Editing Obstetrics (section)

== History ==

[[File:Eucharius Rößlin Rosgarten Childbirth.jpg|thumb|right|Two [[midwives]] assisting a woman in labour on a [[birthing chair]] in the 16th century, from a work by [[Eucharius Rößlin]]]]

Prior to the 18th century, caring for pregnant women in Europe was [[Occupational segregation|confined exclusively to women]], and rigorously excluded men.<ref>{{cite journal | vauthors = Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H | title = The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review | journal = Reproductive Health | volume = 18 | issue = 1 | pages = 10 | date = January 2021 | pmid = 33461593 | pmc = 7812564 | doi = 10.1186/s12978-021-01070-6 | doi-access = free }}</ref> The expectant mother would invite close female friends and family members to her home to keep her company during [[childbirth]].<ref name="Gelis">{{cite book | vauthors = Gelis J | title = History of Childbirth | location = Boston | publisher = Northeastern University Press | date =  1991 }}</ref>{{rp|96–98}} Skilled [[midwives]] managed all aspects of the labour and delivery.<ref>{{Cite web | author = Healthdirect Australia |date=2021-05-23 |title=What do midwives do? |url=https://www.pregnancybirthbaby.org.au/the-role-of-your-midwife |access-date=2022-04-30 |website=www.pregnancybirthbaby.org.au |language=en-AU}}</ref> The presence of physicians and surgeons was very rare and only occurred if a serious complication had taken place and the midwife had exhausted all measures at her disposal.<ref name="Challenges experienced by midwives">{{cite journal | vauthors = Adatara P, Amooba PA, Afaya A, Salia SM, Avane MA, Kuug A, Maalman RS, Atakro CA, Attachie IT, Atachie C | display-authors = 6 | title = Challenges experienced by midwives working in rural communities in the Upper East Region of Ghana: a qualitative study | journal = BMC Pregnancy and Childbirth | volume = 21 | issue = 1 | pages = 287 | date = April 2021 | pmid = 33836689 | pmc = 8033657 | doi = 10.1186/s12884-021-03762-0 | doi-access = free }}</ref> Calling a surgeon was very much a last resort and having men deliver women in this era was seen as offending female modesty.<ref name="BynumPorter">{{cite book | veditors = Bynum WF, Porter R | title = Companion Encyclopedia of the History of Medicine. | location = London and New York | publisher = Routledge | date = 1993 }}</ref>{{rp|1050–1051}}<ref>{{cite web | vauthors = Carr I | title = Some Obstetrical History: Dying to Have a Baby - the History of Childbirth | work = University of Manitoba: Women's Health. | date = May 2000 | access-date = 20 May 2012 | url = http://www.neonatology.org/pdf/dyingtohaveababy.pdf }}</ref>

=== Before the 18th century ===
{{See also|Women's medicine in antiquity}}
Prior to the 18th and 19th centuries, [[midwifery]] was well established but obstetrics was not recognized as a specific medical specialty. However, the subject matter and interest in the [[female reproductive system]] and sexual practice can be traced back to Ancient Egypt<ref name= "McGrew_1985">{{cite book | vauthors = McGrew RE | title = Encyclopedia of Medical History | location = New York | publisher = McGraw-Hill Book Company | date = 1985 }}</ref>{{rp|122}} and Ancient Greece.<ref name="Hufnagel">{{cite book | vauthors = Hufnagel GL | title = A History of Women's Menstruation from Ancient Greece to the Twenty-first Century: Psychological, Social, Medical, Religious, and Educational Issues. | location= [[Lewiston, New York]] |publisher=[[Edwin Mellen Press]] | date = 2012 }}</ref>{{rp|11}} [[Soranus of Ephesus]] sometimes is called the most important figure in [[Surgery in Ancient Rome|ancient]] gynecology.<ref name="Challenges experienced by midwives"/> Living in the late first century AD and early second century, he studied anatomy and had opinions and techniques on abortion, contraception&nbsp;– most notably ''[[coitus interruptus|coitus interruptus&nbsp;]]''– and birth complications. After his death, techniques and works of gynecology declined; very little of his works were recorded and survived to the late 18th century when gynecology and obstetrics reemerged as a medical specialism.<ref name= "McGrew_1985" />{{rp|123}}

