|
|
Obstetric Literature and the Changing Character of Childbirth
Birthing is a normal, yet extraordinary event that has been with us from time
immemorial. This exhibit is an attempt to show, through our collection of rare books, how birth has changed over time. For most of human history childbirth was an event mediated by midwives, who delivered women in their homes with the comfort and help of female friends and family. This began to change in the seventeenth century, with the advance of anatomical knowledge, the introduction of the obstetric forceps, and the emergence of man-midwifery, which became the field of obstetrics.
The earliest printed illustrated manual for midwives was published in 1506 by Rösslin, and this was improved upon in 1554 by Rueff, who directed his text also to well-to-do women, physicians, and scholars. In the mid 17th century, Mauriceau authored the first great obstetric textbook with new ideas, such as the uterus being the active agent and the fetus being passive in the birth process. This work established obstetrics as a separate field of scientific study and became the dominant force in 17th century obstetrical practice. Mauriceau's chief practical impact consisted of abandoning the birthing chair in favor of delivery in bed. The first obstetric forceps appeared around 1580, probably invented by Peter Chamberlen, but remained a closely guarded trade secret until the 1730s.
In the 18th century the increase of anatomical knowledge about the birth process had a profound impact. Early in the century Van Deventer gave the first accurate description of the female pelvis, showing that it was unyielding during labor. Toward the middle of the century, a new breed of men-midwives emerged, led by Smellie and Hunter. These two Scotsmen made great contributions to the anatomical understanding of gestation and birth, and also served as renowned teachers of obstetrics. Smellie and Levret simultaneously improved the forceps by adding a pelvic curve to the cephalic curve of the instrument. Smellie's work was essentially conservative, discouraging intervention, but less competent men-midwives showed less hesitation and among them instrumental deliveries proliferated. Hunter re-emphasized a conservative approach and this continued with greater force by his protégé Denman in the late 18th century. During this period Baudelocque demonstrated the importance of gauging the shape and dimensions of the pelvis as a guide to obstetrical practice. In America, Shippen became the chief advocate of man midwifery and began private instruction based upon Hunter's teachings in 1765. Formal lectures on obstetrics in American medical schools began with Dewees in 1820, but clinical instruction lagged until much later in the century.
Arch-conservatism in obstetrics came to a close with the death in childbirth of Charlotte Augusta, Princess of Wales, in 1817. Physicians attending her had failed to act with effective means at their disposal, hastening her demise. In the aftermath of this widely publicized tragedy, "rational intervention" -- best represented in the work of Davis -- gained force once again. This development included the use of ergot (to stimulate uterine contraction during labor and for expulsion of the placenta), experimentation with blood transfusion, and the introduction of anesthesia for obstetrics by Simpson, all intended to make birth safer, as well as less painful. Maternity hospitals came into existence in this period, beginning in this country with the founding of Boston Lying-In Hospital in 1832. In such places, obstetricians like Hodge developed new and improved forms of obstetric forceps. Care in an obstetric clinic entailed risk of puerperal infection, the leading cause of maternal death. This changed only with the advent of the germ theory, which helped to identify the disease-causing organisms and their means of transmission. Antisepsis and asepsis went a long way to making hospital birth safer by the opening years of the 20th century.
These changes promoted the rapid "medicalization" of birth. In 1900 less than five percent of women gave birth in a hospital; by 1940 half of all women, and seventy five percent of all urban women had their children in a hospital. The most visible proponent of this change was the obstetrician De Lee, who saw birth as a potentially pathological condition that should be averted through instrumental intervention. He advocated "prophylactic forceps delivery" and
episiotomy
(surgical opening of perineum). To this was added the prospect of Caesarean section and induction of labor. By its move to the hospital, therefore, birth became a surgical event, controlled by physicians who wielded the technology, and decision making passed out of the hands of the prospective mother.
Text written by James M. Edmonson, PhD Chief Curator, Dittrick Medical History Center and Julian Kassen MD.
Photography and web design by Laura Travis.
|
 |
