Obstetrics#19th century

Prenatal care is important in screening for various complications of pregnancy.{{cite book | vauthors = Tulchinsky TH, Varavikova EA | chapter = Chapter 6 - Family Health | title = The new public health. | publisher = Academic Press | date = March 2014 | pages = 311–379 | edition = Third | doi = 10.1016/B978-0-12-415766-8.00006-9 | isbn = 978-0-12-415766-8 }} This includes routine office visits with physical exams and routine lab tests along with telehealth care for women with low-risk pregnancies:{{Cite journal |last1=Cantor |first1=Amy G. |last2=Jungbauer |first2=Rebecca M. |last3=Totten |first3=Annette M. |last4=Tilden |first4=Ellen L. |last5=Holmes |first5=Rebecca |last6=Ahmed |first6=Azrah |last7=Wagner |first7=Jesse |last8=Hermesch |first8=Amy C. |last9=McDonagh |first9=Marian S. |date=2022 |title=Telehealth Strategies for the Delivery of Maternal Health Care: A Rapid Review |url=https://www.acpjournals.org/doi/10.7326/M22-0737 |journal=Annals of Internal Medicine |language=en |volume=175 |issue=9 |pages=1285–1297 |doi=10.7326/M22-0737 |pmid=35878405 |s2cid=251067668 |issn=0003-4819}}

Image:Ultrasound_image_of_a_fetus.jpg|3D ultrasound of {{convert|3|in|mm|adj=on}} fetus (about 14 weeks gestational age)

Image:Sucking his thumb and waving.jpg|Fetus at 17 weeks

Image:3dultrasound 20 weeks.jpg|Fetus at 20 weeks

Routine tests in the first trimester of pregnancy generally include:

• Complete blood count
• Blood type
• Rh-negative antenatal patients should receive RhoGAM at 28 weeks to prevent Rh disease.
• Indirect Coombs test (AGT) to assess risk of hemolytic disease of the newborn{{Cite web | vauthors = Rath L |title=What Is a Coombs Test? |url=https://www.webmd.com/a-to-z-guides/antibody-coombs-test |access-date=2022-04-29 |website=WebMD |language=en}}
• Rapid plasma reagin test to screen for syphilis
• Rubella antibody screen{{Cite web | vauthors = Rath L |title=Why Do I Need a Rubella Test? |url=https://www.webmd.com/a-to-z-guides/rubella-test-antibodies |access-date=2022-04-29 |website=WebMD |language=en}}
• HBsAg test to screen for hepatitis B{{Cite journal|date=2021-04-03 | vauthors = Mekaroonkamol P, Hashemi N | veditors = Staros EB |title=Hepatitis B Test: Reference Range, Interpretation, Collection and Panels |url=https://emedicine.medscape.com/article/2109144-overview | journal = Medscape }}
• Testing for chlamydia (and gonorrhea when indicated{{cite journal | vauthors = Fontenot HB, George ER | title = Sexually transmitted infections in pregnancy | journal = Nursing for Women's Health | volume = 18 | issue = 1 | pages = 67–72 | date = 2014 | pmid = 24548498 | doi = 10.1111/1751-486X.12095 }}
• Mantoux test for tuberculosis{{Cite web |last=CDCTB |date=2020-12-16 |title=Tuberculosis (TB) Fact Sheets- Tuberculin Skin Testing |url=https://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm |access-date=2022-04-29 |website=Centers for Disease Control and Prevention |language=en-us}}
• Urinalysis and culture{{Cite web |title=Urinalysis: What It Is, Purpose, Types & Results |url=https://my.clevelandclinic.org/health/diagnostics/17893-urinalysis |access-date=2022-04-29 |website=Cleveland Clinic}}
• HIV screen

Genetic screening for Down syndrome (trisomy 21) and Edwards syndrome (trisomy 18), the national standard in the United States, is rapidly evolving away from the AFP-quad screen, done typically in the second trimester at 16–18 weeks.{{cite journal | vauthors = Cereda A, Carey JC | title = The trisomy 18 syndrome | journal = Orphanet Journal of Rare Diseases | volume = 7 | pages = 81 | date = October 2012 | pmid = 23088440 | pmc = 3520824 | doi = 10.1186/1750-1172-7-81 | doi-access = free }} The newer integrated screen (formerly called F.A.S.T.E.R for First And Second Trimester Early Results) can be done at 10 plus weeks to 13 plus weeks with an ultrasound of the fetal neck (thicker nuchal skin correlates with higher risk of Down syndrome being present) and two chemicals (analytes), pregnancy-associated plasma protein A and human chorionic gonadotropin (pregnancy hormone level itself{{cite journal | vauthors = Malone FD, Canick JA, Ball RH, Nyberg DA, Comstock CH, Bukowski R, Berkowitz RL, Gross SJ, Dugoff L, Craigo SD, Timor-Tritsch IE, Carr SR, Wolfe HM, Dukes K, Bianchi DW, Rudnicka AR, Hackshaw AK, Lambert-Messerlian G, Wald NJ, D'Alton ME | display-authors = 6 | title = First-trimester or second-trimester screening, or both, for Down's syndrome | journal = The New England Journal of Medicine | volume = 353 | issue = 19 | pages = 2001–2011 | date = November 2005 | pmid = 16282175 | doi = 10.1056/NEJMoa043693 | doi-access = free }}). It gives an accurate risk profile very early. A second blood screen at 15 to 20 weeks refines the risk more accurately.{{Cite web |date=2021-08-08 |title=Common Tests During Pregnancy |url=https://www.hopkinsmedicine.org/health/wellness-and-prevention/common-tests-during-pregnancy |access-date=2022-04-29 |website=www.hopkinsmedicine.org |language=en}} The cost is higher than an "AFP-quad" screen due to the ultrasound and second blood test, but it is quoted to have a 93% pick up rate as opposed to 88% for the standard AFP/QS. This is an evolving standard of care in the United States.{{cite journal | vauthors = Carlson LM, Vora NL | title = Prenatal Diagnosis: Screening and Diagnostic Tools | journal = Obstetrics and Gynecology Clinics of North America | volume = 44 | issue = 2 | pages = 245–256 | date = June 2017 | pmid = 28499534 | pmc = 5548328 | doi = 10.1016/j.ogc.2017.02.004 }}{{cite journal | vauthors = Zhang W, Mohammadi T, Sou J, Anis AH | title = Cost-effectiveness of prenatal screening and diagnostic strategies for Down syndrome: A microsimulation modeling analysis | journal = PLOS ONE | volume = 14 | issue = 12 | pages = e0225281 | date = 2019 | pmid = 31800591 | pmc = 6892535 | doi = 10.1371/journal.pone.0225281 | doi-access = free | bibcode = 2019PLoSO..1425281Z }}{{Cite web |date=2021-08-08 |title=Common Tests During Pregnancy |url=https://www.hopkinsmedicine.org/health/wellness-and-prevention/common-tests-during-pregnancy |access-date=2022-04-28 |website=www.hopkinsmedicine.org |language=en}}

