"In All Circumstances": Home Births and Collaborative Health Care in Ireland, 1900-1950

This article examines the development of a collaborative model of home-based reproductive caregiving in Ireland from 1900 to 1950, focusing on the interactions of different practitioners in childbirth cases in the domestic sphere. In Ireland the move to obstetrics and trained nursing and midwifery was gradual, complicated by the needs and wants of ordinary women, who were reluctant to give up their trusted care givers and who actively sought to maintain long-standing domestic health care traditions. The result was a hybrid and collaborative model of domestic reproductive health care, requiring the attention of different practitioners, placing them in the same space, and necessitating that they work together. This dynamic and evolving system provided most pregnant, laboring, and postparturient women with essential reproductive care, but it would be overtaken by hospital-based reproductive medicine by around 1950, remaining only in folklore and memory by the late twentieth century.

Angélique Marguerite Le Boursier du Coudray (1712-1790) - Pioneer of simulation

Madame du Coudray (1712-1790) was a French midwife who educated peers in rural areas. She was seen as a pioneer of simulation as she developed the first obstetric mannequin, known as 'the machine'. Complex cases could be simulated in a safe environment, which enabled midwives to improve their abilities in managing such deliveries.

BADGES/PINS OF NURSING AND MIDWIFERY SCHOOLS IN SLOVENIA FROM 1925 UNTIL EARLY 1980s

INTRODUCTION

Many nursing and midwifery schools in many countries around the world awarded or still award graduation badges or pins to their graduates. All graduates from different parts of the former Kingdom of Yugoslavia and later the Republic of Yugoslavia educated in Slovenian healthcare schools received badges from these schools. Some of the graduates later employed in medical institutions across former Yugoslavia wore these badges on their uniforms. The main purpose of this historical research was to establish which Slovenian health care schools awarded the graduation badges and what they looked like. It was also investigated why the badges ceased to be awarded and what motivated Angela Boškin Faculty of Health Care in Jesenice to reintroduce awarding the badges.

METHODS

Due to a lack of written sources, we conducted 393 face to face and telephonic interviews with former badge recipients across Slovenia. Their existing badges were photographed. On the authors' initiative, a private collection of badges was started.

RESULTS

It has been established that in the 20th century all Slovenian secondary health schools awarded badges. The Nursing College, Ljubljana also awarded graduation badges. Five different types of badges in many variants were issued. The first badges were awarded to graduates by Slovenian oldest Nursing School, Ljubljana in 1925. The badges ceased to be awarded in the late 1970s and the early 1980s. Some questions about probable reasons for cessation of awarding badges remain unanswered. Less than a fifth of interviewees kept their badges. Graduating nursing badges were reintroduced in Slovenia in 2017 with a new badge which is presented and depicted in this article. The motivation for the reintroduction of graduating badges is also investigated.

DISCUSSION AND CONCLUSION

Unfortunately, many Slovenian nurses and midwives are not sufficiently aware of the meaning and importance of their badges. Although badges are important for professional image and identity of nurses, badges as a symbol of nursing have become almost completely forgotten. Graduation badges are miniature works of art and are proof of the existence and development of Slovenian healthcare schools. Nursing badges present a part of nursing history as well as being our cultural heritage. The badges deserve to be written and talked about and should be displayed in a planned future Slovenian Health Care Museum.

['A case of decapitation'; calamity investigation in 1822]

A case of childbirth with a fatal outcome described in the book 'The King's Court Physician: the Adventurous Life of Franz Joseph Harbaur, 1776-1822' (De lijfarts van de koning. Het avontuurlijkeleven van Franz Joseph Harbaur, 1776-1822) puts the work of the Dutch Health and Youth Care Inspectorate into an historical context by pointing out the similarities between a calamity investigation held in 1822 and the situation today. Conflicts between medical disciplinary law and criminal law, boundary disputes between various professions (in this particular case midwives and gynaecologists) and questions of openness and transparency turn out to be nothing new. By doing case studies on how to deal with calamities, it is possible to gain insight into medical failures of the past and how they were managed. It is also possible to get a better picture of the expectations that medicine had to meet in the past, and how, and under what circumstances, these have changed. This information is of value in making choices in today's healthcare system.

