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Taking the expectant mother’s blood pressure. This photograph is from a highly illustrated guide which aimed to provide ‘mothers and fathers’ with ‘accurate, scientific information concerning childbirth’. The first section, on the prenatal period, strongly emphasized the importance of medical supervision. The author, who had written a popular nursing textbook, explained: ‘Having a baby is a natural process, but pregnancy makes many additional demands on the mother’s body; and the only way to determine the mother’s physical status and her ability to meet these demands is through the examination made by the doctor’.
Photograph by Percy Byron from Louse Zabriskie, Mother and baby care in pictures, 4th edition, Philadelphia: J. B. Lippincott Company, 1953, fig. 2, p. 3. 23.5 x 16 cm.
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The obstetric patient. Women had once been the ultimate authorities on their own pregnancies; now obstetricians possessed critical knowledge and the power to make decisions. Popular books had long advised pregnant readers on diet, exercise and relaxation; from the 1950s they were also prepared for a string of medical encounters. Some, such as hormonal tests and blood-pressure measurement were simple, but others uncomfortable, occasionally painful and even dangerous. Radiography, for instance, required emptying the bowels with castor oil and immobilizing the fetus with a band around the mother. She had to lie on her back while carbonic gas was pumped into her abdomen. By the 1960s pressure-groups were campaigning for more woman-centred treatment in an increasingly high-tech field. But to some degree most women and doctors shared trust in the benefits of medical surveillance.
Seeing the fetal skeleton
In the early to mid-twentieth century, X-rays were widely used to predict a difficult labour.
Announced to the world in early 1896, Wilhelm Roentgen’s X-rays were the most sensational invention in what has become the major field of medical imaging. By 1897, obstetricians had X-rayed the female pelvis. They saw fetal parts by the twelfth week of pregnancy and constructed maps of the forming bones. Yet by the mid-twentieth century radiography of fetal development had been largely abandoned. While X-rays were still occasionally used to diagnose dangerous cases of pregnancy outside the uterus, fetal death and abnormalities, obstetricians concentrated on more effective control of labour.
Between the 1920s and 1950s, obstetricians studied the shapes and sizes of pelves, compared them with fetal heads, and predicted fetal presentation and position. Palpation was now supplemented with the supposedly more objective method of tracing, from radiograms, an outline of the pelvic bones and fetal head to estimate whether the head would fit through the pelvis. Yet the use of X-rays was tainted with danger. After Hiroshima and Nagasaki, the mutagenic effects came under much closer scrutiny. The final blow was a 1956 study by an Oxford team led by Alice Stewart that found an increased incidence of childhood cancer following in utero irradiation.
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Pelvimetric charts. These charts were used to predict difficulties in childbirth. The outlines of the pelvis at its widest (the brim), left, and narrowest, right, are superimposed on an ellipse with diameters in the ratio 9:10, representing the flexed and slightly moulded fetal head in labour. Poor maternal diet was a significant obstetric concern: figure 89 shows the pelvic disproportion in a woman affected by rickets. The caption to figure 90 indicates the range of obstetric problems and solutions. The first labour resulted in fetal death by craniotomy, but three more were succeeded by Caesarean section.
From Francis James Browne, Antenatal and postnatal care, 6th edition, London: Churchill, 1946, p. 607, figs 89 and 90. 21 x 14 cm.
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Charts of pelvic dimensions and shapes, 1946
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| Obstetric roentgenology. This X-ray of a pregnant abdomen, with a caption referring to placental location, fetal position and bone maturation, summarizes the kind of information obstetricians sought to obtain. It comes from an American textbook that promised to marshal the experience of 2,500 clinical cases into a comprehensive and innovative guide for obstetricians using X-rays. But while in the 1920s it had been suggested that each obstetric clinic should have an expert radiographer, by the time of the textbook’s publication attitudes towards ionising radiation had become more cautious and obstetricians had already begun to abandon X-rays.
From Robert Berman, Obstetrical roentgenology, Philadelphia: F. A. Davis Company, 1955, p. 269, fig. 10.13. 25 x 18 cm.
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A textbook of obstetric roentgenology, 1955
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