Note from the author:
I first posted these essays in 2010, just two years after first reading Dr. J. Whitridge Williams’ 1914 book “Twilight Sleep: Simple Discoveries in Painless Childbirth“. When his small, 128-page book was published in 1914, Dr. Williams was highly accomplished as an obstetrician and well-known as the author of “Williams’ Obstetrics” (first edition 1903).
After graduating from medical school, Dr williams has been hired by Johns Hopkins University Hospital in 1893 to set up its new gynecological surgery department. This was followed by a promotion to Chief of Obstetrics, a position he held for a decade. Then in 1910 he was appointed Dean of the University’s School of Medicine. When he wrote on his book on “Simple Discoveries in Painless Childbirth”, Dr. Williams was at the very pinnacle of his professional career.
Given such an extraordinary background, it’s not surprising that Dr. Williams became influential in the political world of organized medicine (AMA). He and Dr. Joseph DeLee came to be known as the fathers of American obstetrics. They personally molded the public narrative and official policies of obstetrics in America as they still exist.
Combining obstetrical medicine and gynecology surgery into one hybrid profession was an extreme departure from the historical tradition of obstetrics, which was basically part of a general medical practice. General practitioners (GPs) made house calls and attended the births of their maternity patients in the family’s home.
Under this traditional system, GPs were not trained to do surgery so they had to call a gynecological surgeon whenever one of their patients needed a Cesarean. This one-sided dependency relationship required GPs to turn their patients over to another physician who had advanced training and often criticized the judgement, intelligence or parentage of these ‘mere’ GPs. This also meant lost income for the GP and was frequently accompanied by arguments and hard-feelings between these two disciplines.
The decision by Doctors Williams, DeLee and other influential leaders to simultaneously train medical students in obstetrics and gynecological surgery ended this embarrassing rivalry. Even more important, becoming a single and independent profession gave ob-gyn doctors control over all aspects of women’s reproductive biology and gave us the hospital-based surgical specialty of obstetric as we know it today.
Dr. Williams’ little book is very revealing on many level. Its target audience was not women or even the greater public but the wealthy philanthropists of his day, who he hoped to convince to give large endowments to his alma mater and employer, Johns Hopkins, as well as government officials and husbands.
It’s clear that he was both a producer and a product of this formative era and the often limiting and counterproductive politics of organized medicine. I found his professional politics and patriotism to be better and more interesting than I imaged and at the same time, to be far worse than I thought possible.
Surprisingly, his ultimate goal was no directly ‘obstetrical’ but to finance a nation-wide and sorely needed system of general hospitals. This required him to create a system that would produce a dependable and profitable revenue stream to finance this enormous undertaking. He hoped to transform the 8,000 tiny 2 to 10 bed private overnight-clinics/hospitals into a system in which there was a single well-equipped and well staffed general hospital with an emergency room, x-ray, clinical labs and surgical department in every community with a population over 3,000.
@@@@@@ ?? subheading to change topic gracefully @@@@@@@@@@@@@@
Aspects of Dr. Williams’ book, particular the blatant unrepentant and repugnant sexism, racism and lack of personal insight and compassion were so hard for me to wrap my mind around that it took an entire year for the shock to wear off. In spent many more months screaming into a pillow before i could come to terms with Dr. Williams life. As a man of his time and his station as a white upclass male from a wealthy and politically influential family, Dr. Williams is a hero in many important ways, but in the final frame, his legacy includes causing great harm to a great many people, both personally as a physician and as the inventor and perpetuator of a profoundly dysfunctional system.
He and the rest of the obstetrical profession in the US fooled themselves into thinking that the highly medicalized form of care required by laboring women who suffered from obstetrical complications — the routine use of medical and surgical interventive and invasive procedures would likewise be beneficial to healthy women who didn’t need or want a type of care that literally handcuffed them to the bedrails and exposed them and their unborn babies to risky, painful and humiliating interventions that caused them to die or be permanently disable.
@@@@@@@@@ need subheading for new topic @@@@@@@@@
However, I recently decided to expand and repost this material after watching the 2018 movie ‘The Post” (starring Tom Hanks).
If you haven’t seen this movie yet (highly-recommended), it is about the national crisis surrounding the 1973 the publication of 7,000 classified documents by the Washington Post and the public’s reaction to the trove of secret information it revealed. Known as the Pentagon Papers, they documented the fundamental lie about America’s official involvement in Vietnam. It turned out that a succession of American presidents knew full well that it was impossible for America to ever win this war, no matter how many soldiers we sent there or how many bombs we dropped on the country-side and its civilian population.
Nonetheless, these presidents – particularly Nixon and Johnson — actively promoted the Vietnam War and continued to send American soldiers to fight and die — over 50,000 of them — knowing for sure that thousands of American heroes were dying in vain year after year. At the same time, these presidents authorized the use deadly force against American citizens who protested the war at home — for example, four Kent State college students not even involved in any kind of protest were killed by National Guards firing without warning or cause as they fired military rifles weapons into a crowd of college students going between classes.
I was stunned to see many ethical parallels btw the unconscionable behavior of the United States’ Federal government (official lies and well-financed and decades-long disinformation campaign), and the American new surgical speciality of obstetrics and gynecology, which also was well-finances and decades long disinformation campaign, with a result as disastrous to healthy CB women as being shot at in war was to our healthy young soldiers.