=== 18th century ===
The 18th century marked the beginning of many advances in European [[midwifery]], based on better knowledge of the physiology of pregnancy and labour.<ref>{{Cite web | author = International Confederation of Midwives |date=2022-01-31 |title=The Origins of Midwifery |url=https://www.internationalmidwives.org/icm-news/the-origins-of-midwifery.html |access-date=2022-04-30 |website=ICM |language=en}}</ref> By the end of the century, medical professionals began to understand the anatomy of the uterus and the physiological changes that take place during labour.<ref>{{cite book | vauthors = Gasner A, Aatsha PA | chapter = Physiology, Uterus |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK557575/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491507 |access-date=2022-04-30 }}</ref> The introduction of [[forceps in childbirth]] also took place at this time. All these medical advances in obstetrics were a lever for the introduction of men into an arena previously managed and run by women – midwifery.<ref name="BynumPorter" />{{rp|1051–1052}}

The addition of the male-midwife (or man-midwife) is historically a significant change to the profession of obstetrics.<ref>{{cite ODNB | vauthors = Rhodes P | chapter = Leake, John (1729–1792), man-midwife |date=2004-09-23 |doi=10.1093/ref:odnb/16239 | title = Oxford Dictionary of National Biography | isbn = 978-0-19-861412-8 }}</ref> In the 18th century medical men began to train in area of childbirth and believed with their advanced knowledge in anatomy that childbirth could be improved.<ref name="Initiation of traditional birth att">{{cite journal | vauthors = Aziato L, Omenyo CN | title = Initiation of traditional birth attendants and their traditional and spiritual practices during pregnancy and childbirth in Ghana | journal = BMC Pregnancy and Childbirth | volume = 18 | issue = 1 | pages = 64 | date = March 2018 | pmid = 29514607 | pmc = 5842514 | doi = 10.1186/s12884-018-1691-7 | doi-access = free }}</ref> In France these male-midwives were referred to as ''accoucheurs'', a title later used all over Europe. The founding of [[lying-in]] hospitals also contributed to the medicalization and male-dominance of obstetrics.<ref>{{cite book | vauthors = Al-Gailani S |title=Reproduction |chapter=Hospital Birth |date=2018 |chapter-url=https://www.cambridge.org/core/books/reproduction/hospital-birth/E333A8D517E0A5B068C0C4EA7A73744A |work=Reproduction: Antiquity to the Present Day |pages=553–566 | veditors = Kassell L, Hopwood N, Flemming R |place=Cambridge |publisher=Cambridge University Press |doi=10.1017/9781107705647.046 |isbn=978-1-107-06802-5 |s2cid=239583227 |access-date=2022-04-30 }}</ref> These early [[maternity hospital]]s were establishments where women would come to have their babies delivered, as opposed to the practice since time immemorial of the midwife attending the home of the woman in labour.<ref>{{cite journal | vauthors = Sialubanje C, Massar K, Hamer DH, Ruiter RA | title = Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study | journal = BMC Pregnancy and Childbirth | volume = 15 | issue = 1 | pages = 216 | date = September 2015 | pmid = 26361976 | pmc = 4567794 | doi = 10.1186/s12884-015-0652-7 | doi-access = free }}</ref> This institution provided male-midwives with endless patients to practice their techniques on and was a way for these men to demonstrate their knowledge.<ref name="Martell2000">{{cite journal | vauthors = Martell LK | title = The hospital and the postpartum experience: a historical analysis | journal = Journal of Obstetric, Gynecologic, and Neonatal Nursing | volume = 29 | issue = 1 | pages = 65–72 | date = 2000 | pmid = 10660278 | doi = 10.1111/j.1552-6909.2000.tb02757.x }}</ref>

Many midwives of the time bitterly opposed the involvement of men in childbirth. Some male practitioners also opposed the involvement of medical men like themselves in midwifery and even went as far as to say that male-midwives only undertook midwifery solely for perverse erotic satisfaction. The accoucheurs argued that their involvement in midwifery was to improve the process of childbirth. These men also believed that obstetrics would forge ahead and continue to strengthen.<ref name="BynumPorter"/>{{rp|1050–1051}}

