Ancient Obstetrics!

Obstetrics-the state of the art 70 years ago!

   When I started learning how to deliver babies there was no ultrasound, there were no fetal monitors, x rays were considered dangerous and not very precise. Epidural anesthesia was unheard of. Most deliveries that were considered to be uncomplicated took place at home.

   I recall coming into my office one Monday morning to find an X-ray pelvimetry report on my desk that stated, "There is gross disproportion between the baby's head and the pelvic inlet. This delivery will require a Caesarian section."

   In fact I was called at three o'clock on Saturday morning and barely got there in time for the delivery which proceeded without difficulty.

   Medical students in the world famous Rotunda Hospital got rigorous hands-on training, much of it in the slums of Dublin, 'on the district' as home deliveries were called. The 'delivery suite' might be half of a one room apartment with a sheet divider crudely hanging so as to divide the room in two. The pregnant woman and the 'delivery team were on one side of the sheet, while the husband and the kids (often several) were on the other side.

   Behind the screen was the bed, often sagging and dirty and cleaning that up and preparing it for the forthcoming event was one of the duties of the medical students - usually under the watchful eye of the midwife, who ruled us with an iron fist. The bed needed to be stripped and a rubber sheet placed on top of the mattress and well tucked in so that the mattress, which may have to last a long time would not be destroyed with blood and amniotic fluid. To stop the fluids overflowing , on top of the rubber sheeting several layers of newspaper to sop up the excessive fluids. Over this was placed a single sheet on which the pregnant woman would lie and eventually give birth.

   In those days, Caesarian Section carried a substantial risk and women often laboured for a long time. It was before the philosophy of "Never let the sun set twice on a contracting uterus" and it was not unusual for a woman to be in labour for two or three days or more, with all the attendant risks.

   Once contractions started the husband or one of the kids would jump on their bicycle and race to the hospital. None of these patients had telephones.

   "My wife (or Mammy) is going to have the baby. Send the doctor right away."

   What they got was a midwife and a couple of students. The midwife was in charge and we were there to evaluate the situation. Was the woman actually in labour? Was the baby's head engaged (down into the birth canal)? What position was the baby in?

   She taught us how to do the initial evaluation, how to do a proper pelvic examination, how to talk avoiding embarrassment for oneself and the patient. If the woman was not in well established labour the midwife would go on her way with a comment that she would be back in an hour or two after she called on some other patients in the vicinity who had recently given birth to see how they were feeling.

   "I don't think she'll be doing much for a while but if the is any problem there is a public phone just half a block away and you can call the hospital for help. ".

   This was long before the day of the cell phone and none of the patients had telephones. So two or three of us terrified students were left in charge barely aware of which orifice the baby might pop out of.

   The midwife made sure we were instructed in the patient's medical history

particularly her obstetrical history. She would instruct and supervise each of us (2 or 3 students) in doing a pelvic examination emphasizing the need to assess cervical dilation and the necessity to determine the fetal position.

   "She's not very dilated, is she?" inquired the Midwife. I had no idea.

   "Er. I don't think so,". I tried to sound as though I at least had some idea of what I was doing.

      "What about position?"

      "Er. I'm not sure." I said stupidly.

      She told me what I should looking for.

      And so it went. We students learning all about the dramatic high forceps maneuvers in rare complicated cases that we would never be called upon to do, by high powered hospital Actor-specialists and learning the vital common everyday obstetrical skills which we would need as GPs from the midwife.

    We also learned a great deal about life in the slums of Dublin and the influence of the Roman Catholic church that caused the poor and unfortunate to become even more poor and unfortunate. Ten, eleven, twelve and even thirteen children was not uncommon. I once delivered a woman of her seventeenth child and more than once I cared for a woman and daughter about to give birth at approximately the same time.

Come back in a couple of weeks and I'll take you with me on one of those adventures!