Midwife crisis

Scott Gordon

Matthew Kim has seen some bizarre sights during his time as an obstetrician and gynecologist — “I’ve had moms labor on all fours, which is very disconcerting,” he says — but he knows that in centuries past, childbirth was nearly always strange and dangerous.

Kim, also an assistant professor of obstetrics and gynecology at Northwestern’s Feinberg School of Medicine, gave his lecture “Delivering Babies: A Man’s Job” Thursday night at the Evanston Historical Society, 225 Greenwood St., telling an audience of about 15 how pregnancy and childbirth have changed over the centuries. The topic has some important local ties, as city founder John Evans was an obstetrician. The lecture also compliments the society’s current exhibit of clothing worn by small children and pregnant women in the Victorian era.

Kim started out his presentation with slides of medieval woodcuts and reliefs depicting birth scenes in Europe and the Middle East. In each image, the mother was giving birth in the same position — sitting up in a chair.

“The pain, the blood, the flow of fluids, must have been horrifying,” Kim said.

Women did have access to hospital delivery wards by about he 15th century, but they were a “last resort” where women were accommodated two to a bed and often died in “horrifying numbers,” Kim said.

Ironically, as medical education became more hands-on and incorporated more corpse dissection, women giving birth were even more likely to die because doctors at the time did not understand the benefits of sanitizing their hands. Doctors would go from their morning dissections — which in some countries they were required by law to perform — straight to treating their patients.

By the 19th century, nearly one-fifth of all healthy women died in childbirth, Kim said. Most of these deaths resulted from puerperal fever, a bacterial infection of the uterus. Nobody really thought to promote hand-washing until Hungarian physician Ignaz Semmelweis guessed that the fever was actually being transmitted from person to person and forced everyone in his Vienna hospital to wash their hands in chlorine. Puerperal fever deaths dropped sharply, but rose again after Semmelweis was fired by doctors angered by his policies.

These dangers ensured that childbirth mostly took place at home with the help of midwives, sisters and mothers. As physicians learned more about bacteria and sanitation in the early 20th century, hospitals became safer places, Kim said. By the late 1960s, most women expected hospitals and physicians to ensure that their babies would be healthy and properly delivered. Doctors became more useful to pregnant women, especially with the 1968 arrival of equipment used to monitor the heartbeat of fetuses.

“Every mom who goes into labor gets this not because of good medical reasons, but because they expect it,” Kim said.

Though childbirth had been “Henry Forded” by the 1950s, Kim said, women still have the option of giving birth in the home with the help of specially trained midwives.

But Kim says it’s important to be aware that “the way we’re doing it is not the end of the story.” While childbirth is cleaner and physically safer, Kim said that currently, physicians and society at large make it more difficult for new mothers by putting too much pressure on them, leading to a high incidence of psychological problems like post-partum depression.

City Editor Scott Gordon is a Medill junior. He can be reached at [email protected]