Obstetric Anomalies

Anomalies and Curiosities of Medicine
by George M. Gould, M.D., Walter L. Pyle, M.D.

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General Considerations. In discussing obstetric anomalies we shall first consider those strange instances in which stages of parturition are unconscious and for some curious reason the pains of labor absent. Some women are anatomically constituted in a manner favorable to child-birth, and pass through the experience in a comparatively easy manner; but to the great majority the throes of labor are anticipated with extreme dread, particularly by the victims of the present fashion of tight lacing.

It seems strange that a physiologic process like parturition should be attended by so much pain and difficulty. Savages in their primitive and natural state seem to have difficulty in many cases, and even animals are not free from it. We read of the ancient wild Irish women breaking the pubic bones of their female children shortly after birth, and by some means preventing union subsequently, in order that these might have less trouble in child-birth - as it were, a modified and early form of symphysiotomy. In consequence of this custom the females of this race, to quote an old English authority, had a "waddling, lamish gesture in their going." These old writers said that for the same reason the women in some parts of Italy broke the coccyxes of their female children. This report is very likely not veracious, because this bone spontaneously repairs itself so quickly and easily. Rodet and Engelmunn, in their most extensive and interesting papers on the modes of accouchement among the primitive peoples, substantiate the fear, pain, and difficulty with which labor is attended, even in the lowest grades of society.

In view of the usual occurrence of pain and difficulty with labor, it seems natural that exceptions to the general rule should in all ages have attracted the attention of medical men, and that literature should be replete with such instances. Pechlin and Muas record instances of painless births. The Ephemerides records a birth as having occurred during asphyxia, and also one during an epileptic attack. Storok also speaks of birth during unconsciousness in an epileptic attack; and Haen and others describe cases occurring during the coma attending apoplectic attacks. King reports the histories of two married women, fond mothers and anticipating the event, who gave birth to children, apparently unconsciously. In the first case, the appearance of the woman verified the assertion; in the second, a transient suspension of the menstrual influence accounted for it. After some months epilepsy developed in this case. Crawford speaks of a Mrs. D., who gave birth to twins in her first confinement at full term, and who two years after aborted at three months. In December, 1868, a year after the abortion, she was delivered of a healthy, living fetus of about five or six months' growth in the following manner: While at stool, she discovered something of a shining, bluish appearance protruding through the external labia, but she also found that when she lay down the tumor disappeared. This tumor proved to be the child, which had been expelled from the uterus four days before, with the waters and membranes intact, but which had not been recognized; it had passed through the os without pain or symptoms, and had remained alive in the vagina over four days, from whence it was delivered, presenting by the foot.

The state of intoxication seems by record of several cases to render birth painless and unconscious, as well as serving as a means of anesthesia in the preanesthetic days.

The feasibility of practising hypnotism in child-birth has been discussed, and Fanton reports 12 cases of parturition under the hypnotic influence. He says that none of the subjects suffered any pain or were aware of the birth, and offers the suggestion that to facilitate the state of hypnosis it should be commenced before strong uterine contractions have occurred.

Instances of parturition or delivery during sleep, lethargies, trances, and similar conditions are by no means uncommon. Heister speaks of birth during a convulsive somnolence, and Osiander of a case during sleep. Montgomery relates the case of a lady, the mother of several children, who on one occasion was unconsciously delivered in sleep. Case relates the instance of a French woman residing in the town of Hopedale, who, though near confinement, attributed her symptoms to over-fatigue on the previous day. When summoned, the doctor found that she had severe lumbar pains, and that the os was dilated to the size of a half-dollar. At ten o'clock he suggested that everyone retire, and directed that if anything of import occurred he should be called. About 4 A.M. the husband of the girl, in great fright, summoned the physician, saying: "Monsieur le Medecin, il y a quelque chose entre les jambes de ma femme," and, to Dr. Case's surprise, he found the head of a child wholly expelled during a profound sleep of the mother. In twenty minutes the secundines followed. The patient, who was only twenty years old, said that she had dreamt that something was the matter with her, and awoke with a fright, at which instant, most probably, the head was expelled. She was afterward confined with the usual labor-pains.

Palfrey speaks of a woman, pregnant at term, who fell into a sleep about eleven o'clock, and dreamed that she was in great pain and in labor, and that sometime after a fine child was crawling over the bed. After sleeping for about four hours she awoke and noticed a discharge from the vagina. Her husband started for a light, but before he obtained it a child was born by a head-presentation. In a few minutes the labor-pains returned and the feet of a second child presented, and the child was expelled in three pains, followed in ten minutes by the placenta. Here is an authentic case in which labor progressed to the second stage during sleep.

Weill describes the case of a woman of twenty-three who gave birth to a robust boy on the 16th of June, 1877, and suckled him eleven months. This birth lasted one hour. She became pregnant again and was delivered under the following circumstances: She had been walking on the evening of September 5th and returned home about eleven o'clock to sleep. About 3 A.M. she awoke, feeling the necessity of passing urine. She arose and seated herself for the purpose. She at once uttered a cry and called her husband, telling him that a child was born and entreating him to send for a physician. Weill saw the woman in about ten minutes and she was in the same position, so he ordered her to be carried to bed. On examining the urinal he found a female child weighing 10 pounds. He tied the cord and cared for the child. The woman exhibited little hemorrhage and made a complete recovery. She had apparently slept soundly through the uterine contractions until the final strong pain, which awoke her, and which she imagined was a call for urination.

Samelson says that in 1844 he was sent for in Zabelsdorf, some 30 miles from Berlin, to attend Hannah Rhode in a case of labor. She had passed easily through eight parturitions. At about ten o'clock in the morning, after a partially unconscious night, there was a sudden gush of blood and water from the vagina; she screamed and lapsed into an unconscious condition. At 10.35 the face presented, soon followed by the body, after which came a great flow of blood, welling out in several waves. The child was a male middle-sized, and was some little time in making himself heard. Only by degrees did the woman's consciousness return. She felt weary and inclined to sleep, but soon after she awoke and was much surprised to know what had happened. She had seven or eight pains in all. Schultze speaks of a woman who, arriving at the period for delivery, went into an extraordinary state of somnolence, and in this condition on the third day bore a living male child.

Berthier in 1859 observed a case of melancholia with delirium which continued through pregnancy. The woman was apparently unconscious of her condition and was delivered without pain. Cripps mentions a case in which there was absence of pain in parturition. Depaul mentions a woman who fell in a public street and was delivered of a living child during a syncope which lasted four hours. Epley reports painless labor in a patient with paraplegia. Fahnestock speaks of the case of a woman who was delivered of a son while in a state of artificial somnambulism, without pain to herself or injury to the child. Among others mentioning painless or unconscious labor are Behrens (during profound sleep), Eger, Tempel, Panis, Agnoia, Blanckmeister, Whitehill, Gillette, Mattei, Murray, Lemoine, and Moglichkeit.