File:Down Syndrome karyotype.png

• MSAFP/quad. screen (four simultaneous blood tests) (maternal serum AFP, inhibin A, estriol, and βHCG) – elevations, low numbers or odd patterns correlate with neural tube defect risk and increased risks of trisomy 18 or trisomy 21{{Cite web |title=Quad screen - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/quad-screen/about/pac-20394911 |access-date=2022-04-29 |website=www.mayoclinic.org}}
• Ultrasound either abdominal or transvaginal to assess cervix, placenta, fluid and baby{{Cite web |title=Prenatal Ultrasound Procedure Information |url=https://my.clevelandclinic.org/health/diagnostics/9704-pregnancy-prenatal-ultrasonography |access-date=2022-04-29 |website=Cleveland Clinic}}
• Amniocentesis is the national standard for women over 35 or who reach 35 by mid pregnancy or who are at increased risk by family history or prior birth history.

• Hematocrit (if low, the mother receives iron supplements){{Cite web | vauthors = Uscher J |title=Anemia in Pregnancy: Causes, Symptoms, and Treatment |url=https://www.webmd.com/baby/guide/anemia-in-pregnancy |access-date=2022-04-29 |website=WebMD |language=en}}
• Group B Streptococcus screen. If positive, the woman receives IV penicillin or ampicillin while in labor—or, if she is allergic to penicillin, an alternative therapy, such as IV clindamycin or IV vancomycin.
• Glucose loading test (GLT) – screens for gestational diabetes; if > 140 mg/dL, a glucose tolerance test (GTT) is administered; a fasting glucose > 105 mg/dL suggests gestational diabetes.{{Cite web |title=Glucose challenge test - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/glucose-challenge-test/about/pac-20394277 |access-date=2022-04-29 |website=www.mayoclinic.org |language=en}}

Most doctors do a sugar load in a drink form of 50 grams of glucose in cola, lime or orange and draw blood an hour later (plus or minus 5 minutes). The standard modified criteria have been lowered to 135 since the late 1980s.{{Cite web |title=Glucose tolerance test - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/glucose-tolerance-test/about/pac-20394296 |access-date=2022-04-29 |website=www.mayoclinic.org |language=en}}

File:Ultrasonography of abdominal pregnancy.jpg

Image:Scan12weeks.jpg at 12 weeks]]

Obstetric ultrasonography is routinely used for dating the gestational age of a pregnancy from the size of the fetus, determine the number of fetuses and placentae, evaluate for an ectopic pregnancy and first trimester bleeding, the most accurate dating being in first trimester before the growth of the foetus has been significantly influenced by other factors.{{Cite journal | vauthors = Kansky C, Ramus RM |date=2021-06-15 | veditors = Pierce Jr JG |title=Basic Obstetric Ultrasound: Background, Indications, Contraindications |url=https://emedicine.medscape.com/article/2047305-overview | journal = Medscape }} Ultrasound is also used for detecting congenital anomalies (or other foetal anomalies) and determining the biophysical profiles (BPP), which are generally easier to detect in the second trimester when the foetal structures are larger and more developed.{{cite book | vauthors = DeFrancesco V | chapter = Perinatology. | title = Clinical Engineering Handbook | date = January 2004 | pages = 410–416 | publisher = Academic Press| doi = 10.1016/B978-012226570-9/50102-2 | isbn = 978-0-12-226570-9 }}

X-rays and computerized tomography (CT) are not used, especially in the first trimester, due to the ionizing radiation, which has teratogenic effects on the foetus.{{cite journal | vauthors = Shaw P, Duncan A, Vouyouka A, Ozsvath K | title = Radiation exposure and pregnancy | journal = Journal of Vascular Surgery | volume = 53 | issue = 1 Suppl | pages = 28S–34S | date = January 2011 | pmid = 20869193 | doi = 10.1016/j.jvs.2010.05.140 | series = Radiation Safety in Vascular Surgery | doi-access = free }} No effects of magnetic resonance imaging (MRI) on the foetus have been demonstrated,{{cite journal | vauthors = Alorainy IA, Albadr FB, Abujamea AH | title = Attitude towards MRI safety during pregnancy | journal = Annals of Saudi Medicine | volume = 26 | issue = 4 | pages = 306–309 | year = 2006 | pmid = 16885635 | pmc = 6074503 | doi = 10.5144/0256-4947.2006.306 }} but this technique is too expensive for routine observation. Instead, obstetric ultrasonography is the imaging method of choice in the first trimester and throughout the pregnancy, because it emits no radiation, is portable, and allows for realtime imaging.{{cite book | vauthors = Herbst MK, Tafti D, Shanahan MM | chapter =Obstetric Ultrasound |date=2022 | chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK470450/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29261880 |access-date=2022-04-29 }}

