For the LOVE of Medical History

For our final #MuseumWeek post we’re talking about why we LOVE medical history and why we hope that love is contagious! #loveMW


It’s not uncommon for the Dittrick Medical History Center to be referred to a bit like a cabinet of curiosities,  a niche museum, or perhaps more kindly, a “hidden treasure.” Although we’ve always worked to make collections accessible and major public engagement efforts are underway, we still often have to make the case for the (sometimes not so) implicit question “Why should I care about medical history?”

The answer tends to go a little like this:

Medical history is the history of how we come into the world. Our Re-conceiving Birth gallery is not only about doctors, nurses, and midwives — it examines the experiences of women and babies from the 18th century to the 1940s. Beyond the particular questions of labor position, pregnancy diet, and types of forceps, this gallery calls visitors’ attention to larger, still pertinent questions: Is birth a normal or pathological event? Who’s experiences and knowledge are important during labor? Should birth hurt? How are difficult decisions made when both the mother and infant are at risk?

By framing these questions through history, we hope to add to modern debates that these are not new concerns and that “traditional” approaches are not singular or homogenous.

Medical history is the history of how we change and respond to our environments. Humans have faced a range of emerging health concerns through travel to new places, movement into cities, changing diets, and exposure to industrial hazards. Many of the museum’s exhibits examine both the impact of these shifts, such as crowded city-dwelling facilitating the transmission of infectious diseases, and how we respond to these novel health environments. For example, Cleveland was racked by a deadly and disfiguring smallpox epidemic in 1901 and 1902, which was halted through a coordination of efforts to develop and widely distribute a safe vaccine.

These stories speak to the dynamic relationship between humans and their environment and cautions against assumptions that medical progress has eliminated any risk of new health challenges.

Medical history is the history of how we manage pain and suffering. When visitors arrive at the museum, they are greeted with display cases that detail “If you were sick in…” various years throughout history. These exhibits contextualize both the conditions and therapeutics Americans encountered in 1810, 1860, and 1910 including purgatives and emetics of humoral medicine and the sanitizing devises and techniques developed under germ theory. The types of surgeries, pharmaceuticals, and instruments used by practitioners and the popular advertisements for health restoring or ensuring products reveal the way the body and illnesses are understood.

Conceptions of the body and what it means to be healthy are not static, but reflect contemporary challenges and concerns. For example, medicine during WWI developed ways to address mass trauma in the form of gunshot, shrapnel and shell wounds and fractures through pain-free, sterile surgeries that prevented patient shock and hemorrhage. Meanwhile, home front practitioners sought to ensure the continued well-being of citizens living under rations. We’re taking a closer look at these wartime public policies and their attempts to ensure health on April 7th.

Medical history is the history of how we mediate sexual relations and family size. The museum prominently features the Skuy Collection on the History of Contraception, the world’s largest and most comprehensive collection of historical contraception artifacts. This space provides a chronological look at the way fertility has been understood and managed, starting with early texts like the 17th century Aristotle’s Masterpiece, through the 19th century Comstock Laws, the development of the birth control pill, to modern contraceptive devices. Controlling fertility is not a modern pursuit, but has been shaped through history by contemporary social and cultural values regarding family size, appropriate sexual behavior, and the alignment (or not) between biomedicine and popular beliefs about reproduction.

Today’s discussions about access to fertility controlling pharmaceuticals and procedures is part of a longer history of politicized decisions about what is best for certain bodies and for the general public at large. The gallery highlights that “best medical practices” have been occasionally overruled by social pressures against contraception, as well as how a lack of oversight in the development and use of some contraceptive technologies lead to suffering or death of unprotected citizens.

Medical history is the history of how and why we die. Even the way death is depicted — as a failure of medical treatment or an inevitable end — is shaped by the unique historical ways health has been understood. For example, diphtheria, once a deadly disease for children in the late 19th century, became both relatively treatable and preventable within a few decades through use of diphtheria antitoxin and large-scale immunization efforts.

