The history of women in gynecology in the U.S. (part one)

Rachel Kahn
Marketing Manager
at Delfina
min read
“[Women were] the unlicensed doctors and anatomists of western history. They were abortionists, nurses and counsellors. They were pharmacists, cultivating healing herbs and exchanging the secrets of their uses. They were midwives, travelling from home to home and village to village.” - Witches, Midwives, and Nurses: A History of Women Healers, Deirdre English and Barbara Ehrenreich

Women have always been present in obstetric and gynecological medicine: From Metrodora, a Greek woman who lived in 400 BCE who is believed to be the author of the oldest female-authored medical text (and the namesake of our investor), to Virginia Apgar, a 20th century OBGYN who created the scoring method still used worldwide to determine newborn health. But in the U.S., long before women were allowed to practice medicine—and even before birth fell under the purview of doctors—women passed down knowledge of childbearing within their communities.

Women healers have existed in some form throughout history: records show that women studied at the royal medical school in Egypt as early as 1500 BCE (Pastena 1993). The prevalence of images on tombs and temples depicting women practicing medicine suggests that these women physicians were accepted by the population. The women oracles and priestesses to deities of medicine often practiced it themselves, interpreting their deity’s will through medical care (Hurd-Mead 1938).

With the fall of the Roman empire, professional medical practice declined. While the formal education of women in medicine dwindled, the practice of medicine fell to women healers—either at home, or within the church. There were some outliers: in 11th century Salerno, Italy, a woman named Trotula was a professor at a progressive medical school. Frequently regarded as the world’s first gynecologist, her book on gynecology was used as a reference by doctors for more than 400 years (Wynn 2003). 

In this pre-colonial period, Indigenous communities all over the world practiced their own birthing rituals and traditions. In Peru, Andean women gave birth with the assistance of a midwife and female family members, often the squatting position—towards Pachamama, or Mother Earth. They drank local herbal teas and remedies, and followed specific social traditions (Pacino 2015). In Indigenous Canadian communities, because the pregnant woman was viewed as a conduit between the spiritual and the physical world, prenatal care and birth were viewed as the responsibility of the whole community as opposed to an individual family (Hayward et al. 2021).

Between the 13th and 18th centuries in Europe, witch hunting became common practice. Single women, widows, and other women who refused to conform to the expectations conferred by their low social status, including healers and midwives, were the targets of witch hunts (Wynn 2003). Since women could not study medicine, their healing “powers” were thought to be knowledge gifted by the devil. These “witches” had, in reality, developed these pharmacological cures over generations of experience, many of which still have their place in medicine today. Witches used ergot to ease labor pains at a time when the church believed that the pain of labor was punishment for Eve’s sin (Ehrenreich, English 1973). Though modern medicine has advanced far beyond these often risky birth practices, medications that contain ergot compounds were commonly used to prevent postpartum hemorrhage in the US through the 20th century, and are still used in some areas of the world today (“Ergot poisoning” 2022).

In Europe, the concurrent establishment of professional medical training, as well as the formation of guilds and passage of licensure laws, enabled men to box women out of the medical profession (Wynn 2003). However, women still dominated the field of childbearing up until the 1700s: most physicians in the early 1700s believed that medicine and midwifery had “nothing to do with each other.” The most common practice of delivery up until this point could be defined as “social childbirth:” pregnant patients would undergo labor and delivery surrounded and assisted by female family, neighbors, and midwives (Martucci 2017). Despite this, as the medical profession became more trusted and established, midwives became viewed as inferior to doctors, and men gradually took over the practice of gynecology and obstetrics (Wynn 2003). Colonization also played a role in this transition: in the US, centuries-old Indigenous midwifery traditions were eradicated by colonial health practices, a loss that still reverberates today.

By the end of the 18th century, there had been a marked shift in the ways that people were choosing to deliver their babies. Deliveries were still located in the home, but women were choosing to work with a male medical practitioner as opposed to a female midwife for an estimated half of all births (Louden 2008). The move away from social childbirth, and away from birth as a woman’s domain, had solidified.

Want to learn how birthing practices continued to change over the 19th and 20th centuries? How about the women of late modern history who worked to improve maternal and child health? Tune in next week for part two!

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