Chainsaws, vacuums and forceps: The dark, brutal history of birth technology

Deep breath in, deep breath out...

Ignore the fluorescent lights, the watchful eyes of six medical students gazing at your lower body, obscured behind a sheet.

Ignore the vice grip you have on your partner's hand as they naively coach you through those deep breaths. 

Ignore the immense pressure on your abdomen, the pain of your body stretching, in some cases even tearing itself open down below.

Focus on remembering that as painful as this may be, it could be worse...

They could be sawing through your pelvic bones with a hand-cranked chainsaw.

Welcome to the grim world of birth technology. 

You'd think after thousands of years, we'd have gotten the knack of childbirth by now. People give birth every single day -- it's how we all got here. According to the UN, about 385,000 babies are born every single day. That's almost 400,000 opportunities to learn about the process and develop better ways of handling it (for both the parents and the child).

And yet a lot of the technology that surrounds the process of birth is barely spoken about. Worse still, before the advent of contemporary birth tech, a few of the more notable forays into birth tools and implements were... Well, let's just say they were ill-advised at best.

Mothers, gird your loins.

Handcranks and opium and spinning, oh my

Childbirth in the Middle Ages was a hard slog. Typically it was performed in the home, and the mother would be supported by midwives and family members who coached them through the process. It was done by women, for women. A relatively successful process in many ways, it was highly natural and full of support, with coaching from people who'd been through the same experience. Besides the hygiene and pain, it really wasn't too far off from what you'd call a "natural" birth nowadays. 

Back in those days, pain management varied from opium and its derivatives to nothing at all. Hygiene standards were limited, to say the least, and the mortality rate was terrifyingly high, with between 1% and 1.5% of women giving birth dying during the process. 

Then in the mid-1800s, childbirth became more officially medicalized. Surgeons and scientists claimed the domain which, in effect, meant men claimed the domain. The field of obstetrics was born. Births were transferred to hospitals, most of which were unsanitary and resulted in high levels of infection. 

That is, until Ignaz Semmelweis, a Hungarian doctor, discovered in 1847 that a lack of hand-washing in hospitals was spreading  infection from patient to patient in a maternity ward. His contribution to medicine not only led to our understanding of hygiene now, but it also helped significantly reduce the mortality rate of birthing mothers and their children under his care.

Yet birth was still one of the most dangerous things a woman could do, both for her and for her child. The transition from the home to the hospital inevitably led to the development of new technologies and tools to make the process "easier," though not all of these tools had the long-term health of their patients in mind -- especially that of the mothers.

I came, I saw, I cringed

In 1780, two Scottish doctors invented the prototype of the chainsaw. Not to cut down trees or clear debris. 

No, John Aitken and James Jeffray invented the hand-cranked chainsaw to cut through the pelvises of delivering mothers who were having trouble pushing their babies out.

It was called a symphysiotomy, and it was largely done without anesthesia. Mothers were completely conscious through the entire process

After seeing how well it worked in the delivery room -- according to the male doctors -- the machine was then co-opted to saw through wood and other materials, gradually growing in size to become the chainsaw we know today. 

But if the idea of sawing through a person's pelvis isn't visceral enough to make you cringe, it gets weirder -- much weirder.

You spin me right round baby, right round 

In 1963, a patent application was filed by George and Charlotte Blonsky to facilitate the creation of a machine that would help mothers give birth through the use of centrifugal force.

Yes, centrifugal force. You read that correctly. 

More specifically, it was devised with so-called "civilized" women in mind. A quote from the patent application reads:

"In the case of a woman who has a fully developed muscular system and has had ample physical exertion all through the pregnancy, as is common with all more primitive peoples, nature provides all the necessary equipment and power to have a normal and quick delivery. This is not the case, however, with more civilized Women who often do not have the opportunity to develop the muscles needed in confinement."

Put simply, "civilized" women wouldn't have developed the muscles needed to push when required, so the apparatus would rotate at a speed of about 7g's in order to create enough centrifugal force that the baby would shoot right out. Critical pieces of the machine include a net, to catch said baby as it comes out, and a system that recognizes when the birth has completed so that the spinning stops.

The patent application was granted, but thankfully expired in the early 1980s. There's only one official life-sized machine in existence -- unused, thankfully -- which made an appearance at the Science Gallery Dublin's #FailBetter exhibition, demonstrating some less than effective but ultimately instructive creations.

If the thought of such a device makes your head spin, just be thankful you didn't come into the world that way.

