Obstetrics

The branch of medicine relating to the treatment of women before, during and after childbirth is known as obstetrics. Today it is realized that antenatal care, or supervision of the pregnant woman in the nine months preceding delivery, is at least as important for the well-being of both mother and child as the techniques used in childbirth and postnatal care.

Maschion, a Greek medical writer of the fourth century AD, wrote a work now considered to be the first book on obstetrics. Virtually no progress was made from then until 1513, when Eucharius Rosslin published a book on obstetrics, or midwifery, in Germany.

A Frenchman, Peter Chamberlen (1560-1631), invented the obstetrical forceps to aid delivery of the infant. His invention remained a closely guarded family secret until 1738. It was eventually released and then used by the British surgeon William Smellie (1697-1763). Smellie's practical classes held in London were invaluable in teaching the techniques of obstetrics to medical students.

In the nineteenth century, a more sympathetic attitude to the sufferings of women in labor was developed. J. Y. Simpson (1811-70) introduced chloroform as a general anesthetic to alleviate the patient's pain. Hungarian-born I. P. Semmelweis (1818-65) advocated strict cleanliness in the delivery room in order to decrease the incidence of postnatal puerperal fever. Full aseptic techniques were adopted in obstetrics in the late nineteenth century following the work of Lister, Koch and Pasteur.

Since 1935 the use of sulphanimide drugs has eradicated puerperal fever, which is caused by the streptococcus bacteria. Local anesthetics, which minimize pain while allowing the mother to remain conscious, are now preferred.

Modern Methods

Current antenatal care involves advice on the general health of the expectant mother as well as examinations and tests to monitor the progress of the pregnancy. Weight gain and blood pressure of the woman are carefully recorded throughout pregnancy and urine and blood samples are taken at regular intervals.

Biochemical tests are carried out on these samples. Blood is analyzed to detect the presence of antibodies raised against the Rhesus positive (Rh+) factor. About 85 per cent of people have RH+ blood. If the fetus has the Rhesus negative (Rh-) factor, it will raise antibodies as a defense in cases where the RH+ blood of its mother enters the fetal blood circulation.

The obstetrician also determines the pelvic measurements of the pregnant woman to ensure that the birth canal will be sufficiently large. He routinely ascertains the position of the foetus in the uterus, which is particularly important towards the end of the pregnancy.

In addition, the obstetrician may use special tests, such as an ultrasound scan, to confirm the age of the fetus and the condition of the placenta. All these measures are designed to promote the health and development of mother and child and to prevent abnormalities occurring.

The obstetrician delivers the child during labor, which consists of three stages. Firstly the involuntary uterine contractions dilate or open the cervix. Secondly, the baby passes through the birth canal and is born, usually head first. Finally the placenta is expelled from the uterus.

Some women have a natural childbirth during which no drugs or instruments are used. In many cases sedatives and pain relieving drugs may be administered to alleviate the stress of strong uterine contractions. Birth-inducing drugs are sometimes given when the baby is overdue by more than a few days. The obstetrician may perform a Cesarean section, removing the baby directly through the walls of the uterus and abdomen, for a number of reasons including inadequate size of the mother's pelvis.

The obstetrician also supervises care of the woman during the puerperium, a period of six to eight weeks following delivery. During that time, the uterus shrinks back to normal size. In addition the obstetrician is called upon to treat a number of conditions related to the functioning of the female reproductive organs.

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