*Disclaimer*

Please be advised this body of research contains discussion of miscarriage and infant death that can be triggering for some.

The season is upon us, so let me tell you a horror story kids. Picture it, the late 1800s, and a monster in our midst. Its name: obstetrics. If the base biological horrors of childbirth weren’t enough to strike fear into the uterus of any woman, then the tools of the trade should’ve pushed her over the edge. Either for better or worse, however, women’s education was lacking so that many new mothers would be unlikely to learn the fate of their cervix until it was too late.  As there is quite the selection in this catalogue of horrors, a select few will be listed below in ordered chronologically to the order that they might be used.  

Chapter One: Inducing Labour 

Lee’s Obstetric Membrane Perforator with Ebony Handle, 19th century. The Old Operating Theatre Museum & Herb Garret Collection.

Membrane perforator: you know those umbrellas where you push a button and it just opens? Well the first collapsible umbrella was invented in 1928, and the push-button umbrella sometime later. Anyway, picture that mechanism and realise that before umbrellas somebody used this basic technique to create the membrane perforator. A device used to artificially induce labour by perforating the womb and ‘break the water’. The tip of the rod would be inserted into the body, and upon making contact with the wall of the uterus, the button on the base of the instrument was pressed to send the unseen inner rod forward 10mm to break the membrane of the womb, thus inducing labour.

De Ribes bag: an alternate tool of labour induction, the decidedly softer looking De Ribes (pronounced der reebz) bag was used to simulate the contraction of the uterus. Designed in 1887, the silk-encased rubber bag could be inserted into a partly dilated cervix with the use of forceps and would then be pumped full of sterilised water to create said contractions. Though some controversy was brought to their bulk and fragility, De Ribes bags were used into the first half of the 20th century.

Plated Steel Adjustable Cervical Dilator, turn of the 20th century. The Old Operating Theatre Museum & Herb Garret Collection.

Cervical Dilator:  In the late 1800s obstetricians began to get pretty impatient with the whole birthing process and started to use more forceful methods of inducing labour in order to get to the good stuff. There are several surviving examples of the cervical dilator, all with multiple prongs to be interested into the body and then opened to forcefully expand the cervix. The one currently displayed in the Old Operating Theatre museum has eight whole prongs.

Chapter Two: Get Out

An illustrated selection of forceps from The principles and practice of obstetrics / by Hugh L. Hodge, 1864. Wellcome Collection.

Forceps: the womb is the last bastion of complete warmth and safety that any of us will ever experience, so it’s no surprise that sometimes babies are reluctant. Forceps are in this sense a motivational tool, and one that has been in use since the 1700s with some speculation as to use of a crudely similar tool as early as the Ancient Greek and Roman eras. The shape lends itself to seizing baby’s head and extraction with minimal damage, though much debate was given to the efficacy of any one design and as such there have been many redesigns. Still in use in cases of operative vaginal delivery, as of 2011 there were 700 models of forceps (NHS).

Illustrative diagram on use of forceps in birth from The principles and practice of obstetrics / by Hugh L. Hodge, 1864. Wellcome Collection.

Vectis: a vectis is basically a half-forcep, kind of like a fancy spoon used to manoeuvre the baby’s head and offer ‘gentle’ encouragement. Early designs were made in bone or ivory and covered in leather. Wildly unhygienic and caused many women to die of puerperal fever, a form of blood poisoning contracted during birth from use of unsanitary instruments that is usually fatal. They were later made of steel.

Obstetrical fillet: Despite its imposing name, the fillet was actually one of the first devices used in childbirth that posed minimal damage to mother and child. A flexible tool, often made of whalebone or leather, the fillet would be inserted then to loop around the baby (normally the head), allowing the physician to gently pull the child from the birth canal. One assumes with a flourish.

Chapter Three

It is an unfortunate fact that not all pregnancies end in life. And while it is sometimes easy (and fun) to see these doctors as ringleaders of the macabre, for the most part they were in fact healers, who did their best with the tools of the time. Learning of the following instruments may be grim, but it is in our best interests to understand them and their use.

Cleidotomy scissors: in the event of late term miscarriage, the focus is then placed on reducing risk to the mother. This often means delivering the body quickly and by whatever means necessary. In these scenarios there are often further complications with the positioning of the child and the mother’s ability to deliver. Cleidotomy scissors are a tool used to assist in breaking down the body, specifically by dividing the clavicles (cleidotomy) to collapse the shoulders, in order to facilitate delivery.

Decapitating hook: a destructive obstetric tool, the design of the decapitating hook is fairly simple. It is a hook with a serrated inner edge. Inserted into the birth canal it is designed to hook on to part of the child and remove it, either whole or in parts.

In conclusion 

Upon sight and description, perhaps you recoil. Maybe crossed your legs tights and vowed that no child would ever enter this mortal coil on your watch. And that’s your prerogative. But in truth, this is not really a horror story at all, but one of progress. Every piece of cold metal or clammy leather inserted was there with only the best intentions, and led to the development of tools that we still use today in bringing about new life. Presented here is only a small, curated selection of obstetric instruments. For further reading on the subject please see the source list for this piece and/or visit the museum’s women’s health and midwifery section. It’s truly awful. You’ll love it.

References

About the author

May Prothero is currently volunteering at the Old Operating Theatre Museum & Herb Garret as a welcome host and research assistant. May is a London based designer and artist with a vested interest in anatomy and the history of medicine; her work focuses primarily on environmental and social issues.

Childbirth in the Victorian Era in Three Chapters
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