What happened before c-sections? - Mothering Forums

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#1 of 12 Old 01-20-2014, 10:34 AM - Thread Starter
 
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How were difficult births handled way back when? I know there are too many c-sections these days, but I also know some are very necessary.

My grandma had a large baby breech and survived. I suppose some difficult births resolved themselves fine. But I do find myself wondering what options were available before modern medicine.

Of course the mortality rate was higher. I guess what I'm wondering is if there is lost knowledge. Like if there were things that midwives did before hospitals and all that to help in difficult births - things that aren't done anymore.
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#2 of 12 Old 01-20-2014, 10:46 AM
 
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I'm pretty sure I've read that the mortality rates were higher because they didn't understand germs and how they caused infections way back when. Like doing vag exams gloveless and without washing their hands first.

I'm fairly positive that midwives have been around since time began and knew how to handle worrisome situations. Like having the mother change positions (think what we now call "baby spinning" I highly doubt this is new knowledge, rather its more likely ancient wisdom) Also different pushing positions offer more pelvic room to accomodate larger babies. I'm sure there's thousands more "tricks of the trade" out there, but they may be being lost as older generations die off..
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#3 of 12 Old 01-20-2014, 11:58 AM
 
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I think to the extent things are not done any more it is because they are either not effective or something safer has replaced them. There is no reason to use high forceps when a c-section can be safely provided.

I compare it to aspirin -- sure I could make myself willow bark tea for my headache but why on earth would I want to when I can take an aspirin that is free from contamination and of a certain safe dosage?

I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#4 of 12 Old 01-20-2014, 12:01 PM
 
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And not just germs, but placenta previa, pph, eclampsia, fatigue, CPD, etc were all killers and there was little any midwife could do.

Google Anne Bradstreet's poem "Before the birth of one of her children" to get a 1600s view of childbirth..."How soon my dear Death may my steps attend..."

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#5 of 12 Old 01-20-2014, 12:15 PM
 
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For a really interesting read on the pros and cons of life before c-sections, there is a series of books called the FoxFire books, written by students in the '70s about the "old ways" and life in Appalachia. In either book 1 or 2 there is a chapter called "Mid-wives and Grannie Women" and while all of the book is amazing and interesting, that chapter is absolutely fascinating - both for the collection of knowledge and how good some of those midwives were - with passed down knowledge and skills, but also for a reality check for how much more matter of fact the death or injury of moms and or babies used to be, even within the last 100 years.

 

What I took from it was that childbirth, while natural and a part of everyday life, was also seen as less of a guaranteed good outcome.  There was no expectation of the low mortality/low birth injury rates that we now have.  I think c-sections are certainly overused now and that the de-medicalizing of childbirth is important, but that's not to put too rosy a hue on the way things used to be.  It was a hard, hard life generally for women (and especially mothers and midwives), particularly in remote areas.  Obviously the book is anecdotal and I'm not claiming all experiences were like that, but it's a really good read and gives some interesting insight into some of what happened before c-sections and the option for obstetrical care (the good and the bad) :)

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#6 of 12 Old 01-20-2014, 12:19 PM
 
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Originally Posted by Buzzbuzz View Post

And not just germs, but placenta previa, pph, eclampsia, fatigue, CPD, etc were all killers and there was little any midwife could do.

It's been a while since I looked into this stuff, but if I'm remembering right, there were some herbs for pph (I think catnip was one?), old-school inductions and some other tricks for eclampsia, the mother could be saved in some CPD cases (the method was pretty unpleasant, though), and Ina May mentions in one of her books that she found records of a midwife who figured out how to identify placenta previa and managed to deliver some babies past it.  Obviously modern c-sections are preferable in most of those cases, but there were some very knowledgeable, highly skilled midwives over the years.

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#7 of 12 Old 01-20-2014, 01:25 PM
 
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Loving this thread and I want to check out those books, sounds so fascinating!


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#8 of 12 Old 01-21-2014, 01:43 AM
 
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There are a couple of midwives who kept meticulous records at various points throughout history whose books have survived. One account is "A Midwife'sTale: The Life of Martha Ballard". I wouldn't suggest it for pregnant women since there is a fair amount of not super happy stuff, but it is a great glimpse into what a skilled midwife might have experienced. My general impressions were that there was a substantial increase in infant and fetal deaths but that most complications of the mother ended up with a scarred but living mother.

