Practices and Social Relations of Obstetrical Objects

“Constructing Centimeters: Emanuel Friedman’s Cervimeter and the Dilatation-Time Curve”
By: Rebecca Jackson, Indiana University--Bloomington
Due to high rates of caesarian sections in the US, there has been recent pushback against the use of cervical dilation thresholds for decisions during labor (ACOG & SMFM 2014; King and Pinger 2014). The professional organizations and practitioners pushing for reform have traced the historical misuse of dilation back to Emanuel A. Friedman and his eponymous curve of dilatation-over-time. By a careful examination of Friedman’s published papers (including some often overlooked), as well as an oral interview with Friedman, this paper shows that the story behind the Friedman Curve is more complex than appears, and does not start with Friedman at all. It starts with an eminent woman anesthesiologist (Virginia Apgar) with attention to laboring women’s needs, and the young junior physician she charged with finding answers for her (Friedman). This young man created a new dimension for measuring labor: change in dilatation rate over time, allowing the woman’s own body to participate in the definition of what it meant for labor to be “arrested.” Yet, in constructing a “normal” standard curve of dilatation-over-time for guiding labor decisions and constructing a “cervimeter” to be the (so-called) objective measuring instrument for evidencing the shape of this curve, he unintentionally enabled a new dimension of labor to emerge: centimeters of dilation, today read as the state of labor progress. This paper traces how Friedman’s cervimeter was constructed to evidence his claims about the “sigmoidal” shape of the dilatation curve, which was originally intended to test research claims about caudal anesthesia. The cervimeter effectively reified centimeters as an “objectively” measurable interval-scale unit (rather than representing an ordinal approximation felt by hand) and enabled the later transformation of Friedman’s Curve from a graphical tool which was meant to conform to women into a tool which was used to conform them.
 
Rebecca Jackson is a PhD Candidate in History and Philosophy of Science and Medicine at Indiana University - Bloomington, with particular interest in clinical measurement methodology and history and philosophy of measurement more broadly. She was awarded the 2021-2022 John C. Slater Predoctoral Fellowship, a 12-month residential Predoctoral Fellowship with the American Philosophical Society in Philadelphia, to conduct research for her dissertation, Measuring ‘Well’: Clinical Measuring Practices and Philosophy of Measurement. This dissertation focuses on four cases of successful patient-centric and non-standard clinical measuring practices from the 19th century to current debates.

‘What Does the Eye Have to Do with Obstetrics?’: Obstetrical Machines and the Instruction of Touch in Late Eighteenth-Century Italy
By: Jennifer Kosmin, Assistant Professor, Department of History, Bucknell Unviersity

My discussion takes the commission of an elaborate and life-like obstetrical machine for Pavia’s newly opened midwifery school in 1791 as a starting point for considering the ways that medical practitioners were renegotiating the relationship between the senses at the end of the eighteenth century. In particular, this essay focuses on the cultivation of touch as an authoritative and professionalized source of bodily knowledge. This article argues that the Pavia obstetrical machine reflects an important moment of transition in the way medical practitioners were trained to interact with female patients, in which the manual exploration of a woman’s genitals was re-contextualized as an expression of scientific rationality and medical authority. A close examination of the use of obstetrical machines in midwifery training suggests, moreover, that women, too, whose touch had often been accused of irrationality and ignorance, had to be taught how to perform manual procedures in a rational and scientific manner.

Jennifer F. Kosmin is Assistant Professor of History at Bucknell University (Pennsylvania, USA) since 2015. Her research focuses on the intersections of the history of medicine, gender history, the history of the body, and the popular display and study of anatomy in eighteenth-century Italy. Her book, Authority, Gender, and Midwifery in Early Modern Italy: Contested Deliveries (Routledge, 2020) explores the negotiations over birthing knowledge and authority that took place in the context of new state-sponsored public midwifery schools and the emergence of public maternity wards in Italy during the eighteenth century. 
 