=== 19th century ===
18th-century physicians expected that obstetrics would continue to grow, but the opposite happened. Obstetrics entered a stage of stagnation in the 19th century, which lasted until about the 1880s.<ref name="Gelis" />{{rp|96–98}} The central explanation for the lack of advancement during this time was the rejection of obstetrics by the medical community.<ref>{{cite journal | vauthors = Aborigo RA, Reidpath DD, Oduro AR, Allotey P | title = Male involvement in maternal health: perspectives of opinion leaders | journal = BMC Pregnancy and Childbirth | volume = 18 | issue = 1 | pages = 3 | date = January 2018 | pmid = 29291711 | pmc = 5749010 | doi = 10.1186/s12884-017-1641-9 | doi-access = free }}</ref> The 19th century marked an era of medical reform in Europe and increased regulation over the profession. Major European institutions such as The College of Physicians and Surgeons{{where|date=May 2018}} considered delivering babies ungentlemanly work and refused to have anything to do with childbirth as a whole. Even when [[Medical Act 1858]] was introduced, which stated that medical students could qualify as doctors, [[midwifery]] was entirely ignored.<ref>{{Cite journal |date=1892-09-10 |title= The Midwives' Registration Bill |journal=The Lancet |series=Originally published as Volume 2, Issue 3602 |language=en |volume=140 |issue=3602 |pages=631–634 |doi=10.1016/S0140-6736(01)86961-0 |issn=0140-6736}}</ref>  This made it nearly impossible to pursue an education in midwifery and also have the recognition of being a doctor or surgeon. Obstetrics was pushed to the side.<ref name="BynumPorter" />{{rp|1053–1055}}

By the late 19th century, the foundation of modern-day obstetrics and midwifery began developing. Delivery of babies by doctors became popular and readily accepted, but midwives continued to play a role in childbirth.<ref name="Initiation of traditional birth att"/> Midwifery also changed during this era due to increased regulation and the eventual need for midwives to become certified.<ref>{{Cite book | publisher = World Health Organization. | location = Switzerland | title = Midwives voices, midwives realities. Findings from a global consultation on providing quality midwifery care. | year = 1991 | url = https://apps.who.int/iris/bitstream/handle/10665/250376/9789241510547-eng.pdf | isbn = 978-9241510547 }}</ref> Many European countries by the late 19th century were monitoring the training of midwives and issued certification based on competency. Midwives were no longer uneducated in the formal sense.<ref name="Drife">{{cite journal | vauthors = Drife J | title = The start of life: a history of obstetrics | journal = Postgraduate Medical Journal | volume = 78 | issue = 919 | pages = 311–315 | date = May 2002 | pmid = 12151591 | doi = 10.1136/pmj.78.919.311 | pmc = 1742346 }}.</ref>

As midwifery began to develop, so did the profession of obstetrics near the end of the century.<ref>{{cite journal | vauthors = Rabinerson D, Horowitz E | title = [The evolution of midwifery] | journal = Harefuah | volume = 146 | issue = 5 | pages = 380–4, 405 | date = May 2007 | pmid = 17674557 | url = https://pubmed.ncbi.nlm.nih.gov/17674557/ }}</ref> Childbirth was no longer unjustifiably despised by the medical community as it once had been at the beginning of the century. But obstetrics was underdeveloped compared to other medical specialities. Many male physicians would deliver children but very few would have referred to themselves as obstetricians. The end of the 19th century did mark a significant accomplishment in the profession with the advancements in [[asepsis]] and [[anaesthesia]], which paved the way for the mainstream introduction and later success of the [[Caesarean section]].<ref name="Drife"/><ref>{{cite journal| vauthors = Low J |title=Caesarean section-past and present|journal=Journal of Obstetrics and Gynecology Canada|volume=31|issue=12|date=2009|pages=1131–1136| doi=10.1016/S1701-2163(16)34373-0 | pmid=20085678 |access-date=May 20, 2012|url=http://www.sogc.org/jogc/abstracts/full/200912_Obstetrics_2.pdf|archive-url=https://web.archive.org/web/20130123154808/http://www.sogc.org/jogc/abstracts/full/200912_Obstetrics_2.pdf |archive-date=January 23, 2013}}</ref>

Before the 1880s mortality rates in lying-hospitals would reach unacceptably high levels and became an area of public concern. Much of these maternal deaths were due to [[puerperal fever]], then known as childbed fever. In the 1800s [[Ignaz Semmelweis]] noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth by physicians in lying-hospitals. His investigation discovered that washing hands with an [[antiseptic]] solution before a delivery reduced childbed fever fatalities by 90%.<ref>{{cite journal | url=http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html | title=The Childbed Fever Mystery and the Meaning of Medical Journalism |  vauthors = Caplan CE | journal=McGill Journal of Medicine | year=1995 | volume=1 | issue=1 | url-status=dead | archive-url=https://web.archive.org/web/20120707205101/http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html | archive-date=2012-07-07 }}</ref> So it was concluded that it was physicians who had been spreading disease from one labouring mother to the next. Despite the publication of this information, doctors still would not wash. It was not until the 20th century when advancements in aseptic technique and the understanding of disease would play a significant role in the decrease of [[maternal mortality]] rates among many populations.{{cn|date=August 2023}}