Matthew Flinders Senior (1751-1802): Surgeon and 'man midwife'

Until the eighteenth century, midwifery was the sole domain of women, but changes in medical science saw it appropriated by medical men and the 'man-midwife' emerged. This paper demonstrates the work of a man-midwife in a small English village in one year, 1775, using his accounts and correspondence. The man was Matthew Flinders Senior, 'surgeon and man-midwife' at Donington, Lincolnshire. He was the father of Captain Matthew Flinders, the famous navigator who mapped the coast line of Australia and who coined that name. Primary sources, published as a collection by the Lincoln Record Society, were used. Flinders Senior made a good living from his midwifery, charging rates commensurate with those charged by obstetricians today (with reduced costs for the poor). His descriptions of his practice show how midwifery was conducted in rural England during the development of medicine as a high-status profession. The paper uses data from one year to provide a snap shot of the work of a rural surgeon and man-midwife, but much more is available in the published collection, providing ready access for researchers who may like to pursue such work further.

"Something Wasn't Clean": Black Midwifery, Birth, and Postwar Medical Education in All My Babies

Set in rural Georgia, the 1953 health film All My Babies: A Midwife's Own Story was a government-sponsored project intended as a training tool for midwives. The film was unique to feature a black midwife and a live birth at a time when southern health officials blamed midwives for the region's infant mortality rates. Produced by the young filmmaker George Stoney, All My Babies was praised for its educational value and, as this article demonstrates, was a popular feature in postwar medical education. Yet as it drew acclaim, the film also sparked debates within and beyond medical settings concerning its portrayal of midwifery, birth, and health care for African Americans. In tracing the controversies over the film's messages and representations, this article argues that All My Babies exemplified the power and limits of health films to address the complexities of race and health during an era of Jim Crow segregation.

For the good of the nation: scientific discourses endorsing the medicalization of childbirth in Peru, 1900-1940

Over the course of the twentieth century, a series of changes occurred in the understanding of childbirth, which went from being a natural reproductive phenomenon belonging to the female, domestic sphere to a professional medical matter handled in an institutional setting. Through procedures like the use of anesthesia, Cesarean sections, ultrasound and other techno-scientific interventions, rapid and significant improvements and changes took place in the health and life of society and of women. The medicalization of childbirth in the early twentieth century was part of a broader process of constructing the state and institutionalizing the patriarchy that was common throughout the region.

Santayana's Axiom: The South Dakota State Medical Association and Medical Practice Legislation in 1929 and 2017

In 1928 members of the South Dakota State Medical Association (SDSMA or the Association) held a special meeting in Huron to consider a basic science bill that conformed "…in its entirety to the conditions existing in our state." Their draft bill proposed a standardized examination for all practitioners of the healing arts. A legislative committee, with its attorney, "…was in Pierre during the early part of the 1929 legislative session to make sure the bill was properly launched and in effective channels." Shortly after its introduction, the bill was withdrawn due to opposition from one SDSMA district whose legislative representatives were among the most influential in the legislature. A similar bill promoted by the SDSMA in 1933 also failed. It would be another six years before a basic science bill was enacted by the legislature. Eighty-nine years later, a bill governing the practice of certified nurse practitioners (NP) and certified nurse midwives (NM), including a board independent of the South Dakota Board of Medical and Osteopathic Examiners, was considered (Senate Bill 61). Introduced by a senator who characterized herself as representing the "House of Nursing," the bill challenged "…the overarching role that medicine thinks and perceives that they may have regarding advanced practice nursing practice." SB 61 passed in the senate and house and was signed by the governor. For this legislation in the 1930s and in 2017, the SDSMA's interest was defining and maintaining control of medical practice under the twin rubrics of quality and patient welfare. In both circumstances, legislators and other health care professional organizations contested not only the SDSMA's motivations, but also the evidence supporting their efforts. Our research explored (1) whether the collective viewpoints and conduct of the legislature, the SDSMA, and non-physician medical professionals are comparable in the two circumstances; and (2) if the circumstances are comparable, can we derive a useful concept or theme that could help guide the SDSMA in the future?

