The history of childbirth: Women and doctors in the lying-in hospital of Göttingen University, eighteenth – nineteenth century
ČlánekOtevřený přístuppeer-reviewedpublishedDatum publikování
2008
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Univerzita Pardubice
Abstrakt
The case of Göttingen is a clear example of how crucial the maternity hospital
was in Germany, both for the emergence of man-midwifery and for turning
midwifery into a ‘science’. In this regard, the Göttingen case is clearly closer to the
conventional wisdom about the role of lying-in hospitals than, for example, the maternity
hospital of Port-Royal in Paris, which was directed by the chief-midwife
and trained only female midwives. In spite of this, even the Göttingen hospital was
far from being able to transform women into mere cases and objects of the
emerging obstetrical science. The women who decided to deliver in the hospital
tried to use this institution for their own purposes as much as they could.
With regard to the relationship between medical men and female midwives,
the picture that emerges from a closer scrutiny of German sources is also more
complicated than expected. Well into the twentieth century and in spite of their
often wild polemics against traditional midwives, German obstetricians, including
those at the University of Göttingen, did not really mean to replace them with
medical doctors. The number of doctors was far too small to attend every delivery,
and most families were much too poor to pay a fee adequate to a university-trained
man. Doctors wanted to control and instruct midwives, not to take their place. That
is why even most university lying-in hospitals trained medical students and midwives.
Most doctors were willing to attend deliveries themselves only with well-todo
‘private’ patients, and in difficult cases. The point was not so much a new division
of labour between midwives and medical men, but rather a shift in the distribution
of power and authoritative knowledge.
This ambivalent attitude to midwives becomes visible even in the Göttingen
maternity hospital, if we carefully analyse its educational policy. Around 1800, in
78 per cent of the cases, the birth attendants were male (medical students and professor
Osiander), and only in 22 per cent, the attendants were female (midwife apprentices
and the hospital midwife). Furthermore, in every semester, the number of
medical students trained at the hospital was five to ten times higher than that of the
midwife apprentices. This confirms professor Osiander’s statement that the first
aim of this institution was educating medical men, and that training midwives was
only second priority. Because of the much greater number of medical students,
however, the opportunities for practical training per person were clearly fewer for
medical students than for midwife apprentices. One third of all the medical
students who took the course in obstetrics never participated hands-on in a delivery, but only watched. And the majority of those who did were in charge of only
one birth. On the other hand, the majority of midwife apprentices were involved,
hands-on, in several deliveries. This probably means that most of the medical
students, even of those trained at the Göttingen maternity hospital, had a lot of
practical skills to acquire after their university years, in their own practice.
Beginning in the late eighteenth, definitively by the second half of the nineteenth
century, the directors of maternity hospitals and professors of obstetrics in
Germany had achieved their goal: they were, at least in the eyes of governments
and the educated male public, acknowledged as the leading experts in childbirth.
The reasons why they succeeded deserve further investigation, for measured by
their own aim of saving mothers' and children's lives their achievements appear to
be less than convincing. Throughout Europe, the maternal mortality rate was higher
in hospitals than for normal home deliveries attended by midwives. The main
reason was of course puerperal fever, a highly infectious disease. It is true that the
record is better for Göttingen's lying-in hospital than for its larger counterparts. But
maternal mortality in hospitals worsened towards the middle of the nineteenth
century. These mortality data were well-known to, and publically discussed by
experts.8 Whatever the achievements of maternity hospitals were in the eighteenth
and nineteenth centuries, reducing maternal mortality was not among them, at least
not for deliveries which took place within the hospital walls.
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s. 149-160
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Theatrum historiae. 3, 2008
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978-80-7395-139-9
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historie porodnictví, nemocnice Göttingen, porodní asistentky, lékaři, 18.-19. století