Gynecology

Historical Background

In the United States, gynecology did not come into being as a medical specialty until the mid-1800s. The man widely acknowledged as the “father of American gynecology” is J. Marion Sims, the founder of the Woman's Hospital of the State of New York. Before the mid-1800s, women's health was primarily under the purview of women midwives, who attended a large proportion of births. At that time, pregnancy and childbirth—not to mention the workings of the reproductive system—were not well understood by anyone. Furthermore, concerns about modesty also made it difficult for men to attend to women during childbirths. In effect, female midwives held a monopoly on attending pregnancy and childbirth because there was little competition.

After 1750, American men began to return from Europe, having obtained medical education there. At the same time, they brought back new knowledge about childbirth and innovations in birthing equipment. These male physicians became known as “man-midwives” to distinguish them from the traditional, female midwife, and there soon existed a division of labor where women midwives attended to pregnancies and births, but called upon man-midwives during emergencies. The foundation was being laid for a new understanding of pregnancy and childbirth—one that eventually privileged man-midwives (later to become ob-gyns) over female midwives.

Beginning around 1810, physicians began to consolidate their domination of the market in pregnancy and childbirth. They primarily did so by making the case that they were the only ones with sufficient scientific knowledge and expertise to be birth attendants—a strategy that ultimately proved successful. In addition, male-midwives began to organize as a profession and further bolstered their professional status and authority by diminishing the image of the female midwife, using [Page 399]racist and xenophobic ideologies. Against this backdrop, in the mid-1850s, Sims moved to New York City and began a medical practice. Sims is generally credited today with developing the technique of repairing vesico-vaginal fistulas (vaginal tears that result from childbirth) and the speculum. However, Sims remains a controversial figure because he perfected his technique by practicing on poor immigrants and slave women without the use of anesthesia.

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