Other exhibits tell about the detective-like work of medical practitioners in discovering the causes of death. For example, development of the stethoscope allowed physicians to hear inside the body, however what they heard was not immediately clear. Doctors used the stethoscope to listen to ill patients’ breathing and heartbeats in the early 19th century and attempted to treat their conditions. When the patients almost invariably died from their diseases, the practitioners conducted post-mortem  examinations to match the sound they’d heard with internal abnormalities. The Blaufox Hall of Diagnostic Instruments illustrates how this process led to an improved ability to diagnose pathologies in living patients while providing directed treatment for their particular needs. Understanding why and how we die improves how we interpret our bodily experiences into symptoms and causes for concern.

Our forensics collections offer a different way of understanding causes of death. New methods to detect poisons or cause of death not only reveal how our bodies function, but also speak to larger stories about personal relationships and the integration of science into courts of law.

Basically, medical history is the history of people. Through a shared focus on the biological, environmental, and social aspects of people’s lives, engaging with medical history not only allows for a more nuanced perspective on how people have lived, but tells us something about the diversity of challenges and responses that await us.

 

Secrets! The curious history of the Chamberlen forceps

It’s #MuseumWeek, where museums around the world take to Twitter in a behind-the-scenes look at collections! Today’s theme concerns secrets; join on here, on Twitter and on Instagram, to see what the buzz is about! #secretsMW

Chamberlen forceps.
Chamberlen forceps

Secret Instruments of Medicine!
In 1569, a family of Huguenots (members of the Protestant Reformed Church of France) fled religious persecution and settled in England. Their surname name was Chamberlen, and this enterprising family forever changed the world of obstetrics. Described by Bryan Hibbard as bold, undaunted, and even unethical and “rogue”-like, [1] the Chamberlens made as many enemies as friends, particularly in the practice of medicine. But they were hard-working, too, innovative and creative. Sometime in the late 16th  century, Peter the elder invented an unusual device for the purpose of delivering children alive even during difficult labors. The hinged, spoon-like instrument would later be called forceps–but for the next several decades, they were known largely as “the secret.”

Spratt Forceps
Spratt Forceps

Why? In an age before patents were employed by doctors or instrument makers, the family had every reason to protect their mystery device! They carried something with them that could mean life to both mother and child, and they might have done a bit of show-boating to distract the public (while marketing their services) [see our previous post]. They drove to births in closed or curtained carriages, and it is rumored that they  carried “the secret” in an enormous, gold-covered box that required at least two people to carry it.

Victorian Obstetric Set
Victorian Obstetric Set

[2] It has also been recorded that patients were blind-folded and that everyone else was required to leave the room during the delivery. They even employed noisemakers and clappers to keep anyone from eave-dropping on the goings on through the adjoining door!

A family member, Hugh Chamberlen, eventually sold the secret for much needed funds–though the design had already been leaked; forceps appeared in various parts of the European continent and England, eventually making it to America and serving as a preferred tool in the early twentieth century before falling out of favor. At the Dittrick, we have a large collection of forceps; for an instrument with a singular purpose, they are surprisingly diverse!

More secrets? Breeding Rabbits’ and the Power of Instruments

Instruments played a part in uncovering at least one more ‘secret’ of birth… In 1727, Mary Toft mimicked birth pangs and contractions and fooled many into believing she had given birth to a brood of baby rabbits. The case was finally overturned by surgeon Sir Richard Manningham, who threatened to cut her open in a live vivisection. Toft confessed to the hoax–(who wouldn’t?) While Manningham’s threat was probably an empty one, it is useful case study for two reasons; first, Toft—as an uneducated woman—was thought incapable of fooling the medical men (who presumably “knew” more about birth than she). Second, Manningham’s threats were of a particularly surgical kind. The mystery of female anatomy would be rendered plain through the surgeon’s instruments.

One way or another, instrumentation had been part of how 18th c male surgeons protected their interests, for only a surgeon could wield instruments, and only those wielding instruments could be considered surgeons. The fact that only man-midwives could use forceps helped to build their practice. The rise of the man-midwife and the rise of forceps tend to go together.