Oral Histories of Nurse-Midwives in Georgia, 1970-1989: Blazing Trails, Building Fences, Raising Towers

INTRODUCTION

This article provides an account of the establishment and development of the contemporary nurse-midwifery profession in Georgia, which was previously undocumented. Oral history interviews with nurse-midwives who were in clinical and educational practice in Georgia during the 1970s and 1980s were collected and analyzed to identify factors that affected the establishment of nurse-midwifery in this state.

METHODS

This study relied on historical methodology. Oral history interviews provided primary sources for analysis. Secondary sources included archives belonging to the narrators' nurse-midwifery services as well as scholarly and professional publications from 1923 to the present. Data were analyzed using Miller-Rosser and colleagues' method.

RESULTS

In-depth interviews were conducted with 14 nurse-midwives who worked in clinical practice or education in Georgia in the 1970s and 1980s. The narrators' testimonies revealed facilitators for the establishment of nurse-midwifery in Georgia, including increasing access to care, providing woman-centered care, interprofessional relationships, and the support of peers. Resistance from the medical profession, financial constraints, and public misconceptions were identified as barriers for the profession.

DISCUSSION

Oral histories in this study provided insight into the experiences of nurse-midwives in Georgia as they practiced and taught in the 1970s and 1980s. Interprofessional connections and cooperation supported the nurse-midwifery profession, and relationships with peers anchored the nurse-midwives. Mentoring relationships and interprofessional collaboration supported the nurse-midwives as they adapted and evolved to meet the needs of women in Georgia.

Thomas Secker M.D.: Archbishop and man-midwife

This paper provides a biographical outline of the career of Thomas Secker, MD, who from 1758-68 was Archbishop of Canterbury. Although much has been written on Secker, this study seeks to highlight his training in medicine, which has been largely overlooked hitherto by historians.

Back to Bed: From Hospital to Home Obstetrics in the City of Chicago

This article analyzes the role of doctors and activists in Chicago who successfully redefined the practice and politics of childbirth both locally and ultimately nationwide. It begins with the story of Joseph DeLee's Chicago Maternity Center, responsible for supervising over 100,000 home births between 1932 and 1972. Most of the mothers cared for by the Center were nonwhite, poor, and had little or no access to prenatal care, yet their babies had a far higher survival rate than the nationwide average. Thousands of medical students from all over the Midwest experienced their first deliveries not in hospitals, but in these homes. The article then addresses a very different demographic: a rising number of middle-class white families in the suburbs of Chicago who, beginning in the 1950s, opted for out-of-hospital births. Many of them learned about home birth through their involvement in La Leche League, the breastfeeding organization formed in a Chicago suburb in 1956. Seemingly separated by class, race, and locale, the link between these two groups of home birthers was the philosophy and training in place at the Chicago Maternity Center.

Women Physicians in Byzantium

Women were allowed to practice the medical profession during the Byzantine Empire. The presence of female physicians was not an innovation of the Byzantine era but actually originated from ancient Greece and Rome. The studies and the training of women doctors were apparently equivalent to those of their male colleagues. The principal medical specialties of the female doctors were gynecology and midwifery. Byzantine legislation treated relatively equally both female and male doctors. For this reason, it can be assumed that the presence of female doctors was correlated with the position of women in Byzantine society. However, there is not sufficient information in the literature to clarify whether female and male doctors used to earn equal payment for the same service.

