Trotula of Salerno (??-1097)
Midwife, teacher, and author, Trotula's treatise
on gynecology, Passionibus Mulierum Curandorum (The Diseases of
Women), in which she identified herself as a woman, was used in medical
schools until the sixteenth century. Long regarded as one of the
preeminent medieval scientists, Trotula lost her place in the history of
medicine only in the beginning of the 20th century when historians became
unable to accept that such a woman could exist in eleventh-century Italy.
Writing with disarming frankness, Trotula dealt with gynecology,
obstetrics, cosmetics, and skin disease in a sensible and humane manner.
Generally up-to-date for its time, Passionibus Mulierum was far ahead of
the current practices when discussing surgery, analgesics, and the care of
the mother and child during the post-partum period. Her topics included
the need for cleanliness, a balanced diet, and regular exercise, warned of
the effects of emotional stress, and discussed birth control, problems of
infertility, male infertility, sewing (and avoiding) tears suffered in
childbirth, repositioning a baby during a breech birth, and the problems
of sex and celibacy. She even told how a woman might pretend to be a
virgin. Unlike many other works of the period, her cures rarely include
prayers, incantations, astrology, or other forms of blatant superstition.
Margaret Alic, Hypatia's Heritage, A History of Women in Science from
Antiquity through the Nineteenth Century,
Beacon Books, 1986, pp. 50-56
Women and Childbirth
Two great curses haunted natural childbirth from ancient times,
the shrunken pelvis and obstructed labour.
With urbanization and hospitalization, puerperal fever became common.
Because so often mothers died in childbirth and children in infancy,
attitudes towards birth and babies were different from ours. Parents
expected that children would die in infancy, and death in childbirth was
an expected tragedy.
In developed countries, child mortality is now low, and maternal mortality
a rare catastrophe; the natural phenomena of birth up till this century
can be best understood by a quotation from an XVIIIth century Scottish
obstetrician, William Smellie:
Case 454 Natural delivery; death from cold afterwards. In the beginning of
my practice I was sent for in a cold frosty night to a poor woman in the
country, who had been safely delivered. As she was excessively cold all
the time of labour from the badness of the house, the want of clothes and
the necessities of life, I gave her husband some money to go to an
alehouse at a mile distance and bring from thence something comfortable. I
left directions with the midwife to get her warm as soon as possible. The
fellow got drunk and did not return for several hours. I was told
afterwards that the cold and shivering continued, and the poor creature
died the next morning. Indeed as there was little or no fuel for fire,
both the midwife and I caught severe colds; for it was a lone house and at
a distance from any inhabited neighbourhood.
The classical Romans had considerable obstetric skill. Soranus (A.D.
98-138), wrote a textbook of obstetrics which was used until the sixteenth
century. Soranus described podalic version, and the use of the obstetric
chair, and gave detailed instructions on the care of the new- born--
boiled water and honey for the child for the first two days, then on to
the mother's breast.
These skills largely disappeared during the Dark Ages; there is little
record of obstetric practice after this until early modern times.
Presumably obstetrics during the Dark Ages was a matter for the mid-wife,
and no doubt, free of the possibilities of infection found in a large
hospital, she did a good job. We know some of the superstitions: women
were whipped to induce labour. There is a tale of a mediaeval German
Empress in whose labour room 20 men were whipped, two to death. She went
into successful labour. We know of Dr Wertt of Hamburg in 1522, who had
the effrontery to dress up in woman's clothes to gain entry to a labour
room; and who was thereafter burned at the stake. The new medical
knowledge of the Renaissance was spread by the printing press. The first
book on obstetrics in English --The Birth of Mankynde was produced in 1544
by Thomas Raynalde. In it he considers such problems as caesarean section.
The whole process of pregnancy was considered by Jacob Rueff (1500-1558)
in his De conceptu generationis hominis, published in 1554. There followed
a spate of publications applying the new techniques of anatomy and
anatomical illustration to obstetrics.
Ambrose Pare (1509-1589) apprenticed in a small rural town, and then
further trained in the famous Paris Hotel Dieu in the midst of a busy
surgical life, had like most surgeons of his time obstetric skills. Of
podalic version he wrote
...he must lift him (the baby) up gently, and so turn him that his feet
come first--then little by little turn the whole body
from the womb. Pare induced labour by dilating the cervix, and first used
nipple shields, made of lead, to protect cracked nipples. William Harvey
who discovered the circulation of the blood practised obstetrics, and
wrote a major text on Reproduction, giving for instance the first
description of involution of the uterus, post partum.
Obstructed labour terrified women --William Smellie wrote:
Case 386. A neglected transverse lie. The arm had
been pulled down by the midwife till the shoulder was at the vulva.
Twenty four hours later Smellie was sent for, cut off the swollen arm,
performed internal version and brought down one leg. This came off on
pulling, so the other leg was brought down and the same thing happened
again. Ultimately delivery was accomplished with the crotchet. The woman
behaved with great courage............
This snippet is from a longer
piece - DYING
TO HAVE A BABY - THE HISTORY OF CHILDBIRTH
by Dr. Ian Carr, Professor of Pathology
but I can no longer find
the original article and Dr. Carr seems to have retired. So goes the
disappearing Web!
another account of the history of
childbirth
A History of Childbirth in the
United States
Until the late 1930s, childbirth was the domain of women. Pregnant
women gave birth at home, generally with other women attending the birth.
