An Address ON THE MIDWIFERY OF THE PRESENT DAY: Delivered before the Lambeth Division of the British Medical Association
Authors: P. Horrocks
Journal: BMJ (1906)

GENTLEMEN, The evolution of antiseptics and asepsis has wrouglit a revolution in medicine anid all its branches.,On the practice of midwifery the effect lhas beeii enormous, and it is my privilege to-day to tell you wlhat this has been up to the present time, and to indicate the patlh of progress in the future.Let me call your attention to tlhe fact that, whilst the physician aind the surgeon and the specialist are dealing as a rule with disease, or some deviation from the normal, the accouclheur deals in the vast majority of cases withl no -disease at all, and witlh no deviation from tIme normal state, but witlh a physiological act of Nature.It is difficult to state precisely how many confiiieneents are normal, but certainly statistics prove that they constitute nlot less than 90 per cent.Probably 95 per cent.would be niearer the mark, but even at the former figure it means that nine cases out of ten are normal.It would take me far beyond the time at my disposal to deal witlh abnormal labour, except incidentally, or even to indieate how to find out whetlher a given labour is, or is about to be, abnormal.One of the most remarkable facts in Nature is that mlo ainimal the female member of which gives birth to progeniy after impregnationi and gestationi, Tequires as a rule aniy assistanice durinig parturition.It is quite true that help is often rendered to lhorses, cows, sheep, pigs, goats, and to some wild animals kept captive.But those wlho have to deal with these cases admit that each animal when left to its own devices will as a rule deliver itself suceessfully of a livinlg offsprinig.Mankind is no exeeption to this rule.A woman can in most cases deliver herself successfully, without lhelp, without instruction, and without knowledge beyond lher own instinets.Only recently the newspapers contained aecounts of a case in whieli a woman wa"-a .livered in a tram, anotlher in an omnibus, and a third in a motor car.They all did well.Doubtless many of you can remember the first time you ever attended a conifinement.How ignorant you felt!How fearful you were lest something !hould go wrong!How glad you were when eve-ything went right.And lhow proud you felt when all the kudos was bestowed upoIn you by the husband and relatives, ;althoughl you knew the ease had managed itself, and that you had practically been a mere spectator.Poor womlen often deliver tlhemselves quite satisfactorily with no lhelp beyond such as a neighbour can give, and this help is more that of companionship and that of waitress than assistaince in lhelping oni the birtlh.In other words, Nature carries out tIme physiologieal act.Again, a young girl, wlho lhas never seen a parturition, and wlho is quite ignorant of all its details, will creep inlto a hiding place to conceal lher sliame, and yet will deliver herself unaided of ;a living child and take no lharm.All these facts prove, if proof were needed, that par- turition is an act of Nature, and, like all other phy-'siological acts, it is well-nigh perfect.If you compare it witlh other plhysiological acts, suclh as swallowing, breatlh- ing, dlefaecation, or micturition, you will find thmat it is very ~similar to them in that it is a reflex act, which can be mnodified to a limited extent by volition.The labour can be helped or hiindered by voluntary ,muscular efforts on tile part of the woman.But. on tIme one hiand, such help is not absolutely essential, as is proved by those cases in whiclh there is complete severance of the will power tlirough a lesion of tile spinal cord, and yet delivery takes place by uterine action alone; aild, on tIme other liand, hindrance is limited, for nio womani could prevent delivery taking place at term by mere voluntary efforts.And.indeed, if you will watch a woman ill labour you will be struck by time fact that instinct alomme teaches her how to help herself; shle will splant her feet against whatever gives support, flex her