[1] Hibbard, Bryan. The Obstetrician’s Armamentarium. (San Anselmo: Norman Publishing, 2000).

Recent Acquisition! Tea-cups, Princess Charlotte, and the History of Birth

IMG_7448Recent acquisition! This cup and saucer set c. 1818 commemorates the death of Princess Charlotte after giving birth. The heir to the throne of England labored for 50 hours without intervention before delivering a large, stillborn son in 1817. Charlotte’s physicians came from the non-interventionist school of #obstetrics, meaning they used no forceps to assist or hasten the child’s stalled birth. Further, no destructive instruments (those that would have sacrificed the child to spare Charlotte) would have been used because of infant’s royal status. In fact, physicians attempted to resuscitate the stillborn baby, thinking he was in a state of “suspended animation” before attending to Charlotte’s delayed delivery of the placenta. This event forever changed the course of birth and delivery methods.

V0048368 Queen Caroline and George Prince of Wales
Queen Caroline and George, Prince of Wales

Who Decides, Who Delivers?

Prior to the 18th century in Britain, babies were delivered by midwives, women practitioners who had apprenticed under other women–or sometimes just an elder matron who had given birth many times herself. Then, suddenly, things began to shift. In a relatively short space of time, midwifery developed from the rare intervention of surgeons to a robust and nearly exclusive male practice. A confluence of events led to this shift, including changes in the “bodily and social event” of childbirth with the advent of lying-in hospitals, as well as changes in fashion, politics, and social structure.[i]  Medical technology was the male calling card, so to speak. With the invention of the forceps, skilled surgeons (who were always men), could deliver children even in difficult or near-hopeless cases:

The more it was known [the surgeon] could deliver a living child, the less women would fear him; the less they feared him, the earlier they would call him; the earlier they called him, the more often he could deliver the child alive; and the more other this was so, the further it would be realized that he could achieve this.[ii]

Birth became a subject of medical science and of medical men, and by 1764, Queen Charlotte made William Hunter her royal obstetrician. The new age of obstetrics did not put an end to the birthing debate, however! Instead, two schools of thought arose–one that favored intervention by the obstetrician with the forceps, and one that favored non-intervention (letting nature take its course). Like Queen Charlotte, Princess Charlotte (her granddaughter) also had a physician obstetrician overseeing her pregnancy and birth–Sir Richard Croft. Unfortunately for Charlotte, Croft followed non-intervention methods and Charlotte and the baby both died.

Princess Charlotte
Princess Charlotte

Croft committed suicide, feeling that he had been responsible for two deaths (and royal deaths at that). Charolotte’s funeral attracted enormous crowds of mourners–and some have compared it to the national grief that followed the death of Princess Diana.[iii].  The tragedy and its response ushered in a new age of “rational intervention” including the use of stimuli (for contractions), blood transfusion, and anesthesia.[iii] For a period of time following, no one would have criticized a princess for preferring an obstetrician and the most advanced of medical tools!

Commemoration and Change

The death of Princess Charlotte was commemorated through the sale of inexpensive transfer-wear porcelain tea cups and saucers. It may seem morbid to us, but these pieces were popular and widely used, meaning the message was also widely transmitted. If you look close, this set features a weeping #Britannia, symbolizing how the country mourned the heir’s passing. In response to her death, physicians moved toward interventionist approaches to childbirth in attempt to prevent such mortality. Texts including David Davis’s Elements of Operative #Midwifery (1825) served as important guides on the use of instruments to expedite labor.

 

[i] Wilson, Adrian. The Making of Man-Midwifery. (Cambridge: Harvard University Press, 1995): 6.

[ii] Wilson, Adrian. The Making of Man-Midwifery. (Cambridge: Harvard University Press, 1995): 97.

[iii] “Triple Tragedy” by Vic, Jane Austen’s World

About the blogger

Brandy Schillace is a medical humanist, literary scholar and writer of Gothic fiction. She is the Managing Editor for Culture, Medicine, and Psychiatry, a guest curator for Dittrick Museum, and a SAGES fellow for Case Western Reserve University (she has also worked as an assistant professor of literature at Winona State). She runs the Fiction Reboot and Daily Dose blogs, leads interdisciplinary conferences abroad for IDnet, and spends a lot of her time in museums and medical libraries.