=== History of obstetrics in America ===
The development of obstetrics as a practice for accredited doctors happened at the turn of the 18th century and thus was very differently developed in Europe and in the Americas due to the independence of many countries in the Americas from European powers. "Unlike in Europe and the British Isles, where [[midwifery]] laws were national, in America, midwifery laws were local and varied widely".<ref name="Roth">{{cite book | vauthors = Roth J | title = Pregnancy & Birth: The History of Childbearing Choices in the United States. | publisher = Human Service Solutions | url = http://www.ourbodiesourselves.org/ }}</ref>

Gynaecology and Obstetrics gained attention in the American medical field at the end of the nineteenth century through the development of such procedures as the ovariotomy.<ref>{{cite book | vauthors = Baskett TF | chapter = Houstoun, Robert (1678–1734) |date= 29 March 2019 |doi = 10.1017/9781108421706.154 | isbn = 978-1-108-33671-0 | title = Eponyms and Names in Obstetrics and Gynaecology |pages=194 |publisher=Cambridge University Press }}</ref> These procedures then were shared with European surgeons who replicated the surgeries. This was a period when antiseptic, aseptic or anaesthetic measures were just being introduced to surgical and observational procedures and without these procedures surgeries were dangerous and often fatal.<ref name="Lavers_2018">{{cite journal | vauthors = Lavers A, Yip WS, Sunderland B, Parsons R, Mackenzie S, Seet J, Czarniak P | title = Surgical antibiotic prophylaxis use and infection prevalence in non-cosmetic breast surgery procedures at a tertiary hospital in Western Australia-a retrospective study | journal = PeerJ | volume = 6 | issue =  | pages = e5724 | date = 2018 | pmid = 30386692 | pmc = 6202972 | doi = 10.7717/peerj.5724 | quote = Table 2: Types of procedures and association with surgical site infections (SSI). ''P''-values were obtained from Fisher's Exact test, unless otherwise specified. | doi-access = free }}</ref> Following are two surgeons noted for their contributions to these fields include [[Ephraim McDowell]] and [[J. Marion Sims]].<ref>{{cite journal | vauthors = Vernon LF | title = J. Marion Sims, MD: Why He and His Accomplishments Need to Continue to be Recognized a Commentary and Historical Review | journal = Journal of the National Medical Association | volume = 111 | issue = 4 | pages = 436–446 | date = August 2019 | pmid = 30851980 | doi = 10.1016/j.jnma.2019.02.002 | s2cid = 73725863 | doi-access = free }}</ref>

Ephraim McDowell developed a surgical practice in 1795 and performed the first ovariotomy in 1809 on a 47-year-old widow who then lived on for 31 more years.<ref>{{cite journal | vauthors = Rutkow IM | title = Ephraim McDowell and the world's first successful ovariotomy | journal = Archives of Surgery | volume = 134 | issue = 8 | pages = 902 | date = August 1999 | pmid = 10443816 | doi = 10.1001/archsurg.134.8.902 }}</ref> He had attempted to share this with John Bell whom he had practiced under who had retired to Italy. Bell was said to have died without seeing the document but it was published by an associate in ''Extractions of Diseased Ovaria'' in 1825.<ref>{{Cite journal |date= January 2016 |title=Iceman Ötzi may have had tummy trouble when he died |journal=New Scientist |volume=229 |issue=3056 |pages=17 |doi=10.1016/s0262-4079(16)30115-4 |bibcode=2016NewSc.229...17. |issn=0262-4079}}</ref> By the mid-century the surgery was both successfully and unsuccessfully being performed. Pennsylvanian surgeons the Attlee brothers made this procedure very routine for a total of 465 surgeries – John Attlee performed 64 successfully of 78 while his brother William reported 387 – between the years of 1843 and 1883.<ref>{{Cite journal | vauthors = Sieber WK |date= September 1970 |title=Total prosthetic transplantation of the inferior vena cava, with venous drainage restoration of the one remaining kidney on the graft, successfully performed on a child with Wilms' tumor |journal=Journal of Pediatric Surgery |volume=5 |issue=6 |pages=694–695 |doi=10.1016/s0022-3468(70)80085-9 |issn=0022-3468}}</ref> By the middle of the nineteenth century this procedure was successfully performed in Europe by English surgeons Sir [[Thomas Spencer Wells|Spencer Wells]] and [[Charles Clay (surgeon)|Charles Clay]] as well as French surgeons [[Eugène Koeberlé]], [[Auguste Nélaton]] and [[Jules-Émile Péan|Jules Péan]].<ref name= "McGrew_1985" />{{rp|125}}

