Justina Siegemund and the Art of Midwifery

THE ART OF MIDWIFERY THE technique or practice of helping to deliver babies and offering advice and support to pregnant women is one of the oldest of acquired skills. Childbirth was a hazardous event in the days before modern drugs and surgery, and difficult deliveries could mean death for both mother and child. The lower life expectancy of women in the ancient world in part reflects the high female mortality rate due to the risks of childbearing. A skilled midwife was indeed an important asset to a community.

Image courtesy of the Mayo Clinic Libraries History of Medicine Collection, from Siegemund, J. 1690.

Die Chur-Brandenburgische Hoff-Wehe-Mutter. Das ist: Ein Höchst-Nöthiger Unterricht von Schweren und Unrech-Stehenden Geburten in Einem Gespräch Vorgestellet von Justinen Siegemundin. Cölln an der Spree U. Liebperten. Plate no. 19.

Most midwives guarded the secrets of their profession, and many were illiterate, so little of practical value was handed down in writing. Theirs was a largely oral tradition. By the mid-17th century, however, some physicians were writing books of instructions for midwives.¹ This image is from a book, Court Midwife by Justina Siegemund (also known as Siegemundin; 1636–1705), a renowned German midwife.² Her book, published in 1690, was the first German medical text written by a woman.

As a young woman, Siegemund had suffered at the hands of midwives who wrongly assumed she was pregnant when, in fact, she suffered from a prolapsed uterus. Because of this trying experience, she began to study obstetrics and started practice as a midwife in 1659. At first she provided free services to peasant and poor women, but as her reputation grew, she ministered to the needs of women from merchant and noble families. In 1683, she was given an official post as the City Midwife of Lignitz. Her expertise attracted much attention and in 1701, Frederick William, Elector of Brandenburg, appointed her Court Midwife in Berlin. Serving as Court Midwife, she helped deliver the children of the royal family. It is said that Mary II of Orange was so impressed by her skill that she asked Siegemund to write a training manual for other midwives. Court Midwife was the result.

Siegemund published her richly illustrated text at her own expense and incorporated detailed embryological and anatomical engravings by Regnier de Graaf (1641–1673) and Govard Bidloo (1649–1713), two of the leading medical illustrators of the period.³ This image shows one of the possible complications of childbirth presentation and how to manage the situation. The child is presenting by shoulder—in those days, a difficult situation that could lead to the death of the baby and possibly also the mother.⁴ Justina used a two-handed intervention to rotate the baby in the uterus while securing one extremity with a sling. Siegemund (along with François Mauriceau) was also responsible for introducing the practice of puncturing the amniotic sac to arrest hemorrhage in placenta previa.

Siegemund was sometimes attacked by male physicians and male midwives who charged her with unsafe birthing practices, but she was able to withstand all such challenges to her professional reputation.⁵ Unlike male midwives and physicians, she rarely used pharmaceuticals or surgical instruments in her practice. By the time of her death in 1705, she had helped birth almost 6200 infants, according to the Berlin deacon who presided over her funeral.