Event and Gallery Opening! From Ether to Epidural by Jacqueline Wolf

IMG_5115Anesthesia: it calls to mind surgeries, treatment of shock–the rendering of a patient unconscious and free (temporarily) from pain.  But anesthesia has played an enormous role in the shifting ideas surrounding labor and birth in America generally–and right here in Cleveland. It’s more than a knock-out; it’s an ever-changing history!

On Thursday, November 19th at 6:00pm, Dittrick will share this fascinating story through a gallery opening (Childbirth in America, 1840-1940) and a talk by celebrated author and historian Jacqueline Wolf. Reproduction, birth, and women’s health in the 19th century shaped the way we practice obstetrics today. One of the biggest changes since then has been the use of obstetric anesthesia… From ether and chloroform in the 1890s, to barbiturates and narcotics in the 1950s, to the “natural” childbirth movement of the 1970s, each generation of American women has faced a very different birth experience! In this opening lecture, Jackie Wolf will explain how and why women’s obstetrician’s views of labor pain and its appropriate treatment changed over time. Dr. Wolf has explored this topic in her evocative Deliver me from Pain (2009), and will share her more recent insights.

IMG_5116The lecture is free, the gallery will be open late, and a reception will be provided in the museum space itself. We hope you will join us for the opening–to see the new permanent exhibit and the birth-chair platform (a generous gift from the Cleveland Medical Library Association), and to hear from a leading researcher in the field!

Exhibit: Childbirth in America 1840-1940, curated by Catherine Osborn in collaboration with Jim Edmonson and Anna Claspy.

Talk: Ether to Epidural: Obstetric Anesthesia in Historic, Medical, and Social Context, Jacqueline Wolf, PhD

Location: Dittrick Medical History Center and Museum, 3rd floor Allen Memorial Medical Library.

RSVP: Jennifer Nieves at 216-368-3648 or email jks4@case.edu

Living (and Breathing) Museum Research

What is it? Does this inhaler featured in this 1875 trade card reside in the Dittrick’s collections?

When the museum receives donations from the community, sometimes little surprises find their way into unexpected collections. Frequently, we classify artifacts based on the donor’s description and our expectations. Until we dig into their stories for an exhibit, these unexplored artifacts sit on shelves among surgical sets, microscopes, and pharmaceuticals, waiting to be discovered. One such specimen found its way into our work space as we pulled items for a recent installation on Obstetrical Anesthesia from 1850 to 1890.

We were familiar with the Bennett Inhaler (Fig. 1), a handheld device intended to be filled with chloroform for laboring women to self-administer anesthetic. During childbirth, women using this inhaler would lose the ability to hold the item close to their face, their hand would drop, and they were less likely to experience a chloroform overdose. Although we were delighted by this object, there was one problem — it was patented in 1910, outside of our desired time period.

Fig. 1. Bennett Inhaler from the Dittrick Museum Collections.
Fig. 1.: Bennett Inhaler from the Dittrick Museum Collections.
Fig. 2: Bennett Inhaler Ad from the American Journal of Clinical Medicine, 1910.
Fig. 2: Bennett Inhaler Ad in the American Journal of Clinical Medicine, 1910.

A little digging in an artifact box entitled “Inhalers” turned up this item: a small, hard rubber device with two nozzles, a center cork, and a lid (Fig. 3). Other than being marked “Patented in 1873,” we had little else to go on, except the hope that it was used far earlier than the Bennett Inhaler in obstetrical cases, and could fit in our exhibit.

Fig. 3: Mystery Inhaler from Dittrick Museum Collections.
Fig. 3: Mystery Inhaler from Dittrick Museum Collections.

The first step was looking through lists of inventions from 1873, published in the Official Gazette of the U.S. Patent Office (1874)– a task made significantly easier with digitized records. We searched individual patents for all of the the objects listed as “inhaler,” “respirator,” or “anesthesia,” and compared the drawn plans to our item. Only one stood out as a possibility (Fig. 4).

