The association of parturition scars and pelvic shape: A geometric morphometric study.

OBJECTIVES: Pelvic features, mostly known as parturition scars, have been extensively studied in the last decades and are frequently investigated in archaeological and forensic contexts. It is still unclear, however, whether they really relate to pregnancy and birth, or whether these features are caused by other biomechanical factors. Because the length and difficulty of labor correlates with the form of the birth canal, we studied the association between the expression of pelvic features and pelvic shape using geometric morphometrics. MATERIALS AND METHODS: We scored the expression of the preauricular sulcus, margo auricularis groove, sacral preauricular extension, dorsal and ventral pubic pitting for 54 individuals from a 19th century collection and 19 individuals from the Bronze Age cemetery of Hainburg-Teichtal, Austria. Based on photogrammetric surface models, pelvic shape was captured by 331 landmarks and semilandmarks. The multivariate association between pelvic features and pelvic shape was explored by partial least squares analysis. RESULTS: Within the female subsample, we detected a significant association of a constrained birth canal with a strong expression of the preauricular sulcus, the margo auricularis groove, and a retroverted position of the acetabulum. No significant association was found among males. DISCUSSION: This suggests that difficult or prolonged labor may indeed cause more strongly expressed pelvic features, presumably because of increased strain of the pelvic ligaments during birth. Furthermore, the retroversion of the acetabulum, which is known to cause sacroiliac joint dysfunction, changes the strain on pelvic ligaments and can thus also result in the development of pronounced pelvic features.

Shifting understandings of labour pain in Canadian medical history.

While pain in childbirth is a universal, cross-cultural, biological reality, individual experiences and perceptions of this pain are historically and culturally specific. At the turn of the 20th century-a key period in terms of both the medicalisation of birth and the professionalisation of obstetrics in the Canadian context-Canadian physicians understood and conceptualised 'birth pangs' in a number of varying (and at times competing) ways. Throughout the 19th century, doctors emphasised the broader utility of pain as a diagnostic tool and a physiologically necessary part of the birthing process. With the advent of anaesthetics, including chloroform and ether, however, a growing subset of the medical profession simultaneously lauded the professional, physiological, and humanitarian benefits of pain relief. By the first decades of the 20th century, shifting understandings of labour pain-and particularly growing distinctions between 'pain' and 'contraction' in mainstream medical discourses-underscored the increasing use of obstetric anaesthesia. Drawing on a broad range of medical texts and professional literature, and focusing on a key historical moment when the introduction and adoption of a new medical technology opened up possibilities for professional debate, this paper unpacks both the micropolitics and the macropolitics of shifting understandings of labour pain in modern Canadian medical history.

An Early History of Anesthesia in Labor.

Fear of pain often overshadows childbirth, and each woman must decide whether to receive anesthesia to combat labor pain. Historically, this choice resulted in unintended consequences and marked the beginnings of medical interventions in labor and birth. The purpose of this article is to trace the use of anesthesia in childbirth from the mid-19th to the mid-20th centuries and to explore its influence on childbearing women and nurses.

La inauguración de la Casa de Salud de Santa Cristina de Madrid y su Escuela de Matronas / The opening of the Casa de Salud de Santa Cristina de Madrid and its school of midwifery

INTRODUCCIÓN: La Casa de Salud de Santa Cristina y Escuela Especial de Matronas fue una de las primeras escuelas para matronas fundadas en Madrid y en España. El edificio que la albergaba, un hospital destinado a cuidados obstétrico-ginecológicos, se inauguró en la capital de España en 1924, veinte años después de la colocación de la primera piedra. OBJETIVO: Analizar los orígenes de la institución, y explicar cómo fueron los primeros años de su funcionamiento y las repercusiones que esto tuvo sobre el colectivo de matronas de la época. MATERIAL Y MÉTODO: Investigación histórica que utiliza diversas fuentes primarias, como el informe de su primer director, José Gálvez Ginachero, y otros documentos procedentes de diferentes fuentes hemerográficas y documentos de archivo originales obtenidos en diversos archivos nacionales. RESULTADOS: En sus primeros años de funcionamiento, la Casa de Salud de Santa Cristina y Escuela Especial de Matronas (posteriormente, Escuela Oficial de Matronas) formó a estas profesionales con el objetivo de que fuesen fundamentalmente meros auxiliares para los médicos en el parto. Se han localizado en los archivos a 32 matronas que estudiaron en la institución desde su inauguración hasta el curso 1934/1935. Aunque el número inicial de alumnas fue escaso, con los años fue incrementándose progresivamente. CONCLUSIONES: La inauguración de la Casa de Salud de Santa Cristina mejoró la formación práctica de estas profesionales, pero también se convirtió en una herramienta para su control y su subordinación profesional a la figura del médico. También constituyó el inicio de la institucionalización del parto en Madrid

INTRODUCTION: The Casa de Salud de Santa Cristina and its school of midwifery was a women's hospital and one of the first schools for mid-wives on Madrid and also in Spain which opened in 1924, twenty years after its founding stone was laid. AIM: The purpose of this historiographic essay is to show the origins of this hospital, to explain the first years of its functioning and its consequences on midwifery care during childbirth. METHODOLOGY: Historical research which uses primary sources such as the report of José Gálvez Ginachero, the first director in the institution, and other files obtained from hemerographic sources of information and original archive documents from various national archives. RESULTS: The Casa de Salud de Santa Cristina and its school of midwifery formed midwives in order to be merely assistants for doctors. We have found 32 midwives formed in this institution during the first ten years of its functioning. In the beginning, only two or three midwives a year, but this number was progressively growing on. CONCLUSIONS: The opening of the Casa de Salud de Santa Cristina improved the practical training of midwives but also was a way for professional control and subordination of midwives in Spain. It also contributed to the institutionalization of childbirth in Madrid

BORZOUYEH, AN ANCIENT PERSIAN PHYSICIAN WHO FIRST REPORTED UTERINE CONTRACTIONS IN NORMAL VAGINAL DELIVERY.

