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

Rachel Kahn
Marketing Manager
at Delfina
min read

This is part 2 of our Women’s History Month series. To catch up on the history of women in gynecology up until the 19th century, read here

Over the course of the 19th century, advances in pain medication and technology spurred more and more United States pregnant patients to choose male obstetricians for their deliveries. With the transition away from midwives, over a century would pass before women again had a major foothold in the practice of gynecology in the U.S. 

In the US, the 1800s saw many gynecological developments: anesthesia became used in surgical practice and then occasionally during birth, and surgeons developed tools like the speculum alongside critical surgical techniques. Unfortunately, many gynecological advancements were made possible by Lucy, Anarcha, and Betsey, enslaved women who were operated upon dozens of times without their consent, with no anesthesia. These women are essential contributors to the field of gynecology as it stands today.

Another 19th century pioneer in the field of maternal and child health was Dr. Rebecca Lee Crumpler, the first Black woman to earn a medical degree in the U.S in 1864. Dr. Crumpler cared largely for free African Americans and other patients living in poverty, and wrote a book that provides guidance on maternal and child health.

Even without medical degrees, many Black women at this time in the U.S. occupied a crucial role in childbirth and obstetrics. Experienced African midwives who survived the middle passage continued to practice in the United States, and were regarded as important community members. Their expertise, and that of the women they trained, was widely respected: these enslaved midwives delivered babies not only for other enslaved people, but also for their masters’ families. Unlike most enslaved individuals, these midwives could earn money for their services and traveled to assist in childbirths across their region. This granted them unusual physical and social mobility. After emancipation and into the 20th century, these “Granny Midwives” continued to serve people of all races in rural communities that didn’t have access to hospitals. 

The availability of technology like forceps and pain medication drew pregnant patients to seek out physicians and hospitals, and between 1910-1938, hospital births exceeded the number of home births in the U.S. (Martucci 2017). However, this initially brought little improvement in maternal mortality rates or pregnancy outcomes (Martucci 2017). The New York Maternal Mortality Study, funded by the Commonwealth Fund and conducted by the New York Academy of Medicine from 1930 to 1932, found that home births attended by midwives actually had the lowest maternal death rates. Despite initial defensive reactions from (male) obstetricians, over time, acknowledgement of these risks alongside scientific discoveries like that of antibiotics worked to lower maternal mortality rates to where they are today (Schram 2009). 

The 20th century saw many advancements pioneered by women in the field of maternal health: In her work as director of the New York Bureau of Child Hygiene, Dr. Sara Josephine Baker drastically reduced New York’s child and maternal mortality rate. A feminist and a lesbian, she was the first woman to receive a doctorate in public health. Unlike her colleagues, who largely focused on lab-based public health measures, Baker was dedicated to preventative measures and social determinants of health. By the time she retired in 1923, New York had the lowest maternal mortality rate of any major city in the US (Parry 2006). 

Virginia Apgar, the first director of Columbia-Presbyterian Hospital’s new division of anesthesia, developed the Apgar Score in 1953. The Apgar Score is a checklist to scientifically devise a neonate’s health in their first hours of life and remains the gold standard in early newborn care. According to former U.S. Surgeon General Julius Richmond, Apgar had “done more to improve the health of mothers, babies, and unborn infants than anyone else in the 20th century” (Siang Yong Tan et al 2018). 

Now that the medical establishment had complete ownership over childbirth, the fight for the right to have a so-called “natural” birth—unmedicated, often at home, away from the supervision of doctors—emerged in opposition. In the 1970s, women like Ina May Gaskin brought midwifery back into the mainstream. The author of several books, she pioneered the first obstetric procedure to be named after a midwife. 

Today, 82% of doctors matching into OBGYN programs are women. Invaluable research is conducted by women doctors and surgeons, and women are essential contributors to innovative pregnancy care solutions—if we do say so ourselves. Past and present, it is impossible to overstate women’s contributions to maternal health. 

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