1873 Patent Illustration for Crumb's Inhaler
Fig. 4: 1873 Patent Illustration for Crumb’s Inhaler
Fig. 5: 1873 Crumb's Inhaler Ad
Fig. 5: 1873 Crumb’s Inhaler Ad

William R. Crumb of Buffalo, NY patented an inhaler of a similar shape to the Bennett Inhaler used, not for anesthesia, but as a general means of treating any and all respiratory ailments. An ad in the Gem of the West and Soldier’s Friend journal in 1873 claimed the inhaler instantaneously improved catarrh (excessive mucous), bronchitis, asthma, and colds if used in tandem with Crumb’s other product — “Carbolated Chloride of Iodine” as an inhalant (Fig. 5).

As a proprietary medicine salesman, Crumb fashioned himself as an “MD,” to assure customers of his credibility. However, in 1881 the Buffalo Medical College of Physicians revoked his recent degree on the grounds of plagiarism, “having been proven upon examination that the thesis upon which the degree was conferred was written by a Dr. Walton.”

Fig. 6: 1886 Crumb's Inhaler Ad
Fig. 6: 1886 Crumb’s Inhaler Ad

Despite this news (and a move to Ontario), Crumb continued to improve his inhalers and advertised their popularity in later ads showing a model of the inhaler similar to our’s. It featured a lid so customers could easily carry the inhaler in their pocket and sleeker medication chamber (Fig. 6). At this point in our search, we felt more confident that the object in question was one of the 500,000 products W.R. Crumb had peddled by 1886.

Although we couldn’t use the inhaler in our childbirth exhibit, we reunited this object with its story and made our archivist, and future researchers, very happy.

References:

[1] Mattison, Richard V., ed. 1881. The Monthly Review of Pharmacy and Medicine 9(6): 180.
[2] Crumb, W.R. Improvement in Inhalers. U.S. Patent 134858. January 14, 1873.
[3] United States Patent Office. 1874. Official Gazette of the United States Patent Office, Vol. 5. p. 665.
[4] Crumbs Pocket Inhaler. Haviland, C. A. and Mrs. C. A. Haviland, eds. 1873. Gem of the West and Soldier’s Friend 7(12): 522.
[5] Crumb’s Rubber Pocket Inhaler. 1886. Hall’s Journal of Health 33(12): ix.

About the Authors:

Catherine Osborn, MA is a Research Assistant at the Dittrick Museum of Medical History and the Editorial Associate of Culture, Medicine, and Psychiatry. She enjoys pursuing historical tangents and proving she can find any source online.

Anna Claspy is a summer intern at the Dittrick Museum and a student of history at the College of Wooster. She enjoys causing trouble on social media.

Rediscovering the Birthing Chair: Delivering Life While Sitting Up

Blog by Anneliese Braunegg, student at Case Western Reserve University
Essay winner, USNA 287Q Gothic Science, SAGES 2015
Instructor: Dr. Brandy Schillace

Birth Chair, Dittrick Museum
Birth Chair, Dittrick Museum

Envision two women. Each is in labor, each is in pain, and each is accompanied by a professional caretaker who is assisting her in giving birth. Here the similarities end. The first woman lies on a hospital bed with her hair strewn across the pillows; she is accompanied by a doctor, and she is simultaneously pushing her baby into the world as he pulls on it with forceps. The second woman sits on a birthing chair that was brought to and assembled in her bedroom; her hair is strewn across the chair back, she is accompanied by a midwife, and she is pushing her baby into the world as the midwife guides her through the process (“Midwifery Chair, c. 1850”).

The first woman is giving birth in 2015. The second woman is giving birth in 1850 (“Midwifery Chair, c. 1850”). In the generations between the second woman’s labor and the labor of her great-great granddaughter in this hospital room in 2015, now the present day, many changes will take place in the medical world. In an “‘unexplained revolution,’” typical birthing practice will “shift from female to male midwifery practice,” and “the female midwife… castigated as a rustic or vilified as a witch,” will come to “serve,” at most, “at the pleasure of the [male] surgeon” (Schillace). Pregnancy and labor will come to be “treated [not] as a natural process [but as] a medical condition” requiring a doctor’s intervention. (“Birth Chairs, Midwives, and Medicine”).

