so “bright” and “efficient” that she makes “loveliness and poetry sound like the attributes of an advanced industrialism, and babies something to be turned out in series like Fords.”⁷⁶ Pauline “manage[s]” Lita’s delivery at “the most perfect ‘Twilight Sleep’ establishment in the country,” and the latter “drift[s] into motherhood” without having “minded [it] in the least.”⁷⁷

Rather than recoil from the obstetrics regimen like Treadwell’s protagonist does, Pauline delights and Lita takes comfort in the technological advances that transform birth into a desensitized factory production line. Treadwell’s Young Woman experiences overt horror as the male-dominated medical establishment dictates the terms of her entry into motherhood—possibly with a Twilight-Sleep-like anesthetic intervention, given the line “lie still – don’t move – can’t move – rest – forget – they say you forget” that appears in the episode’s closing monologue.⁷⁸ Wharton’s novel instead casts this type of modern medical intervention in terms of Pauline’s “bright efficiency” and Lita’s passive willingness to embrace drugged oblivion.⁷⁹ From this vantage point, technological developments and regimented health management appear to ease the mental distress that plagues women who live in fear of labor. Importantly, though, the overtly satirical bent of Wharton’s narrative undercuts the sincerity of Pauline’s and Lita’s outlooks. The novel in fact mobilizes its eponymous obstetric drug as a trope to criticize upper-class New York society’s perpetual quest for a panacea that will dispel—or at least distract from—the pains and frustrations of modern life. Indeed, as the novel unfolds, both characters’ apparent control over and satisfaction with their “modern” approaches to life fracture and dissolve, eventually leading to a bizarrely melodramatic (and confusing) finale that involves potential infidelity, a near scandal, and an accidental gunshot that wounds the play’s third central female character (Pauline’s daughter, Nona). Overall, then, Wharton’s literary engagement with early twentieth-century obstetric care reinforces, rather than opposes, the type of feminist critique—with its goal of exposing the violence inherent in modern social institutions—that Treadwell much more darkly stages in her play.⁸⁰

In light of this connection, and in conversation with our initial comparative reading of Loy’s “Parturition” poem, Treadwell’s dramatic representation of an “ordinary” woman’s postpartum experience takes its place as one of several examples of early twentieth-century literary engagements with the theme of pain in the context of childbirth and obstetric care. The multifaceted elements of labor-related pain—and the (male-dominated) medical system’s responses to parturient women—serve, in these authors’ hands, to heighten audience awareness of interrelated physical and mental distress that modern social institutions, and the rigid gender roles they promote, can inflict on women. Treadwell’s “Maternal” episode is particularly poignant in this regard because it portrays the Young Woman’s postpartum state in such close alignment with broadly circulating debates about the legitimacy of maternal fears and the diagnosis of perinatal “nervous shock.” This depiction accomplishes much more than simply reaffirming the Young Woman’s status as “ordinary”; it enables Treadwell to stage a visceral collision between one of modernity’s increasingly dominant infrastructures (the medical system’s obstetrics branch) and one of women’s most intimate and personal experiences (their entrance into motherhood). Deeply attuned to the contradictions inherent in early twentieth-century media coverage of women’s issues, Treadwell crafts the scene—and positions it strategically within the play’s longer arc—to contribute a case against prevalent attitudes and practices that deploy medical authority to limit women’s bodily autonomy. She demands that audiences acknowledge how these external forces of control can wreak havoc not only on women’s physical health but also their psychological wellbeing, offering a valuable counter-narrative to social scripts that prioritize hierarchical conceptions of medical expertise over the personal narratives that women have—and desire—to tell.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This article draws on research supported by the Social Sciences and Humanities Research Council of Canada and a Mary Louise Nickerson Travel Grant (through McGill University’s Osler Library of the History of Medicine).

Notes on contributors

Heather A. Love

Heather A. Love is Assistant Professor of English at the University of Waterloo (Ontario, Canada), where her research and teaching focus on topics related to literature, communication, culture, technology, and health. She is the author of Cybernetic Aesthetics: Modernist Networks of Information and Data (forthcoming from Cambridge UP) and her work has appeared or is forthcoming in Modernism/modernity, the Journal of Modern Literature, New Literary History, the Johns Hopkins Guide to Cultural and Critical Theory, and the IEEE Technology and Society Magazine.

