The Hidden History of Obstetrics (& How It Affects You Today)

Modern obstetrics tends to be presented in a romantic light. It serves the narrative that technology and medicalization have somehow advanced pregnancy and birth and that they’re here to “save you and your baby.” This is far from the truth. The real history of obstetrics reveals a deep mistrust of the female body and a desire of medicine men to control the birth process (and be the ones to “deliver” your baby).

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Food for thought: What kind of prenatal care and birth support do YOU want?

The same narrative that shaped the history of obstetrics continues today.

Next time you are presented with a routine test, intervention, or medical opinion about your pregnancy, birth, or body–ask yourself:

Where is this recommendation coming from? What do I really feel is right, and what do I want? What is the evidence on this procedure and how biased is the research? Does my care provider understand the physiology of pregnancy and birth without pathologizing it?

I can’t possibly present the whole history of modern obstetrics in one post, and I discover new appalling facts each day. This is just a glimpse of what we’ve been through in the past couple of centuries and the so-called experts that shaped modern obstetrics.

16th century

It all begins by pathologizing pregnancy

In a way, modern obstetrics starts with François Mauriceau, an OB in 1600s. He believed that pregnancy was a disease and concluded that women should give birth lying on their backs to “reduce pain.”

Surprise, surprise–he also invented the “head pull” (tire-tête) forceps, the external pelvimeter, and stitching up the perineum.

The semi-reclining “French” birthing position actually worsens back labor and makes baby’s entrance into the world more difficult. It also increases the risk of tearing. But it’s more convenient for doctors. It gives them a “full view” for control and ease of intervention–the number one reason this position is still recommended in many hospitals around the world.

Many hospitals also take pelvic measures and use these non-evidence-based measures to justify recommending C-sections and other interventions to women with “small hips.”

Francois recommended suturing of the perineum after delivery, “cleansing .. with red wine then applying three or four stitches.” Sadly, many women are given unnecessary stitches after birth even today, although without wine “cleanses.”

Next comes Peter Chamberlen, in the mid-1650s. Peter invented another type of forceps that he used as a family trade secret “by extraordinary violence in desperate occasions.”

18th century

What’s private becomes public & fear prevails

Until the 18th century, protecting the perineum during birth was still seen as important. It was believed that any manual dilation or stretching of the perineum can cause damage.

That was until 1742, when Sir Fielding Ould performed the first episiotomy. He cut a woman’s perineum, making a surgical incision that requires major stitching. Ould describes labour as dangerous for the baby and dictates routine episiotomies.

Ould is the “father” of episiotomy and he further demanded that women give birth in a semi-reclining position so that doctors could have better accessibility for intervention.

The perineum becomes “public”, a focus of fear, a pathological entity and a place of surgical intervention under observation (Rodrigues & Néné, 2018).

By the 19th century, episiotomy was also seen as a way to restore women’s “virginal conditions.” This caused extreme pain during sex and contributed to incontinence, many pelvic floor problems, depression, and other health issues. Today, excess stitching is known as the horrendous “husband stitch.”

In the early 20th century, a physician called De Lee advocated that routine episiotomy would prevent the newborn from having a criminal life. You read that right.

Even in 2020, we still sadly have scientific articles published in peer-reviewed journals starting with “Childbirth has always carried traumatic stress to the woman’s body. To deliver with less perineal trauma, obstetricians have used episiotomies.” The truth couldn’t be further. Yet, the lies and misogyny are still being perpetuated. The episiotomy rates in some parts of the world are still high.

Due date madness

Let’s skip to Herman Boerhaave, a botanist, and how most OBs still calculate your due date in the 21st century.

In 1774, Herman figured birth dates should be calculated by adding 7 days to your last period + 9 months on a sample of 100 women and evidence in the Bible that human gestation lasts approximately 10 lunar months.

Franz Naegele, an OB, popularized Herman’s work in 1812. Yet, neither Franz nor Herman knew whether 7 days should be added to the first or last day of your period.

Not to mention that they didn’t take into account that not all women have 28-day cycles and ovulation on day 14. These guys obviously understood female physiology well… and most OBs still go by their “rule” for estimating your due date.

Also, a lunar month isn’t really 28 days. It’s 29.53 days (the time from new moon to new moon), which makes 10 lunar months about 295 days. That’s 15 days longer than the 280 days we’re taught is the “normal.” This information got lost in translation over the centuries.

Puerperal fever

Alexander Gordon, a physician, is perhaps the only hero I came across writing this article. Around 1789, Alexander realized that many maternal deaths were caused by the contagious nature of puerperal fever that was being transmitted from one case to another by doctors.

He wrote: “It is a disagreeable declaration for me to mention that I myself was the means of carrying the infection to a great number of women”.