Birth chair, Dittrick Museum
Birth chair, Dittrick Museum, circa 1920

The primary birthing method shifted from use of the birthing chair to use of the birthing bed, “not necessarily because [lying on the birthing bed] is the best position for birth but… [because] it is the most convenient position for [the] doctor,” as it allows him to view the baby more easily and use a device that midwives have not used, the forceps (“Effective Birthing Positions”). Thus modern birthing culture will be born, and while women would, over time, become doctors, and pregnancy would come, once again, to be viewed as a natural state, the main method of delivery remained the birthing bed–the birthing chair largely forgotten. This is the way the world is today; however, hospitals of the present should not dismiss the method of the birthing chair too quickly. Giving birth on a bed, though it is the modern norm, is neither the only viable birthing option nor always the best one, and the expansion of birthing options would benefit the large number of modern women who go to hospitals to give birth to their babies.

Today, when most people picture a woman giving birth, they picture the woman lying on the hospital bed; less often do people picture the woman sitting on the birthing chair. The birthing chair birthing method is still used, but is much less common. This imbalance seems to imply that giving birth on a bed is somehow safer or more efficient than giving birth on a chair; however, studies evaluating the effectiveness of birthing chairs have shown that the birthing chair is a satisfactory birthing method for most patients who use it (Liddell, H. S., and P. R. Fisher) and that the use of a birthing chair does not increase the health risk to either the mother or the baby and is therefore a safe alternative to the use of a birthing bed (Kafka, M., et al.). Additionally, studies contrasting the birthing chair and the birthing bed have found there to be “less transient cord compression in upright positions” (Cottrell, B. H., and M. K. Shannahan) such as that taken while seated in a birthing chair and have found that “patients who delivered in the [birthing] chair [have] significantly lower rates of episiotomy [surgical cutting below the vagina performed to aid delivery] and manual separation of the placenta” in comparison to patients who delivered in a birthing bed (Scholz, H. S., et al.).

Birth chair, Dittrick Museum
Birth chair, Dittrick Museum,

While the birthing chair presents “minor disadvantages such as increased soiling of the chair” and, depending on the chair’s structure, “impedes operative deliveries from the perineal floor,” the advantages were determined to outweigh the minor disadvantages, and the suggested solution to the operative delivery impediment was not the use of a bed instead of a chair but instead a combination of the two into a birthing bed that can be shifted to accommodate all positions from sitting to recumbent (Schurz, A. R., H. Concin, and M. Kobermann). The results of these five studies indicate that while the birthing chair can safely be used as an effective alternative birthing method the birthing bed. In addition, because the less conventional birthing chair birthing method has been found to be a viable, potentially advantageous alternative to the birthing bed method, it would be beneficial to explore further the advantages of other less conventional birthing methods that exist.

The most effective of these other less conventional birthing methods include the birthing bar that attaches to a bed, the birthing stool, the upright sitting position, the kneeling position, and the curled side position, and each of these methods and positions presents certain advantages for the woman in labor (“Effective Birthing Positions”). These advantages include expanding the size of the woman’s pelvis (birthing bar and birthing stool), taking advantage of gravity to help push the baby (bar, stool, and upright sitting position), providing physical support for relaxation between contractions (bar, upright sitting position, kneeling position, and curled side position), and protection from back pain and vaginal tearing (kneeling position for the former and curled side position for the latter) (“Effective Birthing Positions”). Evidently, a variety of valid birthing methods exist. However, even though these methods present certain advantages to a woman in labor and even though, in the case of the birthing chair, research was performed as many twenty years ago indicating that the method is a positive one, the bed birthing method remains the primary birthing method made available to and used by laboring women. It is time that these studies’ suggestions be effected and that hospitals make information about and access to birthing chairs available to pregnant women, and it is time that other alternative birthing methods be scientifically examined and, if also found to be valid, also be publicized and made available.