"The Experimentation of the Cesarean Section in Early Twentieth-Century Brazil"
By: Isabela Dornelas, Federal University of Minas Gerais (Brazil)
Brazil has the second-highest rate of cesarean section in the world. The surgery today considered to be overused in the country was not always a safe obstetric practice. Until the 1950s, the cesarean section was a dangerous resource, and it has killed and mutilated women over the years.
To investigate the past of cesarean section is also to explore how Brazilian obstetricians used the experimentation as a strategy. The most renowned obstetricians of the country Dr. Fernando Magalhães (1878 - 1945), Dr. Hugo Werneck (1878 - 1935), and Dr. Raul Briquet (1887-1953), were professors and directors of different philanthropic maternity hospitals where the procedures happened and where women of color and the disenfranchised ones sought for assistance in childbirth.
The discussion about the experimentation of techniques and the appropriation of hygienist and eugenicist ideas is mandatory to elucidate the historical paths of bioethical issues involved in the cesarean section's technical development in Brazil. The paper is a work in progress that will focus on the argument that Brazil's poverty and racial tension provided the human resources for establishing the C-section as an experimental technique to expand obstetrical knowledge and improve the surgical procedure.
 
Isabela Dornelas is a Ph.D. candidate in History at the Federal University of Minas Gerais, in Brazil. She holds a scholarship from the Minas Gerais Research Foundation and was recently awarded the best dissertation prize conferred by the Brazilian Society of History of Science. Her current research interests are technical experimentation, History of intervention in childbirth during the XIX and XX centuries.

"Curving the Pelvis: The Sociomaterial Practices of André Levret's Curved Forceps"
By: Scottie Hale Buehler, Insitute for Historical Studies, University of Texas at Austin
 
 
In 1747, André Levret presented his newly invented curved obstetrical forceps to the Académie Royale de Chirurgie. He claimed they would save more lives and were more humane than other forceps because they conformed to the maternal body, at least if they were used properly. In this work-in-progress paper, Scottie explores the sociomaterial practices that produced Levret's curved pelvis and forceps.
 
 
Scottie Buehler is a midwife turned historian of medicine. She earned her PhD in the history of science, technology, and medicine from UCLA in 2020. Currently, she is adapting her dissertation into a book, tentatively titled Being and Becoming a Midwife in the French Atlantic 1750-1820. It explores local negations around the widespread implementation of midwifery training courses across the French Atlantic.

"Contracted pelvises, complicated births--Pelvic research and obstetric practice in the 19th century"
By: Karen Nolte, the University of Heidelberg
Using the pelvic collection of the University Women's Hospital Würzburg, Dr. Nolte will work out which questions motivated pelvic research and the collecting activities of obstetricians in the 19th century and which ethical questions arose from the results of this research for obstetric practice.
 
In February 2018 Dr. Karen Nolte has been appointed professor and director of the Institute for History and Ethics of Medicine at the University of Heidelberg, Germany. Prior to this appointment she held a research appointment at the Institute of History of Medicine, University of Wuerzburg. She is a nurse by training and has studied history, cultural anthropology/European ethnology and sociology at the University of Goettingen in Germany. Her current research interests are: history of gynaekology, nursing history, material cultures in medicine and care in the 19th and 20th century

"How to undo the pelvis: Hugo Sellheim’s experimental obstetrical research and the enactment of a new birthing body"
By: Martina Schlünder, research scholar Max Planck Institute for the History of Science
At the turn of the twentieth century, German obstetrician Hugo Sellheim (1871-1936) embarked upon a research project on the laws of birth mechanics. In a comprehensive experimental program, he tried to find out what kind of mechanical and expulsive forces were at work in the birthing process. In my presentation I argue that studying Sellheim’s experimental practices offers an excellent lens to examine the epistemic shifts that obstetrics underwent in the early twentieth century when it moved from an anatomical to a physiological thought style, leaving the focus on the pelvis-skull ratio behind, instead studying the impact of mechanical laws on soft tissues, its content of water and thus its flexibility. Through Sellheim’s extensive experimental work new tools like birthing objects and machines as well as new concepts came into being, and at the end a new birthing body emerged not defined by the anatomy of mother and child, rather composed and defined by a set of mechanical forces. Sellheim aimed at establishing a new norm, a physiological, standard procedure of delivery based on experimental, scientific knowledge that also captured all of its possible deviations, turning treatments from improvised and experience-based interventions into standards based on scientific norms. I analyze Sellheim’s experimental system from a perspective of sociomateriality (aka relational ontology or praxeography), which emphasizes the world-making capacities of (scientific) practices. Thus, matter e.g. obstetrical tools and bodies are not understood as given, they are effects of practices and emerge and disappear with their respective practices that enact them.

