Handmaids, Hospitals, and The Pageantry of the Newborn Nursery Window Hannah Fagen Gender Studies, Science & Medicine This story originally appeared on NursingClio, a collaborative blog project that ties historical scholarship to present-day issues related to gender and medicine. Sixteen minutes into the second episode of Hulu’s new Handmaid’s Tale, Offred (Elizabeth Moss), having recently given birth to her first child, follows a nurse to the hospital’s newborn nursery, where her baby will have her first bath. Arriving at the nursery, Offred is taken aback by an unusual sight. “Where are the babies?” she asks. “Oh, we had a difficult night. Two went to the intensive care unit, and the others all have died.”1 The camera zooms in on Offred as she looks in through a massive window into a newborn nursery with three rows of empty bassinets. Ominous music plays in the background. Offred stares in at the empty room for a few minutes, before entering the nursery and pacing between its rows. This scene, which is part of a flashback in the show, serves as a powerful warning of things to come for a community grappling with widespread infertility.2 As Handmaid’s’ creative team understands, an empty nursery is jarring — a seriously bad omen. That viewers of all ages and life experience can easily recognize the gravity of a nursery devoid of babies speaks to the peculiar and particular role that nursery windows have played in modern American hospitals. The “Birth” of the Nursery Window Newborn nurseries became fixtures of American hospitals in the early twentieth century, during the transition from home to hospital as the preferred and default place to give birth. When hospitals built new maternity units to house women during labor, delivery, and recovery, they also built separate nurseries where newborns were cared for, en masse, apart from their mothers. Photo of the Admitting Nursery at a Houston-area hospital with listed times for baby showings in approximately 1960. (John P. McGovern Historical Collections and Research Center, Houston Academy of Medicine – Texas Medical Center Library; Houston, Texas.) These nurseries shared a striking similarity: they prominently featured large windows facing out to hospital corridors. These windows placed the hospitals’ youngest patients on display for family, friends, hospital staff, and members of the general community. The 1943 edition of Standards and Recommendations for Hospital Care of Newborn Infants, first published as a collaboration between the American Academy of Pediatrics and The Children’s Bureau, prescribed that “A viewing window should be provided between each nursery and the nurses’ station, and one between each nursery and the corridor so that relatives may see the infants without coming in contact with them.”3 Here, the stated purpose for the viewing window is twofold: first, the window allows relatives to “see the infants,” and second, the window serves as a barrier to prevent contact between relatives and the newborns they have come to see. While hospitals justified the construction of these windows as sanitary barriers between newborns and the general hospital community, it is quite unlikely that infection prevention was a primary motivator. If windows were only to serve as antibacterial barriers, the hospitals would have had no reason to install them in the first place; standard windowless walls surrounding nurseries would have been less trouble to build, and would have eliminated the potential for compromising the barrier between the nursery and the corridor via cracks between the window and the wall. Thus, the ubiquitous nursery window served a primarily social function. Roots for the practice of clinical baby viewing may lie in the late-nineteenth- and early-twentieth-century European and American tradition of incubator shows, which placed premature and otherwise weak infants on display in both permanent and traveling exhibitions. In the United States, incubator shows charged admission and displayed sick infants among “ethnic villages and freak shows,” most famously on New York’s Coney Island.4 Nursery windows differed fundamentally from these displays. Newborn nurseries, unlike incubator shows, were widely accepted and endorsed by mainstream medical organizations. Nurseries did not charge admission for spectators, and were in hospitals, which are presumably spaces for the provision of clinical care, and not for entertainment. Most importantly, the babies displayed in the windows of newborn nurseries were almost all healthy. These windows were, at their core, displays of happy, healthy, and hopeful normalcy. Fathers at the Window While large picture windows often displayed the swaddled newborns to all who passed through hospitals’ corridors, some nurseries had specific times in the day reserved for family members and friends to get a closer look at a particular baby. During these more intimate viewings, a nurse would often hold a newborn up to the window so that the eager observer could get a closer look. Admirers in this scenario could be mothers, grandparents, members of the extended family, or adoptive parents, but appear to have most frequently been fathers. For most of the twentieth century, fathers did not meet their babies in person until they took them home, and hospitals seem to have had fathers’ desires in mind when designing nursery windows. The picture of a father meeting his newborn through a pane of glass undoubtedly appears in countless family photographs from the mid-twentieth century, and was immortalized in all forms, from art to advertising. A full-page ad for The Prudential Insurance Company of America in a 1943 issue of LIFE magazine uses the classic nursery window interaction between father, nurse, and baby to convince new fathers to purchase life insurance. The page features a large photograph of a handsome young man, dressed in a suit and tie, smiling into the eyes of his newborn child through a glass window. With an empty bassinet in sight, the baby is in the arms of a uniformed nurse, who cradles the baby, tilting the child towards its father. The photograph’s caption reads, “PICTURE OF A MAN LOOKING INTO THE FUTURE.” Underneath, the text reads, “Row upon row of tiny bassinets – and a nurse holding up a