Transcript Document

History of Birth
Presented on December 08, 2010
Tamar Chachibaia
TSMU
c. - 400
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In Hippocratic oath abortion is forbidden.
c. 100
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Soranus of Ephesus writes on
gynaecology.
These illustrations, from a 14th
century version of Soranus'
Gynaecology, depict a variety of
foetal positions within the uterus
which is shown as an upside-down
jar or vessel. In Medieval texts,
the word vas (vessel) was used as
a synonym for woman'. In the top
picture, a woman in labour is
shown hanging onto a rope.
Soranus appreciated that infants
did not always present head first,
and in difficult labours, he
recommended podalic version'
whereby a hand is inserted into
the uterus and the baby drawn out
feet first..
c. 200
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Romans invent ingenious baby's bottle.
This bottle, shaped like a female breast, was
constructed so that no flies or dust could reach its
contents. The milk was introduced by inverting the
bottle, and pouring it through an open tube
ascending within from the centre of the base
almost to the apex (see cross section). This same
tube prevented the escape of milk when the bottle
was placed on its base. The child sucked through
the spout, on the opposite side of which is a small
round handle. Bottles like this from the 1st to 5th
centuries CE.
Soranus taught that breast-feeding should not
begin until 3 weeks after birth so that the mother
might regain her health and produce wholesome
milk.
Substitutes for human milk included honey diluted
with water or goat's milk although neither would
have provided the correct balance of nutrients and
fat content. If a wet-nurse was not available for
this important period in a new-born's life, its
survival prospects on artificial feeding would have
been grim.Votive offering excavated from Forum of
Augustus, Rome.
In 1513 Rösslin publishes first
textbook for midwives
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This is an illustration from the first
printed textbook for midwives,
written by a German physician,
Eucharius Rösslin. The text was
swaddled
largely compiled from the
writings of
Soranus although Rösslin added his
own woodcuts. The book went
through at least 40 editions and, in
1540, was translated into English as
The byrthe of mankynde.
It maintained its place as a textbook
of midwifery until the 18th century.
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Nicholas Culpeper and his house
The Culpepers lived at Red Lion House,
Spitalfields, in East London.
In his Directory for midwives Nicholas was
generally critical of the care afforded to
infants, particularly by (wealthy) parents who
left their tender offspring to the sole care of
nurses, who are either too negligent to do
their duty or too ignorant to know it. I venture
to affirm that more human lives are lost by the
carelessness and inattention of parents and
nurses as are saved by physicians ... A little
medical knowledge about cleanliness and care
can do more good than many costly potions
from the apothecary'.
Source: Nicholas Culpeper (16161654).Culpeper's complete English physician.
A Hogg, London 1802.
Midwife braves a storm to attend a delivery
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The stereotypical portrait of a 19th
century English midwife is the obese
Sarah Gamp' battling her way through
awful weather to attend a woman in
labour. Her assistant, carrying the
instruments, runs alongside.
Charles Dickens, who created Sarah
Gamp and Betsy Prig for his novel,
Martin Chuzzlewit (1843), later claimed
that these portraits were not meant to
be caricatures but were a fair
representation of the hired attendant of
the poor in sickness'.
Florence Nightingale added that, prior to
her era, ‘It was preferred that ... nurses
should be women who had lost their
characters, ie. should have one child'.
Coloured etching by
Thomas Rowlandson
(1756-1827), London
1811.
In 1740 Men-midwives challenge
women's right to deliver babies
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Representation of a man-midwife, or a
newly discovered animal'. One half of the
figure represents a man-midwife in his
surgery whilst the other half depicts a
traditional midwife in a domestic setting.
This illustration was used as a ‘flyer' to
advertise a book entitled Man-midwifery
dessected, elucidating this animal's
propensities to cruelty'.
Male midwives were perceived, not only as
capable to handle with instruments of
destruction but as a danger to female
modesty and virtue'.
Coloured etching by
Isaac Cruikshank
(1756/571810/11).Published by
SW Fores, London
1793.
Man-midwife delivering a woman under a sheet
and suggestively examines a pregnant woman
Men-midwiveswere often obliged to carry out
manipulations blindly in order to spare not only
their patients' embarrassment but husbands'
unease and disapproval of such intimate physical
contact, regardless of its context. There was a
belief that this amazing prudery' was not as
common amongst royalty. This was not
necessarily the case. Sir James Reid (1849-1923),
Queen Victoria's physician for the last 20 years of
her life, never examined her or made a bedside
diagnosis until the final illness in 1901. He did not
know until after her death that years of
childbearing had left his royal patient with an
abdominal hernia and a prolapsed womb.
Wood engraving after a woodcut from the works
of a Dutch physician, Samuel Janson, 1681.