Professors, principals and textbooks from the Midwifery school in Zadar

Midwifery in Dalmatia was highly undeveloped at the beginning of the XIX century. The health report from 1813 suggested that there were only 48 midwives in the whole province, and none of them with a degree from the midwifery school. After abolishing the Central Schools ("Ecoles Centrales"), which were founded at the time of French reign, and which had the university range, the professors who stayed in Zadar continued their work and teaching in the Midwifery School, which was founded in 1820 according to the decision made by Emperor Franz I, and started working in 1821. Since the school was working continuously for the whole century, a lot of professors and principals passed through. Protomedicus of Dalmatia officially performed the duty of principals of the Midwifery School. Their life and work biographies were gathered in this paper. Although the newcomers were mostly illiterate, very contemporary and valuable textbooks were used at that time. The professors of this school wrote some of these textbooks. This paper analyses those textbooks from the current medical science and praxis point of view, which points out to its significance and contribution of its authors to the reputation that the School enjoyed at that time.

How history shaped the modern day midwife

The midwifery profession can be traced back over thousands of years. Globally, midwives have expressed noticeable changes to their role over the years, and the impact on childbearing women (Larsson et al 2009; Mavalankar and Vora 2008; Dickerson et al 2014). During this time the midwifery profession has battled continuously against external pressures and this, in turn, has shaped the role of the midwife and the midwifery profession as a whole. This article will provide an insight into the history of midwifery; the challenges both midwives and the midwifery profession have faced; how these challenges have changed; and how this has assisted the development of the 'modern day midwife'. Of course this could not be discussed without acknowledging the continuing impact on childbearing women in the United Kingdom and globally.

Childbirth among the Canadian Inuit: A review of the clinical and cultural literature

BACKGROUND

This study reviews the historical, anthropological and biomedical literature on childbirth among Canadian Inuit resident in the Canadian Arctic. The modern period is characterised by increased tension as southern intervention replaced traditional birthing with a biomedical model and evacuation to metropolitan hospitals for birth. Inuit concern over the erosion of traditional culture has confronted biomedical concern over perinatal outcomes. Recently, community birthing centres have been established in Nunavik and Nunavut in order to integrate traditional birthing techniques with biomedical support.

OBJECTIVES

To review the literature on Inuit childbirth in order to suggest avenues for future research.

STUDY DESIGN

Material for this review was gathered through combining library searches, database searches in ANTHROPOLOGYPlus, MEDLINE, CINAHL and Science-Direct, and a bibliographic search through the results.

RESULTS

Epidemiological studies of Inuit childbirth are outdated, inconclusive, or inseparable from non-Inuit data. Anthropological studies indicate that evacuation for childbirth has deleterious social and cultural effects and that there is considerable support for traditional communal birthing in combination with biomedical techniques and technology.

CONCLUSIONS

Investigation of alternative solutions to maintaining acceptable perinatal outcomes among the Inuit seems desirable. Epidemiological and comparative qualitative studies of perinatal outcomes across the Arctic are needed to reconcile the cultural desirability of communal birthing with claims of its medical feasibility.

An Asclepiad family - The Chamberlens and DeLaunes, 1569-1792: Five generations of surgeons, physicians, accoucheurs and apothecaries

When in 1747 Dr Peter Chamberlen wrote in his apologia, 'A Voice in Rhama', that he was nursed up (as from the Cradle) to all Parts of Physick, and that in Asclepiad-Families, he was not referring simply to his father and uncle, the Peters (Younger and Elder) Chamberlen of obstetric forceps' fame. They were surgeons and accoucheurs; his mother's family counted clergymen as well as physicians and apothecaries among their number and the young Peter must indeed have grown up in a family steeped in both medical practice and religious study. Both families were refugees from the religious terrors of sixteenth century France, arriving in England in the second half of the reign of Elizabeth l. Both were to find fortune and royal patronage as they became established in their new lives. One was to found a medical dynasty that lasted through five generations, the other to produce a generation whose varied accomplishments died as the eldest son outlived all his siblings, only one of whose children became an apothecary - and he was to predecease his uncle. This is a brief biography of these two families, bound together by the ties of marriage, profession, faith and nationality.