The birth of new tech 

My parents joke that when I was born, I looked more alien than human. A "conehead." While my tiny newborn body stretched from my father's wrist to the crook of his elbow, my elongated head nearly reached his shoulder.

Indented into my squishy face were the marks of forceps that had scooped me out, stretching my malleable skull in the process. Thankfully, within a few hours it shrank back to a normal size, but without those forceps there's every chance my birth could have caused far more issues for my mother.

While operative delivery can be traced back all the way to sixth century BC in Hindi medicine, forceps themselves became accepted as a specific birth technology and extraction technique in 16th century England, when Peter Chamberlen the Elder and his brother Peter Chamberlen the Younger pioneered the practice of forceps as a tool to deliver live infants.

Now resembling large spoons or salad tongs, forceps are used to position infants in a way they can safely exit the birth canal. The parameters for when forceps are used are specific. 

According to the Mayo Clinic, "A forceps delivery might be considered if your labor meets certain criteria -- your cervix is fully dilated, your membranes have ruptured and your baby has descended into the birth canal headfirst, but you're not able to push the baby out."

The tool brings with it an element of risk. Use of forceps could necessitate episiotomies, in which doctors need to create an incision in the perineum -- the tissue between the vaginal opening and the anus -- in order to make room without tearing the mother open. Forceps have also been associated with seizures and bleeding in the skull of the infant. 

And then there's vacuum extraction.

Nothing exists in a vacuum 

Invented by an automobile mechanic, the process of vacuum extraction is similar to a forceps extraction -- the doctor simply places a suction cup on the baby's head to guide the baby out. The risks associated with the procedure are similar to those of forceps, but because of the slightly less intrusive nature of the tool, it is perceived to be less impactful on the mother. 

Both technologies are regarded largely as safe. However, that doesn't mean that everyone is convinced. 

Mother of two Tijana Jurak had strong feelings about the technology she wanted to use -- and avoid -- going into both her deliveries.

"With my first, my labor started at home with my water breaking in bed. ... When it came time to push I struggled and had to have an episiotomy, then they had a suction cup on her head so as I pushed her out that helped them get her out," she says.

"[But] I was adamant I didn't want forceps used. I know someone whose brother had forceps used on him and he is now permanently disabled because they crushed his skull. They [the doctors] basically said sometimes it's safer than a C section depending on how far along in labor I am. I refused to, I would rather be cut open in a C section than risk that."

It's elective. What works for some won't work for others, and risk is ever present regardless of what methods you choose. Others choose not to have any intervention at all, opting for all-natural home births, with no pain management and only the presence of family and midwives, just as it was done in centuries past.

To tech, or not to tech? 

From pelvic breaks to episiotomies, giving birth comes with its fair share of extended injuries, unexpected side effects and "necessary evils." But there's a growing divide in the birthing community over how much intervention is really necessary -- or helpful at all.

Research out of Australia has confirmed the degree of medical intervention required to deliver safely is a spectrum, rather than a rule. Dr. Timothy Moss specializes in finding new ways to ensure the safety of preterm babies.

"We know from Australian research that there can be better outcomes from a less medicalized management of labor and birth," says Moss. "But then we can look at countries like the Netherlands that have very high home birth rates. They also have high perinatal mortality rates."

There's a distinctive gap in effectiveness not just between countries and cultures, but also among mothers. Operating under a blanket rule where technological intervention is seen as the necessary route doesn't make sense when faced with the reality of different birthing experiences.

"In order for us to function, some of us need medicine. Some of us don't," says Moss. "If you need the medicine and you don't get it, that could be a bad outcome. If you don't need the medicine and you get it anyway? That could be a bad outcome too."

For preterm babies, the use of interventions like forceps or vacuum extraction could be far more damaging than beneficial. From not cutting the umbilical cords straight away to being acutely conscious that a preterm baby's lungs may not have developed enough to function on their own, the treatment and methods behind caring for preterm babies is incredibly different. 

And preterm babies themselves aren't a homogenized group either. It all comes down to the individual's history, development stage, preferences and genetics.

"That goes to the need to tailor intervention to individuals," says Moss. "And the history of the parents will influence that."

Sometimes medical intervention can be the difference between life and death for both mother and child. Sometimes the most scientific birth option is the one that relies on the body's own technology. It's a case-by-case matter, and there shouldn't be a blanket rule for every mother to abide by.

But if there's one thing we can all agree on, it's that no baby should ever be delivered by centrifugal force.