SECTION

1
Midwifery

1
Historical Review
Learning Objectives
Upon completing this chapter, the learner will be
able to:
Identify the early recordings of midwifery practice
Appreciate the early foundations of modern
midwifery
Appreciate the contributions to midwifery by
various physicians through the centuries.

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
Shiprah 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 fifth to the
fifteenth centuries, which was the period of decline of the Roman Empire, untrained midwives
controlled the practice of midwifery.
Leonardo da Vinci (14521519) 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 Pare (15101590) laid the foundations of modern obstetrics. He performed
internal podalic versions and skillfully delivered
women. He was the first to deliver a woman in
bed instead of the birthing-stool. He also
sutured perineal lacerations. Ambroise Pare
founded a school for midwives in Paris, 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 seventeen
editions. He advised cesarean section for
contracted pelvis. William Harvey (15781657),
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

SECTION 1: MIDWIFERY

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. Mauricieau in 1668,
published a treatise on midwifery. Hugh Chamberlen translated it into English, which greatly
assisted the advance of midwifery in Britain.
Mauricieau 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 (16971763) 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 (17101789) 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 Kings College
Hospital where she conducted training for
midwives.
Semmelweiss 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 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 clinics 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 cesareaa Roman law,
which was followed even during Caesars reign.
The law provided for an abdominal 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, Francois Mauricieau
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 De Lee
(1922). Munro Kerr in 1926 introduced the present technique of lower segment cesarean operation and popularized it.
BIBLIOGRAPHY
1. Bullog Vern, Bannie Bullough. The emergency of
modern nursing, New York: Macmillan; 1969.
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3. Fox CG. Toward a sound historical basis for nursemidwifery, Bull, American College of NurseMidwives; 1969;14:76.
4. Parulekar V, Shashank. Textbook for Midwives,
2nd edn. Mumbai: Vora Medical Publishers; 1995.