Wednesday, November 17, 2010

Joseph B. DeLee: Obstetrics that Sucks

My first baby being suctioned with a DeLee Mucus Trap

Joseph B. DeLee, inventor of the suctioning device still commonly used in American hospitals today (though routine suctioning might actually be harmful), was an obstetrician in the early 1900s. In my Childbirth International workbook, I came across this lovely quote from him:

Obstetrics has a great pathologic dignity. Even natural deliveries damage both mothers and babies, often and much. If childbearing is destructive, it is pathogenic, and it if is pathogenic it is pathologic

If the profession would realize that parturition viewed with modern eyes is no longer a normal function, but has imposing pathologic dignity, the midwife would be impossible even of mention.-Dr. Joseph DeLee, 1915

Sometimes the words of Dr. DeLee are so extreme they sound like satire. They're not. The guy was serious. I first read about him in Tina Cassidy's book Birth, the Surprising History of How We are Born, which is a very easy-to-read tracing of the history of obstetrics and midwifery in the U.S.--The author of which, who had a standard hospital birth-turned-cesarean for her first birth, came out of the writing of the book a believer in midwifery, and had a HBAC with her second child (you can find the story if you dig around the archives of her blog). It was also in Cassidy's book that I first learned that a large percentage of women in the late 19th and early 20th century, including the population DeLee would have treated, were afflicted with rickets, a bone softening disorder caused by Vitamin D deficiency that often caused people to have severely deformed pelvises.

With a quick googling his name, I found that Jill at the Unnecessarian has already posted a whole series on the writings of Joseph B. DeLee:
Dr. DeLee was a very influential figure of his time, and his ideas were very shaping of the course maternity care in this country. The influence of DeLee resulted a wiping out of nearly all of the traditional body of knowledge about birth (luckily, a few "grand midwives" survived, mostly in the South, allowing one unbroken link to the midwifery past), and replaced it with an ideology that was not founded in science, but the belief that birth was a problem, and technology was the solution.
Obstetricians, as members of society, tend to blind faith in technology and the mantra: technology = progress = modern. The other side of the coin is the lack of faith in nature, best expressed by a Canadian obstetrician: 'Nature is a bad obstetrician.' So the idea is to conquer nature and results in the widespread application of attempts to improve on nature before scientific evaluation. This has led to a series of failed attempts in the twentieth century to improve on biological and social evolution. Doctors replaced midwives for low risk births, then science proved midwives safer. Hospital replaced home for low risk birth, then science proved home as safe with far less unnecessary intervention. Hospital staff replaced family as birth support, then science proved birth safer if family present. Lithotomy replaced vertical birth positions, then science proved vertical positions safer. Newborn examinations away from mothers in the first 20 minutes replaced leaving babies with mothers, then science proved the necessity for maternal attachment during this time. Man-made milk replaced woman-made milk, then science proved breast milk superior. The central nursery replaced the mother, then science proved rooming-in superior. The incubator replaced the mother's body for care of low-weight newborns, then science proved the kangaroo method better in many cases.
-Marsden Wagner, MD, MSPH, Fish Can't See Water: The Need to Humanize Birth in Australia
...Routine pitocin and cord traction replaced physiological delivery of the placenta, then science found a natural third stage superior for low risk women.

Science has helped American maternity care come a long way from DeLee's time, but the fact remains that the roots of our obstetric system are in the ideas of people who had a lot of things about birth wrong, at least when applied to a population of women with normally developed pelvises. I also believe he was wrong about midwives. Obstetrics (speaking of the profession generally and not of specific members) will continue to be at odds with those who support the midwifery model as long as it continues to dismiss the value of childbirth knowledge gathered by those who learn by being with woman.


  1. I remember reading about him after seeing that in Cassidy's book, and in other places, and came away not being able to say much more than, "This guy was an ass." That still pretty much sums it up. :? Interesting how much of his backwards crap is still practiced today, even though it's outdated and been proven wrong time and time again.

  2. You know what's interesting though. I have written a book, The Midwife of Hope River and in it the midwife references Delee's book as the only tool she and her assistant have to understand the physiology of birth. I guess she didn't know how he hated midwives.

    I ordered an old book on line, couldn't find Delee's, to understand what people knew and did in those days. It's called Obstetrics for the General Practitioner by JP Greenhill, 1935. I am amazed how much they knew about birth and how to do non-interventive births. This guy, Greenhill, studied with Delee and quotes him and dedicates the book to him, but he seems so sensible. Often he will admit that researchers don't know everything and that when in doubt keep your hands out. Mmmmmm Patricia Harman CNM