In a world teeming with religious narratives and expectations, what happens when lived experiences do not align?

Dr. Philippa Koch, Missouri State University associate professor of religion, explored this question through her research on how Christians in colonial America held onto the doctrine of providence. This is the belief that God oversees everything and sometimes intervenes in the world.

This research led to the publication of her book, “The Course of God’s Providence: Religion, Health and the Body in Early America,” in 2021.

In it, Koch explores how Christians maintained this belief, even as medical advancements made it possible to treat illnesses.

“Many people assume that with the rise of modern medicine and science, the belief in God would decline, but my research showed Christians still saw God’s hand in medicine and human ingenuity,” she said.

The maternal body

During her research on medical advances in the 18th century, Koch found maternity-related records that highlighted the changes in the field of midwifery during that period. This became the focus of her book’s final chapter.

She examined how 18th-century Christian teachings shaped expectations around childbirth and motherhood. She also studied the gap between these teachings and women’s lived experiences—a gap that was sometimes heightened when sermons and advice books encouraged norms many women found difficult to meet.

“The chapter on childbirth was supposed to tie up the project as my final chapter,” Koch said. “But it led to a whole new research focus, which is the basis of the new book I’m working on.”

In the chapter, Koch explored how religious leaders shaped people’s beliefs about childbirth. Their teachings set spiritual and social expectations. She used archives of church sermons, medical texts and letters to show how deeply the concepts of sin and redemption were tied to childbirth.

“They believed a woman’s pain during labor was due to original sin, rooted in the biblical story of Eve,” Koch said. “And they thought women could find some redemption through childbirth and self-sacrificial care for their child, as was modeled by Mary, the mother of Jesus.

This wasn’t just a belief; it shaped how women’s families and the community treated them.”

Through her work, Koch found many stories of women who struggled to live up to these expectations.

“For instance, Christian texts stressed the moral duty to breastfeed. They urged mothers to nurse their children as long as possible. This norm was seen as a way for mothers to show love and fulfill their religious role,” Koch said.

“Yet, many women couldn’t meet these demands. Illness, lack of resources and the realities of large families made it difficult. When they fell short, they often faced blame or were considered less devout.”

Marginalized voices

Although the dominant narratives from 18th-century America often centered around the experiences of white, Christian women, Koch’s research includes stories of people who have historically been left out of the narrative.

“Women of color were often completely erased from these discussions,” she said. “It’s not that they weren’t represented in these Christian ideals. They were actively excluded from them. Despite facing harsher realities, such as enslavement and limited access to medical care, these women played crucial roles in the health practices and community support networks of early America.”

Koch highlights how women navigated, resisted and sometimes redefined these prevailing norms.

For example, medical manuals and missionary correspondence counseled women to nurse their own child. Yet manuals and letters also advised how to choose a wetnurse, with considerations for a nurse’s complexion, moral behavior and hygiene. Such evidence suggests the widespread use of nurses from a range of social, racial and economic backgrounds, despite social norms.

Sources also point to the challenges faced by women who, due to their economic situation or position as a servant or slave, were forced to nurse another woman’s child, often to the detriment of their own family.

Personal roots

Koch’s interest in the interplay of medicine and religion is rooted in her ‘80s- and ‘90s-era childhood, when her father served as a family doctor in a rural community near Seattle. His role was part of a national effort to place health care workers in underserved areas.

“There was always this idea that health care was a social duty, which shaped my thinking.”

Her family’s religious background also influenced her. Koch’s grandfather was part of a community that traces its origins to the Amish. While her upbringing was not within that group, she notes her ties to the community gave her a unique insight into how faith can shape both individual and family life.

Today’s world

For Koch, this research is not only about understanding the past. It is a way to think about the present. She hopes her new book will improve understanding of how past ideals still influence modern expectations of women’s bodies and choices.

She also hopes her scholarship will provide a resource for health care practitioners and community leaders who wish to deepen their understanding of cultural factors that affect maternal health.

“When practitioners recognize the historical weight of these teachings, they can better support their patients who may be feeling the same pressures today,” she said. “Debates around motherhood and health are still common. The narratives might have changed, but the core question remains: Who gets to define a woman’s role and worth?”

The book, which she expects to finish within the next three years, will explore this question in depth. It will contrast 18th-century views with today’s discussions around women’s health and rights.

“This is not just history; it’s about real people who lived, loved and suffered. It’s about reclaiming the narratives of women.”

By continuing her research, Koch hopes to encourage a more thoughtful view of women’s health and religion.

“History is full of contradictions,” she said. “By addressing them, we can better understand not just where we’ve come from, but where we might go.”