Eighteenth Century Obstetrics

CASE 2:  Medicine and Childbirth

Global Context: Eighteenth Century Obstetrics

The medical field of “obstetrics” (i.e., delivering babies) was an important area where North American and European doctors applied new discoveries in medical technology and anatomy. Prior to the eighteenth century, most babies were delivered by female midwives, and people felt that childbirth was a woman’s business. This was true in Europe as well as in Asia. For example, Jizhai’s text Treatise on Successful Childbirth, instructs its readers how to avoid being cheated by midwives. Although Jizhai criticizes midwives as being ignorant and dishonest, he still assumes that they will be the ones delivering the baby. Until the twentieth century, Chinese male doctors took almost no interest in delivering babies. But the eighteenth century was an important turning point in Euro-American obstetrics. It was during this time that male doctors actively sought to develop obstetrics into a full-fledged medical specialty. They produced books describing the woman’s body and how its structure affected childbirth, touching on topics such as the role of uterus and the problems that arose when the mother’s pelvis was too small or deformed. They tried to systematize knowledge about the process of labor and how to manage various kinds of emergencies or difficult births. They described ways of turning the baby around if it were to become lodged in an incorrect position for birth and developed surgical instruments to help pull the baby out. These included the forceps, which had first been invented in the seventeenth century but which became widely used during the eighteenth century. Male doctors were especially known for using surgical methods to manage a difficult labor. The most common operations were craniotomy (dismembering the baby’s skull) and symphysiotomy (cutting through the pelvic ligament in an attempt to increase the size of the pelvic opening). Caesarian section was used only as a last resort and, prior to the 1890s, was usually fatal for the mother.

During the eighteenth century, schools of obstetrics were established in major European cities, and the most famous were located in Dublin, Edinburgh, Glasgow, London, Paris, Amsterdam, Copenhagen, Berlin, and Vienna. At the same time, doctors in these cities established maternity hospitals. These would provide care for poor women, while also allowing male medical students to gain clinical experience. In sum, by the end of the eighteenth century, delivering babies had become an important part of a European male doctor’s practice. Not surprisingly, male doctors tried to restrict or eliminate the activities of female midwives, on the grounds that these women did not have sufficient medical training to manage childbirth properly (and they also sought to keep women from attending medical schools on the grounds that medicine was not an appropriate profession for women!). But even as they boasted new and improved methods of managing birth, doctors also recognized the limitations of those methods. For example, many physicians worried that their colleagues were forceps-happy; in their eagerness to prevent difficult labor, they used the forceps too early or unnecessarily, causing injury to the woman and baby. Some doctors even called the forceps a step backwards for medicine, and they urged their fellow physicians to pursue a policy of restraint and minimal intervention in childbirth.

Doctors felt similar ambivalence toward the new “lying-in” (maternity) hospitals that sprang up in European cities during the eighteenth century. These maternity hospitals were designed to incorporate the latest in medical technology and architecture. For example, they were designed to be well-ventilated buildings and located on high ground to reduce the risk from miasma. Yet, doctors were appalled and dismayed to find that the death rates in these hospitals vastly exceeded that for women giving birth outside the hospital, as much as 20 times higher. The most pressing problem was “puerperal fever,” which modern medicine now recognizes as a streptococcal infection of the uterus. In serious cases, the infection would spread throughout the woman’s abdomen, and the poor victim would die in agony. Puerperal fever spread rapidly, and it was not uncommon for entire wards of pregnant women to die during an outbreak. It was eventually discovered that the hospital doctors and medical students were the root of the problem. They would go straight from performing an autopsy on a dead patient to examining a live woman, all without washing their hands, and then spreading the bacteria from woman to woman as they made their rounds. Even with improved cleanliness procedures, doctors lacked the techniques to ensure sterile conditions, and puerperal fever continued to plague the maternity hospitals. The medical historian Irvine Loudon, who has written the most authoritative study on this issue, even stated the following:

The lying-in hospitals were such a disaster that, in retrospect, it would have been better if they had never been established before the introduction of antisepsis in the 1880s.

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