HISTORICAL AND CONTEMPARY PERSPECTIVES
Introduction:-
Midwifery is an old as the history of human species. Archaeological evidence of a woman
squatting in children supported by another woman from behind demonstrates the existence
of midwifery in 50000 BC.
Meaning:-
Obstetrics word is come from a Latin word “OBSTETRIX” means “MIDWIFE”.
Origin of obstetrics:-
As we all know that birth is the complex final act of nature’s greatest miracle i.e. formation
and arrival of a child in the world. And the science and art that deals with human
reproduction is called Obstetrics.
“SORANUS OF EPHESUS” Is the FATHER OF OBSTETRICS He was the first to write about the
Podalic Version.
Earlier man was not welcomed in this field. During Middle Ages in Europe midwives were of
low types and executioner and barbers were called to help with difficult deliveries. Later on
in 16th &17th century Ambroise Pare of Paris and Chamberlens stimulate men to take
interest in obstetrics.
History of midwifery in India:-
In Ancient India, care of women and practice of Midwifery were totally in the hands
of village dais.
Women were subject to the purdah system.
The occupation of dais was hereditary and all dais was from lower caste as the
period of childbirth was considered a time of impurity.
The worst room in the household was allotted for delivery.
Dais gained their skill through observation and practice.
And when dais could not handle the situation serious morbidity and mortality were
the result and these all were explained as “Beyond human control phenomena.”
The historic taboo associated with the examination of female genitalia has long inhibited the
science of gynaecology. This 1822 drawing by Jacques-Pierre Maygnier shows a
"compromise" procedure, in which the physician is kneeling before the woman but cannot
see her genitalia. Modern gynaecology has shed these inhibitions.
During British India:-
In 1900 A.D. Dr. Ida Sophia Scudder after got news from the village people that 3
women died during delivery who were actually calling her to help then she decided
and started with Christian Medical College & Hospital (CMCH) at Vellore. Later in
1950, the doors of CMC & H opened for male training.
In 1899,Zenana Bible and medical mission started training of nurses.
In 1883 Lady Dufferin came to India allotted fund to start maternity hospitals and
training of nurses and midwives all over the country.
It was with help of this Fund that Lady Reading Health School was established in
1918 at Delhi.
Midwifery in Independent India:-
In 1946, Bhore committee laid the foundation for public health planning in India laid
great stress on the need for qualified midwives and health visitors.
In 1947, INC combines the Nursing and Midwifery courses into single course.
In 1955, Shetty Committee recommended training and posting ANMs in health
services with a qualification of class VIII & supervised by LHV.
In 1959, Bischoff supported the training of personnel. ANMs for 3 yrs. And
midwifery for 1 yr.
In 1975, MPHW scheme launched by Kartar Singh Committee.
MPHW were registered as ANMs and were designated as Female Health Workers,
posted at sub centres for 5000 rural population. They supervise the deliveries
conducted by dias.
Historical development in obstetrics:-
In 1739, in London,Willam Smellie and his student Willam Hunter become
obstetrican and work for the same.
In 1744, Willam Smellie introduce steel lock forceps.
In 1752, Willam Smellie publish ‘Textbook of Obstetrics’.
In 1760, Puerperal fever was on peak in London in Lying-in hospital.
On Jan 14th, 1794 first Cesarean operation was performed by Dr. Jesse
Benaett of Virginia on his wife.
First school of midwives was established at Pare instigation at the hotel Dieu
in Paris.
In 18th century National regulation of education and practice of midwifery
begans.
In 1807, Samuel Bard publish first book on obstetrics on four stages of
labour.
In 1847, Semmelweis, in Vienna, demonstrate that washing of hands in
chlorine of lime solution before examining women in labor reduce puerperal
fever. Chloride of lime used as antiseptic.
Obstetrical forceps was developed by Dr. Peter Chamberlen. In the past only
Greeks used variety of hooks and tractors to deliver dead fetus.
In 1853, Dr. James Y. Simpson of Glasgow succeeded in introducing the use
of Chloroform anaesthesia as an aid in obstetrics called “ERA OF MODERN
OBSTETRICS”.
Then, Pinard Fetoscope was developed and Ian Donald from Glasgow
introduces Ultrasound in Obstetrics.
In 1950,Fritz Fuch of Copenhagen performed Amniotomy identified the fetal
cells present in it which identify sex of the baby by barr bodies. CONTD…
Later on emphasis on Antenatal check-ups, blood pressure, urine analysis
was came in attention.
In 1892, Dr. Pierre Budin initiated consulation for nursing mothers.
In 1949, first world health organization expert committee on maternal child
health met in Geneva.
In 1950, Oral contraceptives were introduced for the control of fertility.
Then b-HCG tracing was done with chorion villus sampling at 10th wk.
Identification of IUGR was done by NS test. Later on Raoul Palwer & Patrick
steptol discover Laproscopic Sterlization.
In 1960, Witness abortion gets started.
1971 – MTP Act
1974 – Family Planning Services Incorporated In MCH Care
1977 – Renaming Family Planning To Family Welfare
1978 – Expanded Programme on Immunization
1985 – Universal Immunization Programme
1992 – Child Survival& Safe Motherhood Programme
1996 – Target Free Approach
1997 –RCH Programme Phase-1 (15-10-1997)
2005 – RCH Programme Phase-2 (01-04-2005)
Contempary Perspective of Obstetrics:-
In current view all the focus from obstetrics care shifted to perinatal care.
Advancement in Obstetrics care has reduces the MMR.
Govt. has started programme to identify high risk mothers.
Training of health personnels, Allocation of facilities & equipment decreases MMR.
MMR can be reduces
Early registration of pregnancy.
At least three antenatal check-ups.
Dietary supplements can correct anemia.
Prevention of infection and haemorrhage during puerperium.
Prevention of complications e.g. Eccalmpsia, malpresentation, & ruptured uterus.
Treatment of medical conditions e.g. hypertension, DM & TB.
Anti-malaria and tetnus prophylaxis.
Clean delivery practice.
Institutional deliveries for women with BOH and risk factors.
Promotion of family planning.
MCH services have started which aims at reduction in morbidity and mortality rate of
mother and baby.
Baby friendly hospital scheme has launched in 1993 for effective breastfeed to child.
Genetic counselling to the couples.
Screen the mother for HIV.
Future evidence based practice:-
Mapping of human genome and genetic research.
Use of intrauterine shunts.
Aseptic techniques to be used during PV, PROM.
Care of mother during labor.
Care after delivery for puerperium infections.
