Abu al-Qasim al-Zahrawi, known in the West as Albucasis, was a pioneering 10th-century physician and surgeon from Al-Andalus. In his comprehensive medical encyclopedia,
Al-Tasrif, he introduced over 200 surgical instruments, many of which he designed himself. Notably, al-Zahrawi devised surgical scissors, grasping forceps, and obstetrical forceps. The obstetric forceps were introduced into the European practice by the eldest son of the Chamberlen family of surgeons. The Chamberlens were French
Huguenots from Normandy who worked in Paris before they migrated to England in 1569 to escape the religious violence in France. William Chamberlen, the patriarch of the family, was most likely a surgeon; he had two sons, both named Pierre, who became maverick surgeons and specialists in midwifery. William and the eldest son practiced in Southampton and then settled in London. The inventor was probably the eldest
Peter Chamberlen the elder, who became obstetrician-surgeon of
Queen Henriette, wife of
King Charles I of England and daughter of
Henry IV, King of France. He was succeeded by his nephew,
Dr. Peter Chamberlen (barbers-surgeons were not doctors in the sense of physician), as royal obstetrician. The success of this dynasty of obstetricians with the royal family and high nobles was related in part to the use of this "secret" instrument allowing delivery of a live child in difficult cases. In fact, the instrument was kept secret for 150 years by the Chamberlen family.
Hugh Chamberlen the elder, grandnephew of Peter the eldest, tried to sell the instrument in Paris in 1670, but the demonstration he performed in front of
François Mauriceau, responsible for Paris
Hotel-Dieu maternity, was a failure which resulted in the death of mother and child. The secret may have been sold by Hugh Chamberlen to Dutch obstetricians at the start of the 18th century in Amsterdam, but there are doubts about the authenticity of what was actually provided to buyers. The forceps were used most notably in difficult childbirths. The forceps could avoid some infant deaths when previous approaches (involving hooks and other instruments) extracted them in parts. In the interest of secrecy, the forceps were carried into the birthing room in a lined box and would only be used once everyone was out of the room and the mother blindfolded. Models derived from the Chamberlen instrument finally appeared gradually in England and Scotland in 1735. About 100 years after the invention of the forceps by Peter Chamberlen Sr. a surgeon by the name of
Jan Palfijn presented his obstetric forceps to the Paris Academy of Sciences in 1723. They contained parallel blades and were called the Hands of Palfijn. These "hands" were possibly the instruments described and used in Paris by Gregoire father and son, Dussée, and Jacques Mesnard. In 1813, Peter Chamberlen's midwifery tools were discovered at
Woodham Mortimer Hall near
Maldon (UK) in the attic of the house. The instruments were found along with gloves, old coins and trinkets. The tools discovered also contained a pair of forceps that were assumed to have been invented by the father of Peter Chamberlen because of the nature of the design. The Chamberlen family's forceps were based on the idea of separating the two branches of "sugar clamp" (as those used to remove "stones" from bladder), which were put in place one after another in the birth canal. This was not possible with conventional tweezers previously tested. However, they could only succeed in a maternal pelvis of normal dimensions and on fetal heads already well engaged (i.e. well lowered into maternal pelvis). Abnormalities of pelvis were much more common in the past than today, which complicated the use of Chamberlen forceps. The absence of pelvic curvature of the branches (vertical curvature to accommodate the anatomical curvature of maternal sacrum) prohibited blades from reaching the upper-part of the pelvis and exercising traction in the natural axis of pelvic excavation. In 1747, French obstetrician
Andre Levret, published (
Observations on the Causes and Accidents of Several difficult Deliveries), in which he described his modification of the instrument to follow the
curvature of the maternal pelvis, this "pelvic curve" allowing a grip on a fetal head
still high in the pelvic excavation, which could assist in more difficult cases. This improvement was published in 1751 in England by
William Smellie in the book
A Treatise on the theory and practice of midwifery. After this fundamental improvement, the forceps would become a common obstetrical instrument for more than two centuries. The last improvement of the instrument was added in 1877 by a French obstetrician, Stephan Tarnier in "descriptions of two new forceps." This instrument featured a
traction system misaligned with the instrument itself, sometimes called the "third curvature of the forceps". This particularly ingenious traction system, allowed the forceps to exercise traction on the head of the child following
the axis of the maternal pelvic excavation, which had never been possible before. Tarnier's idea was to "split" mechanically the grabbing of the fetal head (between the forceps blades) on which the operator does not intervene after their correct positioning, from a mechanical accessory set on the forceps itself, the "tractor" on which the operator exercises traction needed to pull down the fetal head in the correct axis of the pelvic excavation. Tarnier forceps (and its multiple derivatives under other names) remained the most widely used system in the world until the development of the
cesarean section. Forceps had a profound influence on obstetrics as it allowed for the speedy delivery of the baby in cases of difficult or obstructed labour. Over the course of the 19th century, many practitioners attempted to redesign the forceps, so much so that the Royal College of Obstetrics and Gynecologists' collection has several hundred examples. In the last decades, however, with the ability to perform a
cesarean section relatively safely, and the introduction of the
ventouse or vacuum extractor, the use of forceps and training in the technique of its use has sharply declined.
