Is it true that in the past only women of easy virtue gave birth in maternity hospitals?

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

As medicine developed, the state sought to take control of such an important area as childbirth. How this happened in pre-revolutionary Russia, and will be discussed in this article.

At the end of the 16th century, under Ivan the Terrible, the first state body managing the health care system, the so-called Pharmaceutical Order, was created. The traditions and Domostroy that existed in Russia retained the idea that it was not appropriate for male doctors to engage in obstetrics, and the birth was usually attended by midwives.

Midwives were renowned for their skill, based on the experience of generations. They resorted to the help of midwives until the middle of the 20th century.

Under Peter I, many Western doctors came to Russia, whose opinion was not recommended to be criticized. This is how a scientifically grounded medical "male" approach to the process of childbirth began to form, displacing the natural-intuitive "female" management of pregnancy and childbirth. Although until the beginning of the 19th century “doctors were not only not allowed to study obstetrics on the human body, but if a doctor examined a woman in labor without a midwife, then he was put on trial” (V. P. Lebedeva, 1934).

In 1754, Pavel Zakharovich Kondoidi, a physician-in-law under Empress Elizabeth Petrovna, submitted to the meeting of the Governing Senate "The idea of a decent institution of the Babichi case in favor of society." All "Russian and foreign grandmothers" had to pass qualification certification in the Medical Chancellery, according to this "Submission". Those of them, "who are worthy according to their certificates," were sworn in - which is why such grandmothers were called jurors. The list of sworn attendants who had permission to practice independently was supposed to be submitted to the police "for the people's news."

In taking the Bible Oath, each midwife promised, among other things:

- "day and night, immediately go to women in labor, rich and poor, of whatever rank and dignity";

- "if the homeland will be long, I will not bend or force in vain to torment, but I will patiently wait for the present time, with the same cursing words, oaths, drunkenness, obscene jokes, disrespectful speeches and the like, I will completely hold back";

- "I will not agree to throwing out a baby by giving carry-over and expulsive drugs, or in any other way, and I will never agree to use it, and I will never let myself be used", etc.

On April 29, 1754, the Governing Senate approved the Representation of the Medical Chancellery, with all its annexes, by issuing a Decree "On the Decent Establishment of the Babichi Affair in the Benefit of Society".

Johann Friedrich Erasmus, summoned by Kondoidi from the city of Pernova (now Pärnu), became the first professor and teacher of "women’s business" in Moscow and in Russia in general.

In 1757, the first schools for the training of qualified midwives were founded in Moscow and St. Petersburg. The training was conducted by midwives (foreign, mostly German), not doctors. For the time being, male doctors were not allowed to touch a pregnant woman.

With the beginning of the development of capitalism, yesterday's peasants who entered the city lived in incomparably worse conditions than in the countryside. With the enlargement of cities, moral principles begin to change little by little, and the status of the family is eroding. It is in cities that the number of illegitimate pregnancies is growing. The state was forced to organize maternity hospitals for the poorest urban dwellers. Obstetrics were originally intended exclusively for women from the poorest segments of the population, as well as for unmarried women in childbirth as a secret refuge. It was a shame to give birth in the hospital, so many of those who wanted to use medical help invited midwives to their homes.

In 1764, by decree of Catherine II, an Orphanage was opened at the University in Moscow, and under it was the Obstetrics Department for unmarried women in childbirth, which included the first specialized institution in Moscow - the Maternity Hospital - for poor women in childbirth.

In 1771, by order of Catherine II, an orphanage was opened in St. Petersburg, and the first obstetric hospital was established under it - for unmarried and indigent women in childbirth (now - Maternity Hospital No. 6 named after Prof. VF Snegirev).

In tsarist Russia, it was customary to donate hefty sums to charity. Maternity hospitals were created like shelters and almshouses out of philanthropic motives, and not out of medical necessity.

The scientific development of obstetrics and the improvement of teaching "women’s business" in St. Petersburg was due to N. M. Maksimovich-Ambodik (1744-1812), who is rightly called "the father of Russian obstetrics." In 1782, he was the first Russian doctor to receive the title of professor of obstetric art. NM Maksimovich-Ambodik introduced classes on the phantom and at the bedside of women in labor, used obstetric instruments. He wrote the first Russian manual on obstetrics "The art of obstetrics, or the science of a woman's business", according to which many generations of Russian obstetricians were trained.

