Physiology Matters: A letter to Doctor Joseph B. DeLee

ISSN 2516-5852 (Online)

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AIMS Journal, 2018, Vol 30, No 1

By Celine Lemay

As a practising midwife and long-time AIMS member, I realise that maternity is colonised by the biomedical perspective. This is evident in the discourse and the organization of care. Historians of obstetric medicine consider Dr J. DeLee, an American gynaecologist, as the father of modern obstetrics. As I read his renowned 1920 article, I felt that I wanted to talk to him, both as a midwife and as a woman who has given birth three times. This letter – a flight of fancy if you will – is the result: it is what I want to say to him – and his followers – almost one hundred years later. The letter was originally written in French, as the prologue to my first book (2017).1

Dr. DeLee,

I have just been reading the article you published in the American Journal of Obstetrics and Gynecology in 19202 , almost a century ago. It is that well-known article that so heavily influenced the practice of obstetrics in Western medicine.

At that time, you lamented the numerous difficulties linked to childbirth and you noted the high level of morbidity and mortality among mothers and babies during birth. According to you, very few women could emerge from the childbearing process unharmed. To give birth was to put their lives and those of their unborn babies in danger. Because you recognized the presence of pathologies, you proposed nothing less than to redefine childbirth itself as a pathology.

In your view and in the name of science, you proposed that all births should henceforth take place in hospital under the care of a specialist doctor and be considered as a “necessary” medical surgical procedure. You also argued that we should put birthing women under anaesthesia, systematically cut their perineum and use forceps “preventatively” in order to accelerate the second phase and get the baby out of the uterus.

You declared that midwives were not qualified to attend births and that we should even denounce their approach of favouring vigilance and patience.

Your words still resonate today in the mentality of much modern birth practice, entirely dominated by the potential of pathology, with fear so well concealed under the notion of “risk”. The impact of your claim has been to obscure childbirth physiology, to justify numerous systematic interventions and to encourage a surgical conception of childbirth. Technological possibilities have made this model ever easier and more seductive, as much for healthcare providers as for many women.

Doctor DeLee, nearly 100 years later, I am keen to give you some good news regarding childbirth. Scientific research in human biology has confirmed that pregnancy, birth and breastfeeding are normal physiological processes of the female body. Doctor DeLee, childbirth is not a pathology. The mother and the baby have innate and complex capacities of mutual regulation, endogenous competencies to accomplish the process of childbirth.

Furthermore, healthcare based on the promotion of physiology reduces not only interventions but can generate a cascade of physical, psychological and social benefits for the mother/baby dyad. Fundamentally, it is a question of placing confidence at the heart of maternity care. Women are capable of carrying and bringing a child into our world. Certainly we must act with patience and prudence, respect and kindness to ensure that women give birth with their own power and dignity.

Doctor DeLee, midwives are not part of the problem. They are part of the solution. The journal The Lancet, already renowned and respected by the medical community of your time, has now demonstrated clearly the importance of midwives to global maternal and child health, in its key series of papers investigating midwifery and its role in improving key health outcomes (2014).3

One hundred years later, it is time to trust women and the childbearing process. Our new century is beginning to pick up this essential thread… for the future of our humanity and our world.

Yours sincerely

Céline Lemay

Céline Lemay PhD, anthropologist by academic background, has been a practicing midwife for more than 30 years. She is also a senior lecturer in midwifery at the Université du Québec à Trois-Rivières, and a current council member of the College of Midwives, Québec (l'Ordre des sage-femmes du Québec).

References

1) Lemay, Céline (2017) La mise au monde: revisiter les savoirs Montréal: PUM

2) DeLee, Joseph B (1920) The Prophylactic Forceps Operation Am J Obstet Gynecol 1920(1):pp34-44 Available at: dx.doi.org/10.1067/mob.2002.123205

3) The Lancet series on Midwifery (2014) Available at: www.thelancet.com/series/midwifery

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