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Tuesday
Aug252009

Old Time Obstetrics

So, I have this book... The Nurse's Handbook of Obstetrics... originally written in 1929, but the copy I have sitting here is from 1952. I used to have an original copy that got lost in a move, so know that not much changed from the original printing and this one I have here. In fact, homebirth wasn't terribly common in 1952, especially with a doctor, yet this book has fold-out pages that show how a nurse should set up for a doctor for a home delivery... the room as well as the kitchen (they carried as much stuff as I do!).

So, of course, things were a lot different back then. The cesarean rate, from what I know, was less than 5%. The book never talks about doing cesareans for breeches (I will outline what they *do* say to do a cesarean for), but does make a point of saying the mortality rate for babies was horrid for primip breeches - 1 in 15 births. Eek!

The book utilizes the complete range of casts that Maternity Center Association did early in the 1900's, and that remain exquisitely accurate and beautiful even today, including the casts that show how to deliver the different breeches and doing internal versions (which is never done today).

So, without reading the whole book here, I will share a few examples of the differences between then and now. The examples are random and not in any particular order. I will quote the entire snippet, so's to keep it in context.

- Smoking: While most obstetricians disapprove of excessive smoking in pregnancy, there is no reason for believing that a woman who smokes moderately, ten cigarettes or less a day, need change her custom at this time, except as preparation for hospitalization in a ward where smoking is prohibited.

- Marital Relations: The husband is to realize that his wife is under nervous and emotional tensions whcih call for constant patience and sympathy on his part. If at this time a wife should feel a sudden and unexplained aversion to her mate, let both of them realize that it is an accompaniment of her condition rather than a real change in her attitude.

- Criminal Abortion: Criminal abortion means the instrumental induction of abortion without medical and legal justification. Since these operations always are performed secretly, accurate figures concerning their frequency are difficult to secure, but the very minimum estimate is 100,000 annually in the United States, while some authorities put the figure at over half a million. This means that each year in this country between 100,000 and 500,000 potential lives are destroyed simply for "convenience," a frightful wastage of human life and a sorry reflection on our civilization. Quite apart from the destruction of fetal life, criminal abortion is one of the most common causes of maternal death. Unless the mother's health is at stake, no reputable physician will induce abortion, for it constitutes murder. Consequently, these clandestine operations usually are performed by hands which are not only unskilled but unclean. As a result, fatal infections are common. Of those that survive many are left invalids, others permanently sterile.

- Methods of Anesthesia: The most commonly employed methods of obstetric anesthesia are: inhalation of ether, nitrous oxide, chloroform, cyclopropane, or ethylene; spinal anesthesia, produced by introducing a solution of procaine (Novacain) or similar drug into the lower spinal canal, thereby aboloshing sensation below the level of the umbilicus; caudal anesthesia, produced by introducing a solution of procaine into the caudal space (in the sacrum), thereby producing an effect similar to that of spinal anesthesia; intravenous anesthesia, in which an anesthetic, such as Pentothal Sodium, is introduced directly into the bloodstream by needle; and local infiltration anesthesia, in which the tissues concerned are injected with a solution of procaine, thereby deadening sensation in that particular area. Inhalation and intravenous anesthesia, of course, produce unconsciousness; in spinal, caudal and local infiltration the patient is awake, but sensation has been abolished in the areas concerned.

- Rectal: In modern obstetrics, the majority of the examinations during labor are abdominal and rectal only - not vaginal. Rectal examinations are much safer than vaginal examinations, since they avoid the risk of carrying pathodgenic bateria from the introitus and the lower vagina to the region of the cervix and the lower uterine segment.

- Delivery in the Home: From the beginning of true labor, the patient should use a commode or bed pan, as it may not be wise for her to go to the toilet. After each bowel movement or urination, the external genitals should be sponged with the antiseptic solution ordered by the doctor.

- Cesarean Section: The main indications for cesarean section fall into five groups: 1) Disproportion between the size of the fetus and that of the bony birth canal, that is, contracted pelvis, tumor blocking birth canal, etc. 2) Certain cases in which the patienc has had a previous cesarean section, the operation being done because of fear that the uterine scar will rupture in labor. 3) Certain cases of very severe toxemia of pregnancy, but rarely in eclampsia. 4) Certain cases of placenta previa and premature separation of the normally implanted placenta. 5) Miscellaneous complications.

- Early Ambulation: The hospitals accepting early ambulation set up their individual routines and practices, such as the following: 1. The patient is "up and out" almost immediately. 2. Twelve hours, or the first day after delivery, the nurse assists the patient out of bed to stand and then circle the bed for 5 minutes, allowed to walk but not to sit. The following day the "time up" is increased to 20 minutes. Perineal care is given through the third morning and then the patient is taught "self-perineal care." The patient is discharged after the fifth day. 3. After 48 hours the patient is allowed to stand for 1 minute but not permitted to dangle her feet from the side of the bed. Activity is increased each day, and the patient is discharged the seventh or the eighth dat. Patients who have undergone cesarean sections usually are allowed up on the third or the fourth day and are discharged from the hospital about the tenth day. 4. About 19 hours after delivert the patient is assisted to stand and walk to a near-by chair to sit for 3 minutes. She is encouraged to be active in bed. Out-of-bed periods are increased gradually, and the patient is permitted to be up longer and do more walking. By the third day the patient is up at least 2 hours and is allowed bathroom privileges.