During the final hours of pregnancy, uterine contractions cause the foetus to move through the birth canal and leave the mother's body. Haly Abbas (died 982-994 CE), is believed to be the first writer to explain the role of these contractions. However, this concept had in fact been described in the text titled Bab-e-Borzouyeh, written four centuries earlier by the physician Borzouyeh (Perzoes in Latin) as a prologue to his translation of the Indian collection of fables known as the Panchatantra. Because Haly Abbas probably had access to ancient Persian medical texts, the earliest report of uterine contractions may need to be re-attributed to this earlier author.

The physical activity of parturition in ancient Egypt: textual and epigraphical sources.

Many medical and magical texts concerning childbirth and delivery are known from ancient Egypt. Most of them are spells, incantations, remedies and prescriptions for the woman in labour in order to accelerate the delivery or protect the unborn child and parturient. The medical and magical texts do not contain any descriptions of parturition itself, but there are some literary, astronomical and mythological texts, as well as a few incantations, which describe the biological act of childbirth and also miscarriage in more detail. Besides the textual sources, the decoration of temple walls and mammisis (birth houses), as well as illustrations on a birth brick provide an insight into the moment of delivery. In this paper, I focus on the "scientific"depiction of the biological act of childbirth, on how it is described in non-medical sources. Although the main sources are mythological-theological texts with numerous analogies, it is remarkable how many details they provide. They contain descriptions that would be expected in the context of medical sources.

'Forbidden points' in pregnancy: no plausible mechanism for risk.

It has been suggested that acupuncture may pose particular risks during pregnancy: by enhancing oxygenation to the developing embryo (presumably via increasing blood flow to the uterus); by affecting the level of maternal progesterone in early pregnancy; or by stimulating uterine contractions. This article examines the proposed risks and fails to find any plausible physiological mechanism for them.

Forbidden points' in pregnancy: historical wisdom?

Within the acupuncture literature there is debate on the safety of using specific acupuncture points during pregnancy. Termed 'forbidden' or contraindicated, they refer to acupuncture points that can be used to induce labour but may also include points with no known inducing or labour-enhancing effects. Recommendations range from avoiding these acupuncture points at any time in pregnancy to statements that despite the warnings in the literature, these points are not contraindicated during a normal pregnancy. This discussion paper examines the historical use of contraindicated points, the physiology of the pregnant body and the effect of these points during research trials. It is hoped that this will encourage further discussion and provide a background for practitioners to make informed choices about how they use these points in clinical practice.

From social to surgical: historical perspectives on perineal care during labour and birth.

A review of key historical texts that mentioned perineal care was undertaken from the time of Soranus (98-138 A.D.) to modern times as part of a PhD into perineal care. Historically, perineal protection and comfort were key priorities for midwives, most of whom traditionally practised under a social model of care. With the advent of the Man-Midwife in the seventeenth and eighteenth century, the perineum became pathologised and eventually a site for routine surgical intervention--most notably seen in the widespread use of episiotomy. There were several key factors that led to the development of a surgical rather than a social model in perineal care. These factors included a move from upright to supine birth positions, the preparation of the perineum as a surgical site through perineal shaving and elaborate aseptic procedures; and the distancing of the woman from her support people, and most notably from her own perineum. In the last 30 years, in much of the developed world, there has been a re-emergence of care aimed at preserving and protecting the perineum. A dichotomy now exists with a dominant surgical model competing with the re-emerging social model of perineal care. Historical perspectives on perineal care can help us gain useful insights into past practices that could be beneficial for childbearing women today. These perspectives also inform future practice and research into perineal care, whilst making us cautious about political influences that could lead to harmful trends in clinical practice.

Conception, complicated pregnancy, and labour of gods and heroes in Greek mythology.

Pregnancy and labour are holy moments in a woman's life. Even in Greek mythology we can find descriptions of them. We searched in the Greek myths to find descriptions of labours of ancient heroes and gods. We identified descriptions of extracorporeal fertilization, superfecundation, ectopic pregnancy, preterm labour, prolonged pregnancy and Caesarean section. The use of imagination could help the reader to find similarities in present or future developments in the field of obstetrics. It could be concluded that various aspects of modern obstetrical practice are described in Greek mythology.

The emergence of high-tech birthing.

The journey from "normal" to high-tech childbirth has taken place gradually over the past century. This article gives a historic review of maternity care and defines normal birth according to care practices adapted from the World Health Organization. The issues facing today's consumers, care providers, and caregivers that have led to the high-tech approach to birth are discussed. Recommendations for nursing practice are proposed to balance a normal approach to childbirth with a high-tech clinical environment.