Midwife

MIDWIFE, a person who assists a woman during childbirth, is known from ancient times: in the sacred books of Hindus, Egyptians, and Jews, the midwife is mentioned as a special class of specialists. Their role initially consisted of comforting the suffering woman; among the Greeks, the role of the midwife was precisely defined by the name—"umbilical cord cutter"; in France, midwives were called "sages femmes" ("wise women"). All their knowledge was obtained partly from their own experience, partly from their families, where the eldest woman had to assist younger family members in childbirth. From this, apparently, comes the name "babka" (grandmother). Ancient Rus' also knew the babka; these women, "having acquired experience through long practice" (Richter), were destined to provide obstetric assistance for many hundreds of years. But their help was full of prejudices, superstitions, and the crudest empiricism. The first textbook for midwives was written in 220 AD by the Greek Moschion. In the Renaissance, in the 16th century, Eucharius Isslin wrote a manual: "The Flower of Pregnant Women and Midwives". In the 17th century, the first schools for midwives were established. The Dutch scientist Heinrich Deventer published manuals in 1696 for the preparation of midwives: "The Dawn of Midwives" ("Morgenrot der Hebammen") and in 1701—"A New Guiding Star for Midwives" ("Neues Hebammenlicht"). In the late 17th century, the midwife Justine Siegemundin was known in Germany, who wrote a textbook on obstetrics. In France, in the 17th and 18th centuries, a whole series of midwives were known, represented by Lachapelle, a student of the famous Baudelocque, very skilled in obstetric operations and leaving behind a multi-volume work on obstetrics. The first learned midwife was brought to Russia from Germany in 1712 by Peter I's daughter-in-law, the wife of his son Alexei. The beginning of obstetric education in Russia is associated with the name of the physician P. Z. Kondoidi, the chief physician of the Medical Chancellery during the reign of Elizabeth Petrovna. In 1754, two obstetric schools were founded in Moscow and St. Petersburg. The course of study lasted 6 years and consisted of theoretical lectures by a professor of "midwifery" in German and Russian languages, based on Horn's book (translated by Pagetkampf, Erasmus's assistant, and published in 1764 and 1784): "The Midwife, or a Reliable Instruction through Questions and Answers, How to Assist a Woman, Blessed with a Fetus, in Childbirth", as well as on the book published in Moscow in 1762 by Moscow professor Erasmus: "Instruction, How Each Person in General Regarding Diet, and Especially a Woman in Pregnancy, in Childbirth and After Childbirth, Should Maintain Themselves". For practical exercises, students worked with practicing midwives. Upon completion of practice, students took an exam and, after taking an oath, received a decree from the college granting them the title of "sworn midwives" and the right "to perform midwifery duties". Graduates were sent to cities, where they became "senior midwives". In addition to obstetric assistance, they were also involved in examining women as experts in court proceedings. Midwives delivered monthly reports to the medical administration. In 1784, the first midwifery institutes were opened at the St. Petersburg Foundling Hospital, and in 1801 at the Moscow Foundling Hospital. The first professor of the St. Petersburg institute was Ambodik (see); the first director and professor of the Moscow institute was V. M. Richter (see). The institutes aimed to "supply the capitals, and especially the provinces, with experienced, skilled, and educated midwives". The course of study was three years, later two years; the training was theoretical and practical—in the wards of the obstetric establishment, which had been organized shortly before. Upon completion of the course, to obtain a diploma for the title of "midwife", graduates had to pass an exam in obstetrics at the university. In the second half of the 19th century, obstetric schools began to be created in other university cities at the expense of the state, zemstvos, and cities, and in the last years before the revolution—as private educational institutions. In 1890, there were a total of 35 schools; in 1900—over 40. The majority of them were attached to provincial zemstvo hospitals with a one-year course of study, and they graduated so-called midwives of the 1st and 2nd grade. The number of qualified midwives in the countryside was insufficient, and in the 1880s, special schools for rural midwives were organized at the Moscow, St. Petersburg, and Tiflis midwifery institutes. Midwives of the 1st grade had the right to practice in cities at home and in maternity institutions and in the zemstvo—at independent obstetric points; midwives of the 2nd grade and rural midwives had the right to work only in the countryside. The duties of a midwife included conducting normal births and inviting a physician in case of complications. The inevitability of dealing with pathological births without a physician's help over long distances and the need to improve qualifications made it possible to grant midwives the right, in cases not requiring anesthesia and radical surgical intervention, to perform the following types of assistance: breech extraction, application of forceps, manual separation of the placenta, and suturing of the perineum. Midwives are categorically forbidden from performing abortions. During the era of populism, the activity of midwives acquired the significance of social work, and at first this was the only independent work recognized by society and the government. The zemstvo activity of midwives significantly contributed to the population turning to medical help in contrast to folk healing. But the existence of midwives in zemstvo hospitals did not give proper development to obstetric assistance. Before the revolution, the most qualified midwives were also feldshers (Nadezhdinsky feldsher-midwifery courses in St. Petersburg, Rostov feldsher-midwifery courses in Moscow); zemstvos gladly took them to districts, where they performed the duties of nominal doctors both in medical reception and in the pharmacy alongside the feldsher, while simultaneously conducting births. The revolution changed both the nature of midwife training (see Midwifery) and the requirements imposed on them, especially in the countryside. The appearance of a new branch of work on the protection of motherhood and infancy, the development of a network of consultations for women with mandatory supervision of pregnant women—required new methods of work. Midwives of a new type, especially in the countryside, being the primary conduit for the protection of motherhood and infancy, must possess the necessary skills of social approach and the ability to work with the masses. Their duties include systematic visits to surrounding villages, accounting for and visiting pregnant women, identifying pathological cases, attracting them to the hospital, cultural-educational work among peasant women in the field of care for the pregnant woman, mother, and child, and conducting normal births at home. A very important role belongs to midwives in the organization (and sometimes leadership) of commissions on the protection of motherhood and infancy at volost executive committees and village soviets. In connection with this, the question of freeing midwives from therapeutic and household functions at the hospital, which is being carried out gradually as the staff of the medical district increases, has arisen.