Midwifery is as old as the history of human species. Archeological evidence of a woman squatting in childbirth supported by another woman from behind demonstrates the existence of midwifery in 5000 BC. There are references to the midwives in the Old Testament. Genesis 35:17 “And it came to pass, when she was in hard labor that the midwife said unto her, fear not Rachel, it is another boy.” In Exodus 1:15, it is recorded that the King of Egypt spoke to Shiphrah and Puah, the two midwives who helped Hebrew women when they gave birth. These two Hebrew midwives are the first midwives found in the literature. Through the centuries midwifery, the art of assisting women in childbirth has grown fulfilling its meaning ‘with woman’ at birth.
Hippocrates (460 BC), the Father of Scientific Medicine organized trained and supervised midwives. Hippocrates believed that the fetus had to fight its way out of the womb and the membranes. The efforts of Hippocrates were not appreciated by the midwives.
Aristotle (384–322 BC), the Father of Embryology described the uterus and the female pelvic organs. He also discussed the essential qualities of the midwife. Soranus, in the second century was the first to specialize in obstetrics and gynecology. His book was used for 1,500 years. He used a vaginal speculum, advised on cord care and wet nursing. From the 5th to 15th centuries, which was the period of decline of the Roman Empire, untrained midwives controlled the practice of midwifery.
Leonardo da Vinci (1452–1519) made anatomical drawings of pregnant uterus. In 1513, the first book on midwifery was printed in Germany based on the teachings of Soranus. In 1540, the book was translated into English. For a century and half it was the only book on midwifery in English. During this period, doctors were rigidly excluded from labor rooms and midwives assisted women in labor. Vesalius in 1543, opened the full-term pregnant uterus in a lower animal, extracted the fetus and demonstrated uterus as a single chamber organ.
Ambroise Paré (1510–1590) laid the foundations of modern obstetrics. He performed internal podalic version and skillfully delivered women. He was first to deliver a woman in bed instead of the birthing stool. He also 4sutured perineal lacerations. Ambroise Paré founded a school for midwives in Paris and France. Louise Bourgeois, a midwife trained by Pare, attended the ladies of the French court. She warned midwives against getting infected with syphilis and transmitting it to other women. She recommended induction of labor for pelvic contraction.
Julius Caesar Aranzi, wrote the first book for Italian midwives, which ran 17th edition. He advised cesarean section for contracted pelvis. William Harvey (1578–1657), the Father of British Midwifery, wrote the first English textbook on midwifery. He described the fetal circulation and the placenta, and was the first to deliver the placenta by massaging the uterus. He described the raw placental surface and initiated the study of uterine sepsis. Women remained largely reluctant to be delivered by men during this period. Midwives did not usually seek medical aid until the labor was hopelessly obstructed as in the case of gross pelvic deformity. The resultant death of the mother or the baby gave the physicians unwarranted reputation.
The French King Louis XIV in 1663, employed a Paris surgeon to attend one of his mistresses in labor and pleased with the result, the King honored the surgeon with the title ‘accoucheur’ (a person who assists women in childbirth). The French accoucheurs built a school of midwifery, which attracted doctors from all over Europe. Mauriceau in 1668, published a treatise on midwifery. Hugh Chamberlen translated it into English, which greatly assisted the advance of midwifery in Britain.
Mauriceau was the greatest physician of the 17th century. He described the attitude of the fetus in uterus as that of one of squatting down to pass stools and lowering his head to see what he has done.
Chamberlen in 1675, designed obstetric forceps. William Smellie (1697–1763) is called the Father of British Midwifery. He explained labor to be a mechanical process and described pelvimetry, cephalometry and forceps delivery of the after coming head of a breech. He devised a lock for the obstetric forceps, which permitted each blade to be introduced separately. The chair of midwifery was founded in 1726 in the University of Edinburgh. In 1772, John Leake replaced the obstetric stool by special delivery beds.
Charles White in 1773, stated that puerperal fever was infectious. He used lime as disinfectant and clean linen, isolation, adequate ventilation and sitting posture to facilitate drainage. Fielding Ould (1710–1789) described the mechanism of normal labor and performed the first episiotomy. Gordon in 1795, described puerperal sepsis as a wound contamination of the placental site.
Laennec in 1816, invented a stethoscope and Francois in 1818, first recognized fetal heart sounds in the pregnant uterus. James Young Simpson in 1847, used chloroform first in obstetrics for anesthesia. Florence Nightingale in 1862, organized a small training school in connection with King's College Hospital, where she conducted training for midwives.
Semmelweis in 1861, demonstrated the cause of puerperal sepsis and suggested preventive measures. His students practiced scrubbing their hands in chloride of lime, which reduced maternal mortality rate in the words. Louis Pasteur in 1879, wrote a thesis on puerperal sepsis, which demonstrating the presence of streptococci in the lochia, blood and in fatal cases in the peritoneal cavity. Spencer and Ballantyne promoted the concept of antenatal care for pregnant women. The first antenatal clinic was started about the time of the First World War.
The history of cesarean section dates back to 715 BC and the operation derives its name from the notification Lex Caesarea—a Roman law, which was followed even during Caesar's reign. The law provided for an 5abdominal delivery either in a dying woman with a hope to get a live baby or to perform postmortem abdominal delivery for a separate burial. The operation does not derive its name from the birth of Caesar, as his mother lived long time after his birth. The origin of the word cesarean is also related to a Latin verb caedere, which means ‘to cut’.
A French obstetrician, François Mauriceau first reported cesarean section in 1668. In 1876, Porro performed subtotal hysterectomy. Max Sanger in 1882, first sutured the uterine walls. In 1912, Kronig introduced lower segment vertical incision and it was popularized by DeLee (1922). Munro Kerr in 1926, introduced the present technique of lower segment cesarean operation and popularized it.
STUDY QUESTIONS
Short Notes
- The first book on midwifery.
- Early findings on puerperal sepsis.
- The history of cesarean section.
BIBLIOGRAPHY
- Davis Fred. The Nursing Profession: Five Sociological Essays. New York: Wiley; 1966.
- Fox CG. Toward a sound historical basis for nurse-midwifery. Bulletin of the American College of Nurse-Midwives. 1969;14:76–82.
- ParulekarV, Shashank. Textbook for Midwives, 2nd edition. Mumbai: Vora Medical Publishers; 1995.
- Vern L Bullough, Bonnie Bullough. The Emergency of Modern Nursing. Macmillan; New York: 1969.