DoctorsOffice
Examination chair, circa 1875, Dittrick Museum

Some birthing centers do, in fact, offer some of these alternative birthing methods, and it is noteworthy that these methods are available not only at birthing centers specifically designated as alternative but also at some mainstream hospitals. A well-regarded example of such a hospital is MIT Medical, of the Massachusetts Institute of Technology in Cambridge, Massachusetts. In addition to offering the traditional option of giving birth on a bed, the hospital states on its website that it “alternative birth experiences are also available, including birthing chairs, birthing balls, hypnobirthing, doulas, and water births” (Patient Services: Obstetrics and Gynecology”). The fact that MIT Medical presents these options on its website is important; in order for effective birthing methods currently considered alternative to become accepted as mainstream, it is vital that established, well-respected hospitals embrace these methods and clearly state their availability. In doing so, hospitals make the labors of more women safer and easier, as they become better able to accommodate the needs of all the women who come to the hospital to deliver a child.

No two births are exactly alike. The uniqueness of each birth makes it vital that hospitals pay attention to the fact that giving birth in a bed, while the most common method of birthing, is not the only viable option and not always the best one. Hospitals like MIT Medical have taken a positive step toward addressing non-bed birthing methods, but even at MIT Medical, such methods are still presented as “alternative,” misleadingly implying that they may be less reliable than the bed birthing method (“Patient Services: Obstetrics and Gynecology”). Doctors and midwives should therefore continue to expand their knowledge and provision of different birthing practices and, just as importantly, make available to pregnant women and their partners information about the variety of safe, effective birthing options that exist. In doing so, they will ensure that both the woman in the bed and the woman in the chair will be in those places because they have chosen to give birth there and that they have chosen those places because they made the informed choice that those birthing methods are the best birthing methods for them.

Works Cited

“Birth Chairs, Midwives, and Medicine.” University Press of Mississippi. UP of Mississippi, n.d. Web. 6 Feb. 2015. <http://upress-test.hpc.msstate.edu/books/63&gt;.

Cottrell, B. H., and M. K. Shannahan. A Comparison of Fetal Outcome in Birth Chair and Delivery Table Births. N.p.: n.p., 1987. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/3140301&gt;.

“Effective Birthing Positions.” Taking Charge of Your Health & Wellbeing. U of Minnesota, Aug. 2009. Web. 6 Feb. 2015. <http://www.takingcharge.csh.umn.edu/activities/effective-birthing-positions&gt;.

Kafka, M., et al. The Birthing Stool–An Obstetrical Risk? N.p.: n.p., 1994. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/7988858&gt;.

Liddell, H. S., and P. R. Fisher. The Birthing Chair in the Second Stage of Labour. N.p.: n.p., 1985. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/3862405&gt;.

“Midwifery Chair, c. 1850.” Dittrick Medical History Center and Museum. Allen Memorial Medical Library. 11000 Euclid Ave, Cleveland, OH 44106-1714. 27 January 2015.

“Patient Services: Obstetrics and Gynecology.” MIT Medical. Massachusetts Institute of Technology, n.d. Web. 6 Feb. 2015. <https://medical.mit.edu/services/obstetrics-gynecology&gt;.

Schillace, Brandy. “On the Trail of the Machine: William Smellie’s ‘Celebrated Apparatus.'” Dittrick Museum Blog. Case Western Reserve University, 4 Apr. 2013. Web. 6 Feb. 2015. <https://dittrickmuseumblog.com/2013/04/04/on-the-trail-of-the-machine-william-smellies-celebrated-apparatus/&gt;.

Scholz, H. S., et al. Spontaneous Vaginal Delivery in the Birth-Chair versus in the Conventional Dorsal Position: A Matched Controlled Comparison. N.p.: n.p., 2001. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/11603105&gt;.

Schurz, A. R., H. Concin, and M. Kobermann. Experience with EK-Birthing Chair (Author’s Transl). N.p.: n.p., 1981. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/6915863&gt;.