James Young Simpson was one of the first obstetricians to administer anesthesia during childbirth in nineteenth century Scotland. Before his work in the 1800s, physicians had few ways to reduce the pain of childbirth. Simpson experimented with the use of ether and chloroform, both gaseous chemicals, to temporarily relieve pain. He found that those chemicals both successfully inhibited the pain women felt during childbirth and pain during other surgeries. Patients under the influence of chloroform fell asleep and were unaware of the intense pain of childbirth. Simpson’s work was not popular for a variety of reasons, and the major claim against his practice being that pregnant women should not receive a form of pain relief during labor and childbirth. Against common beliefs at the time, Simpson advocated in favor of using anesthetics for pain-free labor, which later became the standard for surgical procedures and childbirth.

In 1976, midwife Ina May Gaskin published Spiritual Midwifery, with other editions published in 1980, 1990, and 2003. Spiritual Midwifery is a book about pregnancy, birth, and postpartum, or the time period after birth. During the 1970s, it was common for women to receive an epidural, a medication that reduces pain during labor, and for physicians to monitor a fetus’s heartbeat while separating women from their infants after birth. However, according to Gaskin, some women wanted to give birth outside of the hospital without medical interventions. Spiritual Midwifery is a collection of birth stories from women, information about pregnancy and giving birth, and instructions to midwives on how to care for women during childbirth and the period that followed. In Spiritual Midwifery, Gaskin introduced homebirth and midwifery to a broader audience, which helped repopularize midwifery in the US.

In 2018, researchers Elie Nkwabong, Romuald Meboulou Nguel, Nelly Kamgaing, and Anne Sylvie Keddi Jippe published, “Knowledge, Attitudes, and Practices of Health Personnel of Maternities in the Prevention of Mother-To-Child Transmission of HIV in a sub-Saharan African Region with High Transmission Rate: Some Solutions Proposed,” in BMC Pregnancy and Childbirth. In their article, hereafter “Knowledge, Attitudes, and Practices,” the authors state the aim of their study was to establish the knowledge, attitudes, and practices held by health professionals who worked in numerous maternal departments throughout Cameroon. They claimed that effective knowledge, attitudes, and practices would likely reduce mother-to-child, hereafter MTC, transmission of HIV. After finding a deficit in the knowledge, attitudes, and practices among a subset of health professionals, the authors recommended increased training, funding, and supervision to reduce MTC transmission of HIV throughout Cameroon.

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.

In 1999, Joseph Bruner, Susan B. Drummond, Anna L. Meenan, and Ina May Gaskin published, “All-fours Maneuver for Reducing Shoulder Dystocia During Labor,” in the medical journal, Obstetrical and Gynecological Survey. In the article, the authors described a birthing technique named the all-fours maneuver, or the Gaskin maneuver, and explained its effectiveness in treating fetal shoulder dystocia as compared to other maneuvers. Shoulder dystocia occurs when the neonate’s head has exited the vaginal canal, but the shoulders get stuck behind the woman’s pelvic bone, which prevents the birth of the neonate’s body. Healthcare practitioners’ use of previous methods to dislodge the fetal shoulders sometimes resulted in fetal and maternal injury. The all-fours maneuver differed from previous methods by positioning the laboring woman on her hands and knees rather than on her back. Through the article, the authors established the all-fours maneuver as a safe, fast, and effective technique for reducing shoulder dystocia.

Subscribe to Midwifery