The safety of frequent ultrasound scanning has not been confirmed. Despite this, increasing numbers of women are choosing to have additional scans for no medical purpose, such as gender scans, 3D and 4D scans.{{cite journal | vauthors = Edvardsson K, Small R, Persson M, Lalos A, Mogren I | title = 'Ultrasound is an invaluable third eye, but it can't see everything': a qualitative study with obstetricians in Australia | journal = BMC Pregnancy and Childbirth | volume = 14 | issue = 1 | pages = 363 | date = October 2014 | pmid = 25336335 | pmc = 4287579 | doi = 10.1186/1471-2393-14-363 | doi-access = free }} A normal gestation would reveal a gestational sac, yolk sac, and fetal pole.{{cite book | chapter = Obstetric Imaging | veditors = Weissleder R, Harisinghani MG, Wittenberg J, Chen JW |title=Primer of Diagnostic Imagin |date=2011 | pages = 533–574 |publisher=Mosby |location=St. Louis, Mo. |isbn=978-0-323-06538-2 |edition=5th | doi = 10.1016/B978-0-323-06538-2.00010-X }}

The gestational age can be assessed by evaluating the mean gestational sac diameter (MGD) before week 6, and the crown-rump length after week 6. Multiple gestation is evaluated by the number of placentae and amniotic sacs present.{{Cite web | vauthors = Khan AN, Sabih D, Sabih A |date=2021-04-26 |title=Early Pregnancy Loss (Embryonic Demise) Imaging: Practice Essentials, Ultrasonography |url=https://emedicine.medscape.com/article/403208-overview}}

Other tools used for assessment include:

• Fetal screening is used to help assess the viability of the fetus, as well as congenital abnormalities.{{Cite journal | vauthors = Marino T | veditors = Ramus RM |date=2021-06-14 |title=Prenatal Diagnosis for Congenital Malformations and Genetic Disorders: Practice Essentials, Noninvasive Techniques, Invasive Techniques |url=https://emedicine.medscape.com/article/1200683-overview | journal = Medscape }}
• Fetal karyotype can be used for the screening of genetic diseases. This can be obtained via amniocentesis or chorionic villus sampling (CVS{{Cite web |title=Chorionic villus sampling - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/chorionic-villus-sampling/about/pac-20393533 |access-date=2022-04-29 |website=www.mayoclinic.org}})
• Foetal haematocrit for the assessment of foetal anemia, Rh isoimmunization, or hydrops can be determined by percutaneous umbilical blood sampling (PUBS), which is done by placing a needle through the abdomen into the uterus and taking a portion of the umbilical cord.{{cite book | vauthors = Gomella TL, Cunningham MD, Eyal FG, Tuttle DJ |title=Fetal Assessment |date=2013 |url=http://accesspediatrics.mhmedical.com/content.aspx?aid=1107523894 |work=Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs |edition=7 |place=New York, NY |publisher=McGraw-Hill Education |access-date=2022-04-29 }}
• Fetal lung maturity is associated with how much surfactant the fetus is producing. Reduced production of surfactant indicates decreased lung maturity and is a high risk factor for infant respiratory distress syndrome.{{cite book | vauthors = Jobe AH | chapter = Fetal lung maturation and the respiratory distress syndrome. | title = Fetal Physiology and Medicine | edition = Second | date = January 1984 | pages = 317–351 | publisher = Butterworth-Heinemann | doi = 10.1016/B978-0-407-00366-8.50016-2 | isbn = 978-0-407-00366-8 }} Typically a lecithin:sphingomyelin ratio greater than 1.5 is associated with increased lung maturity.
• Nonstress test (NST) for fetal heart rate{{Cite web |title=Nonstress test - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/nonstress-test/about/pac-20384577 |access-date=2022-04-29 |website=www.mayoclinic.org}}
• Oxytocin challenge test

{{Further|Pre-existing disease in pregnancy}}

A pregnant woman may have a pre-existing disease, that may become worse or become a risk to the pregnancy, or to postnatal development of the offspring{{Cite web | vauthors = Dunkin MA |title=High-Risk Pregnancies: Symptoms, Doctors, Support, and More |url=https://www.webmd.com/baby/managing-a-high-risk-pregnancy |access-date=2022-04-29 |website=WebMD |language=en}}

