One of the best things about Penarth, the little town where we live, is the charity shops. They do sell an amazing array of stuff. As I was walking past Oxfam on Bank Holiday Monday last week, I noticed in the window a series of medical instruments on sale. Many were of no particular interest to me, but the next day, I went back to purchase the sphygmomanometer (blood pressure meter for the uninitiated) and the obstetric forceps. As I teach a lot of history of gynaecology, I thought the forceps might be useful in the future as a teaching tool.
While I do love my vintage sphygmomanometer – and I am sure T and G will too – I feel rather more ambivalent towards my forceps. I did boil them for at least an hour, as if they still bore the traces of their primary function. As I weighed them in my hands, I felt extremely grateful obstetric forceps and attendant episiotomy scissors have never been within near vicinity of my babies (and my genitals).
This purchase came at the same time as yet another debate in the British media: are those who promote natural birth bullying in their attitude? In particular, are women who achieved natural birth(s) boastful and lacking understanding towards women who, by choice or necessity, underwent medical interventions during labour.
This came as a reaction to a review, on the front page of the Sunday Times, of the latest book of Michel Odent, a French pioneer of water births. That article was, in rather an inflammatory manner, entitled ‘Mothers risk losing ability to give birth’. I have not read Odent’s book (which is not yet available), and I will therefore not comment on it (unlike many columnists in the press). All I can say is that it is worrying to read that so many births nowadays are instrumental births, and it is important that research is carried out on the causes of this phenomenon. As women, we may feel we have failed if we have not had a ‘perfect’ birth (whatever that may be), but we should understand that statistics and research are not meant to hurt us individually. This is, of course, easier said than done.
An argument one sometimes reads is that ‘before the advent of modern obstetrics, women died in droves in labour’. It would take much more than a short blog to challenge that argument, but let us say that the situation is a bit more complex than that. Certainly, it is true that more women in the past died in labour than they do today in our society. It is also true that, when a baby was stuck in the birth canal, the only solution to attempt saving the mother, embryotomy (look it up, as I do not have the courage to describe the procedure), was absolutely atrocious.
Still, the danger with constant recourse to modern instrumentalised births, is that medical personnel will lose the ability to use other skills. There are no obstetric forceps in ancient medical texts, and no mention of episiotomy. Instead, we have some detailed descriptions of midwives’ skills. Here is Soranus’ (first century CE) description of how midwives should use their hands in labour:
When the orifice of the uterus opens, the midwife, having first anointed her hands with warm oil, should insert the forefinger of the left hand, the nail of which has been cut short, and first dilate the orifice gently and gradually so that the accessible part of the chorion falls forth, while with the right hand, she should anoint the region with oil – bewaring of such oil as has been used for cooking. Soranus, Gynaecology 2.4 (Translation: Temkin).
While midwives still use their hands to measure dilation and to stimulate dilation, they do not usually offer the type of emollient massage that Soranus describes. Instead, they will often recommend baths. For the water, as well as being a good way to alleviate birth pains, also softens the perineum.
I would never claim that one should go back to the way obstetrics was practised in antiquity, but it remains that many babies were born over the centuries without the intervention of forceps – and that is most probably due to the great skill of midwives. As I gaze at my new acquisition, and feel its cold metal, I think once again about my Hippocratic sisters and my friends today, and I have a strong sense that, instead of accusing each other of bullying, we should all campaign for more investment in compassionate midwife- and obstetrician- training.