Martina Schlünder (MD/PhD) is a research scholar at the Max Planck Institute for the History of Science (Berlin, Germany) with a research focus on the history of the life science, medicine and the technoscientific turn in the history of reproduction in the 20th and 21st centuries.

Reproduction and Representation: Visualizing the Maternal Body, 1880–1900
By: Jessica M. Dandona

This paper comprises a close look at the visual culture of medicine in the late 19thcentury, investigating how physicians in three early centers of medical training—Paris, Edinburgh, and Philadelphia—conceptualized the female reproductive body in pictorial terms. Created during a time of growing interest in public health and widespread anxiety over rising infant mortality, these representations define the ideal female body as youthful, fertile, and above all productive: the female body is, without exception, a pregnant body. I will look at three examples of works produced in this period, each of which explores the materiality of paper--at once ubiquitous, fragile, malleable, and portable--as a vehicle for representing reproduction.

Jessica M. Dandona earned her B.A. from Brown University in French Studies and the History of Art and Architecture and her Ph.D. from the University of California at Berkeley in Art History, with a specialization in 19th-century French art and visual culture. She is currently professor of art history at the Minneapolis College of Art and Design, where she teaches courses on art and empire, the body in art and visual culture, and modern art. Dr. Dandona has been the recipient of research grants from the Fulbright Association, the Boston Medical Library, the American Philosophical Society, the Huntington Library, and other institutions. Her current book project, The Transparent Woman: Medical Visualities in Fin-de-Siècle Europe and the United States, 1880–1900, examines the pictorial and material dimensions of teaching anatomy and midwifery at the end of the 19th century.

Flap Anatomies
By Margaret Carlyle and Marcia D. Nichols
Professors Carlyle and Nichols will lead the group through a discussion of interactive anatomies, particularly those relating to the "science of women."
Margaret Carlyle is an assistant professor at the University of British Columbia Okanagan, where she teaches in the history of science and technology. Margaret is working on two book projects: one on the history of Enlightenment anatomy and the other on the history of midwifery technologies.
Marcia D. Nichols is an associate professor at the University of Minnesota Rochester, where she teaches literature and gender studies. Marcia is in the final stages of her first book project, Fixing Women: The Birth of Obstetrics and Gynecology in Britain and America, which will be forthcoming from the University of California Medical Humanities Press. She is also collaborating with a biosciences colleague on a Bakhtian exploration of contemporary pedagogies of scientific discourse.

A Tale of Two Stories: Unearthing the 1939 Dickinson-Belskie Birth Series Sculptures & the Process of Sharing Them With Many Different Worlds
By: Rosemarie Holz, University of Nebraska–Lincoln
In this 2-part presentation, Rose Holz will spend most of her time discussing the little-known but hugely influential 1939 Dickinson-Belskie Birth Series, a series of sculptures created for the 1939-1940 World's Fair in order to educate lay and medical audiences the mechanics of in-utero human development from fertilization through delivery. Not only did these sculptures shape modern obstetrical education for aspiring practitioners and educate lay individuals in matters of pregnancy -- giving rise to modern understandings of pregnancy radically different from those which held sway in the 1800s -- but in so doing they articulated over three decades in advance the language and imagery that would become the hallmarks of the modern pro-life movement, a curious irony given that Dickinson himself was a staunch proponent of the provision of abortion. Thus embedded in this story is the subjectivity of the knowledge we create about our bodies. Also embedded in it, however, are striking new ways to discuss the abortion debate in ways that bridge the pro-choice/pro-life divide.

Holz will then conclude by turning to more methodological considerations, in this case about the process of publication. Drawing upon her experiences publishing this story in two different academic settings, she will open the conversation to what it's like to translate the stories we tell to different academic audiences while at the same time remaining true to one's own voice and desire to reach beyond the walls of the academy.

Methodologies: From Material Culture to Practices