• Diabetes mellitus and pregnancy deals with the interactions of diabetes mellitus (not restricted to gestational diabetes) and pregnancy.{{Cite journal | vauthors = Moore T |date=2022-04-06 | veditors = Griffing GT |title=Diabetes Mellitus and Pregnancy: Practice Essentials, Gestational Diabetes, Maternal-Fetal Metabolism in Normal Pregnancy |url=https://emedicine.medscape.com/article/127547-overview | journal = Medscape }} Risks for the child include miscarriage, growth restriction, growth acceleration, foetal obesity (macrosomia), polyhydramnios and birth defects.
• Lupus and pregnancy confers an increased rate of foetal death in utero and spontaneous abortion (miscarriage), as well as of neonatal lupus.{{Cite journal|date=2021-10-16 | vauthors = Khurana R, Wolf RE | veditors = Talavera F, Singh AK |title=Systemic Lupus Erythematosus and Pregnancy: Practice Essentials, Pathophysiology, Epidemiology |url=https://emedicine.medscape.com/article/335055-overview | journal = Medscape }}
• Thyroid disease in pregnancy can, if uncorrected, cause adverse effects on foetal and maternal well-being.{{Cite web | vauthors = Friel LA |title=Thyroid Disorders in Pregnancy - Gynecology and Obstetrics |url=https://www.msdmanuals.com/professional/gynecology-and-obstetrics/pregnancy-complicated-by-disease/thyroid-disorders-in-pregnancy |access-date=2022-04-29 |website=MSD Manual Professional Edition |language=en}} The deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neurointellectual development in the early life of the child.{{cite journal | vauthors = Alemu A, Terefe B, Abebe M, Biadgo B | title = Thyroid hormone dysfunction during pregnancy: A review | journal = International Journal of Reproductive Biomedicine | volume = 14 | issue = 11 | pages = 677–686 | date = November 2016 | pmid = 27981252 | pmc = 5153572 }} Demand for thyroid hormones is increased during pregnancy, and may cause a previously unnoticed thyroid disorder to worsen.{{cn|date=August 2023}}
• Hypercoagulability in pregnancy is the propensity of pregnant women to develop thrombosis (blood {{cite journal | vauthors = Nichols KM, Henkin S, Creager MA | title = Venous Thromboembolism Associated With Pregnancy: JACC Focus Seminar | journal = Journal of the American College of Cardiology | volume = 76 | issue = 18 | pages = 2128–2141 | date = November 2020 | pmid = 33121721 | doi = 10.1016/j.jacc.2020.06.090 | s2cid = 226205234 | doi-access = free }} clots). Pregnancy itself is a factor of hypercoagulability (pregnancy-induced hypercoagulability), as a physiologically adaptive mechanism to prevent post partum bleeding. However, when combined with an additional underlying hypercoagulable states, the risk of thrombosis or embolism may become substantial.Page 264 in: {{cite book | vauthors = Gresele P |title=Platelets in haematologic and cardiovascular disorders: a clinical handbook |publisher=Cambridge University Press |location=Cambridge, UK |year=2008 |isbn=978-0-521-88115-9 }}
• Hyperemesis gravidarum in pregnancy occurs due to extreme, persistent nausea and vomiting during pregnancy.{{Cite web |title=Hyperemesis Gravidarum: Symptoms & Treatment |url=https://my.clevelandclinic.org/health/diseases/12232-hyperemesis-gravidarum-severe-nausea--vomiting-during-pregnancy |access-date=2022-04-30 |website=Cleveland Clinic}} If untreated, can lead to dehydration, weight loss, and electrolyte imbalances. Most women develop nausea and vomiting during the first trimester.{{Cite web |title=Morning sickness - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/morning-sickness/symptoms-causes/syc-20375254 |access-date=2022-04-30 |website=Mayo Clinic |language=en}} The cause of hyperemesis gravidarum is not known. However, it is believed to be caused by a rapidly rising blood level of a hormone, human chorionic gonadotropin (HCG), which is released by the placenta.
• Preeclampsia is a condition that causes high blood pressure during pregnancy. If left untreated, it can be life-threatening.{{Cite web | vauthors = Gaither K | date = 13 December 2019 |title=Preeclampsia |url=https://www.webmd.com/baby/preeclampsia-eclampsia |access-date=2022-04-29 |website=WebMD |language=en}} In pregnant women, preeclampsia may occur after 20 weeks of pregnancy, often in women who have no history of high blood pressure. Symptoms of preeclampsia may include severe headache, vision changes and pain under the ribs.{{Cite web |title=Preeclampsia - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745 |access-date=2022-04-29 |website=Mayo Clinic |language=en}} However, in some women, symptoms may not occur, until they go for a routine prenatal visit.{{Cite web |date=2021-08-08 |title=4 Common Pregnancy Complications |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/staying-healthy-during-pregnancy/4-common-pregnancy-complications |access-date=2022-04-28 |website=www.hopkinsmedicine.org |language=en}}

{{Main|Induction (birth)|Childbirth}}

{{See|Pain management during childbirth}}

Induction is a method of artificially or prematurely stimulating labour in a woman.{{Cite web | author = Healthdirect Australia|date=2022-02-08 |title=Induced labour |url=https://www.pregnancybirthbaby.org.au/induced-labour |access-date=2022-04-29 |website=www.pregnancybirthbaby.org.au |language=en-AU}} Reasons to induce can include pre-eclampsia, foetal distress, placental malfunction, intrauterine growth retardation and failure to progress through labour increasing the risk of infection and foetal distresses.{{Cite thesis | vauthors = Surányim A | degree = Ph.D. |title=Prenatal and postnatal evaluation of foetal renal hyperechogenicity in pregnancies complicated with pre-eclampsia and intrauterine growth retardation | year = 2000 | doi = 10.14232/phd.2154 |publisher=University of Szeged | doi-access = free }}

Induction may be achieved via several methods:

• Disturbance of cervical membranes{{Cite web | vauthors = Moldenhauer JS |title=Prelabor Rupture of the Membranes (PROM) - Women's Health Issues |url=https://www.msdmanuals.com/home/women-s-health-issues/complications-of-labor-and-delivery/prelabor-rupture-of-the-membranes-prom |access-date=2022-04-30 |website=MSD Manual Consumer Version |language=en}}
• Pessary of Prostin cream, prostaglandin E₂{{Cite web |title=Prostin E2 Vaginal: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD |url=https://www.webmd.com/drugs/2/drug-14108/prostin-e2-vaginal/details |access-date=2022-04-30 |website=www.webmd.com |language=en}}
• Intravaginal or oral administration of misoprostol{{cite journal | vauthors = Ho PC, Ngai SW, Liu KL, Wong GC, Lee SW | title = Vaginal misoprostol compared with oral misoprostol in termination of second-trimester pregnancy | journal = Obstetrics and Gynecology | volume = 90 | issue = 5 | pages = 735–738 | date = November 1997 | pmid = 9351755 | doi = 10.1016/S0029-7844(97)00419-5 | s2cid = 21261210 }}
• Cervical insertion of a 30-mL Foley catheter{{cite journal | vauthors = Adeniji OA, Oladokun A, Olayemi O, Adeniji OI, Odukogbe AA, Ogunbode O, Aimakhu CO, Omigbodun AO, Ilesanmi AO | display-authors = 6 | title = Pre-induction cervical ripening: transcervical foley catheter versus intravaginal misoprostol | journal = Journal of Obstetrics and Gynaecology | volume = 25 | issue = 2 | pages = 134–139 | date = February 2005 | pmid = 15814391 | doi = 10.1080/01443610500040737 | s2cid = 24250115 }}
• Rupturing the amniotic membranes{{Cite encyclopedia |title=Premature rupture of membranes | location = Bethesda (MD) | encyclopedia = MedlinePlus Medical Encyclopedia | publisher = U.S. National Library of Medicine |url=https://medlineplus.gov/ency/patientinstructions/000512.htm |access-date=2022-04-30 |language=en}}
• Intravenous infusion of synthetic oxytocin (Pitocin or Syntocinon){{Cite web |title=Oxytocin 10 IU/ml Solution for infusion - Summary of Product Characteristics (SmPC) - (emc) |url=https://www.medicines.org.uk/emc/medicine/30427#gref |access-date=2022-04-30 |website=www.medicines.org.uk}}

During labour, the obstetrician carries out the following tasks:

