Women's Health

Until recent times midwives have had entire charge of women in labor, and there have been advantages as well as disadvantages in this custom. In the past much meddlesome obstetrics has been done, but, on the whole, modern obstetrics has been increasingly triumphant. The first great advance was the invention of the obstetrical forceps by the Chamberlen family nearly three hundred years ago. This family, contrary to the ethics which good medical men like to practice, kept the secret for several generations. Forceps are used when the mother cannot expel the baby by her own exertions. There are various reasons for this use: the baby may be too large in relation to the mother’s dimensions; the mother, because of prolonged labor or other reasons, may be too exhausted to furnish the proper propulsive force; the baby may be lying in the wrong position. Modern forceps consist of two pieces of metal curved so as to fit both the baby’s and the mother’s anatomy. They lock firmly after they have been placed in position. A handle allows the obstetrician to manipulate the forceps and pull the baby down at the speed and in the direction that he wishes.
When the forceps became generally used, they were, of course, abused. The “high forceps” of a generation ago was brutal. In such an operation, the forceps were applied to the child’s head while was still far up in the pelvis and had not been moulded by the force of labor into a shape which would allow it to come down easily. The pulling of this great head usually resulted in much damage to the mother’s tissues. Our ability to remove the baby by operation (the so-called Caesarean section) in a simpler, safer manner has outmoded this danger.
The good modern obstetrician exercises, in the words of one of my former teachers, “scientific apprehensive expectancy.” He should let most mothers deliver themselves, but he should understand when things are not going well, and he now has many clever ways in which to help out the mothers.
The baby, while in the womb, is out of reach of our direct interference. The child is absolutely under the control of the mother. If nothing abnormal occurs with her, all should go well with the child. Obstetricians realizing this have for many years now given great attention to pre-natal care. This has paid excellent dividends. One authority tells us that in his state six times as many women died in childbirth fifteen years ago as do now. The death rate for babies has been similarly declining. One hopeful aspect of this problem is that we are beginning to appreciate some of the reasons for the deaths and malformations of these infants, and we can see that it is not just chance. A few years ago we knew nothing of the effects of virus diseases of the mother during pregnancy; of conditions causing the baby to get insufficient oxygen; of the Rh factor. So far we have not taken great advantage of our glimmerings of new knowledge but we are bound to get more light and see our way to saving more and more babies.
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WOMEN’S HEALTH