new baby. The baby! But Dad sees much more than a newborn son. He sees a long future stretching ahead…”5 LIFE magazine, in recognizing the cultural significance of the nursery window as a space for thinking about hope and the future, used it as a tool to remind new parents of their responsibility to protect their children’s futures by purchasing life insurance. Photo taken through a reinforced glass nursery window at the Hospital of the University of Pennsylvania in 1969. (Courtesy of the University of Pennsylvania Archives and Records Center) Hospitals relished the opportunity to satisfy new fathers. A 1950 article in The American Journal of Nursing reported on an innovative recessed nursery window installed in a hospital in California, which they called a “Baby Showcase.” This window, they wrote, “is paying dividends in public relations value and making new fathers very much happier…”6 The End of the Newborn Nursery Newborn nurseries are no longer considered best practice in American hospitals, and their use is disappearing thanks in part to the widespread adoption of the WHO’s 1991 Baby-Friendly Hospital Initiative (BFHI). The BFHI, a global program to promote hospital practices that encourage breastfeeding, includes keeping healthy mother-baby pairs together as one of Ten Steps to Successful Breastfeeding. As nurseries have begun closing, popular press coverage and professional discussions have reinforced the idea of the nursery window as a positive space in hospitals, both for babies’ families and unrelated members of the community. In 2002, The American Journal of Maternal and Child Nursing printed a debate on the topic of closing the nursery windows. Dotti James, PhD, RN, argued for keeping the windows open, in part because for “family members, friends, and others… Seeing one of these little miracles engenders smiles and becomes a bright spot in the day.”7 James also noted that, “in some hospitals the nursery window has become a destination for patients and families from other parts of the hospital experiencing a health crisis,” and that “Standing outside the nursery, seeing the babies who have their lives before them can give hope to families trying to cope.”8 Concluding, James urged hospitals to consider keeping their nursery windows open, because, “having an opportunity to see new babies elevates each of us and reminds us of our responsibility to protect the future.”9 Even Barbara Buchko, MS, RN, arguing for closing the windows that she sees as violations of privacy and security, concedes that, “many people enjoy getting their ‘baby fix’ by looking at the babies in the nursery, for new babies are an affirmation of life.”10 Also in 2002, a Los Angeles Times article echoed James’ arguments, lamenting the closure of “the popular viewing areas, where hospital visitors burdened by some of life’s darkest moments could brighten their day a little simply by peering through the nursery window.”11 In the same piece, Michael Baskt, executive director of Community Memorial Hospital in Los Angeles, shared, “… For people where things are not going well, we recognize they would be attracted by the beauty of birth. Sometimes people need to go from the sad, depressing side of the hospital to the happy side. Babies put things in perspective.”12 As influential thinkers and organizations continue to reimagine the postpartum period as a time for breastfeeding, clinically-managed bonding, and a jump start on developing the “right” mothering habits, the iconic display of newborns continues. For better or for worse, whether in hospital-published “online nurseries,” or as the backdrop for emotional scenes in television and movies, the tradition of the nursery seems to be here to stay.13 Further Reading Apple, Rima D. Perfect Motherhood: Science and Childrearing in America. New Brunswick, New Jersey: Rutgers University Press, 2006. Baker, Jeffrey P. The Machine in the Nursery: Incubator Technology and the Origins of Newborn Intensive Care. Baltimore and London: The Johns Hopkins University Press, 1996. Walzer Leavitt, Judith. Brought to Bed: Childbearing in America 1750-1950. Reprint Edition ed. New York, Oxford: Oxford University Press, 1988. Walzer Leavitt, Judith. Make Room for Daddy; the Journey from Waiting Room to Birthing Room. Chapel Hill, North Carolina: University of North Carolina Press, 2009. Notes The Handmaid’s Tale, “Birth Day,” Season 1, Episode 2, directed by Reed Morano, written by Margaret Atwood and Bruce Miller (MGM Television Entertainment Inc. and Relentless Productions, April 26, 2017). For those unfamiliar with Margaret Atwood’s The Handmaid’s Tale, it tells the story of a fertile woman enslaved to bear children for high-ranking officials after an authoritarian pronatalist regime overtakes part of the former United States. Ethel C. Dunham and Marian M. Crane, Standards and Recommendations for Hospital Care of Newborn Infants, Full-Term and Premature (Washington, DC: Children’s Bureau, United States Department of Labor, 1943): 6. Jeffrey P. Baker, “Historical Perspective: The Incubator and the Medical Discovery of the Premature Infant,” Journal of Perinatology 5, (2000): 324. “Picture of a Man Looking into the Future,” LIFE Magazine 15, no. 9 (August 30, 1943): 22. Howard Hatfield, “New Nursery Window Pays Off in Public Relations,” Hospitals 24, no. 56 (May 1950), in “Medical Highlights,” The American Journal of Nursing 50, no. 7 (July 1950): 12-14. Barbara Buchko and Dotti C. James, “Should Newborn Nursery Viewing Windows be Eliminated? Second Opinion,” The American Journal of Maternal/Child Nursing 27, no. 5 (September/October 2002): 263. Ibid. Ibid. Ibid., 263. Ibid. Emphasis is mine. Some hospitals have, in the last two decades, launched websites often termed “virtual nurseries” or “online nurseries,” which I see as an obvious proxy for the nursery window of yesteryear. These sites, some of which are password-protected but many of which are completely public, display images of children recently born in their affiliated hospitals along with varying amounts of personal information. I have chosen not to link to any of those sites in this public forum out of concern for privacy of the children and families displayed on the sites. Featured image courtesy of Library of Congress.