Anesthesia and pain medications were not standard practices. Then, a
curious transformation occurred. Hospital births became the norm. In the
1940s and 1950s women flocked to the hospital to give birth. Male
physicians attended the births. It became common practice to anesthetize
women during labor to eliminate any pain during childbirth. The expectant
father was relegated to the waiting room to protect him from the
"gruesome reality" of childbirth.
Europeans experienced a similar change in birthing practices. However, by
the late 1940s, several European men began questioning the use of general
anesthesia during labor and birth. In France, Dr. Ferdinand Lamaze
developed "childbirth without pain", the Lamaze method. Dr.
Lamaze observed women in the Soviet Union give birth
without anesthesia. The women had been trained to use specific breathing
patterns and relaxation techniques with the assistance of a trained woman,
called a "monitrice." The Russian childbirth system was based on
Pavlovian conditioning. Dr. Lamaze borrowed from this technique. In
addition, he developed a series of breathing patterns to
use during labor. He also implemented the use of intense concentration by
teaching women to stare at a focal point (this technique appears in many
hospital-based education classes). The Lamaze method gained popularity in
the United States after Marjorie Karmel wrote of her childbirth experience
using Lamaze in the 1957 book, Thank You, Dr.
Lamaze.
At about the same time in England, Dr. Grantly Dick-Read began to advocate
natural childbirth. Dick-Read had started as a physician who supported the
use of anesthesia during childbirth. After assisting at a natural
childbirth, he became a supporter of drug-free delivery. Coining the term
"childbirth without fear," Dick-Read emphasized relaxation
techniques and prenatal education. For a long time, Dick-Read gained some
attention in England, but no following within the United States.
In the early 1950s, Dr. Bradley, an American obstetrician, became familiar
with the work of Dick-Read. He believed that women should be awake during
childbirth. Bradley became an advocate of natural childbirth. While most
practitioners left men in the waiting room, Bradley felt that husbands
should in the birth experience. He focused
on educating the pregnant couple so that the husband could serve as a
"coach" during labor. The Bradley Method®, also known as
Husband-Coached Childbirth, emphasized education, controlled breathing and
relaxation, breastfeeding, and maternal nutrition and exercise..
In the 1970s, Natural Childbirth was the vogue. Although most women
continued to deliver in hospital settings, couples flocked to Lamaze and
Bradley Method classes. Medication-free childbirth became a female
initiation rite. Women who failed to manage a natural childbirth (either
because they were unable to tolerate the pain or because they required
a cesarean) felt like failures. As women became more educated about
childbirth, they began to question the medical status quo. Women began to
demand alternatives to the sterile hospital environment, the hard delivery
tables and stirrups, and the "disease" approach to childbirth.
As proponents of early breastfeeding, they questioned the
practice of whisking the baby off to the nursery. Natural childbirth
advocates regarded birth as a normal process which should occur in a warm
setting with family present. Despite a lot of divisiveness, consumer
demand for changes began to result in changes in hospital practices.
While natural childbirth was gaining praise, physicians were making
advances in pain control during labor. The development of the epidural
altered the birth experience for mothers who used medications. Suddenly, a
woman could obtain pain control with drugs without losing alertness or
awareness of the birth and without delivering a sluggish,
"drugged" baby. Even more amazingly, women who required cesarean
sections no longer had to have general anesthesia and miss the arrival of
the baby. Other intravenous pain medications also allowed for pain
control without significant depression of the central nervous system.
As the 1970s faded, attitudes toward childbirth became more muted. The
natural childbirth movement remained vibrant, but many women opted for
pain medications during labor. A small percentage of women
were delivering in birthing centers or at home, but more than 90% of women
in the United States continued to have babies in the hospital setting.
However, the hospital setting was dynamically altered. In response to
consumer demand, hospitals routinely invited men into the delivery rooms
(and even into surgery for cesareans). Birthing rooms
were enlarged to accommodate family members. Curtains were hung and
rocking chairs became popular. Women were allowed to remain in one room
throughout their stay, and "rooming in" with baby became quite
popular.
While decors have changed over the years, "family-centered maternity
care" and "prepared childbirth" have become the norms.
Prepared childbirth stresses the importance of educating a couple to
enable them to make informed, personal decisions about their labor and
delivery experience. Within the framework of prepared childbirth, couples
are
taught about all the possible eventualities of labor, including natural or
medicated labors, cesareans, and episiotomies. "Family-centered
maternity care" is currently the popular hospital marketing strategy.
Ideally, family-centered care recognizes that the birth of a child
represents the birth of a new family, a significant life event. Thus, the
care approach should honor the sanctity of the family by accommodating the
birth wishes of a couple. Family centered care respects the autonomy of
the family members and approaches childbirth decisions in a non-judgmental
fashion.
The childbirth experience has changed dramatically over the years. Since
the 1950s, women have had the opportunity to move from passive victims to
active participants in the birth experience. Natural childbirth is still
regarded as the ideal, and there are several effective educational
training programs for women striving for this birth choice.
Currently, more than 90% of women deliver in hospital settings and most
women use obstetricians. A small number of women use midwives and deliver
in birthing centers or at home. Most men remain at their partners side
during delivery. Couples have a key role in planning and achieving the
birth experience they desire.
