Historically pregnancy and childbirth have been considered the focal events in reproductive life. However, male-centered understandings of these events and their management have shaped women's health and its research in very important ways. For example, as discussed by Duffin (1999), it was believed in the late 1600s that a spermatophore contained an embryo that a woman carries for nine months and later delivers. The human egg was not discovered until the early 1800s, although it is much larger in size than sperm. Female midwives, many of whom were educated and trained like surgeons, were primarily in charge of deliveries. They were often respected as prominent members of their communities. Male midwives began to appear in birthing rooms in the 17th century, mostly in prosperous households. Obstetrics was slow to be incorporated into the medical profession; it was dismissed by the American College of Physicians as an "unintentional profession." By the early 19th century, however, obstetrics became part of the medical curriculum. The study of the gravid uterus, its pathology, and details in measuring the pelvis became important components of obstetrics to predict difficulties in delivery. Ergotamine was introduced in the early 1800s to control postpartum hemorrhage. A significantly higher rate of infections was observed in women attended by physicians than in those attended by midwives. It was hypothesized that the higher rates of infections might be associated with inadequate handwashing techniques by those who performed autopsies on women who had died as a result of postpartum fever, and those who later attended women in labor, resulting in the transmission of infectious agents. Infection control was later introduced with a handwashing program of chlorine solutions. The concept of pain control during delivery faced stiff resistance, however, due to a strong belief that women were meant to suffer in childbirth, following the Biblical imposition of labor pain as a punishment for "original sin." It is unclear why physicians came increasingly to rely on the use of anesthetics despite the high cost, although some historians believe women advocated for it. Pain control evolved from general anesthesia to regional anesthesia, which was shown to be safe for the infant; later, pain was managed using Lamaze education and psychopilaxis. The use of instrumentation during delivery, such as forceps, electronic monitoring of fetal heartbeat and uterine contractions, and cesarean delivery, steadily increased. The use of diagnostic and interventional technology in pregnancy followed; this included diagnostic ultrasound, amniocentesis, and uterine surgery on the fetus. The treatment of infertility, which led to a dramatic increase in multiple births, also advanced rapidly in the 20th century, through hormonal treatments, in vitro fertilization, and more recently, cloning. The movement in favor of natural childbirth and breastfeeding, which recognizes pregnancy and childbirth as natural events, and mother's milk as the best source of nutrition for the infant, originated in the 1970s. The profession of midwifery experienced a rebound during this time. Later, birthing centers were developed and designed to simulate a homelike environment in a hospital setting. There was also increased interest in home delivery and doulas, or laypersons who provide physical, emotional, and informational support to the birthing mother and her partner during labor and postpartum care.