The last and most important UNTOLD story of the 20th century is how erroneous decisions made individually and collectively actually resulted in unnecessary and preventable deaths and disabilities of more childbearing women and their unborn and newborn babies during the first 6 decades of the 20th century than the number of American soldiers shot and killed during battles in Vietnam.
Before i explain further, I have to stop and reiterated just how much I wish I was mistaken or flat wrong, that this highly disturbing, century-long chapter of American obstetrical history, like that of the Vietnam War, had not happened or if it did, it turn out to be a marvelous and unmitigated success that achieved its stated goals with this darkness and unnecessary deaths and life-long disabilities. For those of you who need to read the maternity and neonatal mortality rates associated with (a) eliminating access by healthy childbearing women to the supportive and non-interventive care of trained midwives and (b) substituting the highly medicalized care and and interventive, invasive medical and surgical procedure used on healthy women with normal pregnancies who (c) did NOT need or benefit by the routine or ‘preemptive’ use of these interventions and (d) who died, or their baby dies or they were permanently damaged by a model of care that is profoundly iatrogenic when it is applied to healthy women with normal pregnancies.
Obviously, this was not done on purpose but was an ‘unforced error’ — an “unexpected consequence” based in some instances on wrong information but in many instances the motive was professional promotion and aggrandizement of American obstetrics as a hot new surgical speciality. Expected advantages included elevated social status, increased political influence, personal wealth and other collective advantages associated with their profession.
In the early 20th century, influential leaders of the new obstetrics profession set out to abolish the midwifery profession and take absolute control over all forms of maternity care and replace the supportive care that midwives provided to the healthy women they cared for.
In the
@ ?? @ It should be noted here that care being provided by a surgical speciality would logically assume that the ‘patient’ had a serious complication or condition that could only be cured by performing a surgical operation. The unfortunately fatal flaw (literally and figuratively) in this arrangement was the
organized medicine provided its generous support to advance the obstetrical agenda by providing access to politicians, money, and PR strategies that had already proven effective at manipulating public opinion and controlling political factions.
created a medicalized model care that turned healthy childbearing women into patients of a surgical specialty
campaign financed by
. obstetricians mandated the use of multiple medical intervention in normal labor and made childbirth into a surgical procedure performed by doctors who routinely used forceps to pull babies out of unconscious women who were under the effects of general anesthesia.
Their efforts was extremely successful in healthy women into an unnecessary and risky medical and surgical procedure that resulted in the preventable deaths of more childbearing women .
the expanded and reposted the expanded series earlier this year.
However this broke the series into two part and made numbering system even more complexity, with Part I a, b, c, and d, Part 2-a, b, c- etc.
This was so hard to follow that Several readers asked me to make the navigation easier, this time So I numbered each successive post 1 thru 7. I did indicate the end of the historical background (1-t0-4) and the contemporary commentary (5, 6, and 7).
As the “Idiot-savant” in the history of American obstetrics from the late 19th to now, I have after much thought concluded that our obstetrically top-heavy and unproductively expensive system can never to fixed as long as the history of how the obstetrical profession in the US became an 800-pound gorilla, with a legal and economic monopoly over all childbirth services.
@@@ edit line –> becomes common knowledge and a “Truth and Reconciliation Commission” is established to right these historical wrongs and goin forward, to develop a new system for the 21st century providing maternity care to healthy childbearing women that is based on the the art and science of physiological childbirth as the standard of care for this population, a system that primary. This for with midwives and family practice physicians as the providers of those services
Happy reading and if you think this information should be more widely known
History of Obstetrics ~ series #1 ~
1. Introduction to Dr. Williams’s the book: Twilight Sleep: Simple Discoveries in Painless Childbirth, published 1914 https://tinyurl.com/y8pgewkg
2. part 1-a ~The Dream, the Motives, the Methods & Enduring Impact of 1914 book “Twilight Sleep ~ Simple Discoveries in Painless Childbirth ~ by famous American obstetrician ~ https://tinyurl.com/ycee9xv7
3. Dr. J.W. Williams: Part 1-b ~ Inventing the Economic Engine for America’s private and corporate-owned Hospital System
4. Dr J. Whitridge Williams: Part 1-C Elective Hospitalization ~ the basic economic unit for engine for America’s private system of hospitals
5. Dr. J. Whitridge Williams: part 1-D ~ Selling his odd ideas about childbirth to the public & philanthropists
Comparison between The Pentagon Papers
6. Dr. J. Whitridge Williams’ Little Book & the Pentagon Papers: Part 2-a ~ Intro ~ profound harm introduced by Twilight Sleep & Genera Anesthesia
https://tinyurl.com/y8udohl6
7. Dr. J. Whitridge Williams’ Little Book & the Pentagon Papers: Part 2-b Numbers don’t lie
https://tinyurl.com/yaw5795v
leaders in the field of obstetrics began a concerted and relentless disinformation campaign. With the help of organized medicine, they used various PR strategies – articles in newspapers and women’s magazines — to convince the public that modern science was now able to eliminate all the dangers of childbirth if only women would the supportive care of midwives with a highly medicalized and surgical approach to normal labor and birth.