1750
First Lying-in Hospital Founded in City of London
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Maternal death could destroy a practitioner's
reputation more completely than anything else.
Richard Smith (1772-1843) who practised in Bristol,
bemoaned the fact that a surgeon-apothecary cannot
be compensated at all by the mere lying-in fee,
unless it leads to other business. I know of no
surgeon who would not willingly have given up
attending midwifery cases provided he could retain
the family in other respects.'
Podalic version
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In this manouevre, the doctor introduces a
hand into the womb to turn a malpositioned
child so that it can be delivered feet first.
Although practised since antiquity, the
technique allowed bacteria on the hand to be
transferred to the genital tract of the
parturient woman.
Source: Jacques Pierre Maygrier (17711835).Nouvelles demonstrations
d'accouchemens. Bechet, Paris 1822.
c. 1580
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Chamberlen invents obstetrical forceps
The Chamberlens moved in the highest circles
although it is doubtful whether this was due
entirely to their forceps. They were clearly
accomplished men-midwives. In 1628, Hugh
Chamberlen's son, Peter, was called to attend
Henrietta Maria, wife of Charles I (reigned
1625-1649), after the midwife in charge
swooned with fear' on entering the queen's
bedchamber. Whether he used the forceps
(always carried in a box) is unrecorded. In
1818, several pairs of forceps were found in a
secret compartment at Woodham Mortimer
Hall near Maldon, Essex, which had once been
the home of Peter Chamberlen's son, also
called Peter (1602-1683).
Delivery of a child with forceps
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Despite their increasing use among menmidwives, there was a certain antipathy
towards forceps both amongst patients and
midwives.
Smellie at first employed wooden forceps so as
to avoid the clinking noise of the metal blades.
Later, he modified the shape of metal forceps
by adding the long pelvic' curves and bound
the blades with strips of leather (as in this
illustration). He did suggest that the leather
should be renewed after each case. In 1759,
Smellie returned to his native Lanark in
southern Scotland, leaving influential
successors such as William Hunter, William
Osborn and Thomas Denman. None of these
were enthusiastic about the use of forceps.
Source: William Smellie.A sett of anatomical
tables. London 1754.
Criminal Abortion
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This illustration, from an early 19th
century textbook of �operative
midwifery', shows a procedure for
removing a child during obstructed
labour. The head of the child has been
broken up (craniotomy) and removed via
an instrument introduced into the womb,
after which the headless body is
delivered with obstetric forceps. This
unfortunate and crude delivery
technique, practised since antiquity,
often endangered the life of the mother
by tearing the cervix and womb or
introducing potentially lethal germs into
the maternal passage. In the hands of
poorly trained doctors, craniotomy was a
very dangerous procedure.
Source: D Davis.Elements of operative
midwifery. London 1825.
1861 -Semmelweis washes hands to save life
An anatomical dissection by Dr JohnBlandSutton at the Middlesex Hospital Medical School
in London. The doctors wear outdoor clothes
with no protective covering, and dissect with
their bare hands. In many hospitals and medical
schools, dissections and post-mortems were
carried out first thing in the morning which
meant that doctors and medical students spent
the rest of the day carrying germs around the
wards.
Hand washing was not practised with great
enthusiasm because the need for it was not
understood even by Semmelweiss. He made few
converts because of his dogmatic views and
intolerance of criticism. He was eventually
confined in a lunatic asylum where he died,
possibly from a septic hand - rough justice for a
man who pioneered the use of chlorine
disinfectant as a skin cleanser.
1610 - First documented Caesarian section in
which mother survives.
Caesarian section carried out to rescue an
unbaptised infant from a dead mother may
not have been unusual but the time delay
between verification of death and removal of
the child meant that very few would have
survived the ordeal. In order to determine the
mother's death, the 16th century French
surgeon, Jacques Guillemeau (1550-1613),
advised that ... you shall lay upon her lips,
and about her nose, some light feathers; so if
she breath never so little, they will fly away.
And thus being assured that she is dead, the
chirurgion, presently without delay, after he
hath laid her belly naked, shall there make an
incicion, of the length of foure fingers'.
1847 First child born under anaesthesia
A portrait of Anaesthesia as a young girl. James
Young Simpson discovered the anaesthetic effects of
chloroform by accident when he and his assistants
were experimenting with chemicals and somebody
upset a bottle. When Simpson's wife brought in
dinner she found them all asleep. Simpson was
angered by the objection to chloroform in childbirth
from those who quoted the biblical command, In
sorrow thou shalt bring forth children' (Genesis 3,
verse 16). He made the point that the original
meaning of sorrow was labour' or work' rather than
pain, and argued that a loving God would not oppose
pain relief in labour.
Source: The centenary of an inventor of sleep, 3 June
1911.
