The Brutal History of Obstetrics

January 28, 2022
*Content warning: Discussion of medical conditions and surgical procedures.

This week’s newsletter started out with the title, “Earned Distrust of Medicine in the Black Community.” As I researched, it became clear that there were enough subtopics to warrant a few newsletter editions. So today we’re going to concentrate on the “Father of Modern Gynecology,” James Marion Sims.

Dr. Sims is a hero in the eyes of many, and in fact, there are several statues in his honor scattered around the country. After all, he pioneered the treatment of women’s “lady parts” at a time when the practice was regarded as extremely distasteful by the rest of the medical community. He invented the speculum and pioneered a surgical method of repairing obstetric fistula—a hazard endemic to extended labor during childbirth when Caesarean sections are not an option. (You can read more about fistula, and what a devastating condition it remains today, at the link at the end of this article.)

The speculum--well known to those of us who have done time in the stirrups—and fistula repair are certainly great advances that benefit people with vaginas. Shouldn’t we be grateful for their existence?

The problem is how Sims came by this knowledge--by practicing and honing his fistula repair technique on enslaved women. And due to the prevailing notion of the time that Black people did not feel pain (a notion which persists to a certain extent today—a topic for a future newsletter), he did these surgical procedures without anesthesia. He operated on one young woman, named Anarcha, over 30 times in his quest to perfect the procedure.

After Sims had developed the procedure to his satisfaction, he began to perform the fistula repair surgery on white women—and when he did, he used anesthesia.

James Marion Sims has his champions. The two main arguments in his defense are:
1. that he was a product of his racist time (which I think of as the “everyone else was doing it” defense)
2. that he cured these women of an incurable condition.
While both are true, the second point is an example of an all-too-common historical viewpoint in medicine—that desperate people are only entitled to substandard care and should be glad of it because it’s better than nothing.

The epilogue to this story contains more than a little irony. Today, obstetric fistula has all but disappeared from the Western world due to the advent of the Caesarean section, but it is still very common in Africa and Asia. So the medical advances developed by torturing enslaved African-American women to benefit white women, are still not available to many women of color.

What can you do?
• Read this literary piece that puts a human face on Anarcha, the woman who endured 30 unanesthetized surgeries.
• If you see a gynecologist, during your next visit to their office, ask them about Dr. Sims. See what they know about his research and what their opinion is of it. Based on their answers, ask yourself how safe you would feel if you were a Black woman lying on your back with your feet in the stirrups--an excruciatingly vulnerable and uncomfortable position under the best of circumstances.
• Consider donating to the nonprofit at the below link. Tragically, the personal hygiene difficulties that accompany obstetric fistula often lead to social ostracization for those who suffer from it.

Photo by from Pexels