• Monitor the progress of labour, by reviewing the nursing chart, performing vaginal examination, and assessing the trace produced by a foetal monitoring device (the cardiotocograph){{cite book | vauthors = Prior T, Lees C | chapter = Control and Monitoring of Fetal Growth. | title = Encyclopedia of Endocrine Diseases | date = 2019 | volume = 5 | pages = 1–9 | doi = 10.1016/B978-0-12-801238-3.65414-4 | isbn = 9780128122006 | s2cid = 81797258 }}
• Provide pain relief, either by nitrous oxide, opiates, or by epidural anaesthesia done by anaesthestists, an anaesthesiologist, or a nurse anaesthetist.{{cite journal | vauthors = Lloyd-Thomas AR | title = Pain management in paediatric patients | journal = British Journal of Anaesthesia | volume = 64 | issue = 1 | pages = 85–104 | date = January 1990 | pmid = 2405898 | doi = 10.1093/bja/64.1.85 | doi-access = free }}
• Caesarean section, if there is an associated risk with vaginal delivery, as such foetal or maternal compromise.{{Cite journal | vauthors = Saint Louis H |date=2022-04-14 |title=Cesarean Delivery: Overview, Preparation, Technique |url=https://emedicine.medscape.com/article/263424-overview | journal = Medscape }}

{{Main|Complications of pregnancy}}

The main emergencies include:

• Ectopic pregnancy is when an embryo implants in the uterine (fallopian) tube or (rarely) on the ovary or inside the peritoneal cavity. This may cause massive internal bleeding.{{Cite web |title=Ectopic pregnancy - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088 |access-date=2022-04-30 |website=Mayo Clinic |language=en}}
• Pre-eclampsia is a disease defined by a combination of signs and symptoms that are related to maternal hypertension.{{Cite journal | vauthors = Lim KH, Steinberg G |date=2022-04-13 |title=Preeclampsia: Practice Essentials, Overview, Pathophysiology |url=https://emedicine.medscape.com/article/1476919-overview | journal = Medscape }} The cause is unknown, and markers are being sought to predict its development from the earliest stages of pregnancy.{{Cite web | vauthors = Artal-Mittelmark R |title=Stages of Development of the Fetus - Women's Health Issues |url=https://www.msdmanuals.com/home/women-s-health-issues/normal-pregnancy/stages-of-development-of-the-fetus |access-date=2022-04-30 |website=MSD Manual Consumer Version |language=en}} Some unknown factors cause vascular damage in the endothelium, causing hypertension.{{Cite web |date=2021-11-10 |title=Hypertension: Causes, symptoms, and treatments |url=https://www.medicalnewstoday.com/articles/150109 |access-date=2022-04-30 |website=www.medicalnewstoday.com |language=en}} If severe, it progresses to eclampsia, where seizures occur, which can be fatal.{{Cite journal | vauthors = Seppa N |date=2011-01-20 |title=Body & brain: Uncontrolled epilepsy can be fatal: Study finds more deaths in adults whose seizures persist |journal=Science News |volume=179 |issue=3 |pages=8 |doi=10.1002/scin.5591790305 |issn=0036-8423}} Preeclamptic patients with the HELLP syndrome show liver failure and disseminated intravascular coagulation (DIC).{{cite journal | vauthors = Haram K, Svendsen E, Abildgaard U | title = The HELLP syndrome: clinical issues and management. A Review | journal = BMC Pregnancy and Childbirth | volume = 9 | issue = 1 | pages = 8 | date = February 2009 | pmid = 19245695 | pmc = 2654858 | doi = 10.1186/1471-2393-9-8 | doi-access = free }} The only treatment is to deliver the foetus. Women may still develop pre-eclampsia following delivery.{{Cite web |title=Preeclampsia: Symptoms, Causes, Treatments & Prevention |url=https://my.clevelandclinic.org/health/diseases/17952-preeclampsia |access-date=2022-04-30 |website=Cleveland Clinic}}
• Placental abruption is where the placenta detaches from the uterus and the woman and foetus can bleed to death if not managed appropriately.{{Cite web |title=Placental Abruption: Symptoms, Causes & Effects On Baby |url=https://my.clevelandclinic.org/health/diseases/9435-placental-abruption |access-date=2022-04-30 |website=Cleveland Clinic}}
• Foetal distress where the foetus is getting compromised in the uterine environment.{{Cite web | vauthors = Moldenhauer JS |title=Fetal Distress - Women's Health Issues |url=https://www.msdmanuals.com/home/women-s-health-issues/complications-of-labor-and-delivery/fetal-distress |access-date=2022-04-30 |website=MSD Manual Consumer Version |language=en}}
• Shoulder dystocia where one of the foetus' shoulders becomes stuck during vaginal birth. There are many risk factors, including macrosmic (large) foetus, but many are also unexplained.{{Cite web |title=Shoulder Dystocia: Signs, Causes, Prevention & Complications |url=https://my.clevelandclinic.org/health/diseases/22311-shoulder-dystocia |access-date=2022-04-30 |website=Cleveland Clinic}}
• Uterine rupture can occur during obstructed labour and endanger foetal and maternal life.{{cite journal | vauthors = Astatikie G, Limenih MA, Kebede M | title = Maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture | journal = BMC Pregnancy and Childbirth | volume = 17 | issue = 1 | pages = 117 | date = April 2017 | pmid = 28403833 | pmc = 5389173 | doi = 10.1186/s12884-017-1302-z | doi-access = free }}
• Prolapsed cord can only happen after the membranes have ruptured.{{Cite journal | vauthors = Sims ME |date=2014-01-01 |title=Legal Briefs: Iatrogenesis: Prolapsed Umbilical Cord After Artificial Rupture of the Membranes and Unskilled Stabilization |journal=NeoReviews |volume=15 |issue=1 |pages=e32–e36 |doi=10.1542/neo.15-1-e32 |issn=1526-9906}} The umbilical cord delivers before the presenting part of the foetus. If the foetus is not delivered within minutes, or the pressure taken off the cord, the foetus dies.{{Cite web |title=Umbilical Cord Prolapse: Causes, Diagnosis & Management |url=https://my.clevelandclinic.org/health/diseases/12345-umbilical-cord-prolapse |access-date=2022-04-30 |website=Cleveland Clinic}}
• Obstetrical hemorrhage may be due to a number of factors such as placenta previa, uterine rupture or tears, uterine atony, retained placenta or placental fragments, or bleeding disorders.{{Cite journal | vauthors = Smith JR |date=2022-04-01 |title=Postpartum Hemorrhage: Practice Essentials, Problem, Epidemiology |url=https://emedicine.medscape.com/article/275038-overview | journal = Medscape }}
• Puerperal sepsis is an ascending infection of the genital tract.{{cite journal | vauthors = Demisse GA, Sifer SD, Kedir B, Fekene DB, Bulto GA | title = Determinants of puerperal sepsis among post partum women at public hospitals in west SHOA zone Oromia regional STATE, Ethiopia (institution BASEDCASE control study) | journal = BMC Pregnancy and Childbirth | volume = 19 | issue = 1 | pages = 95 | date = March 2019 | pmid = 30885159 | pmc = 6423770 | doi = 10.1186/s12884-019-2230-x | doi-access = free }} It may happen during or after labour. Signs to look out for include signs of infection (pyrexia or hypothermia, raised heart rate and respiratory rate, reduced blood pressure), and abdominal pain, offensive lochia (blood loss) increased lochia, clots, diarrhea and vomiting.{{cn|date=August 2023}}