Doctors often performed cervical checks and other obstetrical procedures after touching cadavers. They didn’t like the notion of washing their hands nor did they think that this made sense. So, Alexander was met with strong opposition and criticism.

Meanwhile, traditional midwives were being cast out of society. They were being wrongly blamed for maternal and child deaths and infections and presented as “dirty” and “backward-thinking.” Traditional knowledge of physiological birth was being systematically deleted. The concept of experienced women companions was being vilified. This continued into the 19th and 20th centuries.

19th century

Drugs and Colonialism

After trying it out with a couple of friends, James Young Simpson (1811–70) started giving ether and chloroform to render laboring women unconscious “by every principle of true humanity, as well as by every principle of true religion.” Not that women asked for this, but James and other physicians thought this was their duty.

Let’s not forget how colonialism shaped obstetrics. This article can’t possibly cover the topic, so I’ll just mention A.B. Holder, colonial physician at the Crow Agency. In 1889, he wrote that “long and difficult labors were a sign of progress and civilization.” He called indigenous women to whom so much harm was inflicted “savages” and proclaimed that “half-breeds” experienced more difficult deliveries than “full-bloods,” a phenomenon he attributed to the “infusion of white blood.”

Early 20th century

Twilight sleep and eugenics

Carl Gauss and Bernhardt Kronig, OBs, 1903: Invented “twilight sleep,” knocking women out with hyoscine and morphine or scopolamine during birth and extracting the baby out with instruments.

Sadly, feminists of the time thought this procedure was progressive and that it somehow contributed to gender equality. Meanwhile, women were dying and suffering serious consequences from it.

Harry H. Laughlin, eugenist, 1922: Responsible for massive compulsory sterilization of native women and East and South European immigrants in the US. He worked for the Eugenics Record Office, a respected research institution of the time (so much about research). His magnum opus is called “Eugenical Sterilization in the United States.” There, he wrote the following:

“Surgeons in opening the abdominal cavity for the eugenical purpose of removing a section of the Fallopian tube find the conditions such that in their judgment, it is pathologically or physiologically advisable to remove both the ovaries and the entire tubes. This operation is thus looked upon as a surgical incident in eugenical sterilizations.”

The Nazi Germany Reich passed the Law for the Prevention of Hereditarily Diseased Offspring in 1933 based on Laughlin’s model, which led to the sterilization of over 350,000 persons. Laughlin was awarded an honorary degree by the University of Heidelberg in Germany in 1936 for his contribution to the “science of racial cleansing.” He was also fascinated by the idea of establishing a world government.

Late 20th century

Mass medicalization

Grantly Dick-Read, a pioneer in natural childbirth, lived from 1890 to 1959. He was concerned about the increasing use of anesthesia, twilight sleep, and obstetric intervention and also at the neglect of the woman’s psyche before and during childbirth.

When Grantly visited the US in the 50s, he was shocked to hear that doctors thought interventions like episiotomy and instrumental deliveries were a must. He inquired why, and they explained that “baby’s heads have gotten bigger while women’s vaginas haven’t.” Grantly seemed to have been the only one with common sense and respect for women who didn’t buy into this misogynic belief. He was criticized by his colleagues.

Cord clamping

Maggenis (1899) invented the surgical cord clamp but cautioned against cutting the cord immediately. Midwives knew that letting the cord pulsate and continue transferring blood to the newborn after birth was important for optimal outcomes.

Yet, immediate cord clamping became the norm in the late 20th century. The main reason is that, in 1938, doctors discovered that placental and umbilical cord blood can be used as a “new source” of transfusion blood. Today, this has been replaced by the cord blood banks industry.

Then, experts started claiming that early clamping of the umbilical cord could prevent too much antibody-containing blood from entering the newborn in cases of Rh- and ABO blood incompatibility (when your baby has a different blood type than you–read Sara Wickham’s take on this). Subsequent research found that early clamping has no benefits (and many risks), but the practice is still routine.

Apgar scores

In 1952 by Dr. Virginia Apgar, invented the Apgar score to the effects of obstetric anesthesia on babies’ health. The Apgar score was never adapted to physiological birth, yet we still think of it as the holy grail of newborn health.

Ian Donald, an OB, used ultrasound on a pregnant woman for the first time in 1956 to measure the diameter of the fetal head. Ultrasound was initially developed as a submarine detection method in World War I. It was thought to be handy for detecting industrial flaws in ships and metal structures.

Ultrasound

Ultrasound became widely used in the ‘70s and had become a routine part of “prenatal care” by the end of the 20th century. No studies have actually proven that it doesn’t carry risks, especially not using today’s powerful machines at common routine checkups. There are many safety concerns that Sara Buckley wrote plenty about.

