In 1920, Joseph Bolivar DeLee published the article, “The Prophylactic Forceps Operation,” in which he describes how physicians can manually remove a neonate from a laboring woman’s vagina with the use of sedating drugs and forceps. The procedure, according to DeLee, resulted in decreased rates of complications and mortality for both the woman and neonate. DeLee claimed the procedure could reduce damage to the woman such as prolapse, or when internal pelvic organs push down and sometimes protrude from the vagina, and fatal infant brain bleeding. He also suggested that physicians make an incision from the woman’s anus to vagina to accommodate the use of forceps, a procedure later known as an episiotomy. In “The Prophylactic Forceps Operation,” DeLee proposed the technique and use of his procedure, adding to the growing debate in the early twentieth century on the best way to medically assist women during delivery.
In 1992, five maternal-infant health researchers founded Doulas of North America, later renamed DONA International to train certified birth attendants called doulas to provide care to pregnant women both before and after the birthing process. Annie Kennedy, John Kennell, Marshall Klaus, Phyllis Klaus, and Penny Simkin used the term doula, derived from the Greek word for woman servant, to describe a female birthing aide who provides non-medical emotional and physical support to laboring pregnant women. Eventually renamed DONA International, the organization has certified over 12,000 doulas as of 2017. Though the organization aims to provide a doula to everyone who wants one, there have been controversies surrounding the accessibility, affordability, and necessity of pregnant women using a doula before and after birth. DONA International is the largest doula-certifying program in the world and has created global awareness of the risks and benefits associated with using a doula during the birthing process.
Ina May Gaskin is a certified professional midwife, or CPM, in the US during the late twentieth and early twenty-first centuries. She worked at the Farm Midwifery Center in Summertown, Tennessee, a center well known for its low rates of intervention, which contributed to low rates of maternal and fetal mortality. One technique Gaskin used when assisting women with delivery helped resolve a complication called shoulder dystocia, which is when a part of the infant’s body is delivered, but the rest of the body is stuck in the birth canal. Her work served as an example for midwives and obstetricians, physicians who specialize in a woman’s reproductive system, childbirth, and pregnancy, to use a low-intervention approach without medication or a cesarean section. Through her work in developing different birthing techniques, Gaskin provided women with alternative ways to deliver infants without the need for hospitals, medication, or surgical intervention, even in the case of complicated births.