Embryo Project Encyclopedia Articles

Leonard Colebrook was a physician who researched bacteria and infections in England during the twentieth century. In 1936, Colebrook deployed the antibiotic Prontosil to treat puerperal fever, a disorder that results from bacterial infections in the uterine tracts of women after childbirth or abortions. Colebrook also advanced care for burn patients by advocating for the creation of burn units in hospitals and by using antisepsis medication for burn wound infections. Colebrook’s work on treatments for puerperal fever reduced cases of puerperal fever throughout the world.

An intrauterine pressure catheter (IUPC) is a device placed inside a pregnant woman’s uterus to monitor uterine contractions during labor. During labor, a woman’s uterus contracts to dilate, or open, the cervix and push the fetus into the birth canal. The catheter measures the pressure within the amniotic space during contractions and allows physicians to evaluate the strength, frequency, and duration of contractions. Those measurements enable physicians to evaluate the progression of labor and intervene when contractions are too weak to properly dilate a laboring woman’s cervix to successfully deliver a fetus. Though IUPCs are not used routinely, they are important in cases where external fetal monitoring is not sufficient to monitor a difficult labor. Intrauterine pressure catheters give physicians an extremely accurate measurement of intrauterine pressure, making it possible to determine whether intervention is needed to progress the labor.

In 1955, obstetrician Edward Bishop, a physician specializing in childbirth, published the article “Elective Induction of Labor,” in which he proposed the best conditions for pregnant women to elect to induce, or begin, labor. Elective induction of labor requires an obstetrician to administer a drug to help a pregnant woman to start her contractions, and to rupture the fluid-filled sac surrounding the fetus called the amniotic sac. In the early 1950s, Bishop analyzed the results of one thousand elective inductions and discovered that some pregnant women had faster and easier deliveries with induced labor than other pregnant women. In “Elective Induction of Labor,” Bishop describes the characteristics an obstetrician can look for in a pregnant woman to determine if she can safely undergo an elective induction, metrics still used into the twenty-first century to determine whether or not to pursue elective inductions.

In the 1964 article, “Pelvic Scoring for Elective Induction,” obstetrician Edward Bishop describes his method to determine whether a doctor should induce labor, or artificially start the birthing process, in a pregnant woman. Aside from medical emergencies, a woman can elect to induce labor to choose when she gives birth and have a shorter than normal labor. The 1964 publication followed an earlier article by Bishop, also about elective induction. In both articles, Bishop used data gathered from the obstetrics department of Pennsylvania Hospital in Philadelphia, Pennsylvania, where he worked. In “Pelvic Scoring for Elective Induction,” Bishop introduces a scoring system later known as the Bishop Score, used into the twenty-first century, to determine if a pregnant woman fits the criteria for a safe and successful induction.

Virginia Apgar and colleagues wrote “Evaluation of the Newborn Infant—Second Report” in 1958. This article explained that Apgar’s system for evaluating infants’ condition after birth accurately predicted the health of infants. Apgar had developed the scoring system in 1953 to provide a simple method for determining if an infant needed medical attention after birth. The research team, working at Columbia University College of Physicians and Surgeons in New York City, New York, studied the Apgar scores of over 15,000 infants from Sloane Hospital for Women in New York City, New York, over a period of five years. In “Evaluation of the Newborn Infant—Second Report,” Apgar and colleagues established that Apgar scores correlated with infants’ health directly after birth and indicated when medical personnel should treat the infant.

Virginia Apgar worked as an obstetrical anesthesiologist, administering drugs that reduce women’s pain during childbirth, in the US in the mid-twentieth century. In 1953, Apgar created a scoring system using five easily assessable measurements, including heart rate and breathing rate, to evaluate whether or not infants would benefit from medical attention immediately after birth. Apgar’s system showed that infants who were previously set aside as too sick to survive, despite low Apgar scores, could recover with immediate medical attention. Additionally, Apgar researched the effects of anesthesia used during childbirth and advocated for the prevention and management of birth defects. Apgar’s work led to a decrease in infant mortality rates in the mid-twentieth century, and into the twenty-first century, hospitals around the world still used the Apgar score at one and five minutes after birth.

In 1916 Edwin B. Cragin in the United States published Conservatism in Obstetrics in which he discussed medical practices and techniques to preserve the vitality of pregnant women and their fetuses. Cragin argued that women who give birth via cesarean section, the surgical act of making an incision through both the abdomen and uterus to remove the fetus from a pregnant woman's womb, must rely on that method for future births. That claim was later coined the Dictum of Cragin. In Conservatism in Obstetrics, Cragin described obstetric techniques to maintain healthy births for women and fetuses. Cragin's article outlined the best practices for obstetricians in the early twentieth century, and publicized the claim that if a woman delivers a newborn via cesarean section, she should deliver any future newborn via the same method, a theory that persisted throughout the century.

In 2004, Shu-Shya Heh, Lindsey Coombes, and Helen Bartlett studied the association between Chinese postpartum (post-childbirth) practices and postpartum depression in Taiwanese women. The researchers surveyed Taiwanese women about the social support they received after giving birth and then evaluated the depression rates in the same women. Heh and her colleagues focused on the month following childbirth, which according to traditional Chinese medicine, is an important period that warrants a set of specialized practices to aid the woman's recovery. Collectively called zuoyuezi (doing the month), the postpartum practices require the help of someone else, typically the woman's mother or mother-in-law, to complete. Heh and her colleagues found that generally, Taiwanese women with more social support displayed fewer postpartum depressive symptoms, and concluded that the practice of doing the month helped prevent postpartum depression in Taiwanese women.

Starting in 1929, the Royal College of Obstetricians and Gynaecologists was a professional association of physicians in the UK that aimed to improve the care of women in childbirth through training and education and to establish obstetrics and gynecology as a medical specialty. The Royal College of Obstetricians and Gynaecologists has contributed to women’s reproductive health by fostering research, establishing standards for physicians specializing in obstetrics and gynecology, and influencing legislation.

Roberto Caldeyro-Barcia studied fetal health in Uruguay during the second half of the twentieth century. Caldeyro-Barcia developed Montevideo units, which are used to quantify intrauterine pressure, or the force of contractions during labor. Intrauterine pressure is a useful measure of the progression of labor and the health of a fetus. Caldeyro-Barcia’s research on fetal health often contradicted common obstetric practices, prompting him to publically challenge practices such as induction of labor using oxytocin, forced pushing during labor, and birth position in which the woman lays on her back during labor. Caldeyro-Barcia’s methods of monitoring intrauterine pressure and development of Montevideo units furthered research in maternal and fetal health and improved the use of medical interventions during labor and delivery.