You’d be forgiven for thinking that the Champetier de Ribes bag is an old-fashioned water bottle because in many ways that’s exactly what it is. Invented in 1887 by Dr Camille Louis Antoine Champetier-de-Ribes (1848-1935), obstetrician at the Hotel Dieu Hospital in France, the de Ribes bag is designed to artificially dilate a woman’s cervix in order to induce labour.

Ribes Bag, late 19th century. The Old Operating Theatre Museum & Herb Garret Collection.

The nineteenth century was a dangerous time for pregnant women. Unsanitary living and working conditions, disease as well as the underfunding and underappreciation of gynaecological practices meant that the death rates for mother and child were exceedingly high. In 1874 England recorded its highest ever mortality rate where an average of 69.3 women died per 10,000 births (around 7%). This was closely followed in 1893 which saw an average of 65.1 women die per 10,000 births. Today the mortality rate is 0.8 women per 10,000 births (0.008%). About half of these women died due to complications of labour, slowly bleeding to death over a long birth. By inducing labour at (often earlier) crucial stages the de Ribes bag saved thousands of women’s lives.

Made from waterproof silk and covered in a thin layer of rubber, the bags were designed to compact easily to about the thickness of a finger. This collapsed bag was inserted into the uterus by a doctor using a pair of specially designed forceps that were sold with it. It was a largely painless procedure and, once in situ, caused very little discomfort to the woman. A long rubber tube extended from the nozzle of the bag and protruded out of the vagina. Through this, sterilized warm water was pumped in order to slowly distend the bag (like an internal hot water bottle). Fully inflated, the bag held 17oz of water and looked a little bit like an upside-down pear.

Image of a Ribes bag with rubber tube.

This water therapy provided a gentle pressure on the woman’s cervix, stimulating contractions of the uterus, which her body interpreted as the baby’s head pushing to come out. Natural functions take over as the body thinks the baby’s ready and labour begins. With the de Ribes bag, a dilation of 9cm (3.5 inches) could be achieved. For birth, the final dilation is 10cm, so as the mother’s body contracted to the final stage of dilation it would naturally ‘expel’ the bag as a sort of pre-birth.

Conceptually the de Ribes bag was very similar to another piece of equipment known as the Barnes Dilator (or bag) developed in 1850 by Robert Barnes. The Barnes bag also dilated the cervix via an inflatable balloon there was some major differences. The bag was fiddle-shaped and came in multiple sizes which needed to be replaced at regular intervals by a larger one – an uncomfortable experience for the patient and a time-consuming one for the doctor. Furthermore, his bag was made entirely out of rubber and incredibly stretchy which meant it was nearly impossible to tell how full it was and lost its shape when it was invariably over inflated.

Champetier de Ribes’s Bag solved both of these problems. Being made from silk, it didn’t stretch or lose its shape, and instead maintained a fixed shape that was impossible to overfill, it also required only a single insertion.

Camille Louis Antoine Champetier de Ribes (1848–1935) is on the top left. Collection Bibliothèque de l’Académie nationale de médecine.

Despite this, many English doctors were highly critical of it when it first made its way across the pond. The largest objection was a fear that such an item might displace the presenting head – putting the baby at risk by twisting them into a difficult position. Others objected to the use of forceps which were deemed barbaric, unsanitary, and unnatural. However, there were still a large number of practitioners who recognised the value of the de Ribes bag and praised its ease of use and effectiveness. Many credited its utility in difficult and dangerous medical situations.

In 1893 Dr H J Sequeira wrote a report in the British Medical Journal documenting a recent case where the de Ribes bag saved his patient’s life. The woman – a Mrs C as he calls her – was eight months into her tenth pregnancy when she called him about a ‘sudden loss of blood’. Upon examination Dr Sequeira discovered she suffered placenta praevia (where the placenta covers the cervix). This is quite a dangerous malformation which can often stunt the baby’s growth whilst the mothers often haemorrhage to death. Indeed, five years earlier the patient’s sister had died from the same complication. Sequeira and his fellow Dr Hermen, realised that it was vital to induce labour immediately and introduced the de Ribes bag with ‘strict antiseptic precautions’.  Labour pains began twelve hours after insertion and three hours after that she had fully dilated.

Dr Sequera writes:

                ‘At the same time I introduced my left hand, and first encountering the partially detached placenta (fully one-third of its surface was free), found the child lying obliquely, vertex over pubes and face looking backwards. Grasping the left foot I had no difficulty in turning and delivering, the placenta following within a few minutes. The child, a boy, was alive and well nourished. The uterus contracted firmly, and the case presented no further difficulty. The patient made a rapid recovery, and the child was thriving’.

References
  • Bennion, Elisabeth. 1979. Antique Medical Instruments. London : Sotheby Parke Bernet.
  • Herman, Ernest. 1893. “On The Induction Of Premature Labour By Champetier De Ribes’s Bag.” The British Medical Journal 1(1671): 5-8.
  • Heelas, Walter W. 1893. “A report on Twelve Cases of Induction of Labour by Champetier de Ribes’s Bag” The Lancet. 142(3652): 490-492.
  • Loudon, Irvine. 1992. Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950. Oxford: Oxford University Press.
  • Sequeira, H. J. 1893. “Case Of Placenta Prævia Treated By Dr. Champetier De Ribes’s Bag” British Medical Journal. 1(1680):519.
About the author

Harriet Carter is an undergraduate at Oxford University currently studying English Language and Literature. She has previously worked with the Auckland Museum to curate an exhibition on local WWI soldiers, and was an amateur historian within the New Zealand Order of St John.

The Champetier de Ribes Bag
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