Where the thread of home births never broke - An interview with Susanne Houd

BACKGROUND

The option of a planned home birth defies medical and social normativity across countries. In Denmark, despite the dramatic decline in the home birth rates between 1960 and 1980, the right to choose the place of birth was preserved. Little has been produced documenting this process.

AIM

To present and discuss Susanne Houd's reflection on the history and social dynamics of home birth in Denmark, based in an in-depth interview.

METHODS

This paper is part of wider Short Term Scientific Mission (STSM), in which this interview was framed as oral history. The whole interview transcript is presented, keeping the highest level of detail.

FINDINGS

In Susanne Houd's testimony, four factors were highlighted as contributing to the decline in the rate of home births from the 1960s to the 1970s: new maternity hospitals; the development of obstetrics as a research-based discipline; the compliance of midwives; and a shift in women's preference, favouring hospital birth. The development of the Danish home birth models was described by Susanne Houd in regard to the processes associated with the medicalisation of childbirth, the role of consumers, and the changing professional dynamics of midwifery.

CONCLUSION

An untold history of home birth in Denmark was documented in this testimony. The Danish childbirth hospitalisation process was presented as the result of a complex interaction of factors. Susanne Houd's reflections reveal how the concerted action of consumers and midwives, framed as a system-challenging praxis, was the cornerstone for the sustainability of home birth models in Denmark.

Attrition from midwifery programmes at a midwifery school in the English midlands 1939-1973: A historical study

OBJECTIVE

This paper explores the features of attrition from a Midwifery Training programme in mid-twentieth century England.

DESIGN

The research uses an historical methodology to explore rates of attrition from a Midwifery Training School in the English Midlands between 1939 and 1973. It uses principally the record books of the Training School which gave details about pupils across the period. This evidence is contextualised through national written and oral archive material.

SETTING

Mid-twentieth century England. The period was a time of significant change in the maternity services, at both a philosophical and organisational level with the creation of the National Health Service and a move towards institutional rather than community based maternity care. Midwifery pupils were regulated by the Central Midwives Board, the national body which governed midwifery, and sat national exams based on national syllabi.

PARTICIPANTS

Pupil midwives based at the Midwifery Training School whose records are being explored. These included pupils who were had nursing qualifications and those who did not.

FINDINGS

Numbers of pupils entering training varied across the period in relation to external workforce factors. The greatest proportions of those in training were pupils who already held a nursing qualification, although numbers of untrained pupils rose across the period. Rates of attrition were particularly high within this group, but across all groups rates rose across the period.

CONCLUSIONS

The evidence suggests that despite the very different organisation of midwifery training and care across the period in comparison to contemporary practice, rates of attrition from training programmes appear remarkably consistent.

[Historical Review of Cesarean Section at King's Maternity Hospital and Midwifery School Zagreb 1908-1918]

This article presents a historical review of the performance of 23 cesarean sections at the King’s Maternity Hospital and Midwifery School in Zagreb during the 1908-1918 period. Following prenatal screening by midwives and doctors in the hospital, deliveries in high risk pregnant women were performed at maternity hospitals, not at home. The most common indication for cesarean section was narrowed pelvis in 65.2% of women, while postpartum febrile condition was the most common complication in the puerperium. Maternal mortality due to sepsis after the procedure was 8.69% and overall perinatal mortality was 36.3% (stillbirths and early neonatal deaths).

[Integral obstetrics impeded by history? Midwives and gynaecologists through the ages]

There is a long and complicated history concerning the interprofessional collaboration between midwives and gynaecologists, which is still evident in current practice. Yet, in the analysis of collaborative problems, history and its lessons are often overlooked. Consequently, less effective solutions to problems may be found, because the root cause of a problem is not addressed. In this historical perspective we show how policies of the respective professions have often focused on self-preservation and competition, rather than on effective collaboration. We also highlight how the independent midwives lost and regained authorisation, status and income. Finally, using a theoretical model for interprofessional collaboration, we reflect on where history impedes the development of integral obstetrics. The focus must be averted away from professional self-interest and power struggles, but this proves to be a complex exercise.