Historical role in the medicalisation of childbirth The introduction of the obstetrical forceps provided huge advances in the medicalisation of childbirth. Before the 18th century, childbirth was thought of as a medical phase that could be overseen by a female relative. Usually, if a doctor had to get involved that meant something had gone wrong. Around this era in the 18th century, there were no female doctors. Since males were exclusively called in under extreme circumstances, the act of childbirth was thought to be better known to a midwife or female relative than a male doctor. Usually the male doctor's job was to save the mother's life if, for example, the baby had become stuck while exiting the mother. Before the obstetrical forceps, this had to be done by cutting the baby out piece by piece. In other cases, if the baby was deemed undeliverable, then the doctor would use a tool called a crochet. This was used to crush the baby's skull, allowing the baby to be pulled out of the mother's womb. Still in other cases, a caesarean section (c section) could be performed, but this would almost always result in the mother's death. "In addition, women who had forceps deliveries had shorter after-childbirth complications than those who had caesarean sections performed." These procedures came with various risks to the mother's health, along with the death of the baby. However, with the introduction of the obstetrical forceps, the male doctor had a more important role. In many cases, they could actually save the baby's life if called early enough. Although the use of the forceps in childbirth came with its own set of risks, the positives included a significant decrease in risk to the mother, a decrease in child morbidity, and a decreased risk to the baby. Since the forceps in childbirth were made public around 1720, they gave male doctors a way to assist and even oversee childbirths. Around this time, in large cities such as London and Paris, some men would become devoted to obstetrical practices. It became stylish among wealthy women of the era to have their childbirth overseen by male midwives. A notable male midwife was William Hunter. He popularised obstetrics. "In 1762, he was appointed as obstetrician to Queen Charlotte." In addition, with the use of forceps, male doctors invented lying-in hospitals to provide safe, somewhat advanced obstetrical care because of the use of the obstetrical forceps.
Historical complications Child birth was not considered a medical practice before the 18th century. It was mostly overseen by a midwife, mother, stepmother, neighbor, or any female relative. Around the 19th and 20th centuries, childbirth was considered dangerous for women. With the introduction of obstetrical forceps, this allowed non-medical professionals, such as the aforementioned individuals, to continue to oversee childbirths. In addition, this gave some of the public more comfort in trusting childbirth oversight to common people. However, the introduction of obstetrical forceps also had a negative effect, because there was no medical oversight of childbirth by any kind of medical professional, this exposed the practice to unnecessary risks and complications for the fetus and mother. These risks could range from minimal effects to lifetime consequences for both individuals. The baby could develop cuts and bruises in various body parts due to the forcible squeezing of the body through the mother's vagina. In addition, there could be bruising on the baby's face if the forceps' handler were to squeeze too tight. In some extreme cases, this could cause temporary or permanent facial nerve injury or lifelong scarring often along the jawline. Furthermore, if the forceps' handler were to twist their wrist while the grip was on the baby's head, this would twist the baby's neck and cause damage to a cranial nerve, resulting in strabismus. In rare cases, a clavicle fracture to the baby could occur. The addition of obstetrical forceps came with complication to the mother during and after childbirth. The use of the forceps gave rise to an increased risk in cuts and lacerations along the vaginal wall. This, in turn, would cause an increase in post-operative recovery time and increase the pain experienced by the mother. In addition, the use of forceps could cause more difficulty evacuating during the recovery time as compared to a mother who did not use the forceps. While some of these risks and complications were very common, in general, many people overlooked them and continued to use them. ==See also==