{{Further|Postpartum period}}

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.{{cite web |title=WHO Technical Consultation on Postpartum Care |url=https://www.ncbi.nlm.nih.gov/books/NBK310595/ |publisher=World Health Organization |access-date=30 June 2020 |language=en |date=2010}}

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.{{cite journal | vauthors = Jones E, Taylor B, MacArthur C, Pritchett R, Cummins C | title = The effect of early postnatal discharge from hospital for women and infants: a systematic review protocol | journal = Systematic Reviews | volume = 5 | issue = | pages = 24 | date = February 2016 | pmid = 26857705 | pmc = 4746909 | doi = 10.1186/s13643-016-0193-9 | doi-access = free }}

During this time the mother is monitored for bleeding, bowel and bladder function, and baby care. The infant's health is also monitored.{{Cite web |title=Types of Delivery for Pregnancy |url=https://my.clevelandclinic.org/health/articles/9675-pregnancy-types-of-delivery |access-date=2022-04-30 |website=Cleveland Clinic}}

{{main|Veterinary obstetrics}}

File:Eucharius Rößlin Rosgarten Childbirth.jpg assisting a woman in labour on a birthing chair in the 16th century, from a work by Eucharius Rößlin]]

Prior to the 18th century, caring for pregnant women in Europe was confined exclusively to women, and rigorously excluded men.{{cite journal | vauthors = Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H | title = The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review | journal = Reproductive Health | volume = 18 | issue = 1 | pages = 10 | date = January 2021 | pmid = 33461593 | pmc = 7812564 | doi = 10.1186/s12978-021-01070-6 | doi-access = free }} The expectant mother would invite close female friends and family members to her home to keep her company during childbirth.{{cite book | vauthors = Gelis J | title = History of Childbirth | location = Boston | publisher = Northeastern University Press | date = 1991 }}{{rp|96–98}} Skilled midwives managed all aspects of the labour and delivery.{{Cite web | author = Healthdirect Australia |date=2021-05-23 |title=What do midwives do? |url=https://www.pregnancybirthbaby.org.au/the-role-of-your-midwife |access-date=2022-04-30 |website=www.pregnancybirthbaby.org.au |language=en-AU}} 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.{{cite journal | vauthors = Adatara P, Amooba PA, Afaya A, Salia SM, Avane MA, Kuug A, Maalman RS, Atakro CA, Attachie IT, Atachie C | display-authors = 6 | title = Challenges experienced by midwives working in rural communities in the Upper East Region of Ghana: a qualitative study | journal = BMC Pregnancy and Childbirth | volume = 21 | issue = 1 | pages = 287 | date = April 2021 | pmid = 33836689 | pmc = 8033657 | doi = 10.1186/s12884-021-03762-0 | doi-access = free }} Calling a surgeon was very much a last resort and having men deliver women in this era was seen as offending female modesty.{{cite book | veditors = Bynum WF, Porter R | title = Companion Encyclopedia of the History of Medicine. | location = London and New York | publisher = Routledge | date = 1993 }}{{rp|1050–1051}}{{cite web | vauthors = Carr I | title = Some Obstetrical History: Dying to Have a Baby - the History of Childbirth | work = University of Manitoba: Women's Health. | date = May 2000 | access-date = 20 May 2012 | url = http://www.neonatology.org/pdf/dyingtohaveababy.pdf }}

{{See also|Women's medicine in antiquity}}

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{{cite book | vauthors = McGrew RE | title = Encyclopedia of Medical History | location = New York | publisher = McGraw-Hill Book Company | date = 1985 }}{{rp|122}} and Ancient Greece.{{cite book | vauthors = Hufnagel GL | title = A History of Women's Menstruation from Ancient Greece to the Twenty-first Century: Psychological, Social, Medical, Religious, and Educational Issues. | location= Lewiston, New York |publisher=Edwin Mellen Press | date = 2012 }}{{rp|11}} Soranus of Ephesus sometimes is called the most important figure in ancient gynecology. Living in the late first century AD and early second century, he studied anatomy and had opinions and techniques on abortion, contraception – most notably coitus interruptus – and birth complications. After his death, techniques and works of gynecology declined; very little of his works were recorded and survived to the late 18th century when gynecology and obstetrics reemerged as a medical specialism.{{rp|123}}

The 18th century marked the beginning of many advances in European midwifery, based on better knowledge of the physiology of pregnancy and labour.{{Cite web | author = International Confederation of Midwives |date=2022-01-31 |title=The Origins of Midwifery |url=https://www.internationalmidwives.org/icm-news/the-origins-of-midwifery.html |access-date=2022-04-30 |website=ICM |language=en}} 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.{{cite book | vauthors = Gasner A, Aatsha PA | chapter = Physiology, Uterus |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK557575/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491507 |access-date=2022-04-30 }} 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.{{rp|1051–1052}}