- Nursery Care: In today's modern nurseries some of the protections offered new babies are: the beds or units with individual equipment and greater space separation; air conditioning and humidifying apparatus; sterilization of all articles used for the baby; heated bath tables and regulation of thermostatic control of any water used for the babies; limiting the number of individuals who enter the nurseries; culturing the throats of nurses and doctors before assigning them to this service; and provision for isolation for any suspicious or questionable infections of eyes, mouth, skin, and intestinal conditions. Some hospitals have an observation nursery where babies are kept until any question of infection is eliminated.

- Rooming-In: "Rooming-in" is the name given to the present plan of having the new baby share his mother's hospital unit. It is the present custom for any so-called new idea in medicine to be written up immediately in the popular magazines and newspapers, with and without factual basis. This leads the public to make demands of the profession often before hospitals are equipped to meet these requests.

- Baby Care: One of the first fruits to be given the baby is orange juice. Others such as tomato, prune, apricot, pineapple, and other cooked fruits, may be prescribed for variety and to relieve constipation. When the baby is about two weeks old, the doctor probably will order one teaspoonful of freshly extracted strained orange juice to which an equal amount of boiled water may be added to prevent the baby from "choking."

- Diet During Illness: When the baby appears ill, it is always advisable to suspend regular feedings and substitute barley water until the advice of the physician can be obtained. (recipe for barley water follows)

So, these things explain a LOT about my ancestors. There was so much, I didn't know quite what to include. I left out cleaning the cracked nipple with alcohol, putting the baby on the chamber pot as soon as the cord heals (the sooner they learn what the toilet feels like, the faster they will potty train), how every picture of a woman in here has her completely shaved and draped so all you see is the vulva, she always in lithotomy, I didn't talk about the constant comments to help the doctor be more comfortable, even moving the mother into positions so he could reach her without difficulty.

Just amazing! What will OUR future midwives think reading Heart & Hands or Spiritual Midwifery? What will future OBs think about Williams Obstetrics? It would be very interesting to know.

Reader Comments (8)

Very interesting! Thanks for posting!!

I know that I sometimes find parts of "Spiritual Midwifery" to be rather primitive... but after all, that was when American midwifery was just getting its start again! We're always a work in progress.

So glad to see you blogging again. :)

August 25, 2009 | Unregistered CommenterDiana J.

My grandfather was a victim of that barleywater advice, he ended up with Ricketts from it.

August 25, 2009 | Unregistered CommenterRayne of Terror

OUCH! Can you imagine having rectal exams as opposed to vaginal ones?! I understand they want to decrease the risk of infection. Point taken. But OUCH!!!

August 25, 2009 | Unregistered CommenterJoy

My grandmother was the head maternity nurse for 15 years at a hospital in my city. She retired in 1980. have that textbook from her school days, as well as several others and all her notebooks. When my mother began to do doula work in the 90's, she would tell my grandmother about the benefits of natural labour and the risks of intervention. My grandmother LOVED hearing about it. She always felt it was wrong to shave and enema, and hated having to keep women in the bed during labour. These were just her instincts. She always wanted to hear about the births my mother attended and was very encouraged to hear about the progress made (keeping mothers and babies together, no more shaves, pushing in more upright positions etc) She passed away nearly 5 years ago, and I began doing doula work only 4 years ago. Every birth I attend, I think of my grandmother and wish that I could talk to her and hear her stories.

So glad you're back to blogging! You've been missed!

August 26, 2009 | Unregistered Commentermamavee

What's amazing to me is that the reaction to rooming-in from this textbook from the 1950s is exactly the same as what current-day objections to rooming-in are in Hungarian hospitals. "We don't have the resources." As in, somehow you need special resources to let a mother keep her baby in her bed with her.

August 26, 2009 | Unregistered CommenterRéka

are the hospitals equipped to meet the public's requests yet???

August 28, 2009 | Unregistered Commenterabundant b'earth

Rectal exams? Oy, what good would they have been?
How was placenta previa diagnosed before ultrasound?
Many parents are re-discovering "Elimination Communication" and start pottying their babies right at birth. Teach them to pee in a toilet instead of a diaper and then re-train them to use the potty later. Makes sense to me.
And orange juice at two weeks, LOL. I know 'foods' were offered early back then, but didn't realize fruits like that were what was offered.

September 16, 2009 | Unregistered CommenterTracyKM

- You can actually feel the cervix via the rectum.

- I believe EC is very different than what this section had in mind. They speak of keeping the baby on the pot until the baby poops or pees, not being aware of the baby's signals before the go.

- Placenta previa was diagnosed as the cervix opened and the woman hemorrhaged, too often, to death.

September 16, 2009 | Registered CommenterNavelgazing Midwife

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