N. M. Maksimovich-Ambodik, a well-educated doctor, a talented scientist and teacher who passionately loved his work, was the first to introduce the teaching of obstetrics in Russian and fought against foreign domination in Russian medical institutions. He was an ardent patriot who showed concern for the growth of the population of Russia: as an epigraph to his "Art of twisting", he put the words in bold: "Common reason commands more talk about the multiplication of the people, the useful maintenance of newborn children than the population of uncultivated land by German foreign aliens."

On the other hand, it was from this time that male doctors began to be allowed to the pregnant woman and to childbirth - only 200 years ago they were allowed to "touch" the pregnant woman. These 200 years are characterized by the continuous struggle of doctors to increase their influence on the woman in labor. At first, they passed on to the midwives only the basics of scientific knowledge, later the process of ousting the midwife from her legal field, where she regularly worked for millennia, began actively.

During the reign of Catherine II, in 1789, the "Charter for midwives" was given, according to which only those who were tested in knowledge and who had taken a special Oath were admitted to the "woman's occupation". They also required good behavior, modesty, discreetness and sobriety, "so that at any time they would be able to do their job." It is important to note that the jury grandmothers "insufficient mothers" were supposed to "serve without money." In capitals, a sworn midwife was on the staff of every police unit, along with firefighters, lamplighters, etc.

In 1797, in St. Petersburg, on the initiative of Empress Maria Feodorovna, a third maternity hospital with 20 beds was opened. It was the first obstetric and at the same time educational institution in Russia - the Midwife Institute (now the Institute of Obstetrics and Gynecology of the Russian Academy of Medical Sciences named after Ott). "Maternity" received pregnant women at any time of the day. Obstetrics and hospitalization were usually carried out free of charge, and were intended mainly for married poor women in childbirth. The midwifery art at the institute was read by N. M. Maksimovich-Ambodik.

After the death of Maria Feodorovna, Nicholas I, by a decree of December 6, 1828, declared the Midwife Institute a state institution and, according to the wishes of his deceased mother, appointed Grand Duchess Elena Pavlovna as patroness. The institution was named "The Imperial Institute of Midwifery Art with a Maternity Hospital". Under him, in 1845, the first school of rural midwives in Russia began to operate.

In 1806, a new obstetric institute and a three-bed maternity hospital for poor women in labor (now the Moscow Medical School No. 1 "Pavlovskoye") was opened at Moscow University. In 1820, the number of beds increased to six.

After the abolition of serfdom in 1861, the midwife worked both in the newly formed zemstvo medicine and in the state health care system. For their work, midwives were given a salary and an increased pension, as well as "for long-term diligent performance of duties" they were awarded insignia and government awards.

In tsarist Russia, there were three professional groups of women involved in obstetrics: "midwife" (higher medical education), "village midwife" (secondary medical education), and "midwife" (correspondence education).

Midwives were trained by the midwives' institutes, of which there were no less than two dozen by the end of the 19th century in Russia. A diploma for the title of midwife was issued upon completion of training (usually six years) and the adoption of the "Oath of midwives on their position."

The midwife was entrusted with "giving benefits" and caring for the normal course of pregnancy, childbirth and the postpartum state, as well as caring for the newborn. An obstetrician was called up only if the course of all these conditions was incorrect.

Midwives submitted monthly reports to medical boards on the work done, rural midwives - once a quarter.

Those wishing to become a midwife must be at least twenty and not older than forty-five years.

A rural midwife received a three-year medical education in specialized midwife schools in large county towns. There were at least fifty midwife schools across Russia.

In addition, there were the so-called central, local and zemstvo schools, which taught: the law of God, the Russian language, arithmetic and a course in theoretical and practical obstetric art.

The rural midwife worked in the countryside without the right to work in the city. She took birth and trained midwives from neighboring villages.

The midwife received a certificate of correspondence education on the basis of a certificate from the midwife with whom she studied, signed by the city or county doctor.

Great importance was attached not only to experience, but also to moral and ethical qualities. The grandmother had to be of impeccable behavior, be honest and respected in society. She received a blessing from a priest, regularly confessed and received communion. As already noted, according to the Charter, “every midwife should be well-behaved, of good behavior, modest and, sober, should at any time, day or night, from whoever she is called, regardless of the person, immediately go to the puerpera to act kindly and efficiently. " In the textbook "Complete Guide to the Study of Midwifery Art" from 1886, Dr. PI Dobrynin, Associate Professor at the "St. which should always be guided by religion, the prescription of the law, the oath, the rules of the taught science and feelings of honor and dignity."