Jerika Sanderson

Jerika Sanderson is an English PhD candidate at the University of Waterloo (Ontario, Canada). Her doctoral research is funded by the Social Sciences and Humanities Research Council of Canada (SSHRC) and investigates 21st century representations of biomedicine and biotechnology.

Notes

1 For discussions of the history of the Twilight Sleep procedure’s development and American reception, see Leavitt, “Birthing and Anesthesia”, Wolf, Deliver Me from Pain; Johnson and Quinlan, “Technical Versus Public Spheres“; and Thompson, ”The Politics of Female Pain.”

2 Tracey and Leupp, “Painless Childbirth,” 38; Rion Ver Beck, “The Painless Childbirth,” 10.

3 For more detailed analyses of Loy’s poem, see Peppis, “Rewriting Sex”; Schnur, “Mechanical Labor and Fleshy Births”; and Prescott, Poetic Salvage.

4 For rhetorical analyses of the Snyder trial’s media coverage and of its connections to Treadwell’s play, see Ann Jones and Jennifer Jones, respectively.

5 Dickey, “Expressionist Moment.” Dickey and Ozieblo argue that Treadwell “sought to modify [expressionistic] approaches … [and] creat[e] a new aesthetic, one that might have a particular appeal for the female spectator.” 150. Walker likewise emphasizes Treadwell’s status within the American expressionist tradition, though she contends that this “dramatic form … has been long misunderstood” and traces an alternative lineage through S.S. Currie’s theory of “expression” rather than the (more typically cited) German aesthetic movement. 2.

6 Treadwell, Machinal, 11.

7 Ibid., 27. Treadwell’s decision to emphasize new construction for maternity beds makes historical sense, given the rapid shift to hospital-based births during the early twentieth century. See Richard W. and Dorothy C. Wertz, 133.

8 Bywaters, “Marriage, Madness, and Murder,” 104.

9 Scholars who emphasize professional, media, and legal contexts include Walker, Strand, and Lutes. Critics who include brief analyses of the “Maternal” scene include J. Jones, Lòpez Rodríguez, and Dickey and Ozieblo.

10 Walker, Expressionism and Modernism, 211; Dickey, “Expressionist Moment.”

11 Walker, Expressionism and Modernism, 213, 215; Lutes, “Tears on Trial,” 351, 353.

12 López Rodríguez, “New Critical Approaches,” 77.

13 Like this essay, much of the discussion of childbirth and obstetric technologies in North American in the 20th century has focused on the experiences of middle- and upper-class white women in urban centers. For scholarship that examines childbirth experiences and practices beyond this limited scope, see Vandenberg-Daves, Modern Motherhood; Mitchinson, Giving Birth in Canada; Amy Kaler (Baby Trouble in the Last Best West, 2017), Dianne Dodd and Deborah Gorham (Caring and Curing: Historical Perspectives on Women and Healing in Canada, 1994). Carson, “And the Results Showed Promise … Physicians, Childbirth, and Southern Black Migrant Women, 1916–1930,” and Brianna Theobald (Reproduction on the Reservation: Pregnancy, Childbirth, and Colonialism in the Long Twentieth Century, 2019).

14 Treadwell, Machinal, xi.

15 See Leavitt, Mitchinson, Apple, Vandenberg-Daves, and Sharon Hays.

16 Apple, Perfect Motherhood, 2.

17 Vandenberg-Daves, Modern Motherhood, 2.

18 Mitchinson, Giving Birth in Canada, 13.

19 Apple, Perfect Motherhood, 9. Hays discusses how scientifically sanctioned approaches to mothering were adapted across class lines and paved the way for the even more demanding “intensive mothering” trend that she identifies as the norm in contemporary American society. x. Susan J. Douglas and Meredith W. Michaels also explore this in their more polemical book, The Mommy Myth: The Idealization of Motherhood and How It Has Undermined Women (2004).

