It could be said that the twentieth century was a period of stops and starts. Major medical discoveries were made, such as penicillin, but it was often not known how these new methods should properly be harnessed. This is seen, for example, in the over-use of antibiotics encouraging antibiotic resistance. In birth and obstetrics, the same applied, with healthcare professionals having to adjust to radical changes in the field. The ‘Medicine in Worcester’ oral history collection corroborates this, with individuals struggling to cope with new procedures. Given that these oral histories were recorded in 2001, the perspectives provided by interviewees truly reflect on a vast amount of the previous century.
On the one hand, major medical changes increased birthing safety. Hygiene standards were greatly improved; one doctor working in maternity units in 1950s Worcester remembers that doctors never wore gloves, and bandages were not thrown away, but washed and re-used:
“You didn’t have gloves there was no such thing as gloves and I must say when we had to wear gloves I didn’t like it, I didn’t, I felt I could handle the case much better without gloves, but you’ve got to go with the times. […] and on that one in hospital never threw away a bandage, I mean certainly if it was very bad of course you had to throw it away but it would be washed and upstairs I think I’ve got all these bandage winder machines so the bandage could be used again and again. Throw away things, the throw-away society hadn’t come.”
From about the 1960s, this ‘throw-away society’ arrived. Dorothy A. Higgins comments on the changes in midwifery over the course of her career (from her initial training in the 1940s until her refresher course 22 years later). In particular, she discusses the introduction of disposable equipment, such as needles and catheters, and how it was difficult to get used to:
“I can remember the little sister who was on the postnatal ward I was working on, and I went up to her with a catheter, and I said, “Have I really got to throw this away?” Because we used to wash them through and boil them up again, you’d reuse them. Syringes we used to boil, they were glass, used to wrap them up with bits of gauze and boil them up, now you give an injection, throw it away. Everything was disposable.”
Revolutions in birthing procedures were also made, such as Ventouse extraction from the 1950s, which is associated with fewer maternal injuries during a difficult birth. Kate Bradley remembers the introduction of Ventouse extraction, which often left mothers alarmed as their baby had a temporary ‘large pimple’ on its head:
“It was like a suction cup, which was put on the baby’s head, if a woman got stuck in labour we could put this suction cup on the baby’s head and as she pushed, he pulled, er, which sometimes got the baby out a little bit, well lot of occasions got the baby out a lot more quickly obviously if it was getting in distress. These babies would be born with a sort of, a large pimple on their heads, which alarmed the mothers rather but we assured them it would go down and it did literally within an hour or two, this sort of bulge had gone.”
In the early twentieth century, blood groups were discovered which led to the wide use of blood transfusions during births in which the mother was losing a lot of blood. In an oral history, a senior haematologist talks about the progress and benefits of blood transfusion in the 1940s and 50s:
“In early days […] they used to have this flying squad he was interested in blood, he instigated this blood transfusion and they would take the blood to the house and transfuse the lady, once the lady or the doctor, midwife said “oh gosh this girl’s bleeding to death” the, the lab, the erm, blood transfusion staff would come to the house, and they’d transfuse this girl and all the rest of it and be fine by the morning and one tale was they came out of the house one day and all the neighbours had gathered round, and as they came out they gave them a round of applause, erm I mean for saving this girl’s life, and that was purely due to the fact that we could transfuse blood safely.”
As is evident, new medical procedures meant that healthcare professionals needed to learn how to conduct them safely and effectively. With the regular use of X-rays in hospitals from the 1930s, one doctor remembers how careful one had to be when giving a pregnant woman an X-ray:
“When you were x-raying a pregnant woman with her large tummy, you put an ap, a lead apron over parts of her, but also you had to ensure that she wasn’t too close to the x-ray tube because the end of the positive and negative cathodes were connected, were open, […] uninsulated, connected by wires, to the erm, conductors, exposed conductors in the ceiling”
Additionally, Dorothy A. Higgins talks about having to adjust to more rigorous administrative procedures in the later twentieth century.
“You were always having to sign for this, and sign for that and you listened to the baby’s heart and signed that you’d seen it, we used to use a lot of, whereas the midwife in the old days used to listen with the trumpet, er, and put it down, that was it. She might sign it, but now you have the continuous readings going on, on the graph and you had to sign it every so often to say that you’ve seen them and it’s people power taking over, or I felt it was. Erm, you had to ask permission, to examine a patient, whereas in the old days, you said “I’m just coming to do your gram let’s see how you’re getting on.” But if you’d done that, you could have been sued for assault, believe it or not.”
Helen Shirley Brice reflects on the differences between birth and obstetrics in the 1960s in comparison to the early twentieth century. Ultrasound scans were made routine from the late twentieth century:
“[I] Were they, more rare?
[HSB] Caesareans, oh yes, I mean if you had a caesarean then, you, and also I think I can remember er, people could only have two caesareans you know, they didn’t like you having any more
[I] […] Can you think of any other differences between when you had your children and what you know of giving birth today?
[HSB] Well what I’ve gathered from my daughter-in-laws and daughters, I mean I think at about 12 weeks or so they go and have a scan, and a different test are taken, and er, we just got pregnant and had our babies. We never had any special tests to find out if there’s Downs Syndrome around, and any other things that could go wrong. And er, it’s changed a lot, I mean er, so erm, I suppose it’s all for the best really, but when me and my friends and my relations were having babies we never had any of this.”
When one breakthrough is made into the unknown, often further unknowns are revealed. This certainly proved true in the twentieth century (as is evident in the above oral histories), with healthcare staff having to adjust to new procedures and navigate the associated dangers with these methods. This combination of advancement and resistance perhaps renders the twentieth century one of the most complex periods of medical progress.