The Facts of Life: Examining Reproductive Health

Childbirth

Obstetrical Instruments and Painless Childbirth

• If the baby is under stress, indicated by changes in the baby's heart rate.
• If contractions and pushing are no longer effectively moving the baby through the birth canal during the second stage of labor.
• If a medical problem, such as heart disease, makes the stress of pushing during the second stage of labor dangerous for a woman.
• During a breech birth in delivering the baby's head.

Obstetrical Forceps
circa 1850
Manufactured by Otto and Sons.

Having a German-style lock, this forceps was popular in Europe but infrequently used in the United States. The Flattened head fits intoa notch in the stem for easy locking and separation.

On permanent loan from The University of Iowa College of Medicine

Smellie's Obstetrical Forceps
circa 1750

English surgeon William Smellie's forceps employed the most advanced pivot lock -- the "English lock." The notches in each stem fit together to lock the instrument. After well over two centuries, Smellie's forceps continue to be the most popular type in Great Britain.

On permanent loan from The University of Iowa College of Medicine

Elliot's Obstetrical Forceps
circa 1860
Manufactured by Gelman and Shurtleff, Boston.

In 1858, Dr. George Elliot of New York designed a set of obstetrical forceps to prevent compression of the fetal head. A sliding screw and pin on the inner surface of one handle kept the blades separated at the proper distance. The shanks of the forceps are overlapping. These forceps are suitable for an average-sized head or one which has not undergone extensive molding (temporary elongation due to passing through the birth canal).

On permanent loan from The University of Iowa College of Medicine

Simpson's Obstetrical Forceps
circa 1880

Developed in 1848 by Dr. James Simpson of Edinburgh, these forceps were a combination of features from earlier models. He retained the finger rests and deep finger depressions in the handle and connected the forceps with a notched joint.

Gift of Dr. Frank Senska

Smellie's Cranial Perforator
circa 1900

Before aseptic procedures became common practice in the late nineteenth century, over half the mothers undergoing Cesarean section died from infection. Another way to extract a fetus which could not pass through the pelvis was by means of a craniotomy. In this procedure, the head of the fetus was collapsed to ease its passage through the pelvis.

UIHC Medical Museum

Contemporary Obstetrical Forceps
circa 1990

Courtesy of UIHC Central Sterilizing Service

Amniotomy Hook
circa 1990

This instrument is used by a practitioner to break the bag of waters. The procedure is performed to hasten labor, to insert an internal fetal monitor, or to allow sampling of fetal blood to check for fetal well-being. Although ferquently performed, there are potential risks with an amniotomy. Cord prolapse (where the umbilical cord preceeds the baby through the birth canal) and infections (a result of prolonged reupture of the membranes and multiple vaginal examz) are two possible complications.

Courtesy of UIHC Central Sterilizing Service

Episiotomy Scissors
circa 1990

An episiotomy is an incision made to enlarge the vaginal opening right before the birth of a baby. The two-to-four centimeter cut is made through the skin and muscles of the perineum, the area between the vagina and the rectum.

Episiotomies are a controversial practice in the obstetrical field. Routine episiotomies, described as early as 1741, are thought to heal faster and be easier to repair than an unpredictable tear. They may also prevent serious lacerations to the anus and long-term damage to the woman's pelvic-floor muscles. However, many claim that recent studies disprove these assertions. Episiotomies may cause severe postpartum pain, wound infections, and pain during sexual intercourse. Episiotomies are no longer performed on a regular basis by most practitioners.

Courtesy of UIHC Central Sterilizing Service

Painless Childbirth
Anesthesia is the loss of sensation - particularly that of pain - in all or part of the body. Without anesthesia, physicians could not perform most surgical operations. Drugs called anesthetics produce temporary anesthesia and reduce the physical shock and emotional stress of an operation. In 1842, Crawford W. Long, a Georgia physician, used ether vapor to anesthetize three patients. Other anesthetic agents soon came into use, such as nitrous oxide (laughing) gas and chloroform. James Young Simpson, professor of midwifery at the University of Edinburgh, experimented with these agents on himself and his friends. He determined that chloroform was the most effective anesthetic for use in obstetrics.

In Britain, however, the use of pain medication in labor was vehemently opposed by the Calvinist church fathers; they believed that women's experience of pain in childbirth was decreed by the Bible. Simpson ignored the controversy and continued to employ chloroform in his practice. After 1853, when Queen Victoria consented to use chloroform during one of her deliveries, anesthesia gained wider acceptance.

Early 20th century feminists pushed for the right of all women to obtain relief from the pain of childbirth. In Germany, researchers developed "twilight sleep." Women were injected with morphine and scopolamine at the beginning of labor and given chloroform or ether later in the birth process. All sensation was dulled and when the women regained consciousness they had little or no memory of the birth. During the early 1930s, medical schools began offering formal training in anesthesia. Throughout the 1940s and 1950s, many obstetricians routinely anesthetized women during childbirth. By 1960, this practice was criticized by womenÕs activist groups. Natural childbirth, now referred to as prepared childbirth, came into vogue. Prepared childbirth informs women and their partners about labor and delivery and teaches relaxation, visualization and breathing techniques. Today, expectant mothers may decide whether or not to employ medication to ease the pain of labor and delivery. When labor is long and complicated, or when pain is intolerable and interferes with a womanÕs ability to push, some form of anesthesia may be necessary.

Pain Medication
In the past, doctors believed that the placenta acted as a barrier and protected the baby from medications administered to the mother. It is now known that strong sedatives and narcotics do enter the baby's system. Each woman experiences childbirth differently. For one woman, labor and delivery may be strenuous but exhilerating, while for another it may be a difficult, uncomfortable experience. Today, there are a variety of medications which can be administered in safe doses, reducing the chance of any harmful effects upon the baby or the mother.

Analegsic Drugs
Drugs such as merperidine (Demerol,) nalbuphine (Nubain,) and butorphanol (stadol,) are given by injection into a muscle. Offering good pain relief in high doses, they may cause contractions to decrease in strength and frequency.

Regional Anesthesia
An epidural is an injection of anesthetic medication into space surrounding the spinal nreves. Taking effect in a few minutes, it usually reduces (or removes) pain and sensation from the waist the the upper thighs. It is the most widely-used method of anesthesia during childbirth (especially in cesarean sections) and is estimated to be used in as many as 70 percent of deliveries in some hospitals. Pain relief can be excellent and the mother remains fully awake, alert and able to push effectively.

Local Anesthesia
These drugs include procaine, lidocaine and tetracaine. They are injected into the perineum just moments before a baby is born, and dull the pain.

General Anesthesia
Usually reserved for emergency situations, general anesthetics may be gases such as nitrous oxide or halogenated ethers that are inhaled. The mother loses consciousness and feels mothing during the delivery.

Ether or Chloroform Inhaler
circa 1900

This device allowed self-administration of ether or chloroform during child birth. After a woman inhaled the drug, the weight of the instrument caused it to fall away from her nose.

Gift of Richard J. Steves, MD

Chloroform Mask
circa 1900

To administer chloroform, a cloth was treated with the drug and fitted around the outside of the wire basket. The cloth was secured around the edges when the top was pressed shut over the basket. The mask could then be held over the patient's mouth and nose.

Gift of J. Zerwas
Used by Dr. Frank Senska in missionary work in Africa.