With the development of society, the number of trained midwives increased, and not just casual helpers - relatives and neighbors. In 1757, 4 midwives worked for registration in Moscow. In 1817 there were already 40 of them in Moscow, and in 1840 there were already 161 midwives. And in the 1899-1900 academic year, the Military Medical Academy in St. Petersburg alone trained about 500 midwives. In 1902 there were already 9,000 midwives, of whom 6,000 lived and worked in cities, and 3,000 in rural areas.

In the 18th century, maternity hospitals began to open (Strasbourg, 1728; Berlin, 1751; Moscow, 1761; Prague, 1770; Petersburg, 1771; Paris, 1797). Obstetrics and maternity hospitals were set up to accommodate pregnant women from disadvantaged classes of the population during childbirth and the postpartum period, or to provide an opportunity for a fee to carry out childbirth in an environment that meets the scientific requirements of antiseptics and asepsis. But soon after their organization, doctors met with a serious, often fatal complication - "childbirth fever", that is, postpartum sepsis. Massive epidemics of this "fever" were the scourge of maternity hospitals in the first half of the nineteenth century. Mortality from postpartum sepsis fluctuated in certain periods of the 18th - first half of the 19th centuries from 10 to 40 - 80%.

In the 19th century, two major scientific discoveries - the introduction of ether and chloroform for the purpose of pain relief - as well as the study of the ways of spreading infection during and after childbirth and the first means of combating it, had a strong impact on the fate of obstetrics. The development of obstetrics has followed the path of more and more introduction into practice of medicinal and surgical principles and scientific methods. Among others, one can call the operation of a caesarean section, the destructive effect of which on the development of the physiology and psyche of the child was not yet known (see Notes of the midwife. Caesarean section.). The risk of sepsis has decreased, as a result of which this operation has become widespread in obstetric practice.

Operative obstetrics (through surgical intervention) in Russia also had national characteristics. The main distinguishing features of Russian obstetrics were concern for the interests of both the mother and her child and a high consciousness of responsibility in relation to the fate of both lives. It was possible to avoid the extremes of individual European obstetric schools (the ultra-conservative Viennese school and the overly active German school of Oziander) and develop an independent direction designed to maximize the physiological efforts of the woman herself during the act of childbirth and to reasonably limit surgical interventions to the sizes that are really necessary in the interests of the mother and child. Individual operations (for example, dissection of the bosom, or caesarean section) from the very beginning did not meet with the sympathy of the majority of Russian obstetricians due to the crippling results of these operations.

Still, the majority of the Russian population was skeptical about the practice of maternity hospitals. Until the beginning of the twentieth century, only women gave birth in maternity hospitals who did not have the opportunity to give birth at home - because of poverty or because the child was illegitimate. So, in 1897, at the celebration of the 100th anniversary of the Imperial Clinical Midwife Institute, Vel. Book. Elena Pavlovna, its director, life obstetrician Dmitry Oskarovich Ott noted with sadness: “98 percent of women in labor in Russia are still without any obstetric care!”, Or, in other words, they preferred to give birth at home.

In 1913, throughout the vast country, there were nine children's clinics and only 6824 beds in maternity hospitals. In large cities, the coverage of inpatient obstetrics was only 0.6% [BME, volume 28, 1962]. Most women traditionally continued to give birth at home with the help of relatives and neighbors, or they invited a midwife, a midwife, and in difficult cases, an obstetrician.

After the revolution of 1917, the existing system of obstetrics was destroyed.

The state system of training midwives, which developed under the tsarist regime, by inertia continued to work until 1920. At first, the Bolsheviks were simply not up to her. In 1920, a reorganization of health care broke out. Midwifery institutes and schools were redesigned - they stopped training specialists in normal physiology. A course was taken on the comprehensive coverage of women in labor with medical services.

At the IV All-Russian Congress of Health Departments in December 1922, the question of introducing criminal liability for illegal medicine was raised. Since that time, a departure from the practice of home childbirth began, and a course was first taken for collective farm maternity hospitals, and then for full inpatient medical obstetrics. Midwives who continued to practice normal childbirth were prosecuted and subsequently exiled.

Instead of maternity hospitals for poor and unmarried women in childbirth, a grandiose construction of maternity hospitals for all women, without exception, began in the country. So by 1960, there were already more than 200,000 maternity beds in the Soviet Union. Compared to tsarist Russia, there was a 30-fold increase in the number of beds with a simultaneous drop in the birth rate.