The Care of Pregnant Women Through the Ages

In distant ages, when man dwelt in caves and forests, woman gave birth with complete ease, like the animals, sometimes without anyone's help. Nature was harsh with her: if she died in the throes of labor, no one pitied her, nor did neighbor or kinsman concern himself with her. Hence we find that man in that primitive age had many wives and many children.

When man advanced, and history came to be known, and the ancient civilizations were set down in writing, people began to look upon the pregnant woman with reverence and honor. If a criminal hid in her house, he could not be seized and led away to be killed so long as he was under her protection; if she was assaulted and came to harm, the assailant's lot was death; indeed, she was not to be punished for committing a crime or an offense until after her delivery.

Most of the records of the ancients contain precepts for the care of the pregnant woman. The books of China, for example, forbid the pregnant woman coarse foods and strenuous exercise, and in the Torah and the Talmud there is important counsel for the pregnant woman — ancient proof of the importance of pregnancy and the preservation of offspring.

At the dawn of human history, the tribal women who had borne many children would deliver the young wives, and they performed this office well and compounded certain medicines. In India, the Hindu priests would gather the women together and teach them how to care for the pregnant woman during pregnancy and after it, so that they might carry out this mission later on.

Midwives are mentioned in the days of the Israelites at their going out of Egypt. In Exodus, chapter 1, verses 15–19, it is written that the king of Egypt said to the two Hebrew midwives, Shiphrah and Puah: "When you deliver the Hebrew women and see them upon the stools, if it be a son, then kill him; and if it be a daughter, then let her live," etc. From these words it may be inferred that the birthing stool was known in that era, for formerly woman gave birth on the ground or in the lap of her husband or of another woman, as it says in Genesis, chapter 3, when Rachel addressed Jacob: "Go in unto her, and she shall bear upon my knees, that I too may be granted children by her," etc.

Hippocrates, the father of medicine (400 B.C.), studied the science of obstetrics and wrote upon it, and through his pupils he published all that was known of this art in that age. He separated medicine from religion, so that extraction of the fetus became possible when its delivery proved difficult. In his teaching, Hippocrates laid stress upon the care of the pregnant woman for fear of miscarriage, and warned against swallowing strong purgatives and against excessive intercourse. Yet the teachings of "Susruta" in India, in the second century B.C., were clearer than the teachings of Hippocrates and fuller. He laid down special rules for the pregnant woman's food, drink, dress, and exercise; advised that her surroundings be cheering to her and to her child; and did not permit a man or a woman to marry into a family in which consumption and epilepsy were hereditary — and this accords with the newest theories of heredity today.

History records that the first to extract a dead fetus from its mother's womb by instrument were the Egyptians. Their priests also performed the Caesarean operation, and they were unlike the other men of religion in those ages, who, when a woman's delivery proved difficult, would pray in her house and mumble incantations to drive out the evil spirits which, as they claimed, kept the fetus from leaving its mother's womb.

After the time of Hippocrates, anatomy was no longer relied upon, and many women picked up midwifery by mere practice; but they succeeded in delivering pregnant women only when the head of the fetus was descending toward the neck of the womb. In the other positions of the fetus, the pregnant woman died in their hands — such was the scantiness of the knowledge and of the means for discerning the abnormal positions of the fetus.

In that era the pregnant woman gave birth seated on a special stool which the midwife carried from one house to another, and the physician was called in only upon the death of the fetus, or to destroy it in order to save the mother's life. The operations of midwifery rose as the anatomy of woman's organs advanced. "Soranus" was the first to teach and explain how to change the position of the fetus in the womb so that it might be born alive, and this idea of his proved useful — though, like the other physicians, he would cut up the fetus when he could not change its position. Soranus was also the first to observe that the skin of the pregnant woman's abdomen cracks, and for this he prescribed wax and olive oil; he also recommended bathing in tepid water, believing that it helped the abdominal muscles to stretch at the hour of delivery.

It is a matter of pride for us to recall that many women of the Arabs were famed for medicine in the Jahiliyya and after it, and that many Arab physicians were famed also for the medicine of women.

In the age of Harun al-Rashid, Yuhanna ibn Masawayh composed a book entitled "Why Physicians Have Refrained from Treating Pregnant Women in Certain Months of Their Pregnancy," and a book, "The Treatment of Women Who Do Not Conceive." In Andalusia the sister of al-Hafid Ibn Zuhr and her daughter were famous, and they treated the women of kings and princes.

After the fall of the Arab city we hear no more of theories or inventions in the world of women's medicine. But after the ages of decline we find, in the year 550, the French physician "Paré" coming upon what Soranus had written about changing the position of the fetus in the womb; and "Colombo of Cremona," in the year 1559, opposing the opinion of the ancients concerning monstrous births, saying that such a child was born abnormal through a malformation that befell it in the womb, and that this has nothing to do with jinn and demons. In the year 1667 we find, too, the accoucheur "Chamberlen" using the forceps to draw out the fetus; and the famous physician "Mauriceau," in the year 1668, describing the pregnant woman in his book "The Diseases of Pregnant Women," saying: "The pregnant woman is like a ship on a stormy sea, and the skillful captain is he who steers her with deliberation and precision to the port of safety."

Among his sayings is that pure air, and keeping away from hot and cold climates and from rooms full of smoke, improve the pregnant woman's health. He prescribed nourishing food for her, to be taken at fixed times and in small quantities; forbade her hot and fatty dishes, because they cause gases in the bowels; prescribed for her the eating of fresh river fish, the wearing of low-heeled shoes on her feet, and the eating of apples, stewed plums, and figs against constipation — with an enema if it proved stubborn.

This Mauriceau fought against the tight corset that conceals the pregnant woman's belly; and bloodletting was still widespread in his day.

In the year 1773, "Charles White" of "Manchester" set down some fragments on puerperal fever, as did "Alexander Gordon" in the year 1795.

It is as though these few efforts, appearing within a few years of one another, were a prelude to the great rise of the art of midwifery in the nineteenth century; for since the Stone Age, man in Asia and Europe had not advanced as he advanced in that fruitful century. The art of midwifery had sunk to such depths of decline only because its reins were in the grip of fallen women who took it up as a trade, of ignorant midwives who knew nothing of its secrets, and of charlatan priests dealing in magic, prayer, and quackery — and how should quackery and prayer save women in childbirth!

To be continued