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#9 of 12 Old 01-21-2014, 11:08 AM
 
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I was doing some reading that said that given the higher maternal mortality rate and larger families (a mother who delivers 10 times obviously is at a greater risk than one who delivers once) meant that the risk of maternal death in 1600s America was 1 in 8. I'll see if I can find the link.

I do find the idea that there is some ancient lost wisdom of midwives that we would substitute for our care today about as plausible an idea as claiming that Gone With The Wind is an accurate portrait of the old south. It may appeal to some romantics who are sure they would end up being Scarlett (or have the perfect nucb) but otherwise...

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#10 of 12 Old 01-21-2014, 12:18 PM
 
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Originally Posted by Buzzbuzz View Post

I was doing some reading that said that given the higher maternal mortality rate and larger families (a mother who delivers 10 times obviously is at a greater risk than one who delivers once) meant that the risk of maternal death in 1600s America was 1 in 8. I'll see if I can find the link.

I do find the idea that there is some ancient lost wisdom of midwives that we would substitute for our care today about as plausible an idea as claiming that Gone With The Wind is an accurate portrait of the old south. It may appeal to some romantics who are sure they would end up being Scarlett (or have the perfect nucb) but otherwise...

To some extent I agree with you, but there are some situations, such as in the midst of natural disasters, in remote refuge camps, etc... where some of the low-tech approaches really could/do save lives.  Also, we can't rely on all the drugs and chemical we currently use to remain available and effective, and I suspect that studying the historical approaches has the potential to make it easier and faster to develop new techniques.  I think that preserving and studying the historical medical information is worthwhile.

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#11 of 12 Old 01-21-2014, 04:11 PM
 
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Even before anesthesia and sterile technique became widespread and available, people were attempting c-sections for obstructed labor.  The first successful c-section in the united states was performed in 1794, at the request of a woman, Elizabeth Bennett, who (probably rightfully) believed that continuing her labor would kill both her and child.  The first physician she asked refused to do it on ethical grounds, and her husband, also a physician, was the one to actually do the section.  Perhaps miraculously, she and the baby survived.  http://www.wired.com/science/discoveries/news/2009/01/dayintech_0114

 

Medical professionals in resource poor situations are always working to innovate and come up with ways to improve outcomes for their patients.  I don't think there is a need to romanticize punching a hole in a placenta previa and performing an internal podalic version and breech extraction as Vraow Schrader once did.  (Not risk free: risk of hemmorhage killing mother, child, or both, risk of uterine rupture which would be fatal without surgery. But doing nothing would have proven fatal as well.) I imagine that these doctors and midwives already are aware of "pre-technology" or "technology light" methods for dealing with many obstetric difficulties; many of these professionals are from the region they practice in.

 

The reality that access to medical care is unequally distributed is also the reason why low dose oral misoprostol has been studied as a labor induction agent: because it is inexpensive and shelf stable, and there are cases where an induction can be life saving.  http://apps.who.int/rhl/pregnancy_childbirth/induction/CD000941_abdel-aleemh_com/en/

 

An excellent (but occasionally graphic) blog about practicing medicine, particularly obstetrics, in a resource poor area is Jeevan Kuruvilla's The Learner.  http://jeevankuruvilla.blogspot.com/  

 

I think most people can agree that the most pressing matter is making safe care accessible to more people.  This problem is unlikely to be solved with "historical knowledge" because it is a systemic issue rather than a case by case problem.
 


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#12 of 12 Old 01-22-2014, 01:27 PM
 
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There were tools in the birth bags of midwives of days gone by that no one would ever want to have used, or seen used, on any human being.

 

Go to a university library and grab a dusty obstetrics or midwifery book off the shelf - from 100 years ago or so - and have a peek at some of the items you may have found in the midwife's bag.

 

If you think forceps are scary....

 

Those tools didn't exist because all bodies were designed perfectly and birth worked all the time.

 

I'm very much a natural birth and midwife advocate, but I'm reluctant to over-romanticize [Queue Tara's Theme] midwifery of long ago. I think it was, at times, very grim work.

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