The addition of the male-midwife (or man-midwife) is historically a significant change to the profession of obstetrics.{{cite ODNB | vauthors = Rhodes P | chapter = Leake, John (1729–1792), man-midwife |date=2004-09-23 |doi=10.1093/ref:odnb/16239 | title = Oxford Dictionary of National Biography | isbn = 978-0-19-861412-8 }} 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.{{cite journal | vauthors = Aziato L, Omenyo CN | title = Initiation of traditional birth attendants and their traditional and spiritual practices during pregnancy and childbirth in Ghana | journal = BMC Pregnancy and Childbirth | volume = 18 | issue = 1 | pages = 64 | date = March 2018 | pmid = 29514607 | pmc = 5842514 | doi = 10.1186/s12884-018-1691-7 | doi-access = free }} 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.{{cite book | vauthors = Al-Gailani S |title=Reproduction |chapter=Hospital Birth |date=2018 |chapter-url=https://www.cambridge.org/core/books/reproduction/hospital-birth/E333A8D517E0A5B068C0C4EA7A73744A |work=Reproduction: Antiquity to the Present Day |pages=553–566 | veditors = Kassell L, Hopwood N, Flemming R |place=Cambridge |publisher=Cambridge University Press |doi=10.1017/9781107705647.046 |isbn=978-1-107-06802-5 |s2cid=239583227 |access-date=2022-04-30 }} 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.{{cite journal | vauthors = Sialubanje C, Massar K, Hamer DH, Ruiter RA | title = Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study | journal = BMC Pregnancy and Childbirth | volume = 15 | issue = 1 | pages = 216 | date = September 2015 | pmid = 26361976 | pmc = 4567794 | doi = 10.1186/s12884-015-0652-7 | doi-access = free }} This institution provided male-midwives with endless patients to practice their techniques on and was a way for these men to demonstrate their knowledge.{{cite journal | vauthors = Martell LK | title = The hospital and the postpartum experience: a historical analysis | journal = Journal of Obstetric, Gynecologic, and Neonatal Nursing | volume = 29 | issue = 1 | pages = 65–72 | date = 2000 | pmid = 10660278 | doi = 10.1111/j.1552-6909.2000.tb02757.x }}

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.{{rp|1050–1051}}

18th-century physicians expected that obstetrics would continue to grow, but the opposite happened. Obstetrics entered a stage of stagnation in the 19th century, which lasted until about the 1880s.{{rp|96–98}} The central explanation for the lack of advancement during this time was the rejection of obstetrics by the medical community.{{cite journal | vauthors = Aborigo RA, Reidpath DD, Oduro AR, Allotey P | title = Male involvement in maternal health: perspectives of opinion leaders | journal = BMC Pregnancy and Childbirth | volume = 18 | issue = 1 | pages = 3 | date = January 2018 | pmid = 29291711 | pmc = 5749010 | doi = 10.1186/s12884-017-1641-9 | doi-access = free }} 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{{where|date=May 2018}} 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.{{Cite journal |date=1892-09-10 |title= The Midwives' Registration Bill |journal=The Lancet |series=Originally published as Volume 2, Issue 3602 |language=en |volume=140 |issue=3602 |pages=631–634 |doi=10.1016/S0140-6736(01)86961-0 |issn=0140-6736}} 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.{{rp|1053–1055}}

By the late 19th century, the foundation of modern-day obstetrics and midwifery began developing. Delivery of babies by doctors became popular and readily accepted, but midwives continued to play a role in childbirth. Midwifery also changed during this era due to increased regulation and the eventual need for midwives to become certified.{{Cite book | publisher = World Health Organization. | location = Switzerland | title = Midwives voices, midwives realities. Findings from a global consultation on providing quality midwifery care. | year = 1991 | url = https://apps.who.int/iris/bitstream/handle/10665/250376/9789241510547-eng.pdf | isbn = 978-9241510547 }} 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.{{cite journal | vauthors = Drife J | title = The start of life: a history of obstetrics | journal = Postgraduate Medical Journal | volume = 78 | issue = 919 | pages = 311–315 | date = May 2002 | pmid = 12151591 | doi = 10.1136/pmj.78.919.311 | pmc = 1742346 }}.

As midwifery began to develop, so did the profession of obstetrics near the end of the century.{{cite journal | vauthors = Rabinerson D, Horowitz E | title = [The evolution of midwifery] | journal = Harefuah | volume = 146 | issue = 5 | pages = 380–4, 405 | date = May 2007 | pmid = 17674557 | url = https://pubmed.ncbi.nlm.nih.gov/17674557/ }} 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.{{cite journal| vauthors = Low J |title=Caesarean section-past and present|journal=Journal of Obstetrics and Gynecology Canada|volume=31|issue=12|date=2009|pages=1131–1136| doi=10.1016/S1701-2163(16)34373-0 | pmid=20085678 |access-date=May 20, 2012|url=http://www.sogc.org/jogc/abstracts/full/200912_Obstetrics_2.pdf|archive-url=https://web.archive.org/web/20130123154808/http://www.sogc.org/jogc/abstracts/full/200912_Obstetrics_2.pdf |archive-date=January 23, 2013}}

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%.{{cite journal | url=http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html | title=The Childbed Fever Mystery and the Meaning of Medical Journalism | vauthors = Caplan CE | journal=McGill Journal of Medicine | year=1995 | volume=1 | issue=1 | url-status=dead | archive-url=https://web.archive.org/web/20120707205101/http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html | archive-date=2012-07-07 }} 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.{{cn|date=August 2023}}

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".{{cite book | vauthors = Roth J | title = Pregnancy & Birth: The History of Childbearing Choices in the United States. | publisher = Human Service Solutions | url = http://www.ourbodiesourselves.org/ }}