20 Moffett, “Husbands and Better Children,” 26.

21 Baird, Matrimony, 100.

22 Vandenberg-Daves, Modern Motherhood, 79.

23 Treadwell, Machinal, 11.

24 Ibid., 16.

25 Moffett, “Husbands and Better Children,” 27.

26 Treadwell, Machinal, 18, 26.

27 Bywaters, “Marriage, Madness, and Murder,” 103; López Rodríguez, “New Critical Approaches,” 80.

28 Dickey, “Working Women,” 89, 86.

29 See Leavitt, Brought to Bed: Childbearing in America and Mitchinson, Giving Birth in Canada for detailed discussions of the deficiencies that characterized early twentieth-century obstetrics training and practice.

30 See “Achievements in Public Health 1900–1999: Healthier Mothers and Babies,” MMWR Weekly 48.38 (1999): 849–858; Vandenberg-Davis, Modern Motherhood, 80; Wolf, Deliver Me from Pain, 74–78; and Irvine Loudon (Death in Childbirth: An International Study of Maternal Care and Maternal Mortality, 1800–1950, 1992).

31 Leavitt, Brought to Bed, 116.

32 Jones, Medea’s Daughters, 50.

33 Walling, “Twilight Sleep—II,” 64.

34 Burton Blades and Burton Blades, “Twilight Sleep in America,” 68.

35 Beckley, “Twilight Sleep,” 53, 52.

36 Brown et al., The New Tokology, 64.

37 Hague, The Eugenic Marriage, 112.

38 Brown et al., The New Tokology, 64.

39 Hague, The Eugenic Marriage, 112.

40 Shannon et al., Nature’s Secrets Revealed, 183.

41 Stephens, Woman and Marriage, 194.

42 Jones, Medea’s Daughters, 50.

43 Walker, Expressionism and Modernism, 230; Bywater, “Marriage, Madness, and Murder,” 104. For discussions of the Young Woman’s voicelessness in other scenes of the play, see Jones, Women Who Kill and Strand, “Treadwell's Neologism: ‘Machinal’.”

44 López Rodríguez, “New Critical Approaches,” 80, 82.

45 Treadwell, Machinal, 30–31.

46 Ibid., 31.

47 Bywaters, “Marriage, Madness, and Murder,” 103.

48 Treadwell, Machinal, 28.

49 Walker, Expressionism and Modernism, 230; Bywaters, “Marriage, Madness, and Murder,” 105.

50 Treadwell, Machinal, 29.

51 Dickey “The Expressionist Moment”; Walker, Expressionism and Modernism, 217; Bywaters, “Marriage, Madness, and Murder,” 104.

52 Treadwell, Machinal, 29.

53 Bywaters, “Marriage, Madness, and Murder,” 104. The attending Nurse is depicted as sympathetic to her discomfort, but hemmed in by the requirements of her role within the hospital. She speaks for the institution, voicing its priorities (speed, scale, efficiency), but she also shows gender solidarity as she attempts to alleviate her patient’s distress and articulate the Young Woman’s desires to the doctor. The hospital setting, though, makes it impossible for her to succeed, showcasing how challenging it is for the female nurse to juggle competing requests (from patients) and requirements (of her profession).

54 Treadwell, Machinal, 29, 30.

55 Walker, Expressionism and Modernism, 217.

56 Hague, The Eugenic Marriage, 98.

57 Ibid., 98–99.

58 Elizabeth Dolan Kautz’s reading of Charlotte Perkins Gilman’s 1892 short story “The Yellow Wallpaper” emphasizes a similar dynamic between patient and doctor (“Gynecologists, Power and Sexuality in Modernist Texts,” Journal of Popular Culture 28.4 (1995): 81–91).

59 The Husband’s declaration “I know all you’ve been through … Oh, yes I do! … I was right outside all the time!” also reinforces this dynamic. Treadwell, Machinal, 28.

60 For a detailed discussion of the idea that women’s “frailty” or “delicacy” influenced their ability to endure labor pains, see Wood, “‘The Luxurious Daughters of Artificial Life.”

