Short abstract
Pioneer of the epidural anaesthetic for women in labour
Gertie Florentine Marx, a New York anaesthesiologist and a tireless advocate for women and their babies, helped to launch obstetric anaesthesiology as a subspecialty. She devoted her professional career to promoting pain relief for pregnant women and introduced the use of epidural anaesthesia for women during labour and delivery.
Her work transformed obstetric anaesthesia. In 1993 the Queen presented Dr Marx with a lifetime service award and a college medal from the Royal College of Anaesthetists. She also received a distinguished service award from the American Society of Anesthesiologists.
Despite her achievements, Dr Marx faced fierce opposition to her ideas—particularly the use of epidural anaesthesia for pregnant women.
Before the late 1960s, women had one of two options: either accept the well known risks of general sedation or anaesthesia for themselves and their babies or undertake sometimes difficult deliveries without any pain relief, a process that could be brutal for both mother and newborn. “There was no in-between,” said Dr Ingrid Hollinger, professor of anaesthesiology at Mount Sinai School of Medicine, New York.
Dr Marx suggested that epidural anaesthesia could provide pain relief without the risks of respiratory depression, aspiration pneumonia, and death that accompanied systemic sedation. But many obstetricians and midwives argued that epidural anaesthesia would slow delivery and cause an increase in caesarean sections. Some even cited a passage from Genesis in the Bible, “I will greatly multiply your sorrows and your anguish. With sorrows you shall bring forth children,” indicating their belief that childbirth was meant to be painful.
Despite the sometimes acrimonious opposition, Dr Marx held her ground and was able to demonstrate that epidural anaesthesia provided excellent pain relief, did not cause a rise in caesarean section rates, and was safe for the newborn—even though it might, arguably, prolong the first and second stages of labour.
Figure 1.
The use of epidural anaesthesia also helped to usher in a new era in which fathers could be present with mothers as they gave birth. Epidural anaesthesia could be delivered in the birthing room instead of the operating theatre, allowing the father to be present. With the mother alert, childbirth could be a shared event for mother and father.
Dr Marx joined the anaesthesiology department at Albert Einstein College of Medicine, New York, in 1955 and quickly earned a reputation among her residents of being as fiercely devoted to them as she was to the care of pregnant women. Dr Steven S Schwalbe, an admirer of Dr Marx and president of the New York State Society of Anesthesiologists, trained as a resident under Dr Marx. “She was a woman of very definite opinions,” he said. “There was her way and there was the wrong way. She was one tough lady. But, at the same time, she would go out of her way to help residents in her programme who were troubled or had emotional problems. She took them under her wing. We were her children.”
Dr Marx, an early feminist, faced opposition not only to her ideas, but to her mere presence in medicine as a woman. Dr Ronald Simon, associate professor of clinical surgery at Albert Einstein College of Medicine, and a second cousin of Dr Marx, relates an incident in which a senior doctor, staying at the physician residence for men, had a cardiopulmonary arrest. Dr Marx, a resident at the time, went running to help. When several prominent male doctors also arrived to help, they asked her what in heaven's name she was doing. Dr Marx replied, “I am a physician and I go where I'm needed.”
If Dr Marx was prescient in her early embrace of feminism, she was equally early in recognising the dangers of Adolf Hitler. Born in Frankfurt, Germany, she attended a rally in the early 1930s where she heard Hitler speak. She was so alarmed, Dr Simon said, that she raced home to tell her mother, “This man is a lunatic. He's going to mean big trouble for all of us.” She convinced her family to leave Germany. Dr Marx left with them even though she was eligible for support in a German medical school as her father had been killed in the German army in the first world war.
After qualifying at the University of Bern in 1937, Dr Marx immigrated to the United States to work at Beth Israel Hospital. She married Eric Reiss, whom she met in Germany. He was a radiology technician and he died in the 1960s. They had no children.
The Gertie Marx needle for epidural anaesthesia was often described as being developed by Dr Marx, but it was actually named in honour of her, and remains in wide use today.
Dr Marx was a founding member of the Society for Obstetric Anesthesia and Perinatology, the founding editor of Obstetric Anesthesia Digest, and a fellow of the American College of Anesthesiologists.
Gertie Florentine Marx, professor emeritus department of anaesthesiology, Albert Einstein College of Medicine, New York city, United States (b Frankfurt, Germany, 1912; q University of Bern, Switzerland, 1937), d 29 January 2004.