Attitudes to giving birth have changed radically since the 1950s and 1960s. In a hospital birth at that time, the mother was often seen as a 'patient,' who was expected to comply with the advice and instruction of the hospital staff. Often the birth position suggested would be on a bed, possibly with the woman's feet in straps, to make it easy for the doctor to monitor progress. The midwives and nurses would often take a no-nonsense approach, which in some people's opinion could verge on verbal abuse. An article in the The Journal of Perinatal Education in 2009 describes a list of the type of behaviours believed to be common in medical staff at the time as including 'threatening, scolding, ridiculing, shaming, coercing, yelling, belittling, lying, manipulating, mocking, dismissing, and refusing to acknowledge - behaviours that undermine the recipient's self-esteem while enhancing the abuser's sense of power, typical of bullying.' Although many self-confident women like Lexie in the novel, did not submit to such treatment, and expressed themselves and their preferences loudly and clearly, there must have been many women for whom the experience was a frightening and distressing one.
The move towards a more natural birth with the mother in control was emerging at that time, but it by no means had the acceptance that it has today. Here are some records of unassisted births in the USA in the 1950s and 1960s. Nowadays there is much information and support to help a mother choose her preferred style of birth, as is evident from this website called Giving Birth with Confidence, where among other things the pros and cons of various labour positions are openy discussed, giving many examples. From this website it is clear that the squatting position that Lexie chose quite naturally in order to give birth to Theo in the novel is now a standard choice for many mothers. It is interesting that this more upright birthing position has a very long history in Britain, as supported by the use of birthing chairs as pictured here, as far back as the 16th century. This is from what is believed to be the earliest printed text book for midwives, which had its first edition in 1513, and had 40 editions, being used up until 1730.