J. Marion Sims was the surgeon responsible for being the first treating a [[vesicovaginal fistula]]<ref name= "McGrew_1985" />{{rp|125}} – a condition linked to many caused mainly by prolonged pressing of the foetus against the pelvis or other causes such as rape, hysterectomy, or other operations – and also having been doctor to many European royals and the 20th President of the United States James A. Garfield after he had been shot. Sims does have a controversial medical past. Under the beliefs at the time about pain and the prejudice towards African people, he had practiced his surgical skills and developed skills on slaves.<ref name = "IWF">{{cite web | work = International Wellness Foundation. | title = Dr. J Marion Sims: The Father of Modern Gynecology. | date = 12 February 2014 | url = https://wellnessjourneys.org/2017/12/05/dr-j-marion-sims/ }}</ref> These women were the first patients of modern gynecology. One of the women he operated on was named [[Anarcha Westcott]], the woman he first treated for a fistula.<ref name = "IWF" />

=== Historical role of gender ===
Women and men inhabited very different roles in natal care up to the 18th century.<ref>{{cite book | chapter = Gender: A Historical Perspective 
| vauthors = Giuliano P | veditors = Averett SL, Argys LM, Hoffman SD | title = The Oxford Handbook of Women and the Economy. | publisher = Oxford University Press | date = May 2018 | doi = 10.1093/oxfordhb/9780190628963.013.29 | doi-access = free }}</ref> The role of a physician was exclusively held by men who went to university, an overly male institution, who would theorize anatomy and the process of reproduction based on theological teaching and philosophy. Many beliefs about the female body and menstruation in the 17th and 18th centuries were inaccurate; clearly resulting from the lack of literature about the practice.<ref name= "McGrew_1985" />{{rp|123–125}} Many of the theories of what caused menstruation prevailed from Hippocratic philosophy.<ref name="Hufnagel"/>{{rp|16}} [[Midwives]], meaning "with woman", were those who assisted in the birth and care of both born and unborn children, a position historically held mainly by women.<ref>{{cite journal | vauthors = O'Malley-Keighran MP, Lohan G | title = Encourages and guides, or diagnoses and monitors: Woman centred-ness in the discourse of professional midwifery bodies | journal = Midwifery | volume = 43 | pages = 48–58 | date = December 2016 | pmid = 27846406 | doi = 10.1016/j.midw.2016.10.007 }}</ref>

During the birth of a child, men were rarely present. Women from the neighbourhood or family would join in on the process of birth and assist in many different ways.<ref>{{Cite web |title=Situation of women and children in Nigeria |url=https://www.unicef.org/nigeria/situation-women-and-children-nigeria |access-date=2022-04-30 |website=www.unicef.org |language=en}}</ref> The one position where men would help with the birth of a child would be in the sitting position, usually when performed on the side of a bed to support the mother.<ref name="Gelis" />{{rp|130}}

Men entered the field of obstetrics in the nineteenth century, resulting in a change of focus within the profession.<ref>{{cite book | vauthors = Bäcklund I | veditors = Kytö M, Rydén M, Smitterberg E |chapter = Modifiers describing women and men in nineteenth-century English | doi = 10.1017/cbo9780511486944.002 | title =Nineteenth-Century English | year = 2006 |pages=17–55 |place=Cambridge |publisher=Cambridge University Press | isbn = 9780511486944 }}</ref> Gynecology developed as a new and separate field of study from obstetrics, focusing on the curing of illness and indispositions of female sexual organs,<ref>{{cite book | vauthors = Adaikan G |editor1-first=Sabaratnam |editor1-last=Arulkumaran |editor2-first=William |editor2-last=Ledger |editor3-first=Lynette |editor3-last=Denny |editor4-first=Stergios |editor4-last=Doumouchtsis |chapter=Female sexual dysfunction |date= January 2020 | doi = 10.1093/med/9780198766360.003.0060 |title=Oxford Textbook of Obstetrics and Gynaecology |pages=743–752 |publisher=Oxford University Press|isbn=978-0-19-876636-0 }}</ref> encompassing conditions such as menopause, uterine and cervical problems, and tissue damage as a result of childbirth.<ref>{{Cite web |title=Uterine Prolapse: Causes, Symptoms, Diagnosis & Treatment |url= https://my.clevelandclinic.org/health/diseases/16030-uterine-prolapse |access-date=2022-04-30 |website=Cleveland Clinic}}</ref>