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1933 Robert James Minnit invents
gas and air apparatus
The distribution of gas and airapparatus throughout
England owed much to the National Birthday Fund
(later the National Birthday Trust Fund), founded in
1928. The organisation's initial aim was to raise
money to supplement midwives' fees and improve
their training. From the early 1930s, however, it
became involved in the trial and provision of various
analgesia apparatus for the relief of labour pains
including the ‘Queen Charlotte's' and Minnitt
machines which cost around 14. The Fund supplied
such machines free to hospitals and at 5 each to
District Nursing Associations. In 1940, the Sussex
Maternity and Women's Hospital wrote to thank the
Fund for the safe receipt of its 2 gas and air
machines which were giving complete satisfaction'.
The National Birthday Fund benefited from its
association with a number of powerful and
influential people including the Prime Minister's
wife, Mrs Stanley Baldwin, who held fund-raising
events at 10 Downing Street.
Source: National Birthday Trust Fund Papers,c.
1937-1938.
Midwife giving a woman gas and air
The gas and airmachines used by
midwives were portable and easy to use.
This photograph, showing a midwife
applying the mask, was produced for
promotional purposes by the British
Oxygen Company who supplied the gases
used with the machines. Machines
donated by the National Birthday Fund
carried plaques indicating their
provenance.
Source: National Birthday Trust Fund
Papers, c. 1950s.Reproduced with kind
permission of BOC.
1933 - Grantly Dick Read advocates natural childbirth
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Grantly Dick-Read's modern' approach to childbirth
included education, correct breathing, relaxation
and exercises' which would help a healthy woman
achieve a natural birth'. In fact, the techniques
were based on his investigations of childbirth
practices amongst non-westernised African
communities. Despite a new wave of practical
instructions to young people contemplating ...
parenthood', the delivery room was still no place for
fathers. In this cartoon, the father-to-be is
reassured by a nonplussed general practitioner:
Father-to-be: I can'tstand this suspense any longer.
It will kill me'.
Doctor: Calm yourself, my dear sir. I've brought
thousands of babies into the world and never lost a
father yet'.
Source:Punch, 1 February 1928, page 129.
Father-to-be reassured
by the family doctor
Only in 1936 - Prontosil reduces maternal
mortality rate
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A woman dying of puerperal sepsis is being shown her
newborn child for the final time before receiving the last rites.
She is comforted by her husband while other members of the
household mourn. In Britain, this scene was no less prevalent
in the 20th century than it had been in the 19th.
By 1920, the maternal mortality rate in England and Wales
was 43.3 deaths per 1000 deliveries. In the United States it
was 68.9 whilst in the Netherlands, where instrumental
deliveries were rare and most mothers gave birth at home, it
was 24. Dora Russell of the Workers' Birth Control Group,
pointed out to an unresponsive British government that childbearing was far more risky than coal-mining, the most
hazardous male occupation. By 1960, however, the maternal
mortality rates in all 3 national groups were almost identical,
being 3.9, 3.7, and 3.7 respectively.
Nurses and midwives are
needed'
The wartime job that can be your career'
was a recruitment drive for nurses and
midwives after the austerity of the
1930s when low pay and unacceptable
working conditions had made midwifery
an unpopular career choice for young
women. Evelyn Prentis, who trained in
Nottingham during that period, recalled
that the town was packed with beautiful
girls, some earning as much as 2 a week
at Player's [the tobacco company]. They
could afford to bleach their hair and buy
lipstick. None of us could, and anyway,
Matron would have frowned on both'.
Lithograph
poster., 1940
Neonatal intensive care - 1990
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By the 1990s, a child born at
22-23 weeks gestation (the
normal period is 40 weeks) had
about a 24% chance of survival
whilst one born at 25 weeks
had a 50% chance. Most infants
born after 32 weeks survived.
The viability of foetuses at such
early stages of development
raised issues surrounding the
1967 Abortion Act which made
termination of pregnancy legal
until 28 weeks. Various
campaigns were mounted to
limit the time to 20 weeks.
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In this hospital labour
ward of the 1990s, the
mother is attended by a
midwife and doctor. The
father-to-be, no longer
forced to pace the floor
outside the delivery
room, is encouraged to
participate in the birth.
In vitro fertilization 1969
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In this colour-enhanced scanning
electron micrograph (SEM), a
human sperm attempts to
fertilise an egg. Once the sperm
has fused to the egg cell
membrane, the zona reaction'
takes place which prevents other
sperm from entering the egg.
SEM by Yorgos Nikas.
First test-tube baby 1978
8-celled human embryos
Light microscope image of two8-celled
human embryos ready to be implanted
into their mother's womb. Preimplantation embryos withstand
freezing for long periods of time
allowing them to be implanted at
intervals coinciding with normal birth
spacing.
Dolly cloned 1996
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Human cloning in forbidden