http://informahealthcare.com/jmf ISSN: 1476-7058 (print), 1476-4954 (electronic) J Matern Fetal Neonatal Med, Early Online: 1–3 ! 2013 Informa UK Ltd. DOI: 10.3109/14767058.2013.806904 RESEARCH ARTICLE Crouching or lying-down? The reason of a (uncomfortable) delivery position Donatella Lippi and Domizia Weber Department of Anatomy, Histology and Legal Medicine, Faculty of Medicine and Surgery, Florence University, Italy Abstract Trough a deep historical and cultural perspective, this article focuses on the revolution that took place in childbirth, due to the introduction of medical knowledge and surgical skills. Ranging from Greek mythology to the Sixties, this contribution analyses the social, scientific and anthropological reasons that led to the desertion of the delivery vertical position in favour of the lying down one. Keywords Change, forceps, midwife, school of midwifery, surgical skills History Received 14 April 2013 Accepted 7 May 2013 Published online 222 Introduction Until the Early Modern Age, childbirth was something concerning women only: theory, training and practice were assigned to midwives who used to assist their patients without the help of a physician or a surgeon; things underwent a deep change in the 17th century, when surgeons started to enter the labour chamber, leading to a fundamental transformation in the obstetrical practice. Crouching In ancient times, women delivered their babies getting down on their knees or crouching, as the Egyptian hieroglyphics highlight: the hieroglyph indicating the delivery represents a crouching woman, sitting on two short piles of bricks, while the bas-relief of Cleopatra in labour shows the queen standing in a vertical position [1]. Even Greek myths confirm how delivery was carried out: the Homeric Hymn dedicated to Apollo, the god of the sun, describes his birth, telling that his mother embraced the palm with both hands, braced her feet against the soft ground, then earth smiled: the god had come under the sun, and all goddesses shouted out for joy [2]. Apollo’s son, the god of Medicine Asclepius, was born, on the contrary, through a caesarean section after his mother’s death [3]. Romans used this practice, too, having learnt it from Etruscans: it was important to save the life of the baby, if the mother had died. The numerical strength, upon which ancient populations based their power, had to be pursued. Generally, however, Romans could rest on the experience of women and only in the II century a. C, Soranus of Ephesus (98-138 a. C) wrote a book about Gynaecology and Obstetrics titled Gynaecia, where he suggested to use the obstetric chair. This chair had a half-moon opening for the passage of the baby, two handles on the sides to allow the pregnant woman to sustain herself, while the plane of the chair was inclined to the top, to avoid her slipping down. Usually, the woman was held by the shoulders by another woman, while the midwife stood at the base of the chair, ready to take the baby and, in case the obstetric chair was not available, the patient sat on the knees of the midwife herself. Soranus talked about the bed as far as the preparation and the follow up were concerned [4]. The obstetric chairs followed the trends of furniture fashion and in some cases they were decorated with precious stones. This attitude is confirmed by printings and etchings, all depicting the same scene: a pregnant woman standing in a vertical position and being assisted by other women; no men attended this event, to protect women intimacy and because they were not interested in ‘‘women matters’’; the surgeon was called only in case of embryulcia and embriotomy, to extract the dead baby from the mother’s womb [5]. The revolution of the seventeenth century Such ideas on childbirth changed in the seventeenth cen- tury, when, especially in France, wealthy women started to be assisted by surgeons: this new habit was determined by the possibility to use new instruments to improve the delivery (forceps) and by the diffusion of caesarean sections Address for correspondence: Domizia Weber, Phd, Expert subject of Medical Humanities, Department of anatomy, histology and legal medicine, Faculty of Medicine and Surgery, Florence University, Italy. Tel: ++390550138513; ++393497363239. E-mail: domiziaweber@ libero.it 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120