61 Mitchinson, Giving Birth in Canada, 300–301.

62 Leupp and Hendrick, “Twilight Sleep in America,” 36–37, 162.

63 This claim’s connections to eugenicist and racist beliefs are evident in a May 1915 article in The New Statesman titled “The Curse of Eve”: “But in the higher types of Man the brain is bigger still, and so must the head be, even the head of the new-born infant. … Doubtless the pelvis keeps pace, in some degree, with the head, so that woman of the higher races has a more capacious pelvis than, for instance, the negress; and thus we understand the peculiar hardship of the negress mother of a child who inherits a large head from a ‘white’ father. But probably it is this factor of head size that largely accounts for the comparative seriousness of childbirth among modern women.” 107.

64 Tracy and Leupp, “Painless Childbirth,” 43.

65 Walling, “Twilight Sleep—II,” 64.

66 Hitchcock, “In Defense of Caesareans,” 45.

67 Treadwell, Machinal, 11.

68 Ibid., 29.

69 Myerson writes: “Women still regard marriage as their chief goal in life, still enter homes, still bear children, and take their husband's name. But having become more individualized they demand more definite individual treatment and rebel more at what they consider an infringement of their rights as human beings.” The Nervous Housewife 1920. As J. Jones explains it, “by diagnosing a woman who did not enjoy being a wife and mother as mentally ill, doctors like Myerson reinforced traditional notions of femininity and subtly undercut the achievements and goals of emancipated women.” 41. Myerson’s framing of the “nervous housewife” illustrates the broader idea that young women at this time were caught within a social structure whose norms were evolving in paradoxical ways. For more on this theme, see Dorothy Chansky (Kitchen Sink Realisms: Domestic Labor, Dining, and Drama in American Theatre, 2015) and Dickey (“Working Women”).

70 Hamilton, “Chapter XXVI: Puerperal Insanity,” 557.

71 Leupp and Hendrick, “Twilight Sleep in America,” 162.

72 Hitchcock, “In Defense of Caesareans,” 46.

73 A 1915 advertisement in Lippincott’s for twilight sleep states that “there is nothing more distressing than to observe the falling birth-rate practically all over the world. It is due to many complex cases, but a great many of the voluntarily sterile marriages are due to the fear and dread which women have of child-bearing.” “Through Twilight Sleep a New Era Has Dawned for Women,” Lippincott’s Monthly Magazine 95.570 (1915):139. A more explicitly eugenics-focused articulation of these concerns appears in a 1914 article, where the writer considers “[h]ow great a part the dread of childbirth has played in the diminishing birth rate of the well-to-do and educated classes, in the Protestant population of western Europe and the United States, it has not been possible to say, except that it has admittedly been large.” “The Way of Social Selection,” The Independent 79.3433 (Sep 1914): 430. In these arguments, any efforts to ease women’s fear childbirth are primarily motivated by the authors’ eugenics-centered priority of maintaining a consistent birthrate among upper class, wealthy, educated, white American/European women.

74 Wharton, Twilight Sleep, 18.

75 Ibid., 18.

76 Treadwell, Machinal, 27; Wharton, Twilight Sleep, 18.

77 Wharton, Twilight Sleep, 18.

78 Treadwell, Machinal, 30 (our emphasis).

79 This attitude resonates with the argument that historians like Leavitt have made about how women were able to use the medicalization of childbirth as an opportunity to assume control: “they were not succumbing to physicians or technology but were, they thought, demanding the right to control their own birthing experiences.” “Birthing and Anesthesia” 161. Ironically, this initial embrace of anesthetic-aided birth led to women’s further lack of agency in the process. As Wertz and Wertz explain, “only gradually after 1930 did people realize that centralizing birth [in hospitals] had altered it fundamentally and brought new problems. … [W]omen began to feel that the medical treatment and institutional care had alienated them from important birth experiences.” 135.

80 For more in-depth scholarly accounts of the social critique that Wharton presents in Twilight Sleep, see: Lichtenstein, “Domestic Novels of the 1920s,“ 88; Haytock, ”Marriage and Modernism in Edith Wharton's Twilight Sleep“; and Bauer, ”Twilight Sleep.”