History of Birth

1. History of Birth Presented on December 08, 2010 Tamar Chachibaia TSMU

2. c. - 400 • In Hippocratic oath abortion is forbidden.

3. c. 100 • 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..

4. c. 200 • 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.

5. In 1513 Rösslin publishes first textbook for midwives • This is an illustration from the first printed textbook for midwives, written by a German physician, Eucharius Rösslin. The text was 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. swaddled

6. Nicholas Culpeper and his houseThe 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 (1616-1654).Culpeper's complete English physician. A Hogg, London 1802.

7. Midwife braves a storm to attend a delivery • 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.

8. In 1740 Men-midwives challengewomen's right to deliver babies • 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 (1756/57-1810/11).Published by SW Fores, London 1793.

9. Man-midwife delivering a woman under a sheetand 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.

10. 1750First Lying-in Hospital Founded in City of London •  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.'

11. Podalic version • 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 (1771-1835).Nouvelles demonstrations d'accouchemens. Bechet, Paris 1822.

12. c. 1580 • 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).

13. Delivery of a child with forceps • Despite their increasing use among men-midwives, 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.

14. Criminal Abortion • 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.

15. 1861 -Semmelweis washes hands to save life An anatomical dissection by Dr JohnBland-Sutton 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.

16. 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'.

17. 1847First child born under anaesthesiaA 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.

18. 1933 Robert James Minnit inventsgas 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.

19. 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.

20. 1933 - Grantly Dick Read advocates natural childbirth • 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

21. Only in 1936 - Prontosil reduces maternalmortality rate • 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 child-bearing 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.

22. 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

23. Neonatal intensive care - 1990 • 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.

24. 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.

25. In vitro fertilization 1969 • 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.

26. First test-tube baby 1978 8-celled human embryosLight microscope image of two8-celled human embryos ready to be implanted into their mother's womb. Pre-implantation embryos withstand freezing for long periods of time allowing them to be implanted at intervals coinciding with normal birth spacing.

27. Dolly cloned 1996 • Human cloning in forbidden