"Womb with a View": The Introduction of Western Obstetrics in Nineteenth-Century Siam

This article focuses on the historical confrontation between Western obstetrical medicine and indigenous midwifery in nineteenth-century Siam (Thailand). Beginning with the campaign of medical missionaries to reform Siamese obstetrical care, it explores the types of arguments that were employed in the contest between these two forms of expert knowledge. Missionary-physicians used their anatomical knowledge to contest both particular indigenous obstetrical practices and more generalized notions concerning its moral and metaphysical foundations. At the same time, by appealing to the health and well-being of the consorts and children of the Siamese elite, they gained access to the intimate spaces of Siamese political life. The article contends that the medical missionary campaign intersected with imperial desires to make the sequestered spaces of Siamese political life more visible and accessible to Western scrutiny. It therefore reveals the imbrication of contests over obstetrical medicine and trade diplomacy in the imperial world.

[ON THE ISSUE OF BECOMING OF MIDWIFE CARE IN NORTHERN EAST CAUCASUS DURING XIX-EARLY XX CENTURIES]

The article deals with becoming of midwife care in Northern East Caucasus during XIX-early XX centuries. The differentiated analysis is made concerning situation and conditions in cities, highland okrugs and Cossak facilities. The issues of training of midwives in the region and organization of obstetrics in auls and stanitsas are considered.

[Obstetric medical book and women's childbirth in Qing dynasty: the case of the treatise on easy childbirth]

Ye Feng composed what was to become one of the most famous and widely-circulating medical works of the late imperial period, the Treatise on Easy Childbirth. Ye Feng proposed the idea of natural childbirth, When the correct moment for birth had arrived, the child would leave its mother's body as easily as "a ripe melon drops from the stem". He argued attempts to facilitate birth were therefore not only unnecessary, and female midwives artificial intervention was not required. However, this view is to overlook the pangs of childbirth, and women bear responsibility for the failure of delivery. So his views reflect the gender order in male-dominated. Also he constructed the negative image of the midwife and belittle her childbirth techniques. As a result, midwife are excluded from the childbirth field, male doctors grasp guardianship rights of the female body. Ye Feng declared that the key to safe and successful delivery could be summed up in just a few words: "sleep, endure the pain, delay approaching the birthing tub". This view must be consistent with the Confucian norms, women to export to equip the 'patience' and 'self-control'. These norms were exposed desire men want to monitor and control the female body, effect on consolidation of patriarchal family order. In sum, the discourse of "a ripe melon drops from the stem"and "sleep, endure the pain, delay approaching the birthing tub" comprised an important intellectual resource that male doctors drew on to legitimate themselves as superior overseers of women's gestational bodies.

Primate pelvic anatomy and implications for birth

The pelvis performs two major functions for terrestrial mammals. It provides somewhat rigid support for muscles engaged in locomotion and, for females, it serves as the birth canal. The result for many species, and especially for encephalized primates, is an 'obstetric dilemma' whereby the neonate often has to negotiate a tight squeeze in order to be born. On top of what was probably a baseline of challenging birth, locomotor changes in the evolution of bipedalism in the human lineage resulted in an even more complex birth process. Negotiation of the bipedal pelvis requires a series of rotations, the end of which has the infant emerging from the birth canal facing the opposite direction from the mother. This pattern, strikingly different from what is typically seen in monkeys and apes, places a premium on having assistance at delivery. Recently reported observations of births in monkeys and apes are used to compare the process in human and non-human primates, highlighting similarities and differences. These include presentation (face, occiput anterior or posterior), internal and external rotation, use of the hands by mothers and infants, reliance on assistance, and the developmental state of the neonate.