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.{{cite book | vauthors = Baskett TF | chapter = Houstoun, Robert (1678–1734) |date= 29 March 2019 |doi = 10.1017/9781108421706.154 | isbn = 978-1-108-33671-0 | title = Eponyms and Names in Obstetrics and Gynaecology |pages=194 |publisher=Cambridge University Press }} 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.{{cite journal | vauthors = Lavers A, Yip WS, Sunderland B, Parsons R, Mackenzie S, Seet J, Czarniak P | title = Surgical antibiotic prophylaxis use and infection prevalence in non-cosmetic breast surgery procedures at a tertiary hospital in Western Australia-a retrospective study | journal = PeerJ | volume = 6 | issue = | pages = e5724 | date = 2018 | pmid = 30386692 | pmc = 6202972 | doi = 10.7717/peerj.5724 | quote = Table 2: Types of procedures and association with surgical site infections (SSI). P-values were obtained from Fisher's Exact test, unless otherwise specified. | doi-access = free }} Following are two surgeons noted for their contributions to these fields include Ephraim McDowell and J. Marion Sims.{{cite journal | vauthors = Vernon LF | title = J. Marion Sims, MD: Why He and His Accomplishments Need to Continue to be Recognized a Commentary and Historical Review | journal = Journal of the National Medical Association | volume = 111 | issue = 4 | pages = 436–446 | date = August 2019 | pmid = 30851980 | doi = 10.1016/j.jnma.2019.02.002 | s2cid = 73725863 | doi-access = free }}

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.{{cite journal | vauthors = Rutkow IM | title = Ephraim McDowell and the world's first successful ovariotomy | journal = Archives of Surgery | volume = 134 | issue = 8 | pages = 902 | date = August 1999 | pmid = 10443816 | doi = 10.1001/archsurg.134.8.902 }} 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.{{Cite journal |date= January 2016 |title=Iceman Ötzi may have had tummy trouble when he died |journal=New Scientist |volume=229 |issue=3056 |pages=17 |doi=10.1016/s0262-4079(16)30115-4 |bibcode=2016NewSc.229...17. |issn=0262-4079}} 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.{{Cite journal | vauthors = Sieber WK |date= September 1970 |title=Total prosthetic transplantation of the inferior vena cava, with venous drainage restoration of the one remaining kidney on the graft, successfully performed on a child with Wilms' tumor |journal=Journal of Pediatric Surgery |volume=5 |issue=6 |pages=694–695 |doi=10.1016/s0022-3468(70)80085-9 |issn=0022-3468}} 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.{{rp|125}}

J. Marion Sims was the surgeon responsible for being the first treating a vesicovaginal fistula{{rp|125}} – a condition linked to many caused mainly by prolonged pressing of the foetus against the pelvis or other causes such as rape, hysterectomy, or other operations – and also having been doctor to many European royals and the 20th President of the United States James A. Garfield after he had been shot. Sims does have a controversial medical past. Under the beliefs at the time about pain and the prejudice towards African people, he had practiced his surgical skills and developed skills on slaves.{{cite web | work = International Wellness Foundation. | title = Dr. J Marion Sims: The Father of Modern Gynecology. | date = 12 February 2014 | url = https://wellnessjourneys.org/2017/12/05/dr-j-marion-sims/ }} 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.

Women and men inhabited very different roles in natal care up to the 18th century.{{cite book | chapter = Gender: A Historical Perspective

| vauthors = Giuliano P | veditors = Averett SL, Argys LM, Hoffman SD | title = The Oxford Handbook of Women and the Economy. | publisher = Oxford University Press | date = May 2018 | doi = 10.1093/oxfordhb/9780190628963.013.29 | doi-access = free }} 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.{{rp|123–125}} Many of the theories of what caused menstruation prevailed from Hippocratic philosophy.{{rp|16}} Midwives, meaning "with woman", were those who assisted in the birth and care of both born and unborn children, a position historically held mainly by women.{{cite journal | vauthors = O'Malley-Keighran MP, Lohan G | title = Encourages and guides, or diagnoses and monitors: Woman centred-ness in the discourse of professional midwifery bodies | journal = Midwifery | volume = 43 | pages = 48–58 | date = December 2016 | pmid = 27846406 | doi = 10.1016/j.midw.2016.10.007 }}

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.{{Cite web |title=Situation of women and children in Nigeria |url=https://www.unicef.org/nigeria/situation-women-and-children-nigeria |access-date=2022-04-30 |website=www.unicef.org |language=en}} 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.{{rp|130}}

Men entered the field of obstetrics in the nineteenth century, resulting in a change of focus within the profession.{{cite book | vauthors = Bäcklund I | veditors = Kytö M, Rydén M, Smitterberg E |chapter = Modifiers describing women and men in nineteenth-century English | doi = 10.1017/cbo9780511486944.002 | title =Nineteenth-Century English | year = 2006 |pages=17–55 |place=Cambridge |publisher=Cambridge University Press | isbn = 9780511486944 }} Gynecology developed as a new and separate field of study from obstetrics, focusing on the curing of illness and indispositions of female sexual organs,{{cite book | vauthors = Adaikan G |editor1-first=Sabaratnam |editor1-last=Arulkumaran |editor2-first=William |editor2-last=Ledger |editor3-first=Lynette |editor3-last=Denny |editor4-first=Stergios |editor4-last=Doumouchtsis |chapter=Female sexual dysfunction |date= January 2020 | doi = 10.1093/med/9780198766360.003.0060 |title=Oxford Textbook of Obstetrics and Gynaecology |pages=743–752 |publisher=Oxford University Press|isbn=978-0-19-876636-0 }} encompassing conditions such as menopause, uterine and cervical problems, and tissue damage as a result of childbirth.{{Cite web |title=Uterine Prolapse: Causes, Symptoms, Diagnosis & Treatment |url= https://my.clevelandclinic.org/health/diseases/16030-uterine-prolapse |access-date=2022-04-30 |website=Cleveland Clinic}}

{{commons category|Obstetrics}}

{{EB1911 poster|Obstetrics}}

• Henry Jacques Garrigues, who introduced antiseptic obstetrics to North America
• Maternal-fetal medicine
• Obstetrical nursing

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{{reflist}}

{{Women's health|state=collapsed}}

{{medicine}}

{{Pregnancy}}

{{Reproductive health}}

{{Obstetric signs and symptoms}}

{{Authority control}}

Category:Human pregnancy

Category:Women's health