A History of Childbirth

The Spanish Royal National Academy of Medicine began 2016 with an exhibition organized by its Infanta Margarita Museum of Medicine, entitled "A History of Childbirth." It included important pieces documenting the historical and artistic aspects, as well as significant reference works chosen for their illustrative and artistic relevance. The exhibition was sponsored by Asisa (a Spanish healthcare provider), in collaboration with the Complutense University and Santa Cristina Hospital in Madrid, and was commissioned by professor and full member of the Academy, José Antonio Clavero Núñez. As a result, it charted the historical and anthropological course of human childbirth—one of the key moments in any human life.

From very early on, the Academy's universal library of medicine was well stocked with specialist books. This is to be expected for a subject as tangible as pregnancy, with its direct culmination in childbirth—such a commonplace, natural event. To help readers understand their content, some of these books were wonderfully illustrated with precise images that, besides being beautifully drawn, clearly demonstrate the different techniques used in childbirth, including purely manual methods and those requiring tools. Well-preserved editions can be found on the best medical bookshelves, and much of their content is still fundamentally valid thanks to the keen clinical observations of their specialist authors.

Helping a woman through childbirth is one of the oldest healthcare interventions in history, thanks to midwives. They would share information among themselves about the best ways to intervene in difficult births, based on empirical evidence, thereby creating the earliest form of obstetrics. But it was not until after the Renaissance and the progress made in the field of anatomy that the role of obstetrician emerged and techniques were developed for dealing with obstructed labors. The discipline of obstetrics continued to develop, particularly in terms of care during pregnancy, for example in trying to prevent disorders such as the much-feared pre-eclampsia.

This instrument was designed to help with the second stage of labor. Its origins are unknown, although it is mentioned in the Hippocratic Corpus and cited in writings by Soranus of Ephesus, Paul of Aegina, and Al-Zahrawi, seemingly with the purpose of removing a dead fetus. There were numerous attempts to use the tool, in its current guise, during the Renaissance and the 17th century. However, there is consensus on a single name: Chamberlen, which was the name of a French family who settled in England in the 16th century and were pioneers of the forceps' design and use. Over 100 different models were later developed, including those by Levret, Naegele, and Tarnier, but their use depends more on the preferences of each school rather than any proven advantage.

Thanks to antibiotics, the cesarean section became not a risky alternative to death, but another surgical option within the field of obstetrics. From that point on, the life of the fetus was afforded greater value, and this evolved into the concept of it being "a patient along with its mother."

The fetus and neonate have garnered increasing importance, without the mother losing any of hers. This brought about the creation of neonatology, enabling newborns to be given medical care in the delivery room itself.

Scientific progress in the field currently known as obstetrics has been relentless, particularly since the mid-20th century, with a proliferation of excellent specialist teams based around gynecology and obstetrics professorships linked to university hospital services in these specialisms. However, the San Carlos Royal College of Medicine and Surgery in Madrid, for example, already had a "Birth Professorship" by the end of the 18th century. Throughout this long tradition, a wide range of professionals have been granted credentials: practitioners, obstetricians, and midwives, who worked predominantly in Spain after training at well-renowned schools. Until the mid-20th century, babies were rarely born anywhere other than at home, so the first face they would see would be that of the midwife.   The exhibition showcases many different credentials that have been used over the years, from a Royal License for midwives, dating from 1750, to door signs for the offices of midwives and physicians "specializing in births," and a credential for practitioners authorized for "normal births," under the School of Midwifery in Madrid, now Santa Cristina University Hospital.

In line with the times, medicine was taught with the help of iconographic materials to aid better understanding of the professor's explanations in the classroom, clinic, laboratory, or dissection room. In reference to human pregnancy and childbirth, the San Carlos Royal College of Medicine and Surgery went to great lengths to create these remarkable, multi-colored wax figures. They had already been drawn up by the end of the 18th century, under the direction of future professor of anatomy Ignacio Lacaba y Vila, by Juan Chaez, a sculptor to the Spanish Court, and the Italian Luigi Franceschi, a student of Felice Fontana. Just one glance shows you a definitive view of the different moments and positions as the fetus moves through the birth canal, as well as its relationship to neighboring structures. The framed plaster sculptures used for the same purpose, and to aid the correct use of obstetric forceps, are more recent. These splendid figures currently reside in the Javier Puerta Museum of Anatomy, in the Faculty of Medicine at the Complutense University of Madrid, and are part of a wonderful anatomical collection in keeping with the valuable heritage amassed by the oldest university in Madrid.

As is customary during exhibitions put on by the Infanta Margarita Museum of Medicine, a scientific session was held on February 24, 2016. Participants included full members of the Academy, José Antonio Clavero and Manuel Escudero, and Professor Juan Luis Arsuaga. It covered a broad range of topics such as the history of obstetrics, and a history of analgesia and anesthesia in childbirth, delivered respectively by the aforementioned Academy members (professors of obstetrics and gynecology). Arsuaga, a professor of paleontology, delivered a speech on the peculiarity of human childbirth compared to that of other mammals.