Жүктілік және босандыру саласы

Medical specialty concerning pregnancy and childbirth
the medical specialty

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

Prenatal care is important in screening for various complications of pregnancy. This includes routine office visits with physical exams and routine lab tests along with telehealth care for women with low risk pregnancies:

The World Health Organization makes a distinction between the use of postpartum care when it concerns the care of the mother after giving birth, and postnatal care when the care of the newborn is concerned. Postpartum care is provided to the mother following childbirth. A woman in the Western world who gives birth in a hospital may leave the hospital as soon as she is medically stable, and chooses to leave, which can be as early as a few hours later, but usually averages a stay of one or two days; the average postnatal stay following delivery by caesarean section is three to four days. During this time the mother is monitored for bleeding, bowel and bladder function, and baby care. The infant's health is also monitored.

Prior to the 18th century, caring for pregnant women in Europe was confined exclusively to women, and rigorously excluded men. The expectant mother would invite close female friends and family members to her home to keep her company during childbirth. Skilled midwives managed all aspects of the labour and delivery. The presence of physicians and surgeons was very rare and only occurred if a serious complication had taken place and the midwife had exhausted all measures at her disposal. Calling a surgeon was very much a last resort and having men deliver women in this era was seen as offending female modesty.

Prior to the 18th and 19th centuries, midwifery was well established but obstetrics was not recognized as a specific medical specialty. However, the subject matter and interest in the female reproductive system and sexual practice can be traced back to Ancient Egypt and Ancient Greece. Soranus of Ephesus sometimes is called the most important figure in ancient gynecology. By the end of the century, medical professionals began to understand the anatomy of the uterus and the physiological changes that take place during labour. The introduction of forceps in childbirth also took place at this time. All these medical advances in obstetrics were a lever for the introduction of men into an arena previously managed and run by women – midwifery. In the 18th century medical men began to train in area of childbirth and believed with their advanced knowledge in anatomy that childbirth could be improved. In France these male midwives were referred to as accoucheurs, a title later used all over Europe. The founding of lying in hospitals also contributed to the medicalization and male dominance of obstetrics. These early maternity hospitals were establishments where women would come to have their babies delivered, as opposed to the practice since time immemorial of the midwife attending the home of the woman in labour. This institution provided male midwives with endless patients to practice their techniques on and was a way for these men to demonstrate their knowledge. Many midwives of the time bitterly opposed the involvement of men in childbirth. Some male practitioners also opposed the involvement of medical men like themselves in midwifery and even went as far as to say that male midwives only undertook midwifery solely for perverse erotic satisfaction. The accoucheurs argued that their involvement in midwifery was to improve the process of childbirth. These men also believed that obstetrics would forge ahead and continue to strengthen. The 19th century marked an era of medical reform in Europe and increased regulation over the profession. Major European institutions such as The College of Physicians and Surgeons considered delivering babies ungentlemanly work and refused to have anything to do with childbirth as a whole. Even when Medical Act 1858 was introduced, which stated that medical students could qualify as doctors, midwifery was entirely ignored. This made it nearly impossible to pursue an education in midwifery and also have the recognition of being a doctor or surgeon. Obstetrics was pushed to the side. Many European countries by the late 19th century were monitoring the training of midwives and issued certification based on competency. Midwives were no longer uneducated in the formal sense. As midwifery began to develop, so did the profession of obstetrics near the end of the century. Childbirth was no longer unjustifiably despised by the medical community as it once had been at the beginning of the century. But obstetrics was underdeveloped compared to other medical specialities. Many male physicians would deliver children but very few would have referred to themselves as obstetricians. The end of the 19th century did mark a significant accomplishment in the profession with the advancements in asepsis and anaesthesia, which paved the way for the mainstream introduction and later success of the Caesarean section. Before the 1880s mortality rates in lying hospitals would reach unacceptably high levels and became an area of public concern. Much of these maternal deaths were due to puerperal fever, then known as childbed fever. In the 1800s Ignaz Semmelweis noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth by physicians in lying hospitals. His investigation discovered that washing hands with an antiseptic solution before a delivery reduced childbed fever fatalities by 90%. So it was concluded that it was physicians who had been spreading disease from one labouring mother to the next. Despite the publication of this information, doctors still would not wash. It was not until the 20th century when advancements in aseptic technique and the understanding of disease would play a significant role in the decrease of maternal mortality rates among many populations.

The development of obstetrics as a practice for accredited doctors happened at the turn of the 18th century and thus was very differently developed in Europe and in the Americas due to the independence of many countries in the Americas from European powers. "Unlike in Europe and the British Isles, where midwifery laws were national, in America, midwifery laws were local and varied widely". Gynaecology and Obstetrics gained attention in the American medical field at the end of the nineteenth century through the development of such procedures as the ovariotomy. These procedures then were shared with European surgeons who replicated the surgeries. This was a period when antiseptic, aseptic or anaesthetic measures were just being introduced to surgical and observational procedures and without these procedures surgeries were dangerous and often fatal. Following are two surgeons noted for their contributions to these fields include Ephraim McDowell and J. Marion Sims. Ephraim McDowell developed a surgical practice in 1795 and performed the first ovariotomy in 1809 on a 47 year old widow who then lived on for 31 more years. He had attempted to share this with John Bell whom he had practiced under who had retired to Italy. Bell was said to have died without seeing the document but it was published by an associate in Extractions of Diseased Ovaria in 1825. By the mid century the surgery was both successfully and unsuccessfully being performed. Pennsylvanian surgeons the Attlee brothers made this procedure very routine for a total of 465 surgeries – John Attlee performed 64 successfully of 78 while his brother William reported 387 – between the years of 1843 and 1883. By the middle of the nineteenth century this procedure was successfully performed in Europe by English surgeons Sir Spencer Wells and Charles Clay as well as French surgeons Eugène Koeberlé, Auguste Nélaton and Jules Péan. These women were the first patients of modern gynecology. One of the women he operated on was named Anarcha Westcott, the woman he first treated for a fistula. The role of a physician was exclusively held by men who went to university, an overly male institution, who would theorize anatomy and the process of reproduction based on theological teaching and philosophy. Many beliefs about the female body and menstruation in the 17th and 18th centuries were inaccurate; clearly resulting from the lack of literature about the practice. During the birth of a child, men were rarely present. Women from the neighbourhood or family would join in on the process of birth and assist in many different ways. The one position where men would help with the birth of a child would be in the sitting position, usually when performed on the side of a bed to support the mother. Gynaecology directly resulted as a new and separate field of study from obstetrics and focused on the curing of illness and indispositions of female sexual organs. This had some relevance to some conditions as menopause, uterine and cervical problems, and childbirth could leave the mother in need of extensive surgery to repair tissue. But, there was also a large blame of the uterus for completely unrelated conditions. This led to many social consequences of the nineteenth century.