Some doctors have even described ultrasounds as “the best way to terrify a pregnant woman,” criticizing its overuse with highly questionable clinical significance.

Other interventions

The 20th century is when the massive medicalization of birth really took off.

Birth interventions old and new became routine. We saw a rise in routine inductions (including Pitocin–read about the dangers here), epidurals, painkillers (including opioids), C-sections, breaking the bag of waters, cervical checks, electronic fetal monitors, restricted movement, coached pushing, “catching” or pulling the baby, episiotomies, instrumental deliveries, pulling the placenta out with hands or drugs, giving drugs to prevent bleeding or stimulate the placenta, manual uterine revisions, immediate cord clamping, antibiotics, vitamin K injections, and more. The list goes on.

At the same time, various prenatal tests became a must. These include routine ultrasounds, dopplers, frequent blood work, screening for Down syndrome and other genetic disorders, screening for gestational diabetes and hypertension and many other disorders, routine cervical checks and swabs, screening for GBS, routine pregnancy CTG, to mention some. Many are made mandatory if you want to birth within the system (at a hospital, birth center, or with a licensed midwife at home).

Mistakes I made in my first pregnancy

The story of my unnecessary 5-week ultrasound

I made mistakes in my first pregnancy. For example, I went for a vaginal ultrasound at 5 weeks. I didn’t know any better. This was what I’m “supposed to do” to “make sure it’s not ectopic.”

Now I know that there’s no reason to do routine ultrasounds in pregnancy at all.

I can remember the whole exam. The doctor was holding the machine, looking at the computer.

“Looks like twins. I see something else here. It might be triplets…” he said.

The look on my face… Triplets? Doesn’t sound right. Hmmm…

“Also, I see uterine bleeding, non-specific. I’m concerned. You should take total bed rest.”

What?! But I feel completely fine. This just isn’t right. Does this guy know what he’s talking about?

“Come back for another ultrasound in a week.”

“But I’m going on a trip to the mountainside in two days. I’ll stay there for a couple of weeks,” I said.

“To the mountains? No! That’s irresponsible in your condition. I recommend against it.”

He’s advising against spending time in nature? To a woman who just found out she’s pregnant and feels great?

I decided to get outta there. Fast. I started getting up, ready to pack my things, leave his office, and go spend some quality time away from the city.

“Ana, you are too fast. You need to slow down. You are pregnant now. You can’t behave as you did before.”

Most OBGyns won’t be as bad. I’m glad I got a bad draw because I realized so much afterward. I started trusting my body and declined the medicalization and pathologizing of my pregnancy and birth. Leaving that office ASAP and not falling into the fear trap was the first step.

I went to a small cabin in the woods after that appointment, and several times after during my pregnancy. No bleeding, no problems. I had ONE perfectly healthy baby in the comfort of my home 35 weeks later.

You don’t need an ultrasound to know your baby is fine. You don’t need any routine test or intervention to tell you that. Just as your baby doesn’t need an authority figure to give it an Apgar score to be healthy.

My own take on prenatal care and labor support

Prior to deciding to have a homebirth, I realized that not a single OB in the hospitals that were in my region say an undisturbed, physiological birth.

Not a single doctor even SAW a birth without any interventions.

I learned that each intervention leads to the next intervention, each next intervention riskier than the previous one.

I realized that this didn’t happen overnight, and that’s how I started researching the history of modern obstetrics, trying to figure out what got us to where we are now.

As a result, I now know that the whole course of conventional “prenatal care” and hospital birth practices have no ground in evidence, common sense, or knowledge of physiology. They’re cultural, biased, and they’re a big industry.

That’s why it’s all on you, and that may feel like a big responsibility. It may feel scary to start taking responsibility for your own health and for your own body. But if you don’t take this responsibility on yourself, someone else will. And that someone else will likely be a white coat that’s following the dark legacy of obstetrics.

Traditional midwives and birthkeepers are guides that help you tune in to your own intuition and knowing. They don’t try to control, disturb, or take anything from you. Remember that.

Prenatal care can look like eating a nutritious diet, spending time in nature, tuning into your body, activating your body, meditating, communicating with the baby in your belly, being with your partner and family, reading positive birth stories, listening to and reading inspiring books, gathering with other women who share your philosophy, and learning about safe and healing herbs and remedies.

Trust your body. Trust your gut. When something feels off, it usually is.

After reading this text, I hope you’ll take a moment to reflect on the following (which sums up the whole post):

How many of your pregnancy and birth decisions are guided by white men in white coats (and their modern-day disciples) who have no knowledge of normal female physiology?

Are you ready to take on full and radical responsibility for your pregnancy and birth?

Herbal Doula

The Hidden History of Obstetrics (& How It Affects You Today)

Food for thought: What kind of prenatal care and birth support do YOU want?