The History of Modern Obstetrics and Gynecology

Gynecology

Gynecology as a branch of medicine dates back to Greco-Roman civilization, if not earlier. In the early and mid-19th century, physicians became able to successfully perform a limited variety of surgical operations on the ovaries and uterus. The American surgeon James Marion Sims and other pioneers of operative gynecology also had to combat the violent prejudice of the public against any exposure or examination of the female sexual organs. The two great advances that finally overcame such opposition and made gynecologic surgery generally available were the use of anesthesia and antiseptic methods. The separate specialty of gynecology had become fairly well established by 1880; its union with the specialty of obstetrics, arising from an overlap of natural concerns, began late in the century and has continued to the present day.

Gynecologists make routine examinations of cervical and vaginal secretions to detect cancer of the uterus and cervix. They perform two main types of surgical operations: repairing any significant injuries caused to the vagina, uterus, and bladder in the course of childbirth; and removing cysts and benign or malignant tumors from the uterus, cervix, and ovaries. The first ovarian cystectomy was performed in 1809 in Kentucky and the first recorded vaginal hysterectomy, performed accidentally and unplanned was in 1812! Later, in 1853, the first successful abdominal hysterectomy was performed. The modern practice of gynecology requires skill in pelvic surgery; a knowledge of female urologic conditions, because the symptoms of diseases of the urinary tract and the genital tract are often similar; and skill in dealing with the minor psychiatric problems that often arise among gynecologic patients. Screening has also become a large part of gynecological practice, with the first screening test for cervical cancer developed in 1941 by George Nicolas Papanicolau: the pap smear! Most recently, laparoscopic and robotic procedures have infiltrated the world of gynecologic surgery which allows for surgeons and patients to have a minimally invasive major procedure with quick recovery time and less risk of infection. 

Obstetrics

Obstetrics had for a long time been the responsibility of female midwives, in fact, Obstetrix was the Latin word for midwife and it is thought to derive from obstare, to “stand before”, because the attendant stood in front of the woman to receive the baby. In the 17th century, European physicians began to attend on normal deliveries of royal and aristocratic families; from this beginning, the practice grew and spread to the middle classes. Interestingly, in 1668 it was a physician who pioneered primary suturing of the perineum after delivery, “cleansing .. with red wine then applying three or four stitches.” Then in the 20th century, medical schools changed the practice from midwifery to obstetrics.

The name “caesarean” is likely derived from the Latin word caedere, to cut. The Roman law Lex Caesare stated that a woman who died in late pregnancy should be delivered soon after her death, and if the baby died they should be buried separately. The first cesarean section of modern times (with survival of both mother and child) is attributed to a Swiss sow gilder, Jacob Nufer, who in 1500 gained permission from the authorities to operate on his wife after she had been in labor for several days. Nufer's wife subsequently had five successful vaginal deliveries. During this age, cesarean sections were performed without anesthesia. In the mid-19th century death rates remained high and cesarean section was often combined with hysterectomy. In the 1880s, with the introduction of asepsis, a conservative operation was developed and the “classical” operation—a vertical incision in the upper part of the uterus—became more frequently used. This incision did not heal well, however, and in 1906 the modern “lower segment” operation was introduced, which carried less risk of subsequent uterine rupture.

In 1827, fetal heart tones were auscultated for the first time. The invention of the forceps used in delivery, the introduction of anesthesia, and the discovery of the cause of puerperal (“childbed”) fever in 1847 with the introduction of antiseptic methods in the delivery room were all major advances in obstetrical practice. By the early 19th century, obstetrics had become established as a recognized medical discipline in Europe and the United States. Prenatal care and instruction of pregnant mothers to reduce birth defects and problem deliveries was introduced about 1900 and was thereafter rapidly adopted throughout the world. The first epidural for labor anesthesia was given in 1901 and oxytocin was first synthesized for labor augmentation in 1953. Beginning with the development of hormonal contraceptive pills in the 1950s, obstetrician-gynecologists have also become increasingly responsible for regulating women’s fertility and fecundity. With the development of amniocentesis, ultrasound, and other methods for the prenatal diagnosis of birth defects, obstetrician-gynecologists were been able to abort non-viable fetuses and unwanted pregnancies. At the same time, new methods for artificially implanting fertilized embryos within the uterus have enabled obstetrician-gynecologists to help previously infertile couples to have children. The first successful in vitro fertilization was performed in 1978.

With the new age of safe childbirth, the main focus for maternity care is now the quality of the birth experience for the woman and her partner. Services are encouraged to provide choice, including home or hospital delivery, epidurals, or water births.

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